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TECHNIQUE OF LAPAROSCOPIC NEPHRECTOMY

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.

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TECHNIQUE OF LAPAROSCOPIC NEPHRECTOMY

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  1. 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

  2. There are 4 basic techniques used to create pneumoperitoneum: • blind Veress needle • direct trocar insertion • optical trocar insertion • open laparoscopy Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005

  3. In 578 laparoscopic procedures: • blind insertion of the Veress needle (group 1, n = 301) • 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, 2005

  4. 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, 2005

  5. 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. Ralph V. Clayman, J of urol. Pg 1847. Nov, 2005

  6. Organ retrieval

  7. 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.

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