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Laparoscopic radical nephrectomy in extremely obese patients.

Małkiewicz B, Szydełko T, Dembowski J, Tupikowski K, Zdrojowy R - Cent European J Urol (2012)

Bottom Line: Endoscopic management is advantageous for its reduction in perioperative and postoperative complications.In the mid-1990s, morbid obesity was considered a relative contraindication to laparoscopic technique.The aim of this study is not only to present the operative technique but also to show that the laparoscopic procedure is safe and effective in morbidly obese patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Urological Oncology, Wrocław University of Medicine, Wrocław, Poland.

ABSTRACT
Laparoscopic radical nephrectomy has been widely accepted as the preferred management of low stage renal masses. Endoscopic management is advantageous for its reduction in perioperative and postoperative complications. In the mid-1990s, morbid obesity was considered a relative contraindication to laparoscopic technique. The authors present two cases of laparoscopic radical nephrectomy due to renal tumors in extremely obese patients. The aim of this study is not only to present the operative technique but also to show that the laparoscopic procedure is safe and effective in morbidly obese patients.

No MeSH data available.


Related in: MedlinePlus

Port placement in morbidly obese patients.
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Figure 0003: Port placement in morbidly obese patients.

Mentions: The patient was placed in a right 45° flank position. The procedure was performed in a transperitoneal fashion using four ports. To create a pneumoperitoneum a Hasson 2 cm minilaparotomy was used. We placed our ports in a cluster fashion in the ipsilateral upper quadrant (Fig. 3) with lateral shift such that the midline trocars were repositioned lateral to the abdominal rectus muscle. The first 10 mm umbilical trocar was inserted and pneumoperitoneum was achieved in a standard manner. Three additional trocars (2 x 5 mm, 1 x 12 mm) were inserted under direct vision: a 5 mm trocar halfway between the umbilicus and xiphoid in the midclavicular line, a 12 mm trocar below the umbilicus laterally to the edge of the rectus muscle, and another 5 mm trocar in the anterior axillary line below the costal margin. The colon was mobilized medially and the ureter was localized. After the lower pole of the kidney was freed, the kidney covered by the perirenal fat and Gerota's fascia was moved laterally and the renal vessels were identified. Once freely dissected, the renal artery was clipped and transected using titanium clips (TFX Medical Ltd., High Wycombe, UK). The renal vein was secured by means of an Endo-GIA (Tyco Healthcare Group LP, Norwalk, Connecticut, USA) stapling device. Using the Liga-Sure device (Tyco Healthcare UK Ltd., Gosport, UK) the upper pole of the kidney was fully mobilized. The lateral attachments were dissected to completely free up the kidney. The ureter was clipped and dissected as distally as possible; the renal specimen was entrapped in an Endocatch bag (Tyco Healthcare UK Ltd., Gosport, UK). The 5-mm closed suction drain was left in the retroperitoneal space; it was inserted through the port left by the lateral 5 mm trocar. The trocars were removed and the ports were closed. Specimens were removed intact without morcellation through a lengthened incision of the port site. In both cases, blood loss was 300 ml. The operative time was 185 min in first case and 355 min in second. There were no intraoperative complications.


Laparoscopic radical nephrectomy in extremely obese patients.

Małkiewicz B, Szydełko T, Dembowski J, Tupikowski K, Zdrojowy R - Cent European J Urol (2012)

Port placement in morbidly obese patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921779&req=5

Figure 0003: Port placement in morbidly obese patients.
Mentions: The patient was placed in a right 45° flank position. The procedure was performed in a transperitoneal fashion using four ports. To create a pneumoperitoneum a Hasson 2 cm minilaparotomy was used. We placed our ports in a cluster fashion in the ipsilateral upper quadrant (Fig. 3) with lateral shift such that the midline trocars were repositioned lateral to the abdominal rectus muscle. The first 10 mm umbilical trocar was inserted and pneumoperitoneum was achieved in a standard manner. Three additional trocars (2 x 5 mm, 1 x 12 mm) were inserted under direct vision: a 5 mm trocar halfway between the umbilicus and xiphoid in the midclavicular line, a 12 mm trocar below the umbilicus laterally to the edge of the rectus muscle, and another 5 mm trocar in the anterior axillary line below the costal margin. The colon was mobilized medially and the ureter was localized. After the lower pole of the kidney was freed, the kidney covered by the perirenal fat and Gerota's fascia was moved laterally and the renal vessels were identified. Once freely dissected, the renal artery was clipped and transected using titanium clips (TFX Medical Ltd., High Wycombe, UK). The renal vein was secured by means of an Endo-GIA (Tyco Healthcare Group LP, Norwalk, Connecticut, USA) stapling device. Using the Liga-Sure device (Tyco Healthcare UK Ltd., Gosport, UK) the upper pole of the kidney was fully mobilized. The lateral attachments were dissected to completely free up the kidney. The ureter was clipped and dissected as distally as possible; the renal specimen was entrapped in an Endocatch bag (Tyco Healthcare UK Ltd., Gosport, UK). The 5-mm closed suction drain was left in the retroperitoneal space; it was inserted through the port left by the lateral 5 mm trocar. The trocars were removed and the ports were closed. Specimens were removed intact without morcellation through a lengthened incision of the port site. In both cases, blood loss was 300 ml. The operative time was 185 min in first case and 355 min in second. There were no intraoperative complications.

Bottom Line: Endoscopic management is advantageous for its reduction in perioperative and postoperative complications.In the mid-1990s, morbid obesity was considered a relative contraindication to laparoscopic technique.The aim of this study is not only to present the operative technique but also to show that the laparoscopic procedure is safe and effective in morbidly obese patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Urological Oncology, Wrocław University of Medicine, Wrocław, Poland.

ABSTRACT
Laparoscopic radical nephrectomy has been widely accepted as the preferred management of low stage renal masses. Endoscopic management is advantageous for its reduction in perioperative and postoperative complications. In the mid-1990s, morbid obesity was considered a relative contraindication to laparoscopic technique. The authors present two cases of laparoscopic radical nephrectomy due to renal tumors in extremely obese patients. The aim of this study is not only to present the operative technique but also to show that the laparoscopic procedure is safe and effective in morbidly obese patients.

No MeSH data available.


Related in: MedlinePlus