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SURGICAL APPROACHES

SURGICAL APPROACHES. 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. SURGICAL APPROACHES.

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SURGICAL APPROACHES

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  1. SURGICAL APPROACHES

  2. 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

  3. SURGICAL APPROACHES There are three basic laparoscopic approaches: • transperitoneal • retroperitoneal • hand-assisted.

  4. Retro approach

  5. However when the vein is identified, the surgeon should recheck the orientation of the camera and the relationship of the vein to the ureter and psoas to ensure that the identified structure is the renal vein and not the vena cava. • Care must be taken because there are reports of dividing the vena cava during LRPN with theendovascular stapler

  6. Compared with a transperitoneal a retroperitoneal approach offers similar outcomes in: • complication rates, • pain medication requirements, • length of hospital stay, • time to return to normal activity McDougall et al, 1996

  7. Randomized study • 50 pts in transperitoneal vs 52 pts to LRPN • Tumors averaging 5 cm in size. • No difference in: • blood loss, narcotic requirements, hospital stay, or complications. • The retroperitoneal approach had a shorter mean operative time • 150 min vs 207 min in the transperitoneal series (P = 0.001) Desai et al, 2005

  8. Few words about HAL

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