By Frank Hinman Jr. MD FACS FAAP FRCS(Eng)(Hon)
The latest variation of this accomplished, step by step atlas of open urologic operations. good points up-to-date illustrations and textual content depicting methods, symptoms, contraindications, tools, substitute options, positioning, and distinctive medical issues. assurance contains surgical procedure of the adrenal, kidney, ureter, bladder, prostate, urethra, penis, and scrotal contents.
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Additional info for Atlas of Urologic Surgery, 2nd Edition
One can be made from materials available in the operating room (Gauer, 1992): A finger of size 7 surgical glove (washed) or latex balloon is tied over an 8 F red rubber catheter that is attached by a T to the pump of a sphygmomanometer and to a manometer to allow inflation and simultaneous observation of pressure. Alternatively, obtain a balloon dissector commercially. For renal procedures, after the usual preparation and under general anesthesia, place the patient in the lateral position. Make a 2-cm incision through all layers just posterior to the tip of the 12th rib, in the superior lumbar triangle.
For discussion of retroperitoneal laparoscopic nephrectomy, see page 995, Figures 7 and 8. For extraperitoneal exposure of the pelvis for pelvic node dissection, place the balloon just inferior to the umbilicus. For bladder neck suspension, place it midway between the symphysis pubis and umbilicus. Amplify the exposure by blunt dissection. INTRAOPERATIVE PROBLEMS Most complications occur during initial trocar insertion or during insufflation. Preperitoneal emphysema from improper placement of the insufflation needle is heralded by scrotal emphysema early in the case.
Alternatively, grasp the umbilicus in a towel clamp, and have the assistant grasp the lower abdominal wall. Hold the needle with its base in the palm and with the index finger along the shaft. Use the other hand as a brake. Let the edge of the hand rest on the abdomen to prevent inadvertent deep insertion. Keep the insufflation port toward the abdomen. Push the needle through the abdominal wall at a 60- or 90-degree angle, noting two successive planes of resistance as it passes first through the fascia and then through the peritoneum.