By Andrew C. Novick, Inderbir S. Gill, Eric A. Klein, Raymond Rackley, Jonathan H. Ross
Greater than fifty full-time urological clinicians and surgeons from the the world over acclaimed Cleveland health center Glickman Urological Institute describe the commonest in addition to the main cutting edge urological tactics from the perspective of the state of the art, because it is practiced at one of many world's most sensible associations. Their entire atlas of urological surgical procedure deals a different marriage of informative textual content with brilliant illustrations to supply specific, step by step descriptions of all of the usually played inpatient and outpatient urological operations, together with more moderen ways, resembling laparoscopic and minimally invasive surgical procedure. Highlights comprise robot and laparoscopic prostatectomy, open and lapaoscopic partial nephrectomy, renal transplantation, the male sling, and minimally invasive remedies for urological stipulations.
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Kidney. With left-sided kidney tumors, the suprarenal vena cava cannot be resected safely owing to the paucity of collateral venous drainage from the right kidney. In such cases, right renal venous drainage can be maintained by preserving a tumor-free strip of vena cava (Fig. 11), augmented, if necessary, with a pericardial patch; alternatively, the right kidney can be autotransplanted to the pelvis or an interposition graft of saphenous vein may be placed from the right renal vein to the splenic, inferior mesenteric, or portal vein.
If for technical reasons it is not possible to remove a cuff of bladder through an extravesical approach, an open cystostomy is performed with removal of the cuff of the bladder intravesically (Fig. 15). The bladder is closed using 4-0 and 3-0 polyglycolic sutures in two or three layers. The lower portion of the incision is drained using a closed drainage system. An indwelling Foley catheter is left for 7 d. Fig. 13 Technique of veno-venous bypass for removal of supradiaphragmatic vena caval tumor thrombus.
B) The main adrenal vein is identified at the superior border of the main left renal vein, clipped, and divided. (C) The adrenal gland is dissected from the upper pole of the kidney. (D) The medial border of the adrenal gland is mobili ed by dividing aortic branches, and the superior pole is mobili ed by dividing the inferior phrenic branches, thereby completing the adrenalectomy. Note: The 2-mm instruments shown in Figs. 4 are utili ed during needlescopic adrenalectomy, which is the author s preference for most transperitoneal adrenalectomies.