1. Ideas to ease difficulties in Laparoscopic Urology 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

2. Introduction During the last 25 years, probably urology was the surgical specialty that presented the most extraordinary technological development.  Evolution { open  minimally invasive}.  Development {techniques  technology}. Clayman. From knife to needle to nothing, Braz J Urol 2001

3. Introduction Laparoscopic procedures are continuously evolving in Urology. This includes  Ablative procedures: radical nephrectomy  Reconstructive techniques: pyeloplasty.  Both: radical prostatectomy. radical cystectomy.

4. Why to accept laparoscopy as an alternative to open

5. HUYNH, HOLLANDER, J of Urol, February 2005 LAPAROSCOPIC NEPHRECTOMY COMMUNITY HOSPITAL. Michigan, USA

6. HUYNH, HOLLANDER, J of Urol, February 2005 LAPAROSCOPIC DONOR NEPHRECTOMY COMMUNITY HOSPITAL. Michigan, USA

7. Raftopoulos et al, Surgical Endoscopy Oct 2004

10. Recent advances … In laparoscopic surgery  technological improvements. In imaging technologies  Hemal, Menon. Laparoscopy, robot, telesurgery & urology: future perspective. J Postgrad Med 2002

11. Recent advances in laparoscopic surgery  technological improvements. Advances in imaging technologies Urologist acceptance Decrease morbidity Patients interest. Hemal, Menon. Laparoscopy, robot, telesurgery & urology: future perspective. J Postgrad Med 2002

12. RPLND

14. But.. The major impediment to widespread application of laparoscopy in urology has been the complexity and technical demands of urological procedures Bishoff, Kavoussi: Urological Laparoscopy, Why bother? J Urol 1998

15. Difficulties  In starting  While practicing Patients’ factor Instruments  Toward advancement

16. How to overcome?

17. Difficulties  In starting  While practicing Patients’ factor Instruments  Toward advancement

19. Longer OR time  In preparing or starting  Visualization  Instruments

21. Laparoscopic Fenger-plasty.

22. Atlas of the Uro Clin Oct 2003 Vrabec, Al-Zahrani