Laparoscopic nephrectomy simplified – A “two-window technique” for safer approach to hilum for a novice
Though 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...
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Wolters Kluwer Medknow Publications
2018-01-01
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Series: | Indian Journal of Urology |
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doaj-ed544f6fb4e349f38315a0850e70c77d2020-11-25T02:24:44ZengWolters Kluwer Medknow PublicationsIndian Journal of Urology0970-15911998-38242018-01-0134425425910.4103/iju.IJU_231_18Laparoscopic nephrectomy simplified – A “two-window technique” for safer approach to hilum for a noviceMallikarjuna ChiruvellaAshwin Sunil TamhankarSyed Mohammed GhouseMohammed Taif BendigeriPurna Chandra Reddy KondakindiDeepak RagooriThough 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 minimized. En mass hilar control with vascular clamp in cases of partial nephrectomy is possible with same approach as well as the en block stapling is feasible in cases of nephrectomy. This needs a validation across multiple centers with comparative studies before considering it as a standard of practice. We sincerely believe that this is safe and easily reproducible by a novice.http://www.indianjurol.com/article.asp?issn=0970-1591;year=2018;volume=34;issue=4;spage=254;epage=259;aulast=Chiruvella |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mallikarjuna Chiruvella Ashwin Sunil Tamhankar Syed Mohammed Ghouse Mohammed Taif Bendigeri Purna Chandra Reddy Kondakindi Deepak Ragoori |
spellingShingle |
Mallikarjuna Chiruvella Ashwin Sunil Tamhankar Syed Mohammed Ghouse Mohammed Taif Bendigeri Purna Chandra Reddy Kondakindi Deepak Ragoori Laparoscopic nephrectomy simplified – A “two-window technique” for safer approach to hilum for a novice Indian Journal of Urology |
author_facet |
Mallikarjuna Chiruvella Ashwin Sunil Tamhankar Syed Mohammed Ghouse Mohammed Taif Bendigeri Purna Chandra Reddy Kondakindi Deepak Ragoori |
author_sort |
Mallikarjuna Chiruvella |
title |
Laparoscopic nephrectomy simplified – A “two-window technique” for safer approach to hilum for a novice |
title_short |
Laparoscopic nephrectomy simplified – A “two-window technique” for safer approach to hilum for a novice |
title_full |
Laparoscopic nephrectomy simplified – A “two-window technique” for safer approach to hilum for a novice |
title_fullStr |
Laparoscopic nephrectomy simplified – A “two-window technique” for safer approach to hilum for a novice |
title_full_unstemmed |
Laparoscopic nephrectomy simplified – A “two-window technique” for safer approach to hilum for a novice |
title_sort |
laparoscopic nephrectomy simplified – a “two-window technique” for safer approach to hilum for a novice |
publisher |
Wolters Kluwer Medknow Publications |
series |
Indian Journal of Urology |
issn |
0970-1591 1998-3824 |
publishDate |
2018-01-01 |
description |
Though 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 minimized. En mass hilar control with vascular clamp in cases of partial nephrectomy is possible with same approach as well as the en block stapling is feasible in cases of nephrectomy. This needs a validation across multiple centers with comparative studies before considering it as a standard of practice. We sincerely believe that this is safe and easily reproducible by a novice. |
url |
http://www.indianjurol.com/article.asp?issn=0970-1591;year=2018;volume=34;issue=4;spage=254;epage=259;aulast=Chiruvella |
work_keys_str_mv |
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