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451
Index
AAbdominal aortic pathology, partial
nephrectomy, 129Abdominal scars, 6Abdominal surgery, nephrectomy, 66–67Abdominal wall vessels, 6–7Adhesiolysis, 360Adrenal metastasis, adrenalectomy, 147Adrenal vein, dissection, 145Adrenalectomy, 413–414
adrenal gland, exposure of, 144adrenal metastasis, 147adrenal vein, dissection of, 145adrenocortical carcinoma (ACC), 146imaging studies, 144in obese patients, 145large tumors and malignancy, 146patient, preoperative preparation of,
143–144pediatric patients, 146port placement and patient positioning,
144–145postoperative management, 147steps, 137surgical anatomy, 137–138surgical procedure
retroperitoneal approach, 143transperitoneal approach, 138–143
Adult polycystic kidney disease, 250–252Anatomic restoration technique (ART),
238–240Anesthesia
cardiac patients, challenges inagents, 24–25functional capacity, 22intraoperative management, 24intraoperative monitoring, 24preoperative therapy, 23risk assessment, 22, 23surgical risk factors, 22–23
cardiovascular changes in, 19, 20
cerebral circulation, 21contraindications for, 26–27intra-operative complications, 21neurohumoral response, 19patient positioning, 19perioperative renal dysfunction and renal
failure, 26postoperative pain management in
central neuraxial blockade, 28–29ketamine, 29patient-controlled analgesia (PCA),
27–28pharmacological options for, 27
pulmonary changes in, 17–18pulmonary disease, 25–26renal system, 21splanchnic circulation, 21urologic laparoscopic surgery, 21–22
Anomalous kidneyscross-fused kidney, 315horseshoe kidney, 315, 316pelvic kidney, 315, 317retrocaval ureter, 315UPJO and stones, 314
Antegrade ejaculation preservation, 279–280Appendicovesicostomy, 390ART. See Anatomic restoration techniqueASC TriPort, 402Atlas LigaSure™ device, 42Augmentation cystoplasty
positioning and port placement, 338prerequisites, 341procedure, 338–340
BBailez technique, 9–10Bladder
augmentation, 388–390reconstruction (see Ureteral
and bladder reconstruction)
A.M. Al-Kandari and I.S. Gill (eds.), Difficult Conditions in Laparoscopic Urologic Surgery,DOI: 10.1007/978-1-84882-105-7, © Springer-Verlag London Limited 2011
452 Index
Bladder neck dissectionprostatic apical dissection, 223–225robotic radical prostatectomy
enlarged prostate, 217post-transurethral resection of prostate,
219–220prominent median lobe, 218–219prostate, 215–217
Bladder-prostate junction, 170Bleeding
partial nephrectomy, 125–126RPLND, 351
Boari flappositioning and port placement, 323preoperative imaging, 322procedure
non refluxing anastomosis, 325–326ureter, 323–325
CCamera, 34–35Carbon dioxide insufflation, 18Cardiac patients, anesthesia, 22–25Cardiovascular changes, in laparoscopy, 19, 20Central neuraxial blockade, 28–29Centrally located renal masses, LPN, 127Chylous ascites, 352Closed access, veress needle, 8–9Colonic and bowel injury, 231Continuous ambulatory peritoneal
dialysis (CAPD) catheter, 255–256Cost-reductive measures, in laparoscopy
homemade balloon, 47reusable instrumentation, 46robotic technology, 51specimen retrieval, 49–50training alternatives, 50–51vascular control, 47–49
Cross-fused kidney, 315CT scan
centrally located tumors, 127hilum, renal mass, 126renal cyst and giant hydronephrosis,
150, 152three-dimensional, live donor
nephrectomy, 93, 94Cystic lesions, partial nephrectomy, 131Cystoplasty. See Augmentation cystoplasty
Dda Vinci® system, 51Diaphragmatic injury, partial nephrectomy, 129Dissection
presacral, sacrocolpopexy, 372radical prostatectomy
anterior wall of, 188–189denonvillier’s fascia, 200direction of, 187–188posterior bladder neck, 195–196, 198prostatic apex, retrograde, 193, 195vas deferens and seminal vesicles,
197, 199–200rectovaginal space
intraoperative site, 374technical caveats, 381uterosacral ligament (USL), 375vaginal retractor, 372–373
RPLNDbleeding, 351chylous ascites, 352ejaculatory dysfunction, 352exposure and port placement, 350–351indications, 347mechanical bowel preparation, 347–348organ injury, 352postchemotherapy, 347retrocaval dissection, 350small bowel obstruction, 352spermatic cord dissection, 348–349
vesicovaginal spacebladder neck, 378mesh passage, 378–379mesosalpinx, 376–377technical caveats, 381–382
Dorsal venous complex (DVC), 221–222
EElectric thermal instruments, 41–42End stage renal disease (ESRD), 26Endo Catch™ bag, 42, 43, 84, 85, 113Endoeye camera, 34EndoEYE system, 397–398Endoscopic Threaded Imaging Port
(EndoTIP™), 11Endovascular gastrointestinal (GIA)
stapler malfunction, 87Endovascular gastrointestinal anastomosis
(endo-GIA) stapler, 37–38Esmolol, 25Extraperitoneal approaches, 164Extraperitoneal trocar placement, 166–167
FFemale genital prolapse
defects and resulting dysfunctionanterior zone, 368
Index 453
middle zone, 368posterior zone, 368–369
laparoscopic sacrocolpopexyaccess and trocar position, 371–372disadvantage, 370instruments, 371mesosalpinx, 375–376objective, 369operative setup, 370peritoneal incision, 381post hysterectomy, 382presacral dissection, 372rectovaginal space dissection,
372–375, 381sacral promontory, 379–380uterosacral ligament (USL), 381vaginal retractor, 381vesicovaginal space dissection,
376–379, 381–382pelvic anatomy, 367symptoms, 369
Fenoldopam mesylate, 25FloSeal™, 123, 125Foley catheter guide, 175
GGerota’s fascia, 73, 81, 82Giant hydronephrosis. See Renal cyst
and giant hydronephrosisGiant hydronephrosis, nephrectomy, 67
HHand-assisted nephroureterectomy, 111Hasson technique, 9Hem-o-lok® polymer clip, 38–39, 48, 59,
60, 76, 98Hemodynamic changes, 20Hemostasis, retroperitoneal radical
nephrectomy, 85, 86Hilar bleeding, nephroureterectomy, 114Hilar dissection, 74–76Hilum, renal mass, 126–127Hock, cautery equipment, 40Homemade balloon technique, 47Horseshoe kidney, 315, 316
IIleal ureter
positioninginterposition, 331–332pneumoperitoneum, 332port placement, 333–334
procedure, 334–336Inflammatory renal conditions,
nephrectomy, 64–66Instrumentation
and assistant ergonomics, 35–36camera, 34–35electric thermal instruments, 41–42endo-GIA stapler, 37–38guidelines, 36Hem-o-lok® polymer clip, 38–39hock, cautery equipment, 40insufflators, 33–34metal clips, 36–37retrieval bags, 42reusable veress needles and trocars, 33scissors, 40suction devices, 39ultrasonic thermal instruments, 40
Insuflow® laparoscopic gas conditioning device, 35
Intravenous urogram (IVU), 357
KKetamine, 29Kidney extraction, live donor nephrectomy, 99Kidney transplant patients, preoperative
evaluation, 249
LLabetalol, 25LAN. See Laparoscopic anatrophic
nephrolithotomyLaparoscopic access
anatomical considerationsabdominal scars, 6abdominal wall thickness, 6abdominal wall vessels, 6–7umbilicus, 6
closed access, veress needle, 8–9open access
Bailez technique, 9–10Hasson technique, 9
optical accessdisposable visual entry system, 10–11retroperitoneal approach, 11–12reusable visual entry system, 11
patient factorsanatomical variations, 13obesity, 12–13previous surgery, 13surgeon factors, 13–14
port design, 7port insertion techniques, 8
454 Index
Laparoscopic anatrophic nephrolithotomy (LAN), 312
Laparoscopic nephrectomy. See NephrectomyLaparoscopic nephrolithotomy, 312–314Laparoscopic partial nephrectomy (LPN)
bleeding, 125–126calculus/PUJO, 132centrally located tumors, 127complications, 133consent form, 118cystic lesions, 131diaphragmatic injury, 129hilum, renal mass, 126–127horseshoe kidney, 132imaging review, 118laboratory investigations, 118multiple renal arteries, 129–130obese patients, 130–131pelvicaliceal system opening, during
deep renal resection, 126peripheral lesion
CT-1 Vicryl™, 124flank position and port sites, 120FloSeal™, 125hilar clamping, with Satinski
clamp, 120–121methylene blue leakage, from
opened collecting system, 123Surgicel® bolster, 124, 125tumor, cold scissor cutting of, 123ultrasound probe, 122
positioning, 118–119previous renal surgery, 130recommendations, 134solitary kidney and renal function, 127–129standard essential equipment, 119surgeon preparation, 118targeted therapy, 132–133vena caval/abdominal aortic pathology, 129
Laparoscopic pyelolithotomy (LP)pyelotomy and stone removal, 311pyelotomy closure, 312renal pelvis, 309–310stone migration, 311–312
Laparoscopic radical cystectomy (LRC)anterior abdominal wall, 289bladder masses, 289camera ports, 286, 287gross lymphadenopapathy, 290omental/bowel adhesions, appendectomy,
286, 287right subcostal access, 286stenting, 292thick wall, 289
tumor size, 288urethroileal anastomosis, 291–292urinary diversion, 290–291vascular injuries during access, 287–288visceral injuries during access, 288
Laparoscopic RPLND. See Retroperitoneal lymph node dissection (RPLND)
Laparoscopic trainingfellowships, 435legal issues, 446–447medicolegal issues, 445–446mentoring
benefits, 442–443mutual, 443telementoring, 444–445video, 443–444
residents, 434–435self-training
basic laparoscopic courses, 436experts invite, 438–441experts visit, 437–438pelvic trainer, 441–442technical operative and advanced
courses, 436–437Laparoscopic ureteral and bladder
reconstruction. See Ureteral and bladder reconstruction
Laparoscopic ureterolithotomy (LU)lost stone, 308stenting and suturing, 308–309stone adhering, 308stone localization, 306, 308stone migration, 306ureteral stricture, 309ureterolithotomy, 306, 307
Laparoscopic ureterolysis. See Retroperitoneal fibrosis (RPF)
Large median lobes, 233–234Lateral pelvic fascia (LPF), 241LigaSure Atlas™, 110, 111LigaSure™ vessel-sealing system, 41Live donor nephrectomy, 91
exposurepatient positioning, 94port positioning, 95ureter and gonadal vein, 96vena cava, 97
kidney extraction, 99preparation
preoperative evaluation, 92three-dimensional CT, 93, 94
vascular control, 98–99LP. See Laparoscopic pyelolithotomyLRC. See Laparoscopic radical cystectomy
Index 455
LU. See Laparoscopic ureterolithotomyLymphatic tissue
lymph node package dissection, 268–270overlying the aorta, 268overlying the inferior vena cava (IVC),
dissection, 267, 268ventral and lateral, dissection, 273–274
Lymphocele formation, 279
MMalignancy, adrenalectomy, 146Medicolegal issues, laparoscopic
training, 445–446Mentoring
benefits, 442–443mutual, 443telementoring, 444–445video, 443–444
Metal clips, 36–37
NNephrectomy
contraindications, 56difficulties in
giant hydronephrosis, 67inflammatory renal conditions, 64–66obese patients, 67–68previous abdominal surgery, 66–67
indications, 55partial
pediatric laparoscopic urologic surgery, 386–387
urologic laparoscopy complications, 417–418
radical, 414–416retroperitoneal
advantages and disadvantages, 64operative steps, 64patient positioning for, 61port distribution, 63retroperitoneal space, creation
of, 61–63simple, 416–417renal cyst and giant hydronephrosis,
techniquesretroperitoneal approach, 152–154transperitoneal approach, 154–157
transperitonealline of Toldt, incision of, 59needle placement, 56patient positioning for, 56port distribution for, 58
renal pedicle, control of, 59–60room setup for, 57ureter dissection, 58, 59
Nephrolithiasis, 132Nephroureterectomy (NU)
advantages of, 104bladder cuff and intramural ureter,
preparation ofpluck procedure, 106stent placement, with unroofing, 106transvesical laparoscopic ureteral
dissection, 107, 108hand-assisted, 111indications, 104patient positioning, 105patient preparation, 105peritoneal rent, 113persistent hilar bleeding, renal pedicle
ligation, 114preoperative evaluation and preparation,
104–105renal hilum, identification of, 114retroperitoneal approach, 111–112sealed, 110–111specimen entrapment and delivery, 113transperitoneal, 107, 109–110UUT-UC, 103
Nonseminomatous germ cell tumors (NSGCT), 259
NSGCT. See Nonseminomatous germ cell tumors
OObese patients, 256–257
adrenalectomy, 145laparoscopic access, 12–13nephrectomy, 67–68partial nephrectomy, 130–131retroperitoneoscopy, 88
Obturator nerve injury, 232Open access, 9–10Open radical cystectomy (ORC), 285, 289.
See also Laparoscopic radical cystectomy (LRC)
Optical access, 10–12Orchidopexy, 392
PPartial nephrectomy. See also Laparoscopic
partial nephrectomy (LPN)pediatric laparoscopic urologic surgery,
386–387
456 Index
urologic laparoscopy complications, 417–418
Patient controlled epidural analgesia (PCEA), 28
Patient-controlled analgesia (PCA), 27–28Pediatric laparoscopic urologic surgery
counseling and consent, 384equipment and staff, 384ergonomics, 385insufflation, 385patient selection, 383–384pneumoperitoneum maintenance, 385–386port positioning and insertion, 384procedure-specific difficulties
appendicovesicostomy, 390bladder augmentation, 388–390orchidopexy, 392partial nephrectomy, 386–387peritoneal dialysis catheter, 390–392pyeloplasty, 388
Pediatric patients, adrenalectomy, 146Pelvi-ureteric junction obstruction (PUJO), 132Pelvic kidney, 315, 317Percutaneous nephrolithotomy (PCNL), 309,
312Perioperative renal dysfunction, anesthesia, 26Peripelvic cysts, 157Peripheral lesion, partial nephrectomy
CT-1 Vicryl™, 124flank position and port sites, 120FloSeal™, 125hilar clamping, with Satinski clamp,
120–121methylene blue leakage, from opened
collecting system, 123Surgicel® bolster, 124, 125tumor, cold scissor cutting of, 123ultrasound probe, 122
Peritoneal dialysis catheterdialysis, 391–392nonabsorbable suture, 391omentectomy, 391
Pfanensteil skin incision, 85Pluck procedure, ureteral orificetunnel
resection, 106Pneumoperitoneum
cardiac output, 20respiratory compliance, 18
Polymer clips (Hem-o-lok® clips), 38–39, 48, 59, 60, 76, 98
Port design, 7Port insertion techniques, 8Port placement
adrenalectomy, 144–145retroperitoneoscopy radical nephrectomy,
80–82Port-site hernia, 427Post-transplant lymphocoele, laparoscopic
marsupilisation, 253–255Posterior bladder neck dissection, 195–196,
198Postoperative pain management
central neuraxial blockade, 28–29ketamine, 29patient-controlled analgesia (PCA), 27–28pharmacological options for, 27
Pre-transplant nephrectomy, ADPKD, 250–252Pretransplant nephrectomy
adult polycystic kidney disease, 250–252infective conditions and previously operated
cases, 252–253Prostatectomy. See also Robotic radical
prostatectomy; Robotic-assisted nerve-sparing radical prostatectomy (RARP); Simple prostatectomy
radicalcomplications avoidance, 425obturator nerve injury and nerve
apraxia, 425rectal injury, 419–421symptomatic lymphocele, 424ureteral injury, 421–423urinary leak, 423–424
simple, 418–419Prostatic adenoma
dissection of, 171intracapsular prostatic pedicles, 172retraction of, 172Sotelo Prostatotomo, 173–174
Prostatic apical dissectionaccessory pudendal arteries, 220–221bladder neck reconstruction, 223–225dorsal venous complex (DVC), 221–222vesicourethral anastomosis, 225–226
Psoas Hitchpositioning and port placement, 327–328procedure
refluxing and nonrefluxing anastomosis, 328
ureteroneocystostomy, 329–331Pulmonary changes, in laparoscopy, 17–18Pulmonary disease, anesthesia, 25–26Pyeloplasty, 388, 418
abdomen, 303anastomosis, 301, 303approach, 299–300
Index 457
operating room setup, 297patient selection and indication, 295–296port placement, 300positioning, 300retrograde ureterogram and stenting
antegrade placement, 298–299intraoperative placement, 298preoperative placement, 298purpose, 297ureteral catheter, 298, 299
retroperitoneum, 300–301training model, 296–297ureteropelvic junction, 301–303
Pyelotomy and stone removal, 311
QQuality of life, 280
RRadical cystectomy, 425–426Radical nephrectomy, 414–416Radical prostatectomy
anterior bladder neck dissection, 193, 197complications avoidance, 425dissection
anterior wall of, 188–189denonvillier’s fascia, 200direction of, 187–188posterior bladder neck, 195–196, 198prostatic apex, retrograde, 193, 195vas deferens and seminal vesicles, 197,
199–200dorsal venous complex, ligation and division
of, 189–191drainage, 207, 208equipment, 181extraperitoneal approaches
advantages, 183–184disadvantages, 184
extraperitoneal trocar placement, 185instruments, 181–182obturator nerve injury and nerve apraxia,
425patient positioning, 182patient preparation, 182prostate vascular pedicles, 200–201puboprostatic ligament, endopelvic fascia,
188, 189rectal injury, 419–421specimen extraction, 200, 202surgical setup, 183
symptomatic lymphocele, 424transperitoneal approaches, 184transperitoneal trocar placement, 186–187ureteral injury, 421–423urethra, apical dissection and division, 191,
193, 194urethrovesical anastomosis (see
Urethrovesical anastomosis)urinary leak, 423–424
RARP. See Robotic-assisted nerve-sparing radical prostatectomy (RARP)
Rectovaginal space dissectionintraoperative site, 374technical caveats, 381uterosacral ligament (USL), 375vaginal retractor, 372–373
Renal cyst ablation, 414Renal cyst and giant hydronephrosis, 149
evaluationcategories, 150CT scan, 150, 152indications, 151
operative techniques, 151–152retroperitoneal approach
management of, 154nephrectomy technique, 152–154
transperitoneal approachdecortication, 156–157nephrectomy techniques, 154–156
Renal failure, anesthesia, 26Renal hilum, 82–83
nephroureterectomy, 114Renal mass
hilum, 126–127in solitary kidney, 127–129
Renal pelvis, 309–310Renal system, 21Retrieval bags, 42Retrocaval dissection, RPLND, 350Retrocaval ureter, 315Retrograde pyelography, 357Retroperitoneal approach
adrenalectomy, 143nephroureterectomy, 111–112optical access, 11–12renal cyst and giant hydronephrosis
management of, 154nephrectomy technique, 152–154
Retroperitoneal fibrosis (RPF)bowel injury and internal hernias, 346exposure and port placement, 345–346medical management, 343pyelography, 344
458 Index
technique, 344–345ureteral injury and stricture formation, 346vascular injuries, 346
Retroperitoneal laparoscopic nephrectomyadvantages and disadvantages, 64operative steps, 64patient positioning for, 61port distribution, 63retroperitoneal space, creation of, 61–63
Retroperitoneal laparoscopic radical nephrectomy
en bloc specimen, circumferential extrafas-cial mobilization of, 83–84
endovascular gastrointestinal (GIA) stapler malfunction, 87
hemostasis, 85, 86inadverted peritoneotomy, 87–88instrumentation, 80operation room setup, 80orientation in, 87patient positioning, 80persistent renal hilar bleeding, 88port placement, 80–82preoperative evaluation, 79renal hilum, 82–83, 87retroperitoneoscopy, in obese patients, 88specimen extraction
Endocatch II bag, 85, 86Pfanensteil skin incision, 85
specimens entrapment, 84, 88technical difficulties in, 89
Retroperitoneal laparoscopy, 412–413Retroperitoneal lymph node dissection
(RPLND)adjuvant chemotherapy, 281antegrade ejaculation, 281bleeding, 351chylous ascites, 352contraindications, 261cost effectiveness, 281ejaculatory dysfunction, 352equipment, 262–263exposure and port placement, 350–351indications, 347indications and therapeutic concepts,
259–261NSGCT, 259operative technique
initial access and trocars, 264lymph node package, 274, 275lymphatic tissue dissection, template
and incision lines, 265–270nodal package and drainage
removal, 269
patient position, 264, 271peritoneum, 265, 271retroperitoneum, 265, 272splenocolic ligament, 271, 272stage II after chemotherapy, 274, 276trocar arrangement, 271
organ injury, 352overcome difficulties
antegrade ejaculation preservation, 279–280
dissection and hemostasis technique, 277–279
exposure, 276–277lymphocele formation, 279split and roll technique, 276
pathologic stage II after chemotherapy, 281postchemotherapy, 347preoperative measures, 261–262quality of life, 280small bowel obstruction, 352techniques
mechanical bowel preparation, 347–348
retrocaval dissection, 350spermatic cord dissection, 348–349
template, 262–263Robotic nerve-sparing technique, 242Robotic radical prostatectomy
anesthesia cases, 210bladder neck dissection
enlarged prostate, 217post-transurethral resection of prostate,
219–220posterior bladder neck dissection, 216prominent median lobe, 218–219RALP, 215
obese patient, 211–214port placement, 210–211prior inguinal hernia repair, 214–215prostatic apical dissection
accessory pudendal arteries, 220–221bladder neck reconstruction, 221–225DVC, 221–223vesicourethral anastomosis, 225–226
Robotic technology, cost-reductive measures, 51
Robotic-assisted nerve-sparing radical prostatectomy (RARP)
avoiding perioperative complicationsanastomotic leak and bladder neck
strictures, 236lymphocele and lymphedema, 236–237port site hernias, 237
intraoperative complications
Index 459
allograft injury, renal transplant patient, 235–236
bleeding, vascular injury and hema-toma, 230
colon and small intestine injury, 231large median lobes, 233obturator nerve injury, 232rectal injury, 231–232robot malfunction, 234–235ureteric orifice injury, 233–234
optimizing functional outcomesanatomic restoration technique (ART),
238–240da Vinci® system, 243nerve fibers, preservation, 241–242postulated biomechanical instability,
237–239robotic nerve-sparing technique,
242–243RPLND. See Retroperitoneal lymph node
dissection
SSacrocolpopexy
access and trocar position, 371–372disadvantage, 370instruments, 371mesosalpinx, 375–376objective, 369operative setup, 370peritoneal incision, 381post hysterectomy, 382presacral dissection, 372rectovaginal space dissection
intraoperative site, 374technical caveats, 381uterosacral ligament (USL), 375vaginal retractor, 372–373
sacral promontory, 379–380uterosacral ligament (USL), 381vaginal retractor, 381vesicovaginal space dissection
bladder neck, 378mesh passage, 378–379mesosalpinx, 376–377technical caveats, 381–382
Sealed laparoscopic nephroureterectomy, 110–111
Shock wave lithotripsy (SWL), 306, 308, 312, 315
Simple nephrectomy, 416–417Simple prostatectomy, 418–419
adenoma, 168, 170
approaches, 164–166benign prostatic hyperplasia (BPH), 161bladder, 169, 170
hemostasis, trigonization, and closure of, 174–175
drainage, 175equipment, 163extraperitoneal approaches, 164gland volume, 161–162instruments, 163operatory clamp, extraction of, 175–177patient positioning, 164postoperative care, 178preoperative preparation, 163–164prostatic adenoma
anterior face of, 170dissection and enucleation of,
171–174surgical equipment, distribution, 164, 165transperitoneal approaches
advantages, 165disadvantages, 165two lateral peritoneal windows, 166
trocar placementextraperitoneal, 166–167lateral transperitoneal windows,
168, 169transperitoneal, 167–168
Single-port access renal cryoablation (SPARC), 398–400
Single-port laparoscopic pelvic surgeryadvantages, 400cystectomy, 401prostatectomy, 401–402
Single-port laparoscopic surgeryinstrumentation
EndoEYE system, 397–398Triport trocar, 396–397Uni-X Single Port Trocar, 396
pelvic organadvantages, 400cystectomy, 401prostatectomy, 401–402
robotic surgeryASC TriPort, 402intraoperative image, 403
single-port access renal cryoablation (SPARC), 398–400
Single-port robotic surgeryASC TriPort, 402intraoperative image, 403
Spermatic cord dissection, RPLND, 348–349Spermatic vessels, identification and
dissection, 267, 272–273
460 Index
Suction devices, 39Surgicel® bolster, 122, 124, 125
TThermal instruments
electric, 41–42ultrasonic, 40
Transperitoneal approachadrenalectomy, 138–143renal cyst and giant hydronephrosis
decortication, 156–157nephrectomy techniques, 154–156
Transperitoneal approaches, 165Transperitoneal laparoscopic nephrectomy
line of Toldt, incision of, 59needle placement, 56patient positioning for, 56port distribution for, 58renal pedicle, control of, 59–60room setup for, 57ureter dissection, 58, 59
Transperitoneal laparoscopic radical nephrectomy
access, 71–72bowel mobilization, 72–73hilar dissection, 74–76patient positioning, 71specimen retrieval, 77upper pole mobilization, 76–77ureter, identification of, 73–74
Transperitoneal nephroureterectomy, 107, 109–110
Transperitoneal trocar placement, 167–168lateral transperitoneal windows, 168–169
Transureteroureterostomy (TUU)positioning and port placement, 337procedure, 337
Transurethral ablation by microwave thermo-therapy (TUMT), 162
Transurethral resection of the prostate (TURP), 161–162
Transverse cistotomy, 170Transvesical laparoscopic ureteral dissection,
107, 108Triport trocar, 396–397Trocar placement, 166–168Tumors, adrenalectomy, 146
UUltrasonic thermal instruments, 40Umbilical ligaments, 169
Umbilicus, 6Uni-X Single Port Trocar, 396Upper urinary tract urothelial carcinoma
(UUT-UC), 103Ureter, transperitoneal radical
nephrectomy, 73–74Ureteral and bladder reconstruction
augmentation cystoplastypositioning and port placement, 338prerequisites, 341procedure, 338–340
Boari flappositioning and port placement, 323preoperative imaging, 322procedure, 323–326
ileal ureterpositioning and port placement,
331–334procedure, 334–336
Psoas Hitchpositioning and port placement,
327–328procedure, 328–331
transureteroureterostomy (TUU)positioning and port placement, 337procedure, 337
Ureteral stent placement, 106Ureteric orifice injury, 233–234Ureteric reimplantation, 365Ureterolithotomy, 306, 307Ureteroneocystostomy, 329–331Ureteropelvic junction (UPJ). See also
Pyeloplastyanatomy of, 297passive dilation, 298renal pelvis, 309
Ureteropelvic junction obstruction (UPJO), 314
Urethroileal anastomosis, 291–292Urethrovesical anastomosis
absorbable monofilament, 203instruments, 202suturing tips, 202, 203two separate sutures with continuous
stitches, 204–207type of, 203–204
Urinary stonesanomalous kidneys, 314–317laparoscopic nephrolithotomy, 312–314laparoscopic pyelolithotomy (LP), 309–312laparoscopic ureterolithotomy
(LU), 307–309Urologic laparoscopy
Index 461
access-related complications, 407–409adrenalectomy, 413–414hypotension, 428intraoperative complications
chain of action, 410instruments required, 409–410vascular and nonvascular injuries, 409
neuromuscular complications, 412objective, 405–406partial nephrectomy, 417–418port-site hernia, 427positioning complications, 411preventive measures, 406–407pyeloplasty, 418radical cystectomy, 425–426radical nephrectomy, 414–416radical prostatectomy
complications avoidance, 425obturator nerve injury and nerve
apraxia, 425rectal injury, 419–421symptomatic lymphocele, 424ureteral injury, 421–423urinary leak, 423–424
reexploration, 429renal cyst ablation, 414retroperitoneal laparoscopy, 412–413simple nephrectomy, 416–417simple prostatectomy, 418–419visceral complications, 410–411
VVas deferens and seminal vesicles, dissection,
197, 199–200Vascular control, live donor nephrectomy,
98–99Vena caval/abdominal aortic pathology, partial
nephrectomy, 129
Veress needle, closed access, 8–9Vesicourethral anastomosis,
225, 237–238Vesicovaginal fistula (VVF)
anatomy, 355, 356classification, 359clinical presentation, 356–357complications
ReVVF repair, 364supratrigonal and infratrigonal
fistula, 363–364ureteric reimplantation, 365
diagnosis and evaluation, 357imaging studies, 357–358incidence, 356instruments required, 360laparoscopic approach, 360physical examination, 357postoperative problems, 363surgery timing, 358–359surgical
history, 355principles, 359–360
techniques, 360–362treatment, 358
Vesicovaginal space dissectionbladder neck, 378mesh passage, 378–379mesosalpinx, 376–377technical caveats, 381–382
Vicryl™, 124Visiport™, 11Visual entry systems, 10–11
XXanthogranulomatous pyelonephritis (XGPN)
approach, 252hilum, 253