[Initiation of laparoscopic nephrectomy].

Abstract

OBJECTIVE: This work is reported to encourage experienced urologists to take advantage of a laparoscopic nephrectomy technique that has evolved into a remarkably inexpensive, uncomplicated routine procedure almost comparable with the gallbladder operations of general surgery. METHODS: The patient is placed in the lumbotomy position. The unsleeved, uncuffed hand is introduced through a mini-McBurney incision in the iliac fossa. The first 12 mm trocar is introduced just above the posterior part of the iliac crest. The second is placed anteriorly some 10 to 12 cm from the first. The kidney is released by extraperitoneal manual dissection. The artery is clipped and sectioned and then, without dissecting the vein, the rest of the pedicle is sectioned en bloc with the endostapler. However, if the artery is not found, then the whole pedicle is sectioned en bloc. Lastly, the ureter is sectioned. The kidney is then introduced into a simple plastic bag (open urine bag) and digitally fragmented for easy removal through the incision. RESULTS/CONCLUSIONS: The oblique McBurney incision is also useful in the event reconversion to an open lumbotomy is necessary. As we described in 1994, manual manipulation significantly simplifies the procedure. Operators soon gain confidence when they appreciate in practice the surprising versatility of the technique. Because most of the procedure is done under visual control, operator precision soon increases and successive operation times shorten considerably. Operation costs are lower because an expensive inflatable cuff or sleeve is unnecessary, only two trocars are required and a standard urine bag serves to receive the kidney. We are sure that once urologists experienced in conventional surgery try the procedure, they will wonder why they did not adopt it earlier.