Ebook Nephron-sparing surgery: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Nephron-sparing surgery: Part 2
Ebook Nephron-sparing surgery: Part 2
8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2my.1 Since dial lime, laparoscopic-radical nephrectomy for renal minors has been routinely performed in select patients worldwide. During this period, ‘elective’ open partial nephrectomy has estab lished itself as an efficacious therapeutic approach in the treatment of small renal masses2 similar to Ebook Nephron-sparing surgery: Part 2 that of radical nephrectomy in select patients with a small renal tumor. Ar rhe same time rhe widespread use of content porary imaging techniques hasEbook Nephron-sparing surgery: Part 2
resulted in an increased detection ol small incidental renal tumors, in which the management, during the past decade, has been trended away from radi8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2while Winfield er al reported the first human LPN in 1993/ From that time, several centers in the world have developed laparoscopic techniques for partial nephrectomy through retroperitoneal or transperitoneal approaches. In the beginning, only small, peripheral, exophytic tumors were wedge excised, Ebook Nephron-sparing surgery: Part 2 but with experi ence, larger, infiltrating rumors have been managed similarly?I.PN combines lhe advances and benefits ol nephronsparing surgery and lEbook Nephron-sparing surgery: Part 2
aparoscopy to oiler a decreased morbidity inherent to laparoscopy while preserving the renal function offered by partial nephrectomy.Technical difficu8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2pure laparoscopic techniques. Nevertheless, ongoing advances in laparoscopic techniques and operator skills have allowed the development of a reliable technique of laparoscopic partial nephrectomy, duplicating the estab lished principles and technical steps underpinning open partial nephrectomy.In t Ebook Nephron-sparing surgery: Part 2his chapter we evaluate the role of Ll’N in rhe nephron sparing armamentarium.INDICATIONS AND CONTRAINDICATIONSPartial nephrectomy is frequently doneEbook Nephron-sparing surgery: Part 2
for benign and malignant renal conditions. In rhe setting of malignant renal diseases, this is indicated in situations where radical nephrectomy would8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2ed the role of elective PN in patients wilh unilateral renal tumors and normal contralateral kidneys/Due lo its technical limitations, Ĩ.PN was initially reserved for select patients with a small, peripheral, superficial, exophytic rumor, bur as laparoscopic expe rience increased, rhe indications we Ebook Nephron-sparing surgery: Part 2re carefully expanded to select patients with more complex tumors, such as tumor invading deeply into rhe parenchyma up to rhe collecting system or reEbook Nephron-sparing surgery: Part 2
nal sinus, completely intrarenal tumor, tumor abutting the renal hilum, rumor in a solitary kidney, or tumor substantial enough lo require herninephre8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2nction wherein nephron preservation is an important goal.General contraindications to abdominal laparoscopic surgery are applied to LI’.N. specific absolute contra indications to Ll’N include bleeding diathesis (such as renal failure induced platelet dysfunction and blood thinners), renal vein throm Ebook Nephron-sparing surgery: Part 2bus, multiple renal tumors, and aggressive locally advanced disease. Morbid obesity and a history of prior renal surgery may prohibitively increase thEbook Nephron-sparing surgery: Part 2
e technical complexity of the procedure and should be considered a relative contraindication for LPN.88 NEPHRON-SPARING SURGERYOverall, the ultimate d8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2PARATIONPreoperative evaluation includes a complete blood count, renal I unction lest, chest X-ray, and computed tomography angiogram ol the abdomen to clearly assess the vascular anatomy. Renal scintigraphy is obtained if there is a question about the global renal I unction. Clearance for fitness f Ebook Nephron-sparing surgery: Part 2or major abdominal surgery is obtained whenever indicated.We routinely cross match 4 units of packed red blood cells on demand. Mechanical bowel prepaEbook Nephron-sparing surgery: Part 2
ration of one bottle of magnesium citrate is given the evening before the surgery, and intravenous prophylactic antibiotics are given upon calling the8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2ntry into and repair of the collecting system, control of parenchymal blood vessels, and renal parenchymal reconstruction, all usually under rhe ‘gun of warm ischemia.' As such, significant experience in the minimally invasive environment, including expertise with lime-sensitive inlracorporeal sutur Ebook Nephron-sparing surgery: Part 2ing, is essential.LPN can Ik- approached either transpcritoneally (our preferred approach) or retroperiloneally based on the surgeon's experience andEbook Nephron-sparing surgery: Part 2
the tumor location. The transperironeal approach is usually chosen for anterior, anterolateral, lateral, and upper pole apical tumors. Retroperitoneal8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2 are placed prior to patient posi tinning. Cystoscopy and ureteral catheter placement are performed if preoperativc imaging indicates a risk of collecting system violation during resection of the lesion (a requirement for intra parenchyma I resection greater than 1.5 cm or tumor abutting the collect Ebook Nephron-sparing surgery: Part 2ing system). Although many laparoscopists prefer to place their patients at a 45 to 60’ angle in the flank position, we prefer to place our patients uEbook Nephron-sparing surgery: Part 2
ndergoing renal surgery in the lateral flank position at 90°. This provides excellent access to the hilum and allows the bowel and spleen (on the left8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2ch with a Vcress needle, or directly usingthe Optiview trocar system to attain pneumoperitoneum. Three to four ports (including two 10-12 mm ports) are routinely placed in our technique. Exposure of the kidney and the hilar dissection are performed using a J-hook elcctrocaucery suction probe or by u Ebook Nephron-sparing surgery: Part 2sing the ultrasound energy-based harmonic shears (Ethicon F.ndo-surgery). This is done by reflecting the mesocolon along the line of Toldt, leaving GeEbook Nephron-sparing surgery: Part 2
rola’s fascia intact. Mobilizing the kidney within this fascia, the ureter is retracted laterally, and cephalad dissection is carried out along the ps8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2far overlying rhe rumor (Figure 8.1). Intraoperative ultrasonography with a Philips F.nlos LAP 9-5 linear array transducer (Philips) can be used to aid in tumor localization il it is not exophytic or il the tumor is deep into the renal parenchyma. A laparoscopic vascular clamp (Karl Storz) is placed Ebook Nephron-sparing surgery: Part 2 around both the renal artery and the renal vein (without separation of the vessels) for hilar control in cases associated with central masses and hemEbook Nephron-sparing surgery: Part 2
inephrectomy procedures, as described by Gill et al (Figures S.2-8.4). Conversely, during a retroperitoneoscopic partial nephrec tomy, the renal arter8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2kg intravenously) prior to hilar clamping or renal hypothermia. Resection of renal parenchyma is performed with cold scissor (Figures 8.5-8.10), and the specimen is retrieved using a 10-crn laparoscopic F.ndoCalch bag (IIS Surgical Corporation, Norwalk, Connecticut) and sent lor frozen section analy Ebook Nephron-sparing surgery: Part 2sis (sometimes with an excisional biopsy from the base) Io determine the resection margin status (Figures 8.11 and 8.12).Figure 8.1 Defatted kidney, eEbook Nephron-sparing surgery: Part 2
xcept area overlying the tumor.LAPAROSCOPIC PAFigure 8.2 Exposed renal hilum.Figure 8.5 Tumor resection using the cold scissor.Figure 8.3 Exposed hilu8Laparoscopic partial nephrectomySaleh Binsaleh and Anil KapoorINTRODUCTIONIn 1991 dayman el al described the lirst successful laparoscopic nephrectom Ebook Nephron-sparing surgery: Part 2 resection.90 NEPHRON-SPARING SURGERYFigure 8.8 Completely detached rumor.Figure 8.11 rumor entrapment in an Endocatch bag.Figure 8.9 Completely detached tumor with good surrounding parenchyma. Ebook Nephron-sparing surgery: Part 2Gọi ngay
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