451

Index

AAbdominal aortic pathology, partial

nephrectomy, 129Abdominal scars, 6Abdominal surgery, nephrectomy, 66–67Abdominal wall vessels, 6–7Adhesiolysis, 360Adrenal metastasis, adrenalectomy, 147Adrenal vein, dissection, 145Adrenalectomy, 413–414

adrenal gland, exposure of, 144adrenal metastasis, 147adrenal vein, dissection of, 145adrenocortical carcinoma (ACC), 146imaging studies, 144in obese patients, 145large tumors and malignancy, 146patient, preoperative preparation of,

143–144pediatric patients, 146port placement and patient positioning,

144–145postoperative management, 147steps, 137surgical anatomy, 137–138surgical procedure

retroperitoneal approach, 143transperitoneal approach, 138–143

Adult polycystic kidney disease, 250–252Anatomic restoration technique (ART),

238–240Anesthesia

cardiac patients, challenges inagents, 24–25functional capacity, 22intraoperative management, 24intraoperative monitoring, 24preoperative therapy, 23risk assessment, 22, 23surgical risk factors, 22–23

cardiovascular changes in, 19, 20

cerebral circulation, 21contraindications for, 26–27intra-operative complications, 21neurohumoral response, 19patient positioning, 19perioperative renal dysfunction and renal

failure, 26postoperative pain management in

central neuraxial blockade, 28–29ketamine, 29patient-controlled analgesia (PCA),

27–28pharmacological options for, 27

pulmonary changes in, 17–18pulmonary disease, 25–26renal system, 21splanchnic circulation, 21urologic laparoscopic surgery, 21–22

Anomalous kidneyscross-fused kidney, 315horseshoe kidney, 315, 316pelvic kidney, 315, 317retrocaval ureter, 315UPJO and stones, 314

Antegrade ejaculation preservation, 279–280Appendicovesicostomy, 390ART. See Anatomic restoration techniqueASC TriPort, 402Atlas LigaSure™ device, 42Augmentation cystoplasty

positioning and port placement, 338prerequisites, 341procedure, 338–340

BBailez technique, 9–10Bladder

augmentation, 388–390reconstruction (see Ureteral

and bladder reconstruction)

A.M. Al-Kandari and I.S. Gill (eds.), Difficult Conditions in Laparoscopic Urologic Surgery,DOI: 10.1007/978-1-84882-105-7, © Springer-Verlag London Limited 2011

452 Index

Bladder neck dissectionprostatic apical dissection, 223–225robotic radical prostatectomy

enlarged prostate, 217post-transurethral resection of prostate,

219–220prominent median lobe, 218–219prostate, 215–217

Bladder-prostate junction, 170Bleeding

partial nephrectomy, 125–126RPLND, 351

Boari flappositioning and port placement, 323preoperative imaging, 322procedure

non refluxing anastomosis, 325–326ureter, 323–325

CCamera, 34–35Carbon dioxide insufflation, 18Cardiac patients, anesthesia, 22–25Cardiovascular changes, in laparoscopy, 19, 20Central neuraxial blockade, 28–29Centrally located renal masses, LPN, 127Chylous ascites, 352Closed access, veress needle, 8–9Colonic and bowel injury, 231Continuous ambulatory peritoneal

dialysis (CAPD) catheter, 255–256Cost-reductive measures, in laparoscopy

homemade balloon, 47reusable instrumentation, 46robotic technology, 51specimen retrieval, 49–50training alternatives, 50–51vascular control, 47–49

Cross-fused kidney, 315CT scan

centrally located tumors, 127hilum, renal mass, 126renal cyst and giant hydronephrosis,

150, 152three-dimensional, live donor

nephrectomy, 93, 94Cystic lesions, partial nephrectomy, 131Cystoplasty. See Augmentation cystoplasty

Dda Vinci® system, 51Diaphragmatic injury, partial nephrectomy, 129Dissection

presacral, sacrocolpopexy, 372radical prostatectomy

anterior wall of, 188–189denonvillier’s fascia, 200direction of, 187–188posterior bladder neck, 195–196, 198prostatic apex, retrograde, 193, 195vas deferens and seminal vesicles,

197, 199–200rectovaginal space

intraoperative site, 374technical caveats, 381uterosacral ligament (USL), 375vaginal retractor, 372–373

RPLNDbleeding, 351chylous ascites, 352ejaculatory dysfunction, 352exposure and port placement, 350–351indications, 347mechanical bowel preparation, 347–348organ injury, 352postchemotherapy, 347retrocaval dissection, 350small bowel obstruction, 352spermatic cord dissection, 348–349

vesicovaginal spacebladder neck, 378mesh passage, 378–379mesosalpinx, 376–377technical caveats, 381–382

Dorsal venous complex (DVC), 221–222

EElectric thermal instruments, 41–42End stage renal disease (ESRD), 26Endo Catch™ bag, 42, 43, 84, 85, 113Endoeye camera, 34EndoEYE system, 397–398Endoscopic Threaded Imaging Port

(EndoTIP™), 11Endovascular gastrointestinal (GIA)

stapler malfunction, 87Endovascular gastrointestinal anastomosis

(endo-GIA) stapler, 37–38Esmolol, 25Extraperitoneal approaches, 164Extraperitoneal trocar placement, 166–167

FFemale genital prolapse

defects and resulting dysfunctionanterior zone, 368

Index 453

middle zone, 368posterior zone, 368–369

laparoscopic sacrocolpopexyaccess and trocar position, 371–372disadvantage, 370instruments, 371mesosalpinx, 375–376objective, 369operative setup, 370peritoneal incision, 381post hysterectomy, 382presacral dissection, 372rectovaginal space dissection,

372–375, 381sacral promontory, 379–380uterosacral ligament (USL), 381vaginal retractor, 381vesicovaginal space dissection,

376–379, 381–382pelvic anatomy, 367symptoms, 369

Fenoldopam mesylate, 25FloSeal™, 123, 125Foley catheter guide, 175

GGerota’s fascia, 73, 81, 82Giant hydronephrosis. See Renal cyst

and giant hydronephrosisGiant hydronephrosis, nephrectomy, 67

HHand-assisted nephroureterectomy, 111Hasson technique, 9Hem-o-lok® polymer clip, 38–39, 48, 59,

60, 76, 98Hemodynamic changes, 20Hemostasis, retroperitoneal radical

nephrectomy, 85, 86Hilar bleeding, nephroureterectomy, 114Hilar dissection, 74–76Hilum, renal mass, 126–127Hock, cautery equipment, 40Homemade balloon technique, 47Horseshoe kidney, 315, 316

IIleal ureter

positioninginterposition, 331–332pneumoperitoneum, 332port placement, 333–334

procedure, 334–336Inflammatory renal conditions,

nephrectomy, 64–66Instrumentation

and assistant ergonomics, 35–36camera, 34–35electric thermal instruments, 41–42endo-GIA stapler, 37–38guidelines, 36Hem-o-lok® polymer clip, 38–39hock, cautery equipment, 40insufflators, 33–34metal clips, 36–37retrieval bags, 42reusable veress needles and trocars, 33scissors, 40suction devices, 39ultrasonic thermal instruments, 40

Insuflow® laparoscopic gas conditioning device, 35

Intravenous urogram (IVU), 357

KKetamine, 29Kidney extraction, live donor nephrectomy, 99Kidney transplant patients, preoperative

evaluation, 249

LLabetalol, 25LAN. See Laparoscopic anatrophic

nephrolithotomyLaparoscopic access

anatomical considerationsabdominal scars, 6abdominal wall thickness, 6abdominal wall vessels, 6–7umbilicus, 6

closed access, veress needle, 8–9open access

Bailez technique, 9–10Hasson technique, 9

optical accessdisposable visual entry system, 10–11retroperitoneal approach, 11–12reusable visual entry system, 11

patient factorsanatomical variations, 13obesity, 12–13previous surgery, 13surgeon factors, 13–14

port design, 7port insertion techniques, 8

454 Index

Laparoscopic anatrophic nephrolithotomy (LAN), 312

Laparoscopic nephrectomy. See NephrectomyLaparoscopic nephrolithotomy, 312–314Laparoscopic partial nephrectomy (LPN)

bleeding, 125–126calculus/PUJO, 132centrally located tumors, 127complications, 133consent form, 118cystic lesions, 131diaphragmatic injury, 129hilum, renal mass, 126–127horseshoe kidney, 132imaging review, 118laboratory investigations, 118multiple renal arteries, 129–130obese patients, 130–131pelvicaliceal system opening, during

deep renal resection, 126peripheral lesion

CT-1 Vicryl™, 124flank position and port sites, 120FloSeal™, 125hilar clamping, with Satinski

clamp, 120–121methylene blue leakage, from

opened collecting system, 123Surgicel® bolster, 124, 125tumor, cold scissor cutting of, 123ultrasound probe, 122

positioning, 118–119previous renal surgery, 130recommendations, 134solitary kidney and renal function, 127–129standard essential equipment, 119surgeon preparation, 118targeted therapy, 132–133vena caval/abdominal aortic pathology, 129

Laparoscopic pyelolithotomy (LP)pyelotomy and stone removal, 311pyelotomy closure, 312renal pelvis, 309–310stone migration, 311–312

Laparoscopic radical cystectomy (LRC)anterior abdominal wall, 289bladder masses, 289camera ports, 286, 287gross lymphadenopapathy, 290omental/bowel adhesions, appendectomy,

286, 287right subcostal access, 286stenting, 292thick wall, 289

tumor size, 288urethroileal anastomosis, 291–292urinary diversion, 290–291vascular injuries during access, 287–288visceral injuries during access, 288

Laparoscopic RPLND. See Retroperitoneal lymph node dissection (RPLND)

Laparoscopic trainingfellowships, 435legal issues, 446–447medicolegal issues, 445–446mentoring

benefits, 442–443mutual, 443telementoring, 444–445video, 443–444

residents, 434–435self-training

basic laparoscopic courses, 436experts invite, 438–441experts visit, 437–438pelvic trainer, 441–442technical operative and advanced

courses, 436–437Laparoscopic ureteral and bladder

reconstruction. See Ureteral and bladder reconstruction

Laparoscopic ureterolithotomy (LU)lost stone, 308stenting and suturing, 308–309stone adhering, 308stone localization, 306, 308stone migration, 306ureteral stricture, 309ureterolithotomy, 306, 307

Laparoscopic ureterolysis. See Retroperitoneal fibrosis (RPF)

Large median lobes, 233–234Lateral pelvic fascia (LPF), 241LigaSure Atlas™, 110, 111LigaSure™ vessel-sealing system, 41Live donor nephrectomy, 91

exposurepatient positioning, 94port positioning, 95ureter and gonadal vein, 96vena cava, 97

kidney extraction, 99preparation

preoperative evaluation, 92three-dimensional CT, 93, 94

vascular control, 98–99LP. See Laparoscopic pyelolithotomyLRC. See Laparoscopic radical cystectomy

Index 455

LU. See Laparoscopic ureterolithotomyLymphatic tissue

lymph node package dissection, 268–270overlying the aorta, 268overlying the inferior vena cava (IVC),

dissection, 267, 268ventral and lateral, dissection, 273–274

Lymphocele formation, 279

MMalignancy, adrenalectomy, 146Medicolegal issues, laparoscopic

training, 445–446Mentoring

benefits, 442–443mutual, 443telementoring, 444–445video, 443–444

Metal clips, 36–37

NNephrectomy

contraindications, 56difficulties in

giant hydronephrosis, 67inflammatory renal conditions, 64–66obese patients, 67–68previous abdominal surgery, 66–67

indications, 55partial

pediatric laparoscopic urologic surgery, 386–387

urologic laparoscopy complications, 417–418

radical, 414–416retroperitoneal

advantages and disadvantages, 64operative steps, 64patient positioning for, 61port distribution, 63retroperitoneal space, creation

of, 61–63simple, 416–417renal cyst and giant hydronephrosis,

techniquesretroperitoneal approach, 152–154transperitoneal approach, 154–157

transperitonealline of Toldt, incision of, 59needle placement, 56patient positioning for, 56port distribution for, 58

renal pedicle, control of, 59–60room setup for, 57ureter dissection, 58, 59

Nephrolithiasis, 132Nephroureterectomy (NU)

advantages of, 104bladder cuff and intramural ureter,

preparation ofpluck procedure, 106stent placement, with unroofing, 106transvesical laparoscopic ureteral

dissection, 107, 108hand-assisted, 111indications, 104patient positioning, 105patient preparation, 105peritoneal rent, 113persistent hilar bleeding, renal pedicle

ligation, 114preoperative evaluation and preparation,

104–105renal hilum, identification of, 114retroperitoneal approach, 111–112sealed, 110–111specimen entrapment and delivery, 113transperitoneal, 107, 109–110UUT-UC, 103

Nonseminomatous germ cell tumors (NSGCT), 259

NSGCT. See Nonseminomatous germ cell tumors

OObese patients, 256–257

adrenalectomy, 145laparoscopic access, 12–13nephrectomy, 67–68partial nephrectomy, 130–131retroperitoneoscopy, 88

Obturator nerve injury, 232Open access, 9–10Open radical cystectomy (ORC), 285, 289.

See also Laparoscopic radical cystectomy (LRC)

Optical access, 10–12Orchidopexy, 392

PPartial nephrectomy. See also Laparoscopic

partial nephrectomy (LPN)pediatric laparoscopic urologic surgery,

386–387

456 Index

urologic laparoscopy complications, 417–418

Patient controlled epidural analgesia (PCEA), 28

Patient-controlled analgesia (PCA), 27–28Pediatric laparoscopic urologic surgery

counseling and consent, 384equipment and staff, 384ergonomics, 385insufflation, 385patient selection, 383–384pneumoperitoneum maintenance, 385–386port positioning and insertion, 384procedure-specific difficulties

appendicovesicostomy, 390bladder augmentation, 388–390orchidopexy, 392partial nephrectomy, 386–387peritoneal dialysis catheter, 390–392pyeloplasty, 388

Pediatric patients, adrenalectomy, 146Pelvi-ureteric junction obstruction (PUJO), 132Pelvic kidney, 315, 317Percutaneous nephrolithotomy (PCNL), 309,

312Perioperative renal dysfunction, anesthesia, 26Peripelvic cysts, 157Peripheral lesion, partial nephrectomy

CT-1 Vicryl™, 124flank position and port sites, 120FloSeal™, 125hilar clamping, with Satinski clamp,

120–121methylene blue leakage, from opened

collecting system, 123Surgicel® bolster, 124, 125tumor, cold scissor cutting of, 123ultrasound probe, 122

Peritoneal dialysis catheterdialysis, 391–392nonabsorbable suture, 391omentectomy, 391

Pfanensteil skin incision, 85Pluck procedure, ureteral orificetunnel

resection, 106Pneumoperitoneum

cardiac output, 20respiratory compliance, 18

Polymer clips (Hem-o-lok® clips), 38–39, 48, 59, 60, 76, 98

Port design, 7Port insertion techniques, 8Port placement

adrenalectomy, 144–145retroperitoneoscopy radical nephrectomy,

80–82Port-site hernia, 427Post-transplant lymphocoele, laparoscopic

marsupilisation, 253–255Posterior bladder neck dissection, 195–196,

198Postoperative pain management

central neuraxial blockade, 28–29ketamine, 29patient-controlled analgesia (PCA), 27–28pharmacological options for, 27

Pre-transplant nephrectomy, ADPKD, 250–252Pretransplant nephrectomy

adult polycystic kidney disease, 250–252infective conditions and previously operated

cases, 252–253Prostatectomy. See also Robotic radical

prostatectomy; Robotic-assisted nerve-sparing radical prostatectomy (RARP); Simple prostatectomy

radicalcomplications avoidance, 425obturator nerve injury and nerve

apraxia, 425rectal injury, 419–421symptomatic lymphocele, 424ureteral injury, 421–423urinary leak, 423–424

simple, 418–419Prostatic adenoma

dissection of, 171intracapsular prostatic pedicles, 172retraction of, 172Sotelo Prostatotomo, 173–174

Prostatic apical dissectionaccessory pudendal arteries, 220–221bladder neck reconstruction, 223–225dorsal venous complex (DVC), 221–222vesicourethral anastomosis, 225–226

Psoas Hitchpositioning and port placement, 327–328procedure

refluxing and nonrefluxing anastomosis, 328

ureteroneocystostomy, 329–331Pulmonary changes, in laparoscopy, 17–18Pulmonary disease, anesthesia, 25–26Pyeloplasty, 388, 418

abdomen, 303anastomosis, 301, 303approach, 299–300

Index 457

operating room setup, 297patient selection and indication, 295–296port placement, 300positioning, 300retrograde ureterogram and stenting

antegrade placement, 298–299intraoperative placement, 298preoperative placement, 298purpose, 297ureteral catheter, 298, 299

retroperitoneum, 300–301training model, 296–297ureteropelvic junction, 301–303

Pyelotomy and stone removal, 311

QQuality of life, 280

RRadical cystectomy, 425–426Radical nephrectomy, 414–416Radical prostatectomy

anterior bladder neck dissection, 193, 197complications avoidance, 425dissection

anterior wall of, 188–189denonvillier’s fascia, 200direction of, 187–188posterior bladder neck, 195–196, 198prostatic apex, retrograde, 193, 195vas deferens and seminal vesicles, 197,

199–200dorsal venous complex, ligation and division

of, 189–191drainage, 207, 208equipment, 181extraperitoneal approaches

advantages, 183–184disadvantages, 184

extraperitoneal trocar placement, 185instruments, 181–182obturator nerve injury and nerve apraxia,

425patient positioning, 182patient preparation, 182prostate vascular pedicles, 200–201puboprostatic ligament, endopelvic fascia,

188, 189rectal injury, 419–421specimen extraction, 200, 202surgical setup, 183

symptomatic lymphocele, 424transperitoneal approaches, 184transperitoneal trocar placement, 186–187ureteral injury, 421–423urethra, apical dissection and division, 191,

193, 194urethrovesical anastomosis (see

Urethrovesical anastomosis)urinary leak, 423–424

RARP. See Robotic-assisted nerve-sparing radical prostatectomy (RARP)

Rectovaginal space dissectionintraoperative site, 374technical caveats, 381uterosacral ligament (USL), 375vaginal retractor, 372–373

Renal cyst ablation, 414Renal cyst and giant hydronephrosis, 149

evaluationcategories, 150CT scan, 150, 152indications, 151

operative techniques, 151–152retroperitoneal approach

management of, 154nephrectomy technique, 152–154

transperitoneal approachdecortication, 156–157nephrectomy techniques, 154–156

Renal failure, anesthesia, 26Renal hilum, 82–83

nephroureterectomy, 114Renal mass

hilum, 126–127in solitary kidney, 127–129

Renal pelvis, 309–310Renal system, 21Retrieval bags, 42Retrocaval dissection, RPLND, 350Retrocaval ureter, 315Retrograde pyelography, 357Retroperitoneal approach

adrenalectomy, 143nephroureterectomy, 111–112optical access, 11–12renal cyst and giant hydronephrosis

management of, 154nephrectomy technique, 152–154

Retroperitoneal fibrosis (RPF)bowel injury and internal hernias, 346exposure and port placement, 345–346medical management, 343pyelography, 344

458 Index

technique, 344–345ureteral injury and stricture formation, 346vascular injuries, 346

Retroperitoneal laparoscopic nephrectomyadvantages and disadvantages, 64operative steps, 64patient positioning for, 61port distribution, 63retroperitoneal space, creation of, 61–63

Retroperitoneal laparoscopic radical nephrectomy

en bloc specimen, circumferential extrafas-cial mobilization of, 83–84

endovascular gastrointestinal (GIA) stapler malfunction, 87

hemostasis, 85, 86inadverted peritoneotomy, 87–88instrumentation, 80operation room setup, 80orientation in, 87patient positioning, 80persistent renal hilar bleeding, 88port placement, 80–82preoperative evaluation, 79renal hilum, 82–83, 87retroperitoneoscopy, in obese patients, 88specimen extraction

Endocatch II bag, 85, 86Pfanensteil skin incision, 85

specimens entrapment, 84, 88technical difficulties in, 89

Retroperitoneal laparoscopy, 412–413Retroperitoneal lymph node dissection

(RPLND)adjuvant chemotherapy, 281antegrade ejaculation, 281bleeding, 351chylous ascites, 352contraindications, 261cost effectiveness, 281ejaculatory dysfunction, 352equipment, 262–263exposure and port placement, 350–351indications, 347indications and therapeutic concepts,

259–261NSGCT, 259operative technique

initial access and trocars, 264lymph node package, 274, 275lymphatic tissue dissection, template

and incision lines, 265–270nodal package and drainage

removal, 269

patient position, 264, 271peritoneum, 265, 271retroperitoneum, 265, 272splenocolic ligament, 271, 272stage II after chemotherapy, 274, 276trocar arrangement, 271

organ injury, 352overcome difficulties

antegrade ejaculation preservation, 279–280

dissection and hemostasis technique, 277–279

exposure, 276–277lymphocele formation, 279split and roll technique, 276

pathologic stage II after chemotherapy, 281postchemotherapy, 347preoperative measures, 261–262quality of life, 280small bowel obstruction, 352techniques

mechanical bowel preparation, 347–348

retrocaval dissection, 350spermatic cord dissection, 348–349

template, 262–263Robotic nerve-sparing technique, 242Robotic radical prostatectomy

anesthesia cases, 210bladder neck dissection

enlarged prostate, 217post-transurethral resection of prostate,

219–220posterior bladder neck dissection, 216prominent median lobe, 218–219RALP, 215

obese patient, 211–214port placement, 210–211prior inguinal hernia repair, 214–215prostatic apical dissection

accessory pudendal arteries, 220–221bladder neck reconstruction, 221–225DVC, 221–223vesicourethral anastomosis, 225–226

Robotic technology, cost-reductive measures, 51

Robotic-assisted nerve-sparing radical prostatectomy (RARP)

avoiding perioperative complicationsanastomotic leak and bladder neck

strictures, 236lymphocele and lymphedema, 236–237port site hernias, 237

intraoperative complications

Index 459

allograft injury, renal transplant patient, 235–236

bleeding, vascular injury and hema-toma, 230

colon and small intestine injury, 231large median lobes, 233obturator nerve injury, 232rectal injury, 231–232robot malfunction, 234–235ureteric orifice injury, 233–234

optimizing functional outcomesanatomic restoration technique (ART),

238–240da Vinci® system, 243nerve fibers, preservation, 241–242postulated biomechanical instability,

237–239robotic nerve-sparing technique,

242–243RPLND. See Retroperitoneal lymph node

dissection

SSacrocolpopexy

access and trocar position, 371–372disadvantage, 370instruments, 371mesosalpinx, 375–376objective, 369operative setup, 370peritoneal incision, 381post hysterectomy, 382presacral dissection, 372rectovaginal space dissection

intraoperative site, 374technical caveats, 381uterosacral ligament (USL), 375vaginal retractor, 372–373

sacral promontory, 379–380uterosacral ligament (USL), 381vaginal retractor, 381vesicovaginal space dissection

bladder neck, 378mesh passage, 378–379mesosalpinx, 376–377technical caveats, 381–382

Sealed laparoscopic nephroureterectomy, 110–111

Shock wave lithotripsy (SWL), 306, 308, 312, 315

Simple nephrectomy, 416–417Simple prostatectomy, 418–419

adenoma, 168, 170

approaches, 164–166benign prostatic hyperplasia (BPH), 161bladder, 169, 170

hemostasis, trigonization, and closure of, 174–175

drainage, 175equipment, 163extraperitoneal approaches, 164gland volume, 161–162instruments, 163operatory clamp, extraction of, 175–177patient positioning, 164postoperative care, 178preoperative preparation, 163–164prostatic adenoma

anterior face of, 170dissection and enucleation of,

171–174surgical equipment, distribution, 164, 165transperitoneal approaches

advantages, 165disadvantages, 165two lateral peritoneal windows, 166

trocar placementextraperitoneal, 166–167lateral transperitoneal windows,

168, 169transperitoneal, 167–168

Single-port access renal cryoablation (SPARC), 398–400

Single-port laparoscopic pelvic surgeryadvantages, 400cystectomy, 401prostatectomy, 401–402

Single-port laparoscopic surgeryinstrumentation

EndoEYE system, 397–398Triport trocar, 396–397Uni-X Single Port Trocar, 396

pelvic organadvantages, 400cystectomy, 401prostatectomy, 401–402

robotic surgeryASC TriPort, 402intraoperative image, 403

single-port access renal cryoablation (SPARC), 398–400

Single-port robotic surgeryASC TriPort, 402intraoperative image, 403

Spermatic cord dissection, RPLND, 348–349Spermatic vessels, identification and

dissection, 267, 272–273

460 Index

Suction devices, 39Surgicel® bolster, 122, 124, 125

TThermal instruments

electric, 41–42ultrasonic, 40

Transperitoneal approachadrenalectomy, 138–143renal cyst and giant hydronephrosis

decortication, 156–157nephrectomy techniques, 154–156

Transperitoneal approaches, 165Transperitoneal laparoscopic nephrectomy

line of Toldt, incision of, 59needle placement, 56patient positioning for, 56port distribution for, 58renal pedicle, control of, 59–60room setup for, 57ureter dissection, 58, 59

Transperitoneal laparoscopic radical nephrectomy

access, 71–72bowel mobilization, 72–73hilar dissection, 74–76patient positioning, 71specimen retrieval, 77upper pole mobilization, 76–77ureter, identification of, 73–74

Transperitoneal nephroureterectomy, 107, 109–110

Transperitoneal trocar placement, 167–168lateral transperitoneal windows, 168–169

Transureteroureterostomy (TUU)positioning and port placement, 337procedure, 337

Transurethral ablation by microwave thermo-therapy (TUMT), 162

Transurethral resection of the prostate (TURP), 161–162

Transverse cistotomy, 170Transvesical laparoscopic ureteral dissection,

107, 108Triport trocar, 396–397Trocar placement, 166–168Tumors, adrenalectomy, 146

UUltrasonic thermal instruments, 40Umbilical ligaments, 169

Umbilicus, 6Uni-X Single Port Trocar, 396Upper urinary tract urothelial carcinoma

(UUT-UC), 103Ureter, transperitoneal radical

nephrectomy, 73–74Ureteral and bladder reconstruction

augmentation cystoplastypositioning and port placement, 338prerequisites, 341procedure, 338–340

Boari flappositioning and port placement, 323preoperative imaging, 322procedure, 323–326

ileal ureterpositioning and port placement,

331–334procedure, 334–336

Psoas Hitchpositioning and port placement,

327–328procedure, 328–331

transureteroureterostomy (TUU)positioning and port placement, 337procedure, 337

Ureteral stent placement, 106Ureteric orifice injury, 233–234Ureteric reimplantation, 365Ureterolithotomy, 306, 307Ureteroneocystostomy, 329–331Ureteropelvic junction (UPJ). See also

Pyeloplastyanatomy of, 297passive dilation, 298renal pelvis, 309

Ureteropelvic junction obstruction (UPJO), 314

Urethroileal anastomosis, 291–292Urethrovesical anastomosis

absorbable monofilament, 203instruments, 202suturing tips, 202, 203two separate sutures with continuous

stitches, 204–207type of, 203–204

Urinary stonesanomalous kidneys, 314–317laparoscopic nephrolithotomy, 312–314laparoscopic pyelolithotomy (LP), 309–312laparoscopic ureterolithotomy

(LU), 307–309Urologic laparoscopy

Index 461

access-related complications, 407–409adrenalectomy, 413–414hypotension, 428intraoperative complications

chain of action, 410instruments required, 409–410vascular and nonvascular injuries, 409

neuromuscular complications, 412objective, 405–406partial nephrectomy, 417–418port-site hernia, 427positioning complications, 411preventive measures, 406–407pyeloplasty, 418radical cystectomy, 425–426radical nephrectomy, 414–416radical prostatectomy

complications avoidance, 425obturator nerve injury and nerve

apraxia, 425rectal injury, 419–421symptomatic lymphocele, 424ureteral injury, 421–423urinary leak, 423–424

reexploration, 429renal cyst ablation, 414retroperitoneal laparoscopy, 412–413simple nephrectomy, 416–417simple prostatectomy, 418–419visceral complications, 410–411

VVas deferens and seminal vesicles, dissection,

197, 199–200Vascular control, live donor nephrectomy,

98–99Vena caval/abdominal aortic pathology, partial

nephrectomy, 129

Veress needle, closed access, 8–9Vesicourethral anastomosis,

225, 237–238Vesicovaginal fistula (VVF)

anatomy, 355, 356classification, 359clinical presentation, 356–357complications

ReVVF repair, 364supratrigonal and infratrigonal

fistula, 363–364ureteric reimplantation, 365

diagnosis and evaluation, 357imaging studies, 357–358incidence, 356instruments required, 360laparoscopic approach, 360physical examination, 357postoperative problems, 363surgery timing, 358–359surgical

history, 355principles, 359–360

techniques, 360–362treatment, 358

Vesicovaginal space dissectionbladder neck, 378mesh passage, 378–379mesosalpinx, 376–377technical caveats, 381–382

Vicryl™, 124Visiport™, 11Visual entry systems, 10–11

XXanthogranulomatous pyelonephritis (XGPN)

approach, 252hilum, 253