Transperitoneal Izquierda

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, […]

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 the initial exam is

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

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 clamping safely.

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 mesocolon.

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.

For left partial nephrectomy we generally use 4 trocars on a diamond shape (Figure  3.1): Pararectal Hasson´s trocar Left iliac fossa 12 mm trocar. Subcostal 5 or 11 mm Trocar. Lateral 5 mm trocar on the mid-axillary line Figure 3.1: Trocar insertion This preferred trocar disposition admits great variations for partial nephrectomy depending of each

Access is performed with a left pararectal minilaparotomy and placement of a Hasson´s trocar at the upper umbilical line, or slightly higher. Veress needle is another acceptable option. Hasson mini laparotomy and trocar insertion technique: – A 2.0-3 cm incision is performed and deepen to the anterior abdominal fascia. Two reference stitches are taken on