[vc_row][vc_column][vc_column_text] “Minimally invasive surgery in urology” Artibani W, Rassweiler J, Kauk J, Menon M. International Consultation on Minimally Invasive Surgery in Urology. Stockholm 2014. “Tips and tricks in laparoscopic urology” Kumar U, Gill IS. Ed. Springer. “Complications of urologic surgery. Prevention and management” Taneja SS. 4th edition. Ed. Sauders-Elsevier. “Glenn’s Urologic Surgery” Graham SD, Keane …
[vc_row][vc_column][vc_column_text]Forced lateral decubitus. In retroperitoneal access (Figure 12), a forced lateral decubitus is required in order to increase the distance 12th rib and iliac crest. The back of the patient must be on the edge of the surgical table. Preparation is completed with compression stockings in the lower limbs with a progressive pneumatic compression device, …
[vc_row][vc_column][vc_column_text]Basic equipment for renal retropernitoneoscopic surgery: Specific equipment: Gaur’s balloon (comercial or home-made) for dissection of retroperitoneal space. Hasson’s trocar. Consumable material; tourniquet for kidney artery control, sutures for kidney parenchyma. Conventional laparoscopic equipment: Videolaparoscopic tower High flow insufflator Surgical instruments Generators for dissection and haemostasis. Aspirator/irrigator Trocars [/vc_column_text][vc_row_inner][vc_column_inner width=”1/4″][/vc_column_inner][vc_column_inner width=”1/2″][dt_fancy_image image_id=”5743″ animation=”bounce” style=”3″ lightbox=”true”][/vc_column_inner][vc_column_inner …
[vc_row][vc_column][vc_text_separator title=”Indications” title_align=”separator_align_left”][vc_column_text]Retroperitoneoscopic approach allows direct access to the kidney to perform a nephron-sparing surgery. We will choose this approach in selected cases; either because lesion’s location (figure 1) or because the patient had with multiple abdominal surgeries or has catastrophic abdomen, in which transperitoneal access is not recommended or impossible (Figure 2). LOCALIZATION OF …
[vc_row][vc_column][vc_column_text]Once the healthy parenchyma has been exposed around the tumor we proceed to mark the margins for excision. Partial nephrectomy should be oncologically safe. This means that the tumor comes out surrounded by a margin of healthy tissue. Traditionally this margin was 5 mm, although different studies have shown that it may be smaller, minimal, …
[vc_row][vc_column][vc_column_text]This phase has two objectives:: – To identify the tumor. – To clean the margins of the tumor leaving a visible area of healthy parenchyma. The first objective, to locate and identify the tumor, is paramount to perform an appropriate partial nephrectomy. In the transperitoneal approach, the surface of the left kidney visible on …
8. Gerota’s fascia opening and tumor identification Read More »
[vc_row][vc_column][vc_column_text]UPPER POLE DISSECTION Upper pole dissection is an important phase in most partial nephrectomies. In all cases of LPN we perform dissection of the upper pole, to a greater or lesser extent, because it is part of the ascending dissection to release the spleen. I is also important because it contributes to the mobilization of …
[vc_row][vc_column][vc_column_text]The OBJECTIVES of the left renal pedicle dissection include: Identification and dissection of the renal vein and its branches: gonadal, lumbar and adrenal veins Identification of the renal artery behind the renal vein, near its exit from the aorta To achieve enough dissection of the vessels to have vascular control and be able to perform …
[vc_row][vc_column][vc_column_text]The objectives of this phase are: To open the parietal peritoneum, following the line of Toldt, from the iliac fossa up above the spleen To mobilize the descending colon and its mesentery following the avascular plane To identify retroperitoneal references: gonadal vein, ureter and psoas muscle. Errors we should avoid include: To open through the …
5. Access to the retroperitoneum: peritoneal opening and colon mobilization Read More »
[vc_row][vc_column][vc_column_text]We introduce the camera and explore the abdominal cavity to identify the anatomical references (left colon, spleen, kidney) and rule out the presence of adhesions. On the left side, the kidney area exposed is smaller than on the right side. Although it is less frequent, we can visualize anterior side tumors in the initial inspection. …
4. Inspection of abdominal cavity and adhesionlysis Read More »
