TECHNIQUE OF LAPAROSCOPIC NEPHRECTOMY Dr. Anmar Nassir, FRCS(C) Fellowship in Andrology (U of Ottawa) Fellowship in EndoUrology and Laparoscopy (McMaster Univ) Chairman, Department of Surgery Umm Al-Qura Univ Consultant Urology, King Faisal Specialist Hospital, Jeddah

There are 4 basic techniques used to create pneumoperitoneum: 1.blind Veress needle 2.direct trocar insertion 3.optical trocar insertion 4.open laparoscopy Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005

In 578 laparoscopic procedures: 1.blind insertion of the Veress needle (group 1, n = 301) 2.direct trocar insertion with elevation of the rectus sheath using 2 towel clips (group 2, n = 277). Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005

Results: Total complication rates: – gr 1 = 15.7% (n = 33) – gr 2 = 3.3% (n = 4) (P < 0.05) Conclusion: Direct trocar insertion with elevation of the rectus sheath using 2 towel clips is an easy, safe, and effective technique. Gu¨nenc et al. Surg Laparosc Endosc Percutan Tech, 2005

Ralph V. Clayman, J of urol. Pg Nov, 2005 Having been a Veress needle advocate throughout my career, I am loath to change. However, this scientifically well-done study gives me “pause”; quicker pneumoperitoneum with fewer complications is certainly a compelling argument for considering a change.

Organ retrieval Intact through an enlarged incision – After placement into a sac. – The kidney can be worked out of an extended trocar site Pfannenstiel incision. Morcellation. – The specimen should be placed into LapSac – Ring forceps and a Kocher clamp & removed in small pieces.