LAPAROSCOPIC NEPHRECTOMY

1. 2A LAPAROSCOPIC NEPHRECTOMY DURGA D GAUR Bombay Hospital Bombay

2. 2A HISTORY OF LAPAROSCOPIC NEPHRECTOMY First transperitoneal nephrectomy 1991: RV Clayman, J Urology First retroperitoneal nephrectomy 1992: DD Gaur, J Urology

3. 2A RETROPERITONEAL LAPAROSCOPIC NEPHRECTOMY Simple nephrectomy Tumour nephrectomy Donor nephrectomy

4. Indications

5. 2A CONTRAINDICATIONS FOR RETROPERITONEOSCOPIC NEPHRECTOMY Dense retroperitoneal adhesions Prior operations TB pyelonephritis Xanthogranulomatous PN Tumor size > 6cm

6. 2A OPERATIVE STEPS FOR SIMPLE NEPHRECTOMY Identify the psoas muscle Identify ureter, dissect, clip and divide Be careful not to damage the gonadal vein If kidney is large or low lying, this step is done right at the end Divide the Gerota�s fascia and identify the posterior surface of the kidney If kidney is small, follow up the ureter to identify the kidney

7. 2A OPERATIVE STEPS CONTINUED Lift the kidney up through the lower port Dissect the fibro-fatty tissue between the kidney and the psoas to expose the renal pedicle Be careful not to damage a lumbar vein The renal artery is cephalad and can be identified by its pulsations It is dissected, clip ligated and divided Then the renal vein is dealt with similarly

8. 2A OPERATIVE STEPS CONTINUED The kidney is then dissected all around Be careful not to damage the adrenal gland Make sure the kidney is totally free by twisting the specimen Establish haemostasis Put the specimen in a bag if available Remove the specimen by enlarging the 2 cm incision. Place a drain and close the ports properly

9. No urinary catheter is requiredandthe nasogastric tube is removed at the end of the procedure