technique of laparoscopic nephrectomy
DESCRIPTION
TECHNIQUE OF LAPAROSCOPIC NEPHRECTOMY. Dr. Anmar Nassir, FRCS(C) Fellowship in Andrology (U of Ottawa) Fellowship in EndoUrology and Laparoscopy (McMaster Univ) Chairman, Department of Surgery Umm Al-Qura Univ Consultant Urology, King Faisal Specialist Hospital, Jeddah. - PowerPoint PPT PresentationTRANSCRIPT
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TECHNIQUE OF LAPAROSCOPIC NEPHRECTOMY
Dr. Anmar Nassir, FRCS(C)
Fellowship in Andrology (U of Ottawa)Fellowship in EndoUrology and Laparoscopy (McMaster Univ)
Chairman, Department of Surgery Umm Al-Qura UnivConsultant Urology, King Faisal Specialist Hospital, Jeddah
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There are 4 basic techniques used to create pneumoperitoneum:
1. blind Veress needle2. direct trocar insertion3. optical trocar insertion 4. open laparoscopy
Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005
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In 578 laparoscopic procedures: 1. blind insertion of the Veress needle
(group 1, n = 301)
2. direct trocar insertion with elevation of the rectus sheath using 2 towel clips
(group 2, n = 277).
Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005
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Results:Total complication rates:– gr 1 = 15.7% (n = 33)– gr 2 = 3.3% (n = 4)
(P < 0.05) Conclusion:Direct trocar insertion with elevation of the rectus
sheath using 2 towel clips is an easy, safe, and effective technique.
Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005
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Ralph V. Clayman,
J of urol. Pg 1847. Nov, 2005J of urol. Pg 1847. Nov, 2005
Having been a Veress needle advocate throughout my career, I am loath to
change. However, this scientifically well-done
study gives me “pause”;quicker pneumoperitoneum with fewer complications is certainly a compelling
argument for considering a change.
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Organ retrieval
• Intact through an enlarged incision– After placement into a
sac.– The kidney can be
worked out of • an extended trocar site • Pfannenstiel incision.
• Morcellation. – The specimen should be
placed into LapSac – Ring forceps and a
Kocher clamp & removed in small pieces.