Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2erformed in urology. Unlike most procedures offered to our patients, there are no discrete medical indications—it is elective in the truest sense of the word. In addition, there are no direct health benefits for the donor patient other than the reward of knowing that they have provided a life-changi Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2ng gift to the transplant recipient, whether It be a family member, friend, or individual previously unknown to them. The patient must be willing to bEbook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
e a kidney donor, competent to consent, and completely confident in the decisionContraindications to laparoscopic donor nephrectomy include uncorrecte20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2e disease, and other considerations include the presence of any significant medical comorbidities that could affect long-term renal function. presence of communicable disease le.g.. human immunodeficiency virus [HIX'], hepatitis), and good mental health. Prior abdominal surgery is not a contraindica Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2tion to donor nephrectomy, but the extent and nature of the prior surgery must be carefully considered when discussing risks of the procedure and mayEbook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
influence the surgical approach. The presence of microscopic hematuria is not a contraindication to renal donation, provided appropriate urologic eval20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2CT], or magnetic resonance imaging [MRI]). urine cytology, and cystoscopy are the critical elements of the microscopic hematuria workup Nephrology evaluation and possible renal biopsy can also be considered if there is a suspicion of early medical renal disease as the cause of the microscopic hematu Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2ria.The evolution of protocols for recipient immunosuppression has also allowed for the expansion of the donor pool such that ABO incompatibility andEbook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
positive crossmatch are not necessarily prohibitive. Donor swap and donor chain programs are also making transplants possible when they may not have b20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2ensure both physical and mental health and is typically coordinated through the transplant team The goal of donor screening is primarily to determine whether renal function would be significantly compromised by donor nephrectomy. Internists, nephrologists, radiologists, and donor surgeons are most c Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2ommonly involved. Additional medical subspecialists may also be required if there are specific elements in the patient's medical history that may playEbook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
a role in the perioperative course or in determining suitability for kidney donation. As the pool of potential donors expands to include patients wit20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2donation is found to be a suitable candidate for donor nephrectomy. CT angiography is performed to assess renal size and vascular and ureteral anatomy. The imaging plays the most critical role in determining which kidney will be selected for donation. Institutions and surgeons may have their own cri Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2teria for selecting the donor kidney. At some centers the left side is almost always preferred owing to the longer renal vein, even in the presence ofEbook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
multiple renal arteries Others prefer to select the kidney with simpler arterial anatomy to minimize the need for vascular reconstruction. At our cen20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2 size is used as a surrogate to estimate differential renal function. Ureteral duplication is occasionally encountered but does not strongly influence the choice of kidney for donation.Mechanical bowel preparation is not used in our center before donor nephrectomy. Patients are currently being asked Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2 to drink clear liquids in the afternoon and evening on the day before surgery. The patient is given a single dose of prophylactic antibiotic in the oEbook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
perating room within 1 hour before incision.OPERATING ROOM CONFIGURATIONAND PATIENT POSITIONINGLaparoscopic donor nephrectomy can be performed with ei20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2toneal approach means positioning the patient in either a modified or full flank position. At our center, we use a modified flank position with the side of donation elevated 20 to 30 degrees with gel bumps placed to support the scapula and hip (Fig. 20-1). It is not necessary to flex the operative t Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2able or use a kidney rest or axillary roll in this position. The patient s legs are slightly flexed at the knee with a pillow under the knees for suppEbook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
ort. Foam padding is placed around the ankles to eliminate pressure on the heels. The arm contralateral to the donor side is left out. perpendicular t20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2est, above the costal margin to allow exposure to the full abdominal wall. Sequential compression devices are placed for deep venous thrombosis prophylaxis before the induction of anesthesia. The patient IS secured to the table with wide silk tape with towels or foam pads to protect the patient s sk Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2in. A Foley catheter is placed. The kidney extraction site is also marked before putting the patient 111 modified flank position to avoid anatomic disEbook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
tortion when the patient is rotated. Usually a mini-Pfannenstiel incision 4 to 5 cm in length is adequate, upper and lower body warming devices ate us20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2the primary surgeon and assistant stand on the contralateral side facing the abdomen. The equipment required for insufflations, suction, and cautery are placed at the discretion of the surgeon, and typically at our center are placed behind the surgeon143144 SECTION III Renal SurgeryFigure 20-1. Pati Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2ent positional ter trinopartoneai Ion laparoscopic ơoncr nepnrectcmy.Figure 20-2. epaatteg room configuration lor ten donor nephrectomy.and assistant.Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
The surgical technician stands at the elevated hip. and the instrumentation table is ar the foot of the operative table. A standard laparoscopic drap20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2up. An axillary roll is used, and the table is flexed to expand the space between the anterior superior iliac spine and thecostal margin. For this approach, both arms are out in front of the patient, with the lower arm resting on an arm board perpendicular to the table, and the other resting either Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2on stacked blankets or on a purpose-built arm rest. Wide silk tape is used to secure the patient in position with towels or foam strips to protect theEbook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
patient's skin, upper and lower body warming devices are used to maintain the patient's temperature.Laparoscope____________,_______,The laparoscopic 20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2on device, cautery. and suction equipment remain at surgeon discretion. The surgical technician stands opposite the surgeon at the hip. with the instrumentation table at the foot of the operative table The extraction site for a retroperitoneal approach may be in the flank, or a mini-Gibson incision Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2may be used, but the site does not necessarily have to be marked before positioning.TROCAR PLACEMENTTransperltoneal ApproachA Veres.-. needle is placeEbook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
d through the umbilicus 111 achieve insufflation In 15 mm llg. Three trocars are initially placer!, including an 11-mm umbilical port to accommodate l20Laparoscopic Live Donor NephrectomyParas H. Shah, Michael J. SchwartzINDICATIONS AND CONTRAINDICATIONSDonor nephrectomy is unique among surgeries pe Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2al to the donor kidney (Fig. 20-3). Additional trocars may be necessary in some eases for the purpose of retraction, depending on internal anatomy and the patient's body habitus. Shifting the trocars laterally may be necessary if the patient is overweight or obese. A suprapubic trocar may also be us Ebook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2ed to insert a specimen bag ar the time of extraction, as a working port for retraction, or to aid in the ureteral dissection.Retroperitoneal ApproachEbook Atlas of laparoscopic and robotic urologic surgery (3/E): Part 2
A working space posterior to the kidney must be developed before trocar placement for a retroperitoneal approach. There are several well-established tGọi ngay
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