By Alberto Rosenblatt
During this ebook each urologic technique is defined in a step by step series of occasions. The textual content is supplemented with various guidance, coloured illustrations and excessive definition photos depicting the most steps of the techniques. The constitution of each bankruptcy is very transparent, and emphasis is given to the laparoscopic surgical process. the purpose of this handbook is to supply the Urologic health care professional with the state of the art of Laparoscopic surgical procedure. It courses the reader via each degree of the laparoscopic method, from the equipment's settings to the right kind place of the needle at the needle holder.
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The dissection of the right gonadal vein is not necessary, as it enters the vena cava on this side. Attachments between the psoas muscle and Gerota’s fascia are released with sharp and blunt dissection, and small vessels to the ureter and branches of the gonadal vein are coagulated with the bipolar grasper.
The Veress needle is introduced through the incision (see Chap. 1, Veress Needle Introduction). First Port (11 mm, optic 0°) Once pneumoperitoneum is established, the needle is removed, and the 11-mm trocar is introduced through the same incision, perpendicularly to the abdominal wall (Fig. 5). Fig. 5 Perpendicular introduction of the trocar 53 54 Section II The optic is introduced through the trocar, and the abdomen is then inspected for any injury due to insertion of the Veress needle or the trocar, and to identify adhesions in areas where the secondary ports will be placed.
24 Section II Laparoscopic Surgery for Malignant Urological Disorders Trocars and Laparoscopic Instruments Access and Port Placement Right-side nephrectomy: • 2 × 11 mm (optic 0° and bipolar grasper) • 3 × 5 mm (monopolar scissors, suction device, and liver retractor grasper) Four ports are generally enough to perform the procedure, although a fifth trocar may be necessary for liver retraction during a right-side nephrectomy (Fig. 3). Before trocars are placed, the abdomen is insufflated using a Veress needle.