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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. - PowerPoint PPT Presentation
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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 UnivConsultant Urology, King Faisal Specialist Hospital, Jeddah
There are 4 basic techniques used to create pneumoperitoneum:
1. blind Veress needle2. direct trocar insertion3. optical trocar insertion 4. open laparoscopy
Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005
In 578 laparoscopic procedures: 1. blind insertion of the Veress needle
(group 1, n = 301)
2. 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, 2005Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005
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, 2005Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005
Ralph V. Clayman,
J of urol. Pg 1847. Nov, 2005J of urol. Pg 1847. Nov, 2005
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.
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.