Document Detail

The technique of transperitoneal laparoscopic nephrectomy, adrenalectomy and nephroureterectomy.
MedLine Citation:
PMID:  8335045     Owner:  NLM     Status:  MEDLINE    
In the traditional kidney position three trocars are inserted after creation of a pneumoperitoneum: 10 mm periumbilical (port I), 10/12 mm subcostal (port II) and 12/10 mm above the iliac spine (port III) in the mamillary line. After laterocolic incision the colon is dissected away from the lateral wall. Thereafter two 5-mm trocars (ports IV, V) are inserted into the lateral abdominal wall parallel to parts II and III. Following clipping and dissection of the ovarian (spermatic) vein, the ureter is isolated and incised. Then the cranial part of the ureter is used as a retractor exposing the renal hilum for dissection of the renal vessels. The main renal artery and vein are dissected separately by use of an endoscopic stapling device (Endo-GIA, white magazine). Finally, the kidney including Gerota's fascia is isolated from the adrenal and the upper peritoneum. Entrapment of the organ is performed with a specially designed bag (Lap-sac). The neck of the bag is brought out onto the surface of the abdomen (via port II/III) allowing digital morcellation with index finger inside the bag and removal of the organ in several pieces. We have applied this technique for 17 procedures in the upper retroperitoneum: 9 transperitoneal laparoscopic nephrectomies (TLN) for benign disease (5 hydronephrosis, 3 renovascular disease, 1 chronic pyelonephritis), 3 radical TLN including adrenalectomy for renal cell carcinoma (T2G2), 1 adrenalectomy for a cortical adrenaloma, 1 nephroureterectomy, 1 diagnostic ureterolysis and 2 modified retroperitoneal lymphadenectomies for stage I testicular cancer. The mean operation time was 4 h (2-5), the mean postoperative hospital stay 6 days (4-12).(ABSTRACT TRUNCATED AT 250 WORDS)
J J Rassweiler; T O Henkel; D M Potempa; M Coptcoat; P Alken
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European urology     Volume:  23     ISSN:  0302-2838     ISO Abbreviation:  Eur. Urol.     Publication Date:  1993  
Date Detail:
Created Date:  1993-08-20     Completed Date:  1993-08-20     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7512719     Medline TA:  Eur Urol     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  425-30     Citation Subset:  IM    
Department of Urology, Klinikum Mannheim, Clinical Faculty, University of Heidelberg, FRG.
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MeSH Terms
Adrenalectomy / instrumentation,  methods*
Middle Aged
Nephrectomy / instrumentation,  methods*
Postoperative Complications
Ureter / surgery*

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