Laparoscopic transperitoneal left nephrectomy for cancer

Laparoscopy is becoming the "gold standard" approach for living donor nephrectomy for kidney transplantation as well as for surgical treatment of renal diseases including cancer. The video describes our personal technique for totally laparoscopic transperitoneal left nephrectomy for cancer.

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Laparoscopic transperitoneal left nephrectomy for cancer

Authors

L Boni, G Dionigi, R Dionigi, E Cassinotti, M Di Giuseppe, F Rovera, M Grazia Alberio

Abstract

Laparoscopy is becoming the "gold standard" approach for living donor nephrectomy for kidney transplantation as well as for surgical treatment of renal diseases including cancer.
The video describes our personal technique for totally laparoscopic transperitoneal left nephrectomy for cancer.

Classification

basic techniques

Keywords

Laparoscopic transperitoneal left nephrectomy for cancer

Media type

Surgical video

Duration

07'28''

Publication

2009-05

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E-publication

WeBSurg.com, May 2009;9(05).
URL: http://www.websurg.com/doi-vd01en2584.htm

Laparoscopic transperitoneal left nephrectomy for cancer

1. Patient and trocar positioning 00'03''

This video shows our technique for transperitoneal laparoscopic left nephrectomy for cancer. The patient is placed in right lateral decubitus and four trocars are used. The optic is placed 3-4cm above the umbilicus, the left and the right operating ports at the level of the mid-clavicular line. A four trocar for the assistant is placed in the left hypochondrium. The surgical team is placed on the right side of the table. Once the pneumoperitoneum is established, the abdominal cavity is explored.

2. Left colon mobilization 00'31''

Full mobilization of the left colon is carefully carried out using the ultrasonic scalpel, starting from the splenic flexure towards the sigmoid colon.

3. Dissection and division of the ureter and gonadal vessel 01'20''

Once the colonic mobilization is completed, the left ureter and the gonadic vessel are identified, dissected from the surrounding structures, clipped distally and divided. Once the ureter and the vessel are divided, they will then be grasped and used for retraction to reach the hilar vessels. The procedure carries on with the main vessel’s dissection, starting from the left renal vein that should be isolated and then surrounded by a surgical sling. The use of this surgical tape can be useful to apply gentle traction on the vein. This will help to perform a full dissection of the main renal artery.

4. Identification and dissection of the renal vessels 03'16''

The renal artery now appears in the field. By surrounding the artery with a second surgical sling, a full dissection of the artery itself can be achieved. In fact, as well as for the vein, the sling around the artery will facilitate complete dissection of the artery itself.

5. Division of the renal vessels 04'31''

Once completely free, the renal vessels are then divided using a 45mm Endo-GIA with a vascular cartridge, starting from the renal artery, followed by the vein.

6. Kidney mobilization 05'35''

At this point, the procedure carries on with a full mobilization of the kidney and the Gerota’s fascia, starting from the upper pole downwards.

7. Suprapubic minilaparotomy and specimen extraction 06'13''

Once the kidney is fully mobilized, a 5cm suprapubic mini-laparotomy is carried out. Before entering the peritoneal cavity, a purse-string suture using a size 0 monofilament is performed in order to introduce a 15mm Endobag without losing any pneumoperitoneum. Back inside the abdomen, the Endobag is opened and the kidney is inserted in the bag, and then removed through the suprapubic incision. The operative field is checked for hemostasis and the drain is left in place for 48 hours.