The Complete Clinical Guide Humana Press Edited by Stephen Y. Nakada, MD Essential Urologic Laparoscopy E SSENTIAL U ROLOGIC L APAROSCOPY Nakada/FM/1.28F 1/28/03, 3:15 PM1 CURRENT CLINICAL UROLOGY Eric A. Klein, SERIES EDITOR Essential Urologic Laparoscopy: The Complete Clinical Guide, edited by Stephen Y. Nakada, 2003 Pediatric Urology, edited by John P. Gearhart, 2003 Urologic Prostheses: The Complete Guide to Devices, Their Implantation, and Patient Followup, edited by Culley C. Carson, III, 2002 Male Sexual Function: A Guide to Clinical Management, edited by John J. Mulcahy, 2001 Prostate Cancer Screening, edited by Ian M. Thompson, Martin I. Resnick, and Eric A. Klein, 2001 Bladder Cancer: Current Diagnosis and Treatment, edited by Michael J. Droller, 2001 Office Urology: The Clinician’s Guide, edited by Elroy D. Kursh and James C. Ulchaker, 2001 Voiding Dysfunction: Diagnosis and Treatment, edited by Rodney A. Appell, 2000 Management of Prostate Cancer, edited by Eric A. Klein, 2000 Nakada/FM/1.28F 1/28/03, 3:15 PM2 E SSENTIAL U ROLOGIC L APAROSCOPY THE COMPLETE CLINICAL GUIDE HUMANA PRESS TOTOWA, NEW JERSEY Edited by STEPHEN Y. NAKADA, MD The University of Wisconsin Medical School, Madison, WI Nakada/FM/1.28F 1/28/03, 3:15 PM3 © 2003 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 www.humanapress.com For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: 973-256-1699; Fax: 973-256-8341, E-mail: humana@humanapr.com; or visit our Website: www.humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All articles, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experi- ence relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsi- bility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. Production Editor: Robin B. Weisberg Cover Illustration: Laparoscopic live donor nephrectomy procedure. Photo supplied by Stephen Y. Nakada, MD. Cover design by Patricia F. Cleary. This publication is printed on acid-free paper. ∞ ANSI Z39.48-1984 (American National Standards Institute) Permanence of Paper for Printed Library Materials. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $20.00 per copy is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [1-58829-154-5/03 $20.00]. Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Essential urologic laparoscopy : the complete clinical guide / edited by Stephen Y. Nakada. p. ; cm. — (Current clinical urology) Includes bibliographical references and index. ISBN 1-58829-154-5 (alk. paper) 1-59259-381-X (e-book) 1. Genitourinary organs—Endoscopic surgery. 2. Laparoscopic surgery. I. Nakada, Stephen Y. II. Series. [DNLM: 1. Laparoscopy—methods. 2. Urologic Diseases—surgery. 3. Laparoscopes. WJ 168 E78 2003] RD571.E876 2003 617.4'6059—dc21 2002038718 Nakada/FM/1.28F 1/28/03, 3:15 PM4 v I humbly dedicate this book to my loving wife Deanna and my parents Frank and Ayako, without whom I would not be. Nakada/FM/1.28F 1/28/03, 3:15 PM5 Foreword Nakada/FM/1.28F 1/28/03, 3:16 PM6 Preface vii Urologic laparoscopy is in the midst of a clinical resurgence thanks to improvements in technology, education, and a new generation of urologic laparoscopists. At the time of this writing, the problem of educating and training the vast majority of practicing urologists in urologic laparoscopy is creating a significant burden on centers of excellence. The purpose of Essential Urologic Laparoscopy: The Complete Clinical Guide is to provide a practical, step-by-step guide to creating, maintaining and expanding a successful practice in urologic laparoscopy. This text offers clear, concise chapters focused on getting started, laparoscopic instrumentation, and step-by-step procedural adult laparoscopy. Each chapter is organized so that the reader can easily identify key points, pitfalls, and take home messages. Each contributor was selected for his or her clinical expertise in procedural laparoscopy. Essential Urologic Laparoscopy begins with chapters on getting started in laparoscopy, instrumentation, operating room set-up, and accessing the abdomen. What is unique about this text is a complete, cross-referenced instrumentation chapter that will enable operating room and hospital personnel to use Essential Urologic Laparoscopy as a ref- erence guide for most laparoscopic operations. Next, simpler laparoscopic procedures, such as renal cyst decortication, pelvic lymph node dissection, and simple nephrectomy, are described in rich detail. At this point in time, laparoscopic nephrectomy has emerged as the gold standard for most renal pathology. Therefore, three approaches to laparoscopic radical nephrectomy— transperitoneal, retroperitoneal, and hand-assisted—are detailed by the pioneers who have championed each approach. More advanced procedures, including laparoscopic adrenalectomy, partial nephrectomy, radical nephroureterectomy, live donor nephrec- tomy, and pyeloplasty are also described. Finally, cutting-edge procedures such as laparoscopic cystectomy with urinary diversion and laparoscopic radical prostatectomy are clearly detailed for the reader. Essential Urologic Laparoscopy ends with a chapter on laparoscopic complications, including issues of informed consent as they relate to urologic laparoscopy. Essential Urologic Laparoscopy will empower the reader with a step-by-step manual to create an effective practice in adult urologic laparoscopy. This text is written in such a way that its value as a complete reference guide should endure for many years to come. Good luck performing urologic laparoscopy. Stephen Y. Nakada, MD Nakada/FM/1.28F 1/28/03, 3:16 PM7 Acknowledgments I would like to acknowledge the men who have guided me thus far in academic urology, both spiritually and professionally. My success has hinged on their teachings and support. I cannot thank these great men enough. In order of acquaintance: Ronald Rabinowitz in 1988, Ralph V. Clayman in 1994, and David T. Uehling in 1995. I would also like to acknowledge the skill and dedication of my first and only secretary since 1995, Tricia Maier. viii Nakada/FM/1.28F 1/28/03, 3:16 PM8 ix Contents Preface vii List of Contributors xi 1 Getting Started in Laparoscopy 1 Joseph J. Del Pizzo 2 Laparoscopic Instrumentation 9 Patrick S. Lowry and Stephen Y. Nakada 3 Operating Room Set-Up and Accessing the Abdomen 23 Michael D. Stifelman 4 Laparoscopic Pelvic Lymphadenectomy 37 Vincent G. Bird and Howard N. Winfield 5 Laparoscopic Renal Cyst Decortication 59 Yair Lotan, Margaret S. Pearle, and Jeffrey A. Cadeddu 6 Laparoscopic Simple Nephrectomy: Transperitoneal and Retroperitoneal Approaches 79 Ramsay L. Kuo, Tibério M. Siqueira, Jr., and Arieh L. Shalhav 7 Laparoscopic Radical Nephrectomy: Retroperitoneal Approach 107 Sidney Castro de Abreu and Inderbir S. Gill 8 Laparoscopic Radical Nephrectomy: Transperitoneal Approach 121 David I. Lee, Jaime Landman, Chandru P. Sundaram, and Ralph V. Clayman 9 Laparoscopic Radical Nephrectomy: Hand-Assisted 143 Brian D. Kessler and Steven J. Shichman 10 Laparoscopic Partial Nephrectomy 157 Brian D. Seifman and J. Stuart Wolf, Jr. 11 Laparoscopic Nephroureterectomy 171 Jaime Landman 12 Laparoscopic Adrenalectomy 197 Paul K. Pietrow and David M. Albala 13 Laparoscopic Live Donor Nephrectomy 211 Li-Ming Su 14 Laparoscopic Pyeloplasty 233 Sean P. Hedican 15 Laparoscopic Radical Cystectomy and Urinary Diversion 253 Andrew P. Steinberg and Inderbir S. Gill 16 Laparoscopic Radical Prostatectomy: Transperitoneal Approach 271 Chandru P. Sundaram 17 Postoperative Management and Complications of Laparoscopy 289 Timothy D. Moon Index 301 Nakada/FM/1.28F 1/28/03, 3:16 PM9 [...]... references 13 5,6,7,8,9 ,14 ,16 ,17 4,6 4,6,8 ,10 ,11 ,13 ,14 5,7 7 6 6,8 ,16 6,7,8 ,13 ,16 5,8 ,14 16 5,8 ,12 ,13 ,14 ,16 5 ,12 6,7 ,11 ,13 15 6 ,11 ,13 ,16 6 ,16 1, 8 14 ,16 4,8,9 ,13 15 8,9 ,14 ,15 4 ,12 ,13 ,15 8,9 ,11 ,13 15 4,6 ,12 ,14 16 11 11 4,6 ,16 13 11 01/ 08/03, 12 :29 PM Access devices Visiport device Optiview trocars Hasson cannula Veress needle Trocar-mounted balloon Blunt-tip trocar Balloon trocar Imaging technology 5-mm 0°... Urologic U.S Surgical Inlet Medical Computer Motion b b Weck Ethicon ValleyLab b b b Applied Ethicon Weck Smith and Nephew that this list is not all encompassing, but it useful to identify items that are mentioned by multiple experts from multiple vendors bAvailable Chapter references 14 16 16 16 15 10 5 5,6,7,8 ,12 6,7 ,11 ,13 ,15 ,16 8 13 ,16 All chapters 8 ,14 8 8 6–9 ,11 ,12 ,13 ,15 7,9 ,15 7 ,11 ,12 ,13 ,15 17 ... 7 ,11 ,12 ,13 ,15 17 14 16 10 10 9 11 9 ,10 9 ,10 9 ,10 Lowry and Nakada Diamond-flex triangle retractor 5-mm cold knife Urethral sound, 24F curved One-inch cervical dilator 5-mm atraumatic small bowel clam Special adjucts Microwave tissue coagulator Argon-beam coagulator LapSac Endocatch bag, 10 -mm, 15 -mm Carter-Thomason AESOP robotic arm Open tray in room Hemostatis and reconstruction Endostitch Lapra-ty clips... necessary (5,6) We recommend closing CH02, 9-2 2 ,14 pgs 13 01/ 08/03, 12 :29 PM 14 Lowry and Nakada Fig 2 Trocars Left, 5- and 10 -mm nonbladed trocars Right, 5- and 10 -mm bladed trocars Fig 3 Bladed trocars Top, 5-mm (top) and bottom, 10 -mm bladed trocar tips with protective sheath retracted to expose blades all 10 -mm ports after one of our patients developed a hernia at a 10 -mm nonbladed port site (7) Reusable... the following chapter Table 1 includes a list CH 01, 1- 8 ,8pgs 4 01/ 08/03, 12 :29 PM Chapter 1 / Getting Started 5 Table 1 Basic Operative Laparoscopic Instrumentation • Laparoscopic cart Television monitor Color video chip camera High-intensity light source High-flow CO2 insufflator • Lapararoscope, 10 mm 30°, 45° • Clip applicators, 5-mm, 11 -mm • Trocars, two 12 mm, two 5 mm, one 15 mm • Scissors • Harmonic... opportunities to expand the scope of the urologic practice and CH 01, 1- 8 ,8pgs 6 01/ 08/03, 12 :29 PM Chapter 1 / Getting Started 7 Table 2 Direct Costs of Basic Laparoscopy Set-Up Equipment Cost Laparoscopic cart Laparoscopes (3) Trocars (reposable) Instruments Harmonic scalpel Generator Hand pieces Hand access device (2) Total $37,000 $12 ,000 1$ 1,000 1$ 9,000 $20,000 1$ 1,000 $80,000 increase the referral base... surgery: a review of the literature Eur J Surg 2000; 585: 48–56 9 Brazier JE, Johnson AG Economics of surgery Lancet 20 01; 358: 10 77 10 81 10 Kenyon TA, Lenker MP, Bax TW, Swanstrom LL Cost and benefit of the trained laparoscopic team Surg Endosc 19 97; 11 (8): 812 – 814 CH 01, 1- 8 ,8pgs 8 01/ 08/03, 12 :29 PM Chapter 2 / Laparoscopic Instrumentation 2 9 Laparoscopic Instrumentation Patrick S Lowry, MD and Stephen... laparoscope 5-mm 30° laparoscope 10 -mm 0° laparoscope 10 -mm 30° laparoscope Laparoscopic ultrasound probe Dissection and retraction Hook electrode 5-mm bipolar cautery 5-mm Kitner Harmonic scalpel, ultrasonic shear Electrosurgical scissors 5-mm curved dissector (Maryland) Fan retractor 10 -mm right angle 5-mm irrigator/aspirator Endoholder Peer retractor 5-mm locking/grasping forceps 12 -mm Endopaddle... • Department of Urology, University of Michigan Health System, Ann Arbor, MI Nakada/FM /1. 28F 12 1/ 28/03, 3 :16 PM Chapter 1 / Getting Started 1 1 Getting Started in Laparoscopy Joseph J Del Pizzo, MD CONTENTS INTRODUCTION THE SURGEON “TEAM LAPAROSCOPY INSTRUMENTATION PATIENT SELECTION COST CONCLUSIONS TAKE HOME MESSAGES REFERENCES INTRODUCTION Laparoscopy was first performed by Kelling in 19 01 (1) ,... and reconstruction Endostitch Lapra-ty clips and applier 10 -mm Satinsky clamp Endo-GIA stapler, vascular load Reusable clip applier 5- or 11 -mm clip applier Ligasure device Laparoscopic needle drivers Fibrin glue Gelfoam Hand access devices Gel-Port Lap-Disc Omniport Handport 12 Table 1 (continued) Chapter 2 / Laparoscopic Instrumentation 13 Fig 1 Veress needle for closed insufflation of the abdomen Note . 1- 5 882 9 -1 5 4-5 (alk. paper) 1- 5 925 9-3 8 1- X (e-book) 1. Genitourinary organs—Endoscopic surgery. 2. Laparoscopic surgery. I. Nakada, Stephen Y. II. Series. [DNLM: 1. Laparoscopy methods. 2. Urologic. Reporting Service is: [ 1- 5 882 9 -1 5 4-5 /03 $20.00]. Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Essential urologic laparoscopy : the. Nakada, MD Essential Urologic Laparoscopy E SSENTIAL U ROLOGIC L APAROSCOPY Nakada/FM /1. 28F 1/ 28/03, 3 :15 PM1 CURRENT CLINICAL UROLOGY Eric A. Klein, SERIES EDITOR Essential Urologic Laparoscopy: