
MANIOBRAS PARA REALIZAR LA NEFROURETERECTOMIA TOTALMENTE POR VIA LAPAROSCOPICA
Javier Estébanez Zarranz, Igor Oyarzabal Pérez, Lore Aguirreazaldegui García, Iñaki Muro Bidaurre, Gregorio Garmendia Olaizola, Itziar Crespo Crespo, Juan Pablo Sanz Jaka
MANIOBRAS PARA REALIZAR LA NEFROURETERECTOMIA TOTALMENTE POR VIA LAPAROSCOPICA
OBJECTIVES: We describe a series of surgicalmanoeuvres to perform a completely laparoscopicnephroureterectomy.METHODS/RESULTS: We set the patient in the lateral position. The trocars are placed in a rhombus shape, with an accessory trocar for liver retraction on the right side. Once the parietal peritoneum is open the ureter and gonadal vein are localized. We clip and section the gonadal vein. The renal pedicle is localized anddissected. We divide separately the renal artery and vein. We complete the dissection of the kidney. We start the caudal dissection of the ureter from the iliac vessels level down to the pelvis. We clip the ureter. Due to the trocar deployment we reach a point in which ureteral dissection becomes difficult. Then we perform 3 manoeuvres: 1) We change the camera from the lower trocar to the right side one. 2) We move the monitor to the feet of the patient. 3) The surgeon moves to the other side of the patient to work with the superior and inferior trocars. We introduce a retractor through the remaining trocar. With these changes the ureter is in line with the camera and we may have a good access to the pelvis, making the distal dissection of the ureter easier. The dissection ends when the classic image of tent of the vesicoureteral junction is seen. The bladder patch is resected and the bladder is sutured closed with acontinuous suture. The specimen is bagged and extractedopening the orifice of the iliac fossa trocar.CONCLUSIONS: With this technique, a completelylaparoscopic nephroureterectomy may be performedfollowing the oncological principles of open surgery.
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