- •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.
1.3 References
1. Grimshaw J, Eccles M, Russell I.
Developing clinically valid practice guidelines. J Eval Clin Prac 1995; 1: 37-48.
2. Woolf SH.
Practice guidelines, a new reality in medicine. II. Methods of developing guidelines. (Review.) Arch Intern Med 1992; 152: 946-952.
3. Agency for Health Care Policy and Research.
Clinical Practice Guidelines Development, Methodological Perspectives. US Department of Health and Human Services, Public Health Service, Washington DC, 1992, pp. 115-127.
2. TECHNICAL ASPECTS
2.1 Introduction
Laparoscopy is a surgical technique that allows surgical procedures to be performed while minimizing trauma to the body. The following are indispensable for carrying out any laparoscopic procedure:
Basic mandatory equipment
Specific basic instruments
Basic access techniques
Complication management
Specific training.
2.2 Equipment (1-3)
The view of the surgical field is provided by a video-camera, which represents the eye of the surgeon. It goes without saying that a proper video armamentarium is of paramount importance. The basic, indispensable equipment for videoing is as follows:
At least one CCD (charge-coupled device), but preferaby three CCD video-cameras
At least one, but preferably two, video-monitors
Video-recorder cart.
In addition, equipment should also include:
High-flow insufflator
Xenon-light source
High-frequency generator, both mono- and bipolar
Suction and irrigation device. (Other devices for dissecting and for controlling bleeding may be useful, such as an ultrasonic dissector or a radio-frequency coagulator.)
2.3 Instruments (1 -3)
As well as having instruments to enable access to, and development of, working room, the surgeon requires state-of-the-art instruments for optimal performance of laparoscopic procedures, including:
Dissection
Haemostasis
Suturing
Retrieval of specimens.
2.3.1 Access to, and development of, working room
Indispensable instruments for accessing and developing the working space include:
Veress needle (for transperitoneal access only)
Hasson trocar
10 mm trocar with safety sheath
10 mm trocars with ventile valve and reducer to 5 mm
0° and 30° 10 mm telescopes.
An optional instrument is a:
• Balloon dilator (for extraperitoneal access only).
Basically, there are no major differences between performing transperitoneal or extraperitoneal laparoscopic surgery. However, since the peritoneum is already an existing cavity, it is only necessary to inflate the peritoneum to create a working space. However, since the retroperitoneum and pelvis are not a cavity, it is first necessary to dissect the fat which fills the retroperitoneal space to create a working room.
Thus, in the case of a transperitoneal approach, the abdomen is insufflated by use of a Veress needle followed by puncture with a 10 mm trocar with a safety shield or using an open Hasson technique.
The retroperitoneoscopic approach is begun by making an open canal (15-20 mm wide in diameter) down to the retroperitoneal space, followed by finger dissection (with or without balloon dissection). A Veress needle is not required.