- •1. Introduction
- •1.2 Levels of evidence and grade of guideline recommendations
- •1.3 References
- •2.3.1 Access to, and development of, working room
- •2.3.2 Dissection
- •2.3.3 Haemostasis
- •2.3.4 Suture technique
- •2.4 Access techniques (1, 3, 5, 6)
- •2.4.1 Retroperitoneoscopy
- •2.4.2 Transperitoneal laparoscopy of the upper tract
- •2.4.3 Transperitoneal access to the pelvis
- •2.4.4 Extraperitoneal access to the pelvis
- •2.5 Management of complications (7-14)
- •2.5.2 Placement of the trocars
- •2.5.3 Insufflation of carbon dioxide
- •2.5.4 Vascular injuries
- •2.5.5 Injuries to organs
- •2.6 Specific training
- •2.7.1 Criteria
- •2.7.2 Scoring system
- •2.8 References
- •15. Guilloneau b.
- •27. Rassweiler j, Coptcoat m, Frede t.
- •36. Janetschek g, Hobisch a, Peschel r, Hittmair a, Bartsch g.
- •3.2 Colposuspension
- •3.3 Cryptorchidism treatment
- •3.4 Hernia repair
- •3.5 Nephrectomy
- •3.5.1 Simple nephrectomy (for benign disease) (Table 3.6)
- •3.5.2 Radical nephrectomy (Table 3.7)
- •3.5.3 Partial nephrectomy (Table 3.8)
- •3.5.4 Nephro-ureterectomy (Table 3.9)
- •3.5.5 Live-donor nephrectomy (Table 3.10)
- •3.6 Nephropexy (Table 3.11)
- •3.7 Pyeloplasty (Table 3.12)
- •3.8 Pelvic lymph node dissection (Table 3.13)
- •3.9 Radical prostatectomy (Table 3.14)
- •3.10 Retroperitoneal lymph node dissection (for testicular cancer) (Table 3.15)
- •3.11 Renal cyst treatment (Table 3.16)
- •3.12 Ureterolithotomy (Table 3.17)
- •3.13 Varicocelectomy (Table 3.18)
- •3.14 References
- •1. Gagner m, Lacroix a, Bolte e.
- •2. Rassweiler jj, Henkel to, Potempa dm, Coptcoat m, Alken p.
- •3. Go h, Takeda m, Takahashi h, Imai t, Tsutsui t, Mizusawa t, Nishiyama t, Morishita h, Nakajima y, Sato s.
- •12. Suzuki k, Ushiyama t, lhara h, Kageyama s, Mugiya s, Fujita k.
- •17. Takeda m, Go h, Watanabe r, Kurumada s, Obara k, Takahashi e, Komeyama t, Imai t, Takahashi k.
- •18. Rayan ss, Hodin ra.
- •23. Su th, Wang kg, Hsu cy, Wei hj, Hong bk.
- •83. Liem msl, Van Vroonhoven tj.
- •101. Gill is, Kavoussi lr, Clayman rv, Ehrlich r, Evans r, Fuchs g, Gersham a, Hulbert jc, McDougall em, Rosenthal t, et al.
- •104. Fornara p, Doehn c, Fricke l.
- •114. Gill is.
- •118. Janetschek g, Daffner p, Peschel r, Bartsch g.
- •128. Jones dr, Moisey cu.
- •136. Yang sc, Park ds, Lee dh, Lee jm, Park k.
- •140. Suzuki k, Ishikawa a, Ushiyama t, Nobutaka o, Suzuki a.
- •167. O'Dea mj, Furlow wl.
- •168. Temizkan m, Wijmenga lf, Ypma af, Hazenberg hj.
- •169. MossSw.
- •170. Soulie m, Thoulouzan m, Seguin p, Mouly p, Vazzoler n, Pontonnier f, Plante p.
- •174. Ben Slama mr, Salomon l, Hoznek a, Cicco a, Saint f, Alame w, Antiphon p, Chopin dk, Abbou cc.
- •202. Boeckmann w, Effert p, Wolff jm, Jakse g.
- •224. Bollens r, Vanden Bossche m, Roumeguere t, Damoun a, Ekane s, Hoffmann p, Zlotta ar, Schulman cc.
- •241. LeBlanc e, Caty a, Dargent d, Querleu d, Mazeman e.
- •245. Janetschek g, Hobisch a, Hittmair a, Holtl l, Peschel r, Bartsch g.
3.5.5 Live-donor nephrectomy (Table 3.10)
Laparoscopic live-donor nephrectomy is feasible and represents an alternative to open surgery when performed in transplant centres by a skilled and very trained laparoscopist (136-140). In fact more than 500 cases have been done in only two centres (141, 142).
All comparative studies, as well as a retrospective analysis of the literature (N = 738 laparoscopic versus 3502 open living-donor nephrectomies) did not show any disadvantage with respect to the laparoscopic approach, whereas the laparoscopic nephrectomy was superior with respect to post-operative morbidity and convalescence of the donor (143-156). Some authors postulate that the longer warm ischaemia time (1.5 versus 2.5 minutes) may lead to a shorter lifetime of the graft (157, 158). Others, however, have shown that there is no influence (159). Nevertheless, there are no long-term results. Moreover, the procedure is technically very demanding and should always be performed by a very experienced surgeon well trained in laparoscopy.
Table 3.10 Live-donor nephrectomy: guideline recommendations
|
Total number of patients |
About 800 |
|
Expert opinion |
Feasible |
|
Level of evidence |
2a |
|
Grade of recommendation |
В |
|
Current indications |
Live-donor nephrectomy |
3.6 Nephropexy (Table 3.11)
Laparoscopic nephropexy is a feasible procedure for the treatment of symptomatic nephroptosis. It is a minimally invasive alternative to open nephropexy. However, nephropexy is seldom indicated. Only patients with an objective deterioration of renal function and a clear obstruction of renal outflow (as demonstrated in the standing position) will benefit from nephropexy. In doubtful cases (i.e. when it is not definite that a patient's symptoms would be relieved by nephropexy), a minimally invasive approach,such as laparoscopic nephropexy, can provide a reasonable way of allowing for the uncertainty of the results (160-169).
Table 3.11 Nephropexy: guideline recommendations
|
Total number of patients |
Less than 100 |
|
Expert opinion |
Feasible |
|
Level of evidence |
3 |
|
Grade of recommendation |
С |
|
Current indications |
Nephroptosis |
3.7 Pyeloplasty (Table 3.12)
In review papers, the laparoscopic pyeloplasty has been reported with results that are comparable between arms (170-173). Less post-operative pain, shorter hospital stay and shorter convalescence have been reported with the laparoscopic approach, but the design of the studies do not allow any scientific conclusions to be made. Most of the papers (173-190) have reported series including less than 25 patients. The operative time ranges between 89 and 300 minutes, and the complication rate between 10% and 25%, with a success rate of between 75% and 100%. Both dismembered and non-dismembered procedures have been described (172, 187), while transperitoneal and extraperitoneal approaches are possible (182). The procedure is feasible in children (176, 179). However, laparoscopic pyeloplasty is a technically difficult procedure, requiring very good training, especially for suturing.
Expert opinion indicates that this technique can be offered when a pyeloplasty is indicated, provided that the surgical team has mastered the technique. However, there is competition between the use of laparoscopic surgery and other minimally invasive procedures, e.g. endopyelotomy, with the later being probably much easier to learn. The long-term results are unknown.
Table 3.12 Pyeloplasty: guideline recommendations
|
Total number of patients |
More than 200 |
|
Expert opinion |
Feasible |
|
Level of evidence |
3 |
|
Grade of recommendation |
С |
|
Current indications |
Pyeloplasty |