Transperitoneal laparoscopic nephrectomy: training, technique, and results.
Journal Article (Journal Article)
Transperitoneal laparoscopic nephrectomy was integrated into our daily routine within a 6-month period by means of a step-by-step training program progressing from a pelvic trainer to animal studies (N = 15) to laptent-assisted surgery. The pneumoperitoneum is created with the patient in the flank position, enabling insertion of three trocars: 10-mm periumbilical (Port I), 5/12-mm subcostal (Port II), and 12/5-mm above the iliac spine (Port III). After medial mobilization of the colon, two additional 5-mm trocars (Ports IV and V) are inserted into the lateral abdominal wall parallel to Ports II and III. Once clipping and dissection of the ovarian (spermatic) vein has been carried out, the ureter is identified and dissected. Retraction of the proximal ureter exposes the renal hilum, allowing dissection of the renal vessels. The renal vein is dissected using an endoscopic stapling device, while accessory veins and the renal artery are clipped. Organ retrieval is achieved with a specially designed tissue pouch (Lapsac) and digital fragmentation of the kidney within the organ bag. Using this technique, we have treated 24 patients with benign (N = 20) and malignant (N = 4, including adrenalectomy) renal disease. The mean operative time was 239 (115-300) minutes. In four cases, open surgery was required because of bleeding (N = 2), severe perinephric inflammation (N = 1), or bowel injury (N = 1). For relief of wound pain, an average of 1.15 vials of analgesic (morphine derivatives)/patient were administered for 2.4 days. The postoperative hospital stay averaged 6.2 (4-10) days.
Full Text
Duke Authors
Cited Authors
- Rassweiler, J; Henkel, TO; Potempa, DM; Coptcoat, MJ; Miller, K; Preminger, GM; Alken, P
Published Date
- December 1993
Published In
Volume / Issue
- 7 / 6
Start / End Page
- 505 - 515
PubMed ID
- 8124347
International Standard Serial Number (ISSN)
- 0892-7790
Digital Object Identifier (DOI)
- 10.1089/end.1993.7.505
Language
- eng
Conference Location
- United States