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.