Laparoscopic nephrectomy simplified & #8211; A & #8220;two-window technique & #8221; for safer approach to hilum for a novice

Mallikarjuna Chiruvella, Ashwin Sunil Tamhankar, Syed Mohammed Ghouse, Mohammed Taif Bendigeri, Purna Chandra Reddy Kondakindi, Deepak RagooriIndian Journal of Urology 2018 34(4):254-259Though the overall safety of laparoscopic nephrectomy (simple or radical) is well established, for a novice it remains a challenge. The classical description of laparoscopic nephrectomy entails dissection either from caudal to cephalad side or vice versa. Herein we describe our “two window technique” for managing renal hilum during laparoscopic (simple/radical) nephrectomy. Our main intention in description of this technique is to reduce the level of apprehension for a novice urologist for performing laparoscopic nephrectomy. After colon mobilization, sequential lower and upper windows are created around the hilum following which hilar vessels are dissected circumferentially when the hilum is at a stretch by traction from either of the window. There are multiple potential advantages of this method which includes easier and safer dissection especially for novice in this field by giving a safety window of application of vascular clamp in cases of vascular bleeds. Intrahilar dissection in stretched condition becomes safer with vision from all around 360° for safe application of Hem-o-lok® clips. Due to the widely exposed field, injuries to adrenal vein and lumbar veins would be minimized and the chances of missed accessory vessel would be minimize...
Source: Indian Journal of Urology - Category: Urology & Nephrology Authors: Source Type: research