BOOK
Hinman's Atlas of Urologic Surgery E-Book
Joseph A. Smith | Stuart S. Howards | Glenn M. Preminger
(2012)
Additional Information
Book Details
Abstract
Regarded as the most authoritative surgical atlas in the field, Hinman’s Atlas of Urologic Surgery brings you the detailed visual guidance and unmatched expertise you need to confidently perform virtually any urologic surgical procedure. Detailed color illustrations and clinical photographs — accompanied by commentary from leading urologists—lead you step by step through each technique. Instructions and commentary from a veritable "who’s who" in urologic surgery equip you to successfully deliver optimal results.
- Know what to do and expect with comprehensive coverage of nearly every surgical procedure you might need to perform.
- Get a true-to-life view of each operation through illustrations, full-color photographs.
- Find answers fast thanks to a quick, clear, and easy-to-use format - ideal for residents as well as experienced surgeons.
- Turn to the companion reference, Hinman’s Atlas of UroSurgical Anatomy, 2nd Edition, for a more in-depth view of the complex structures you must navigate when performing any procedure.
- Master the latest techniques with new and revised chapters on laparoscopic urologic surgery, robotic-assisted laparoscopic prostatectomy, decision making in hypospadius surgery, Holmium: YAG laser treatment of benign prostatic disease, urethral sling for male and female incontinence, suture techniques, vascular surgery, and many other timely topics and recent advancements.
- Get all the accuracy, expertise, and dependability you could ask for from new editors who are among the most important names in urology, for expert guidance and a fresh understanding of the subject.
- Avoid pitfalls and achieve the best outcomes thanks to a step-by-step approach to each procedure, complete with commentary, tips, and tricks of the trade from leading experts.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc | ||
| Hinman’s atlas of urologic surgery | iii | ||
| Copyright page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Foreword | xxi | ||
| Preface | xxiii | ||
| Table of contents | xxv | ||
| I Surgical basics | 1 | ||
| 1 Surgical basics | 3 | ||
| Strategy and tactics | 3 | ||
| Preoperative evaluation | 3 | ||
| Evaluation of risks | 3 | ||
| Nutrition | 4 | ||
| Venous thromboembolism prophylaxis | 4 | ||
| Evaluation by the anesthesiologist | 4 | ||
| Preparation for surgery | 5 | ||
| Outpatient surgery | 5 | ||
| Preparation of the operative site | 5 | ||
| Marking | 5 | ||
| Shaving and epilation | 6 | ||
| Skin preparation | 6 | ||
| Draping | 6 | ||
| Contamination | 6 | ||
| Bowel preparation | 6 | ||
| Vascular access | 6 | ||
| Perioperative antibiotics | 6 | ||
| Protection during surgery | 8 | ||
| Anesthesia | 8 | ||
| Fluid and electrolyte replacement | 8 | ||
| Local anesthesia | 8 | ||
| General anesthesia | 8 | ||
| Operative management | 8 | ||
| Assistance | 8 | ||
| Protection of the surgical team from viral infection | 8 | ||
| Surgical technique | 9 | ||
| Dissection | 9 | ||
| Visibility | 9 | ||
| Hemostasis and contemporary hemostatic AIDS | 9 | ||
| Blood loss and transfusion | 9 | ||
| Drains | 10 | ||
| Catheters and urinary drainage tubes | 10 | ||
| Suprapubic drainage | 10 | ||
| Postoperative nerve block | 11 | ||
| Postoperative management | 11 | ||
| Operative report | 11 | ||
| Avoidance of postoperative complications | 11 | ||
| Fluid requirements | 11 | ||
| Pain management | 11 | ||
| Nerve blocks | 11 | ||
| Postoperative analgesia | 11 | ||
| Postoperative infections | 12 | ||
| Wound management | 12 | ||
| II The urologist at work | 13 | ||
| 2 Basic surgical techniques | 15 | ||
| 3 Basic laparoscopy | 17 | ||
| Training for laparoscopy | 17 | ||
| Contraindications to laparoscopy and patient selection | 17 | ||
| Monitoring equipment | 17 | ||
| Instrumentation | 17 | ||
| Preparation | 18 | ||
| Patient positioning | 18 | ||
| Pneumoperitoneum | 18 | ||
| Veress needle technique | 19 | ||
| Error | 20 | ||
| Insertion of primary port | 20 | ||
| Open (hasson) technique | 20 | ||
| Insertion of secondary ports | 21 | ||
| Lysis of adhesions | 22 | ||
| Retractors | 22 | ||
| Irrigation | 22 | ||
| Suturing and other methods of tissue approximation | 22 | ||
| Automated suturing devices | 22 | ||
| Polydioxanone clip technique for securing suture | 22 | ||
| Extracorporeal suturing: pushed half knot | 22 | ||
| Laparoscopic suturing | 22 | ||
| Insertion of the needle | 22 | ||
| General considerations | 22 | ||
| Intracorporeal suturing | 23 | ||
| Clipping and stapling | 23 | ||
| Hemostasis | 23 | ||
| Organ entrapment | 23 | ||
| Leaving the abdomen | 23 | ||
| Postoperative care | 24 | ||
| Laparoscopic surgery in children | 24 | ||
| Direct extraperitoneal access (gauer) | 25 | ||
| Intraoperative problems | 25 | ||
| Postoperative complications | 27 | ||
| 4 Suture techniques | 29 | ||
| Knot-tying techniques | 29 | ||
| Sutures | 29 | ||
| Selection | 29 | ||
| Fascia | 30 | ||
| Subcutaneous tissue | 31 | ||
| Skin | 31 | ||
| Urinary tract | 31 | ||
| Intestine | 31 | ||
| Vascular | 32 | ||
| Size and type | 32 | ||
| Skin suture techniques | 32 | ||
| Fascial sutures | 33 | ||
| Interrupted sutures | 33 | ||
| Far-and-near sutures | 34 | ||
| Skin clips | 34 | ||
| Other types of fascial sutures | 34 | ||
| Bowel sutures | 35 | ||
| Connell suture | 35 | ||
| Lembert suture | 35 | ||
| Pursestring suture | 35 | ||
| Lock-stitch | 35 | ||
| Figure-eight bowel suture | 35 | ||
| Laparoscopic suturing | 35 | ||
| 5 Plastic surgical techniques | 39 | ||
| Blood supply to the skin | 39 | ||
| Grafts | 39 | ||
| Thickness of skin grafts | 39 | ||
| Full-thickness skin grafts | 39 | ||
| Split-thickness skin grafts | 39 | ||
| Dermal grafts | 39 | ||
| Application of split-thickness and meshed grafts | 40 | ||
| Flaps | 40 | ||
| Preparation of A flap | 41 | ||
| Local anesthesia | 42 | ||
| Use of langer’s lines | 42 | ||
| Island flap | 42 | ||
| Correction of dog ear | 42 | ||
| Musculocutaneous flaps | 42 | ||
| Gracilis myocutaneous flap | 43 | ||
| Gracilis muscle flap | 46 | ||
| Inferior rectus abdominis flap | 46 | ||
| Dressings for grafts and flaps | 48 | ||
| Problems after graft placement or flap transfer | 49 | ||
| 6 Bowel stapling techniques | 53 | ||
| Gastrointestinal anastomosis instrument | 53 | ||
| Thoracoabdominal instrument | 53 | ||
| End-to-end anastomosis instrument | 54 | ||
| Common bowel applications for A stapling instrument | 54 | ||
| Side-to-side anastomosis | 54 | ||
| End-to-end anastomosis | 55 | ||
| Conclusion | 57 | ||
| 7 Mobilization of the omentum | 61 | ||
| Physiology | 61 | ||
| Anatomy | 61 | ||
| Open surgical technique | 61 | ||
| Laparoscopic technique | 63 | ||
| Conclusion | 63 | ||
| 8 Methods of nerve block | 65 | ||
| Pharmacology | 65 | ||
| Intercostal nerve block | 65 | ||
| III Penis: Plastic operations | 85 | ||
| 12 Basic instructions for hypospadias repair | 87 | ||
| Goals | 87 | ||
| Meatal abnormalities | 87 | ||
| Skin and scrotal abnormalities | 87 | ||
| Penile curvature | 87 | ||
| Hypospadias surgeons | 87 | ||
| Preoperative evaluation | 88 | ||
| Age for operation | 88 | ||
| Outpatient repair | 88 | ||
| Prophylactic antibiotics | 88 | ||
| Magnification | 88 | ||
| Nerve block | 88 | ||
| Surgical hints | 88 | ||
| Hemostasis | 88 | ||
| Artificial erection | 88 | ||
| Suturing | 88 | ||
| Local urinary diversion in children | 88 | ||
| Dressings | 89 | ||
| Set up for operation | 89 | ||
| Instruments | 89 | ||
| Selection of the operative technique | 89 | ||
| Specific operations | 90 | ||
| Postoperative problems | 90 | ||
| Complications | 90 | ||
| Practical conclusions | 91 | ||
| 13 Postoperative management | 93 | ||
| 14 Pediatric meatotomy | 95 | ||
| Indications | 95 | ||
| Technique | 95 | ||
| Steps | 95 | ||
| 15 Decision-making in hypospadias surgery | 97 | ||
| Preoperative considerations | 97 | ||
| Preoperative investigations | 97 | ||
| Straightening penile curvature | 97 | ||
| Etiology | 97 | ||
| Correction | 97 | ||
| Dorsal plication (fig. 15-2) | 97 | ||
| Urethral plate elevation (fig. 15-3) | 98 | ||
| Ventral corporal lengthening (fig. 15-5) | 99 | ||
| Distal tip repair (fig. 15-6) | 99 | ||
| Midshaft and proximal tip (fig. 15-7) | 100 | ||
| Postoperative management | 101 | ||
| 16 Flaps in hypospadias surgery | 103 | ||
| Perimeatal-based flap repair | 103 | ||
| Mathieu, 1932 | 103 | ||
| Onlay preputial transverse island flap | 104 | ||
| Duckett, 1980 | 104 | ||
| Tubularized transverse preputial island flap | 105 | ||
| Duckett, 1995 | 105 | ||
| 17 Two-stage repair of hypospadias | 109 | ||
| Preoperative considerations | 109 | ||
| Preoperative testosterone administration | 109 | ||
| Operative technique | 109 | ||
| First stage | 109 | ||
| Orthoplasty techniques | 109 | ||
| Pedicled dorsal foreskin flaps (byars’ flaps) | 110 | ||
| Extragenital grafts | 110 | ||
| Free, partial thickness skin graft (bracka graft) | 110 | ||
| General postoperative care after first stage | 111 | ||
| Second stage | 111 | ||
| IV Penis: Malignancy | 113 | ||
| 18 Partial penectomy | 115 | ||
| Postoperative problems | 116 | ||
| 19 Total penectomy | 119 | ||
| Technique | 119 | ||
| Step i | 119 | ||
| Step 2 | 120 | ||
| Step 3 | 120 | ||
| Step 4 | 120 | ||
| Step 5 | 120 | ||
| Step 6 | 120 | ||
| Step 7 | 120 | ||
| Step 8 | 121 | ||
| Postoperative problems | 121 | ||
| 20 Ilioinguinal lymphadenectomy | 123 | ||
| Unilateral dissection | 123 | ||
| Sentinel node biopsy | 123 | ||
| Modified inguinal lymphadenectomy for squamous cell carcinoma of the penis | 124 | ||
| Pelvic lymphadenectomy for squamous cell carcinoma of the penis | 127 | ||
| Closure of radical inguinal lymphadenectomy or when skin flap viability is questionable | 127 | ||
| Coverage with sartorius | 127 | ||
| Coverage with rectus abdominis myocutaneous flap | 127 | ||
| Intraoperative precautions | 129 | ||
| Postoperative problems | 129 | ||
| 21 Laser treatment of the penis | 131 | ||
| Choice of laser | 131 | ||
| Diagnostic indications | 131 | ||
| Penile condylomata | 131 | ||
| Erythroplasia of queyrat | 132 | ||
| Squamous cell carcinoma | 133 | ||
| Postprocedure management | 134 | ||
| V Penis: Correction | 137 | ||
| 22 Circumcision | 139 | ||
| Sleeve incision (double-incision) technique | 139 | ||
| Alternative technique | 140 | ||
| Plastibell technique | 141 | ||
| Gomco clamp technique | 141 | ||
| Revision circumcision | 142 | ||
| Postoperative problems from circumcision | 142 | ||
| Uncircumcision | 144 | ||
| Lynch and pryor | 144 | ||
| 23 Dorsal slit | 145 | ||
| Dorsal slit for phimosis | 145 | ||
| Dorsal slit for paraphimosis | 145 | ||
| 24 Penile curvature in the pediatric patient | 147 | ||
| Penile torsion | 147 | ||
| Surgical repair | 147 | ||
| Lateral penile curvature and chordee without hypospadias | 147 | ||
| 25 Hidden penis | 151 | ||
| Preoperative appearance | 152 | ||
| Incision of phimotic ring | 152 | ||
| Degloving the phallus | 152 | ||
| Placement of anchoring stitches | 152 | ||
| Flap closure of penile skin | 155 | ||
| Postoperative considerations and complications | 155 | ||
| VI Penis: Reconstruction | 159 | ||
| 26 Insertion of flexible prosthesis | 159 | ||
| Ventral penile approach | 162 | ||
| Perineal approach | 164 | ||
| Subcoronal approach | 164 | ||
| Dorsal penile shaft approach | 165 | ||
| Ventral approach | 166 | ||
| Pubic approach | 166 | ||
| Postoperative problems | 167 | ||
| 27 Inflatable penile prosthesis implantation | 169 | ||
| Types of penile prostheses | 169 | ||
| Preoperative preparation | 169 | ||
| Surgical approaches | 169 | ||
| Implantation of ams 700 lgx inflatable penile prosthesis | 170 | ||
| Postoperative care | 171 | ||
| 28 Penile arterial revascularization | 173 | ||
| Securing the epigastric artery | 173 | ||
| Exposure of the penile vasculature | 174 | ||
| Epigastric artery-dorsal artery anastomosis | 174 | ||
| Other procedures | 175 | ||
| Epigastric artery—dorsal vein anastomosis | 175 | ||
| Postoperative problems | 176 | ||
| 29 Procedures for peyronies disease | 177 | ||
| Graft techniques | 177 | ||
| Incision and vein graft technique (lue) | 177 | ||
| Dermal graft technique (devine) | 179 | ||
| Plication techniques | 179 | ||
| Nonincisional | 179 | ||
| 16-dot (lue) | 179 | ||
| Incisional | 180 | ||
| Ventral tuck technique (nesbit, pryor-fitzpatrick) | 180 | ||
| Prosthesis implantation | 180 | ||
| Postoperative problems | 181 | ||
| 30 Operations for priapism | 183 | ||
| Diagnosis of priapism (ischemic VS. nonischemic) | 183 | ||
| Ischemic priapism | 183 | ||
| Nonsurgical management | 183 | ||
| Surgical management | 183 | ||
| Corporoglanular (winter) shunt | 184 | ||
| Corporoglanular (ebbehoj and t-) shunt | 184 | ||
| Corporoglanular (al-ghorab) shunt | 184 | ||
| Corporospongiosal shunt | 184 | ||
| Surgical pearls of wisdom for ischemic priapism | 185 | ||
| Nonischemic priapism | 185 | ||
| 31 Repair of genital injuries | 187 | ||
| Genital skin loss | 187 | ||
| Avulsion injuries | 187 | ||
| Burn injuries | 187 | ||
| Bite injuries | 187 | ||
| Meshed unexpanded split thickness skin grafting of the penis | 187 | ||
| Meshed split thickness skin grafting of the scrotum | 188 | ||
| Penile fracture | 188 | ||
| Penile reimplantation | 189 | ||
| Testicular rupture | 190 | ||
| VII Female genital reconstruction | 191 | ||
| 32 Cecal vagina | 193 | ||
| 33 Urethrovaginal fistula repair | 197 | ||
| Bulbocavernosus muscle interposition with fat pad supplement (martius flap) | 199 | ||
| 34 Bulbocavernosus muscle and fat pad supplement | 201 | ||
| Classic martius | 201 | ||
| In situ martius flap | 202 | ||
| Labial flap | 203 | ||
| 35 Female urethral diverticulectomy | 205 | ||
| Marsupialization technique (spence-duckett) | 205 | ||
| Transvaginal excision | 205 | ||
| Postoperative care | 212 | ||
| Suggested readings | 213 | ||
| 36 Lateral flap urethral reconstruction | 215 | ||
| 37 Urethral prolapse-caruncle | 217 | ||
| 38 Cystocele repair, enterocele repair, and rectocele repair | 221 | ||
| Anterior colporrhaphy | 221 | ||
| Concurrent enterocele repair | 223 | ||
| Posterior colporrhaphy | 224 | ||
| Suggested reading | 226 | ||
| 39 The michigan four-wall sacrospinous suspension | 227 | ||
| How does michigan four-wall sacrospinous ligament suspension differ from traditional sacrospinous techniques? | 227 | ||
| Advantages of michigan four-wall technique | 228 | ||
| Operative technique | 229 | ||
| Results | 233 | ||
| Key points | 233 | ||
| VIII Urethral: Reconstruction | 235 | ||
| 40 Urethral reconstruction: general concepts | 237 | ||
| Technical considerations | 237 | ||
| Distal reconstruction | 237 | ||
| Bulbar and membranous urethra | 238 | ||
| 41 Reconstruction of the fossa navicularis | 241 | ||
| Skin flap technique | 241 | ||
| (cohney) | 241 | ||
| IX Testis: repair and reconstruction | 293 | ||
| 47 Testis biopsy | 295 | ||
| Gonadal biopsy for intersexes | 297 | ||
| 48 Sperm retrieval | 299 | ||
| Percutaneous epididymal sperm aspiration | 299 | ||
| Microsurgical epididymal sperm aspiration | 299 | ||
| Testicular fine needle aspiration | 300 | ||
| Percutaneous biopsy | 300 | ||
| Open multi-incision testicular biopsy (tese) | 300 | ||
| Microdissection testicular sperm extraction (microtese) | 300 | ||
| 49 Varicocele ligation | 303 | ||
| Subinguinal varicocelectomy | 303 | ||
| Inguinal approach | 304 | ||
| Retroperitoneal approach | 305 | ||
| Laparoscopic approach | 307 | ||
| Postoperative problems | 307 | ||
| 50 Vasectomy | 311 | ||
| 51 Vasovasostomy and vasoepididymostomy | 315 | ||
| Patient positioning | 315 | ||
| Instruments | 315 | ||
| Incisions | 315 | ||
| Modified one-layer closure | 316 | ||
| Two-layer anastomosis | 316 | ||
| Vasoepididymostomy | 316 | ||
| End-to-side vasoepididymostomy | 316 | ||
| End-to-end vasoepididymostomy | 317 | ||
| Intussusception vasoepididymostomy | 317 | ||
| Postoperative care | 317 | ||
| 52 Excision of utricular cyst | 321 | ||
| Transtrigonal approach (fig. 52-1) | 321 | ||
| Laparoscopic approach (transperitoneal) | 321 | ||
| Posterior sagittal approach | 322 | ||
| 53 Spermatocelectomy | 323 | ||
| 54 Epididymectomy | 325 | ||
| Anatomy and physiology of the epididymis | 325 | ||
| Indication for epididymectomy | 325 | ||
| Surgical technique | 325 | ||
| Postoperative care and complications | 326 | ||
| 55 Undescended testis | 327 | ||
| Inguinal orchiopexy (open technique) | 327 | ||
| Orchiopexy | 327 | ||
| Open inguinal orchiopexy | 327 | ||
| Postoperative problems | 327 | ||
| Scrotal orchiopexy | 330 | ||
| Orchiopexy for abdominal testes | 331 | ||
| Transperitoneal approach | 332 | ||
| Extraperitoneal approach | 334 | ||
| Extended inguinal approach | 334 | ||
| Laroque incision | 334 | ||
| High ligation orchiopexy (fowler-stephens) | 335 | ||
| Open surgical technique | 335 | ||
| Postoperative problems | 336 | ||
| Low ligation orchiopexy | 336 | ||
| Redo orchiopexy | 337 | ||
| Microvascular orchiopexy | 338 | ||
| Laparoscopic orchiopexy techniques | 339 | ||
| Laparoscopic technique in children | 339 | ||
| Insertion of trocars | 340 | ||
| Normal laparoscopic landmarks | 341 | ||
| Exploration for the unilateral nonpalpable testis | 341 | ||
| Single-stage laparoscopic orchiopexy | 342 | ||
| Laparoscopic two-stage orchiopexy (fowler-stephens) | 343 | ||
| First stage: laparoscopic vessel ligation | 343 | ||
| Second stage: placement of the testis | 343 | ||
| Postoperative problems | 344 | ||
| Problems during any laparoscopic procedure | 344 | ||
| Problems from laparoscopic procedures of the testis | 344 | ||
| 56 Reduction of testicular tension | 345 | ||
| Manual detorsion of intravaginal torsion | 345 | ||
| Scrotal fixation of the testis | 345 | ||
| X Testis: Malignancy | 347 | ||
| 57 Simple orchiectomy | 349 | ||
| Simple orchiectomy | 349 | ||
| Epididymis-sparing orchiectomy | 349 | ||
| 58 Testis-sparing surgery for benign and malignant tumors | 351 | ||
| 59 Radical orchiectomy | 353 | ||
| Surgical procedure | 353 | ||
| 60 Retroperitoneal lymph node dissection | 357 | ||
| Staging | 357 | ||
| Preparation | 357 | ||
| Primary retroperitoneal lymph node dissection | 357 | ||
| Postchemotherapy retroperitoneal lymph node dissection | 357 | ||
| Approaches | 358 | ||
| Bilateral lymphadenectomy after chemotherapy | 358 | ||
| Anatomy and templates for nerve-sparing retroperitoneal lymph node dissection | 362 | ||
| Left-sided dissection | 362 | ||
| Right-sided dissection | 362 | ||
| Special considerations | 364 | ||
| 61 Laparoscopic retroperitoneal lymph node dissection | 367 | ||
| Positioning and trocar placement | 367 | ||
| Right-sided lrplnd | 368 | ||
| Left-sided lrplnd | 374 | ||
| Complications | 376 | ||
| Postoperative care | 376 | ||
| XI Surgical approachesto the pelvis | 379 | ||
| 62 Midline lower abdominal peritoneal incision | 381 | ||
| 63 Transverse lower abdominal incision | 385 | ||
| 64 Gibson incision | 391 | ||
| XII Prostate: Malignancy | 393 | ||
| 65 Anatomy and principles of excision of the prostate | 395 | ||
| Surgical approaches | 395 | ||
| Relationship to adjacent structures | 395 | ||
| Arterial blood supply to the prostate | 397 | ||
| Venous drainage of the prostate | 397 | ||
| Lymphatic drainage | 398 | ||
| Innervation | 398 | ||
| Pelvic fascia | 398 | ||
| 66 Radical retropubic prostatectomy | 403 | ||
| Perioperative and postoperative care | 412 | ||
| Intraoperative problems | 412 | ||
| Postoperative problems | 413 | ||
| 67 Radical perineal prostatectomy | 415 | ||
| Preparation and position | 415 | ||
| Instruments | 415 | ||
| Step 1 | 415 | ||
| Step 2 | 416 | ||
| Step 3 | 416 | ||
| Step 4 | 416 | ||
| Step 5 | 419 | ||
| Step 6 | 419 | ||
| Step 7 | 420 | ||
| Step 8 | 420 | ||
| Step 9 | 420 | ||
| Step 10 | 420 | ||
| Step 11 | 421 | ||
| Step 12 | 421 | ||
| Step 13 | 421 | ||
| Step 14 | 421 | ||
| Step 15 | 424 | ||
| Step 16 | 424 | ||
| Step 17 | 425 | ||
| Postoperative care | 425 | ||
| 68 Pelvic lymph node dissection | 427 | ||
| Indications | 427 | ||
| Anatomy | 427 | ||
| Anatomic templates | 427 | ||
| Open technique | 428 | ||
| Modified plnd | 428 | ||
| Extended pelvic lymph node dissection | 429 | ||
| Laparoscopic/robotic (mis) pelvic lymph node dissection | 429 | ||
| Technique | 430 | ||
| Transperitoneal exposure | 430 | ||
| Extraperitoneal technique | 432 | ||
| Mis extended pelvic lymph node dissection | 432 | ||
| Complications | 433 | ||
| Postoperative complications | 433 | ||
| 69 Robotic-assisted laparoscopic prostatectomy | 435 | ||
| Surgical technique | 435 | ||
| Patient positioning | 435 | ||
| Port placement | 435 | ||
| Exposure of the prostate | 436 | ||
| Control of the dorsal vein complex | 436 | ||
| Dissection of the bladder neck | 437 | ||
| Seminal vesicle dissection | 439 | ||
| Development of the posterior plane | 439 | ||
| Preservation of the neurovascular bundle | 440 | ||
| Control of the pedicle | 441 | ||
| Division of the urethra | 442 | ||
| Vesicourethral anastomosis | 442 | ||
| Undocking of the robot and wound closure | 443 | ||
| Postoperative care | 443 | ||
| 70 Cryotherapy | 445 | ||
| Patient selection | 445 | ||
| Preoperative preparations | 445 | ||
| Cryotherapy procedure | 445 | ||
| Postoperative care | 447 | ||
| XIII Prostate: Benign disease | 449 | ||
| 71 Transurethral resection of the prostate | 451 | ||
| Indications | 451 | ||
| Preoperative management | 451 | ||
| Patient positioning | 451 | ||
| Description of surgical technique | 451 | ||
| Complications and their management | 455 | ||
| Postoperative management | 456 | ||
| Clinical efficacy | 456 | ||
| 72 Transurethral incision of the prostate | 459 | ||
| Indications | 459 | ||
| Preoperative management including anesthesia | 459 | ||
| Surgical procedure | 459 | ||
| Complications | 461 | ||
| 73 Laser treatment of benign prostatic disease | 463 | ||
| Rational choice of operating room or office-based therapy | 463 | ||
| High-energy photo vaporization | 463 | ||
| Preoperative management | 463 | ||
| Procedure | 463 | ||
| Postoperative management | 464 | ||
| Holmium laser ablation of the prostate (holap) | 464 | ||
| Equipment | 464 | ||
| Surgical technique | 464 | ||
| Introduction of resectoscope into prostate | 464 | ||
| Ensure proper irrigation | 464 | ||
| Insertion of the laser fiber | 464 | ||
| Bladder neck incision and holmium laser ablation of median lobe tissue | 465 | ||
| Holmium laser ablation of the lateral lobes | 465 | ||
| Postoperative care | 465 | ||
| Holmium laser enucleation of the prostate (holep) | 466 | ||
| Equipment | 466 | ||
| Surgical technique | 466 | ||
| Inspection of the bladder and prostatic fossa | 466 | ||
| Bladder neck incision and enucleation of the median lobe | 466 | ||
| Lateral lobe enucleation | 467 | ||
| Incision of the anterior commissure | 468 | ||
| Division of the apical mucosal bridge | 468 | ||
| Completion of the lateral lobe enucleation | 469 | ||
| Tissue morcellation | 469 | ||
| Final inspection of the prostatic fossa | 469 | ||
| Postoperative care | 469 | ||
| Technique of interstitial coagulation | 470 | ||
| Pretreatment requirement | 470 | ||
| Procedure | 470 | ||
| Postoperative management | 470 | ||
| 74 Suprapubic prostatectomy | 473 | ||
| Preoperative considerations | 473 | ||
| Procedure | 473 | ||
| Intraoperative hemostatic procedures | 479 | ||
| Postoperative care | 479 | ||
| Postoperative problems | 480 | ||
| 75 Retropubic prostatectomy | 483 | ||
| Preoperative management | 483 | ||
| Positioning and approach | 483 | ||
| Incision | 483 | ||
| Postoperative management | 487 | ||
| XIV Bladder: Excision | 491 | ||
| 76 Transurethral resection of bladder tumors | 493 | ||
| Transurethral resection | 493 | ||
| Postoperative problems | 494 | ||
| 77 Partial cystectomy | 495 | ||
| Transperitoneal approach | 495 | ||
| Extraperitoneal approach | 496 | ||
| Postoperative problems | 496 | ||
| 78 Radical cystectomy | 501 | ||
| Preparation and evaluation | 501 | ||
| Preoperative evaluation | 501 | ||
| Preoperative preparation | 501 | ||
| Instruments and sutures | 502 | ||
| Cystectomy in the male | 502 | ||
| Mobilization of bowel and exposure | 503 | ||
| Identification of ureters | 503 | ||
| Division of posterolateral pedicle | 504 | ||
| Anterior dissection and urethral division | 504 | ||
| Remove the specimen | 504 | ||
| Preparation for orthotopic diversion/anterior dissection and urethral division | 508 | ||
| Nerve-sparing modifications | 508 | ||
| Urethrectomy | 508 | ||
| Postoperative care | 508 | ||
| Cystectomy in the female | 508 | ||
| Intraabdominal exposure (fig. 78-12) | 508 | ||
| Anterior dissection and urethral dissection with urethrectomy | 510 | ||
| Vaginal-sparing approach | 510 | ||
| Orthotopic urinary diversion | 512 | ||
| 79 Urethrectomy | 513 | ||
| Urethrectomy in the male | 513 | ||
| Postoperative problems | 515 | ||
| Urethrectomy in the female | 515 | ||
| Treatment of distal urethral tumors | 515 | ||
| Complications | 515 | ||
| 80 Pelvic lymphadenectomy | 517 | ||
| Lymphadenectomy in the male | 517 | ||
| Lymphadenectomy in the female pelvis | 522 | ||
| Postoperative problems | 522 | ||
| 81 Pelvic exenteration | 523 | ||
| 82 Excision of vesical diverticulum | 531 | ||
| Indications | 531 | ||
| Technique | 531 | ||
| Laparoscopic/robotic-assisted bladder diverticulectomy | 536 | ||
| Suggested readings | 536 | ||
| 83 Cystolithotomy | 537 | ||
| Indications | 537 | ||
| Technique | 537 | ||
| 84 Laparoscopic/robotic radical cystectomy | 541 | ||
| Patient and preoperative preparation | 541 | ||
| Preoperative preparation/checklist | 541 | ||
| Technique | 542 | ||
| Postoperative care | 547 | ||
| XV Bladder reconstruction | 549 | ||
| 85 Autologous pubovaginal sling | 551 | ||
| Postoperative problems | 553 | ||
| 86 Tension-free vaginal tape/suprapubic midurethral sling pubovaginal | 555 | ||
| Indications | 557 | ||
| Set up | 557 | ||
| 87 Transobturator midurethral sling | 563 | ||
| Indications | 563 | ||
| Set up | 563 | ||
| 88 Bulking agents for incontinence and reflux | 567 | ||
| Stress incontinence | 567 | ||
| Injection technique | 567 | ||
| Ureteral injection | 567 | ||
| 89 Technique for insertion of artificial urinary sphincter | 571 | ||
| Preoperative evaluation | 571 | ||
| Bulbar urethral placement of cuff | 571 | ||
| Instruments | 571 | ||
| Position for perineal approach | 572 | ||
| Incision | 572 | ||
| Pressure-regulating balloon placement | 574 | ||
| Scrotal pump | 574 | ||
| Postoperative problems | 575 | ||
| Suggested readings | 576 | ||
| 90 Transvaginal repair of vesicovaginal fistula | 577 | ||
| Timing of repair | 579 | ||
| Preliminaries | 579 | ||
| Approaches | 579 | ||
| Transvaginal repair | 579 | ||
| Inverted u-incision flap repair | 580 | ||
| Care after vaginal repair | 581 | ||
| Colpocleisis (latzko) | 581 | ||
| Insertion of flaps | 581 | ||
| Closure with labial fat pad flap | 582 | ||
| Closure with island flap (lehoczky) | 583 | ||
| Closure with gracilis myocutaneous flap | 583 | ||
| 91 Transvesical repair of vesicovaginal fistula | 585 | ||
| Transvesical repair | 585 | ||
| Timing of repair | 585 | ||
| Preoperative evaluation | 585 | ||
| 92 Transperitoneal vesicovaginal fistula repair | 589 | ||
| 93 Female vesical neck closure | 593 | ||
| Indications | 593 | ||
| Abdominal approach | 593 | ||
| Abdominal approach with urethral inversion | 594 | ||
| Urethral approach | 595 | ||
| Vaginal approach | 595 | ||
| 94 Neuromodulation | 599 | ||
| First stage | 599 | ||
| Positioning and prep | 599 | ||
| Selecting the appropriate spinal foramen | 600 | ||
| Needle location of the s3 spinal foramen | 600 | ||
| Placement of the introducer sheath under fluoroscopy | 601 | ||
| Deployment of tined lead | 601 | ||
| Setting up the connection between the tined lead and lead extension | 602 | ||
| Tunneling of tined lead to the connection site | 603 | ||
| Completion of stage 1 | 603 | ||
| Second stage | 603 | ||
| Explantation of tined lead and lead extension wire | 603 | ||
| Placement of implantable neurostimulator | 603 | ||
| XVI Urinary and bowel | 605 | ||
| 95 Vesicostomy | 607 | ||
| Lapides vesicostomy | 607 | ||
| Modifications of vesicostomy technique | 609 | ||
| Blocksom vesicostomy | 609 | ||
| Closure of vesicostomy | 611 | ||
| Incontinent ileovesicostomy | 612 | ||
| Complications | 613 | ||
| Suggested readings | 613 | ||
| 96 Ileal conduit | 615 | ||
| Preparation for surgery | 615 | ||
| Patient education | 615 | ||
| Bowel preparation | 615 | ||
| Stoma site selection | 615 | ||
| Ureteral mobilization | 616 | ||
| Left ureteral identification and mobilization | 616 | ||
| Transection of left ureter | 616 | ||
| Right ureteral identification, mobilization, and transection | 616 | ||
| Harvesting the bowel | 617 | ||
| Identify the bowel segment | 617 | ||
| Divide the mesentery | 617 | ||
| Harvest the bowel with gia | 619 | ||
| Ileoileal anastamosis | 619 | ||
| Side-to-side functional end-to-end stapled ileoileostomy with gia 80 stapler | 619 | ||
| Firing the ta stapler on the ileoileostomy | 619 | ||
| Completing the ileoileostomy | 619 | ||
| Close the mesenteric trap | 621 | ||
| Ureteroileal anastomosis | 621 | ||
| Excise or incise A window in the conduit | 621 | ||
| Open bowel mucosa | 621 | ||
| Prepare the ureter (left side first) | 621 | ||
| Implant the left ureter | 622 | ||
| Creation of the stoma | 623 | ||
| Excise the skin and subcutaneous tissue | 623 | ||
| Cruciate incision in the fascia | 623 | ||
| Tack and mature the stoma | 623 | ||
| Completed conduit | 623 | ||
| Retroperitonealize the proximal end of conduit | 623 | ||
| Completed conduit with ileoileal anastomoses visible | 625 | ||
| Conjoined (end-to-end) | 625 | ||
| Stoma alternatives | 626 | ||
| Umbilical | 626 | ||
| Z-incision stoma | 626 | ||
| Loop stoma | 626 | ||
| Loop stoma (fig. 96-25) | 626 | ||
| Loop stoma (fig. 96-26) | 626 | ||
| 97 Laparoscopic/robotic ileal conduit | 629 | ||
| Isolation of the ileal segment | 629 | ||
| Bowel division and reanastomosis | 629 | ||
| Stoma and ureteral anastomoses | 630 | ||
| 98 Sigmoid and transverse colon conduits | 633 | ||
| Operative indications | 633 | ||
| Preoperative preparation | 633 | ||
| Sigmoid colon conduit | 633 | ||
| Incision | 633 | ||
| Mobilization and division of the ureters | 633 | ||
| Selection and isolation of bowel segment | 634 | ||
| Ureteral anastomosis | 634 | ||
| Creation of stoma | 635 | ||
| Closure | 635 | ||
| Transverse colon conduit | 635 | ||
| Incision | 635 | ||
| Mobilization and division of the ureters | 635 | ||
| Selection and isolation of bowel segment | 635 | ||
| Ureteral anastomosis | 636 | ||
| Creation of stoma | 636 | ||
| Closure | 636 | ||
| Postoperative complications and follow-up | 636 | ||
| 99 Fecal diversion | 637 | ||
| Urologic indications for fecal diversion | 637 | ||
| Ileostomy versus colostomy | 637 | ||
| Selection of stoma site | 637 | ||
| Techniques and postoperative care | 637 | ||
| Loop ileostomy | 637 | ||
| Trephine incision | 637 | ||
| Delivery of the bowel through the abdominal wall | 638 | ||
| Stoma creation | 638 | ||
| Divided loop colostomy | 639 | ||
| End colostomy | 639 | ||
| Postoperative care | 640 | ||
| Laparoscopic stomas | 640 | ||
| Laparoscopic loop ileostomy | 640 | ||
| Laparoscopic loop/end colostomy | 640 | ||
| Ostomy reversal | 641 | ||
| XVII Continent reconstruction | 643 | ||
| 100 Principles of continent reconstruction | 645 | ||
| Blood supply to the ileocecal region and appendix | 645 | ||
| Blood supply to the ascending and transverse colon | 648 | ||
| Blood supply to the jejunum and ileum | 648 | ||
| Blood supply to the descending and sigmoid colon | 648 | ||
| Blood supply to the rectum | 649 | ||
| 101 Ileal reservoir (t-pouch) | 651 | ||
| Surgical technique | 651 | ||
| Step 1 | 651 | ||
| Step 2 | 651 | ||
| Step 3 | 651 | ||
| Step 4 | 653 | ||
| Step 5 | 653 | ||
| Step 6 | 653 | ||
| Step 7 | 654 | ||
| Step 8 | 654 | ||
| Step 9 | 654 | ||
| 102 Ileocecal reservoir | 657 | ||
| Mainz pouch | 657 | ||
| Intussusception through the ileocecal valve | 657 | ||
| Mainz pouch with appendiceal stoma | 661 | ||
| In situ tunneled bowel flap tubes | 661 | ||
| Indiana pouch | 661 | ||
| Gastroileoileal pouch | 667 | ||
| (lockhart) | 667 | ||
| Conduits for continent reservoirs | 668 | ||
| Sutured continent conduit | 668 | ||
| Stapled continent conduit (bejany and politano) | 668 | ||
| Postoperative problems from urinary reservoirs | 668 | ||
| 103 Appendicovesicostomy | 669 | ||
| Implantation into the bladder | 670 | ||
| Stomal maturation | 671 | ||
| Alternatives to the appendix | 671 | ||
| Transversely tubularized bowel segments (yang-monti channel) | 671 | ||
| Postoperative problems | 672 | ||
| Suggested readings | 672 | ||
| 104 Ureterosigmoidostomy | 673 | ||
| Background | 673 | ||
| Patient selection | 673 | ||
| Preoperative preparation | 673 | ||
| Surgical technique | 673 | ||
| Ureterosigmoidostomy with closed extracolonic technique for ureterocolonic anastomosis (leadbetter) | 673 | ||
| Ureterosigmoidostomy with transcolonic technique for ureterocolonic anastomosis (goodwin) | 675 | ||
| Mainz pouch ii (sigma rectum pouch) | 681 | ||
| Postoperative care | 683 | ||
| Outcomes | 683 | ||
| Suggested readings | 683 | ||
| 105 Ileal orthotopic bladder substitution | 685 | ||
| Patient selection | 685 | ||
| Preoperative patient preparation | 686 | ||
| Operative technique | 686 | ||
| Preparation of the ileal segment for the bladder substitute | 686 | ||
| Ureteroileal anastomosis | 687 | ||
| Bladder substitute construction | 687 | ||
| Postoperative care | 688 | ||
| Complications | 689 | ||
| Experience with the technique | 689 | ||
| Suggested readings | 689 | ||
| XVIII Bladder augmentation | 691 | ||
| 106 Ileocystoplasty | 693 | ||
| Ileocystoplasty | 693 | ||
| Postoperative care | 696 | ||
| Suggested readings | 696 | ||
| 107 Colocystoplasty | 697 | ||
| Technique | 697 | ||
| Results | 699 | ||
| Conclusions | 700 | ||
| Suggested readings | 700 | ||
| 108 Ureterocystoplasty | 701 | ||
| 109 Autoaugmentation by seromyotomy | 705 | ||
| Laparoscopic autoaugmentation | 706 | ||
| XIX Ureteral reconstruction and excision | 707 | ||
| 110 Principles of ureteral reconstruction | 709 | ||
| Ureteral anatomy | 709 | ||
| Management of the intraoperative injury to the ureter | 710 | ||
| 111 Ureteroneocystostomy | 711 | ||
| Approach to the bladder (figs. 111-1, 111-2, and 111-3) | 711 | ||
| Transvesical techniques | 712 | ||
| Ureteral mobilization (figs. 111-4, 111-5, and 111-6) | 712 | ||
| Intraextravesical technique (politano-leadbetter) (figs. 111-7, 111-8, 111-9, and 111-10) | 714 | ||
| Modification of the intra-extravesical (politano-leadbetter)technique | 716 | ||
| Ureteral advancement technique (glenn-anderson) (fig. 111-11) | 716 | ||
| Transtrigonal technique (cohen) | 717 | ||
| Unilateral ureteroneocystostomy (fig. 111-12) | 717 | ||
| Bilateral ureteroneocystostomy (fig. 111-13) | 718 | ||
| Sheath approximation technique (gil vernet) | 718 | ||
| Spatulated nipple technique (fig. 111-14) | 718 | ||
| Choice of transvesical technique (figs. 111-15, 111-16, and 111-17) | 719 | ||
| Extravesical techniques | 720 | ||
| Extravesical tunnel, open technique (lich-gregoir) (figs. 111-18, 111-19, and 111-20) | 720 | ||
| External tunnel (barry) (figs. 111-21, 111-22, and 111-23) | 720 | ||
| Detrusorrhaphy (hodgson-firlit-zaontz) (figs. 111-24 and 111-25) | 723 | ||
| Intra-extravesical technique (paquin) | 724 | ||
| Postoperative problems | 724 | ||
| Obstruction | 724 | ||
| Persistent or recurrent vesicoureteral reflux | 725 | ||
| Contralateral vesicoureteral reflux | 725 | ||
| Reoperation | 725 | ||
| 112 Psoas hitch | 727 | ||
| Complications | 729 | ||
| Suggested readings | 729 | ||
| 113 Bladder flap repair (boari) | 731 | ||
| Suggested readings | 733 | ||
| 114 Ureteral stricture repair and ureterolysis | 735 | ||
| Ureteroureterostomy | 735 | ||
| Transureteroureterostomy | 737 | ||
| Graft and flap ureteroplasty | 737 | ||
| Ureterolysis | 739 | ||
| Laparoscopic ureterolysis | 741 | ||
| Omental wrap | 741 | ||
| 115 Repair of ureterovaginal fistula | 743 | ||
| Mobilization of the ureter | 743 | ||
| Ureteroneocystostomy combined with A psoas hitch | 744 | ||
| Postoperative complications | 745 | ||
| 116 Ureteroureterostomy and transureteroureterostomy | 747 | ||
| Ureteroureterostomy | 747 | ||
| Surgical technique | 747 | ||
| Transureteroureterostomy | 749 | ||
| Surgical technique | 749 | ||
| 117 Ileal ureteral replacement | 751 | ||
| Patient preparation | 751 | ||
| Incision and identification of ureteral defect | 751 | ||
| Intact, isoperistaltic ileal segment | 751 | ||
| Yang-monti tube | 752 | ||
| Bilateral ureteral replacement | 754 | ||
| Postoperative management | 754 | ||
| 118 Open ureterolithotomy | 755 | ||
| Surgical approaches | 755 | ||
| Ureterolithotomy | 755 | ||
| Postoperative problems | 756 | ||
| 119 Ureteral access | 757 | ||
| Placement of A safety wire | 759 | ||
| Choice of wire | 759 | ||
| Identifying the ureteral orifice | 759 | ||
| Cannulating the ureteral orifice | 759 | ||
| Advancing the wire | 759 | ||
| Cannulation of the ureteral orifice with A semirigid ureteroscope | 760 | ||
| Placement of A working wire: | 760 | ||
| Placement of A flexible ureteroscope over A guidewire | 760 | ||
| Placement of A ureteral access sheath | 760 | ||
| Special challenges: | 762 | ||
| Suggested readings | 762 | ||
| 120 Ureteroscopic instrumentation | 763 | ||
| Types of ureteroscopes | 763 | ||
| Conventional ureteroscopes | 763 | ||
| Semirigid ureteroscopes | 763 | ||
| Flexible ureteroscopes | 763 | ||
| Digital technology | 763 | ||
| Ureteroscopy accessories | 764 | ||
| Ureteral access sheath | 764 | ||
| Selection of various ureteroscopes | 764 | ||
| 121 Ureteroscopic management of ureteral calculi | 765 | ||
| Ureteroscopy for lower ureteral stones (below iliac vessels) | 765 | ||
| Ureteroscopy for upper ureteral stones (above iliac vessels) | 766 | ||
| 122 Ureteroscopic management of renal calculi | 769 | ||
| Conclusions | 770 | ||
| 123 Ureteroscopic endoureterotomy | 771 | ||
| Postoperative care | 773 | ||
| Suggested readings | 774 | ||
| 124 Ureteroscopic endopyelotomy | 775 | ||
| Patient selection | 775 | ||
| Preoperative preparation | 775 | ||
| Ureteroscopic endopyelotomy: the procedure | 775 | ||
| Ho:yag laser | 775 | ||
| Electrocautery | 778 | ||
| Cold knife | 778 | ||
| Postoperative care | 778 | ||
| Suggested readings | 779 | ||
| 125 Ureteroscopic management of transitional cell carcinoma | 781 | ||
| Preoperative planning | 781 | ||
| Endoscopic technique | 781 | ||
| Posttreatment and surveillance | 784 | ||
| Suggested readings | 784 | ||
| 126 Laparoscopic ureterolithotomy | 787 | ||
| 127 Endoscopic management of vur | 791 | ||
| Preparation | 791 | ||
| Double hydrodistension implantation technique (double hit) | 792 | ||
| 128 Endoscopic incision of ureterocele | 795 | ||
| XX Surgical approaches to the kidney | 797 | ||
| 129 Surgical approaches for open renal surgery | 799 | ||
| Anatomic basis for renal incisions | 799 | ||
| Abdominal and chest wall | 799 | ||
| Retroperitoneal space | 799 | ||
| Three-dimensional relationships | 801 | ||
| Choice of surgical approach | 801 | ||
| Anterior approaches | 803 | ||
| Midline transperitoneal incision (laparotomy) | 803 | ||
| Postoperative problems | 806 | ||
| Subcostal incision | 806 | ||
| Extraperitoneal approach—left side | 806 | ||
| Transperitoneal approach—right side | 808 | ||
| Chevron incision | 809 | ||
| Pediatric transverse abdominal incision | 810 | ||
| Paramedian incision | 812 | ||
| Modified thoracoabdominal, extraperitoneal hockey-stick incision | 813 | ||
| Flank approaches | 814 | ||
| Foley muscle-splitting incision | 814 | ||
| Flank subcostal incision (below twelfth rib) | 814 | ||
| Extension of the incision | 815 | ||
| Twelfth rib supracostal incision | 816 | ||
| Eleventh rib transcostal incision | 820 | ||
| Closure | 823 | ||
| Thoracoabdominal incision | 823 | ||
| Closure | 825 | ||
| Repair of pleural tear | 826 | ||
| Splenorrhaphy and splenectomy | 826 | ||
| Splenorrhaphy after intraoperative injury | 826 | ||
| Initial control | 826 | ||
| Splenorrhaphy | 826 | ||
| Partial splenectomy | 827 | ||
| Splenectomy | 827 | ||
| Postoperative problems | 829 | ||
| Repair of incisional hernia | 830 | ||
| Primary repair | 830 | ||
| Augmented repair of large defects using synthetic materials | 830 | ||
| Postoperative problems | 832 | ||
| 130 Anatomical basis for renal endoscopy | 833 | ||
| Pelviocalyceal system: endourological implications | 835 | ||
| Anatomical background | 835 | ||
| Findings and clinical implications | 835 | ||
| Presence of perpendicular minor calices | 835 | ||
| Position of the calices relative to the lateral kidney margin | 835 | ||
| Position of the calices relative to the polar regions and to the kidney midzone | 835 | ||
| Anatomical relationships of intrarenal vessels (arteries and veins) with the kidney collecting system | 837 | ||
| Relevance for the intrarenal access by puncture | 837 | ||
| Material studied for the anatomical background | 837 | ||
| Intrarenal access through an infundibulum | 837 | ||
| Intrarenal access through the renal pelvis | 839 | ||
| Intrarenal access through A calyceal fornix | 839 | ||
| Relevance for endopyelotomy | 839 | ||
| Vascular background | 840 | ||
| Anterior vascular ureteropelvic junction relationships | 840 | ||
| Posterior vascular ureteropelvic junction relationships | 842 | ||
| Incision at the ureteropelvic junction stenosis based on the vascular anatomy | 843 | ||
| Suggested readings | 844 | ||
| 131 Percutaneous renal access | 845 | ||
| Indications | 845 | ||
| Preoperative evaluation | 845 | ||
| Anatomical considerations | 846 | ||
| Standard lower pole percutaneous access | 846 | ||
| Instrumentation | 846 | ||
| Cystoscopy, ureteral catherization | 846 | ||
| Patient positioning | 847 | ||
| Imaging setup—fluoroscopic | 847 | ||
| Selection of puncture site and needle access | 847 | ||
| Placement of access wires | 848 | ||
| Tract dilation | 849 | ||
| Special access situations | 850 | ||
| Supracostal/upper pole access | 850 | ||
| Calyceal diverticulum/obstructed calyx | 851 | ||
| Multiple access | 852 | ||
| Nondilated puncture | 852 | ||
| Complications | 853 | ||
| Suggested readings | 853 | ||
| 132 Percutaneous nephrolithotomy | 855 | ||
| Preoperative radiologic evaluation | 855 | ||
| Choice of percutaneous tract location and number | 855 | ||
| Management of percutaneous access tract before dilation | 855 | ||
| Nephroscopes | 855 | ||
| Intracorporeal lithotripters | 855 | ||
| Combination icl devices | 856 | ||
| Flexible nephroscopy | 856 | ||
| Placement of nephrostomy tube | 856 | ||
| Tubeless pnl | 856 | ||
| 133 Retroperitoneal laparoscopic access | 857 | ||
| Historical considerations: | 857 | ||
| Contraindications and concerns | 857 | ||
| Anatomic considerations | 857 | ||
| Patient preparation and positioning | 858 | ||
| Retroperitoneal laparoscopic technique | 858 | ||
| Conclusion | 859 | ||
| Suggested readings | 859 | ||
| 134 Transperitoneal laparoscopic access | 861 | ||
| Choosing sites of access | 861 | ||
| Initial access | 862 | ||
| Veress needle | 862 | ||
| “Open” laparoscopy | 862 | ||
| Visualizing trocar | 863 | ||
| Port placement | 865 | ||
| 135 Hand-assisted laparoscopic surgery | 867 | ||
| Role of hand-assisted laparoscopic surgery | 867 | ||
| Preoperative considerations | 867 | ||
| Patient positioning | 867 | ||
| Devices used for hand-assisted laparoscopic surgery | 867 | ||
| Device placement | 867 | ||
| Selecting location for hand-assist device placement (fig. 135-4) | 867 | ||
| Low midline (fig. 135-5) | 867 | ||
| Periumbilical (fig. 135-6) | 868 | ||
| Upper midline (fig. 135-7) | 868 | ||
| Gibson-type or paramedian (figs. 135-8 and 135-9) | 868 | ||
| Conclusions | 870 | ||
| 136 Renal cryosurgery | 871 | ||
| Preliminaries | 871 | ||
| Instruments | 871 | ||
| Isotherms | 871 | ||
| 137 Renal radiofrequency ablation | 879 | ||
| Renal radiofrequency ablation | 879 | ||
| Patient preparation | 879 | ||
| Rfa techniques | 880 | ||
| Percutaneous rfa | 880 | ||
| Laparoscopic rfa | 881 | ||
| Radiographic follow-up | 882 | ||
| Suggested readings | 882 | ||
| XXI Kidney: Reconstruction | 883 | ||
| 138 Anatomy and principles of open reconstructive renal surgery | 885 | ||
| Gross morphology of the kidneys | 885 | ||
| Important variations | 885 | ||
| Position of the kidneys | 885 | ||
| Macroscopic renal collecting structures | 885 | ||
| XXII Kidney: Excision | 965 | ||
| 151 Anatomy and principles of renal surgery | 967 | ||
| Renal anatomy for renal resection | 967 | ||
| Anatomic relationships of the kidney (fig. 151-1) | 967 | ||
| Surgical planes of the kidney (fig. 151-2) | 967 | ||
| Renal vasculature (fig. 151-3) | 968 | ||
| Renal collecting system (fig. 151-4) | 969 | ||
| Lymphatic drainage of the kidney and ureter (fig. 151-5) | 971 | ||
| Nerves of the retroperitoneum (fig. 151-6) | 971 | ||
| Perioperative management of the patient undergoing renal surgery | 973 | ||
| Instruments | 973 | ||
| Suggested readings | 974 | ||
| 152 Simple nephrectomy | 975 | ||
| Indications for simple nephrectomy | 975 | ||
| Preoperative considerations | 975 | ||
| The flank approach | 975 | ||
| Patient positioning | 975 | ||
| Development of the pararenal space | 977 | ||
| Renal exposure and mobilization | 977 | ||
| Renal vasculature control | 978 | ||
| Anterior subcostal approach | 978 | ||
| Patient positioning | 978 | ||
| Renal exposure | 979 | ||
| Renal vasculature control | 979 | ||
| Renal mobilization | 980 | ||
| Kocher maneuver | 980 | ||
| The midline transperitoneal approach | 981 | ||
| Dorsal lumbotomy approach | 981 | ||
| Patient positioning | 982 | ||
| Subcapsular nephrectomy | 983 | ||
| Controlling the renal vascular pedicle | 984 | ||
| Whole pedicle clamp method | 984 | ||
| Cut first, ligate second method | 984 | ||
| Ligate first, cut second method | 986 | ||
| Loss of control of the pedicle | 986 | ||
| Wound closure | 986 | ||
| Suggested readings | 988 | ||
| 153 Radical nephrectomy | 989 | ||
| Indications for radical nephrectomy | 989 | ||
| Preoperative considerations | 989 | ||
| Anterior subcostal approach, right side | 991 | ||
| Left radical nephrectomy, mini-flank approach | 995 | ||
| Regional lymphadenectomy for renal masses | 997 | ||
| Right side | 997 | ||
| Left side | 997 | ||
| Intraoperative and postoperative problems | 998 | ||
| Suprahilar and retrocrural lymphadenectomy | 998 | ||
| Injury to the vasculature of the gut | 998 | ||
| Injury to the liver and spleen | 999 | ||
| Injury to the duodenum | 999 | ||
| Injury to the pancreas | 999 | ||
| Pulmonary complications | 1000 | ||
| Suggested readings | 1000 | ||
| 154 Partial nephrectomy | 1001 | ||
| Preoperative considerations | 1001 | ||
| Enucleation for small cortical tumors | 1002 | ||
| Wedge resection for large cortical tumors | 1003 | ||
| Segmental nephrectomy for large polar tumors | 1004 | ||
| Heminephrectomy for large tumors | 1006 | ||
| Postoperative problems | 1006 | ||
| Urinary fistulas | 1006 | ||
| Postoperative bleeding | 1007 | ||
| Renal insufficiency | 1007 | ||
| Suggested readings | 1008 | ||
| 155 Nephroureterectomy | 1009 | ||
| Preoperative considerations | 1009 | ||
| Techniques of nephroureterectomy | 1010 | ||
| Single-incision thoracoabdominal approach with intravesical dissection of the ureteral cuff | 1012 | ||
| Two-incision approach (mini-flank with gibson) with extravesical dissection of the ureteral cuff | 1017 | ||
| Alternative methods of distal ureterectomy | 1018 | ||
| Transurethral resection of the ureteral orifice (a.k.a. pluck technique) | 1018 | ||
| Ureteral intussusception (a.k.a. stripping technique) | 1018 | ||
| Extravesical transection without A bladder cuff | 1019 | ||
| Suggested readings | 1020 | ||
| 156 Extracorporeal renal surgery | 1021 | ||
| Preoperative considerations | 1021 | ||
| Renovascular disease | 1023 | ||
| Renal neoplasms | 1023 | ||
| Postoperative problems | 1024 | ||
| Suggested readings | 1024 | ||
| 157 Vena caval thrombectomy | 1025 | ||
| Preoperative considerations | 1025 | ||
| Level i vena caval thrombectomy: right side | 1029 | ||
| Level ii vena caval thrombectomy: left side | 1030 | ||
| Level iii–iv vena caval thrombectomy: intra-abdominal approach | 1032 | ||
| Level iii–iv vena caval thrombectomy: combined intra-abdominal and intrathoracic approach | 1035 | ||
| Bypass techniques for inferior vena cava surgery | 1037 | ||
| Veno-venous bypass | 1037 | ||
| Cardiopulmonary bypass with and without deep hypothermic arrest | 1038 | ||
| Patching, replacing and interrupting the inferior vena cava | 1039 | ||
| Patch cavoplasty | 1039 | ||
| Vena caval replacement | 1039 | ||
| Inferior vena cava filtration and permanent interruption for bland thrombus | 1040 | ||
| Perioperative complications | 1041 | ||
| Suggested readings | 1041 | ||
| 158 Open stone surgery: anatrophic nephrolithotomy and pyelolithotomy | 1043 | ||
| Anatrophic nephrolithotomy | 1043 | ||
| Preoperative | 1043 | ||
| Positioning | 1043 | ||
| Incision | 1043 | ||
| Renal dissection | 1043 | ||
| Intraoperative imaging | 1044 | ||
| Identifying anatrophic plane | 1044 | ||
| Institution of ischemic renal hypothermia | 1044 | ||
| Nephrotomy and stone removal | 1044 | ||
| Renal closure | 1044 | ||
| Termination of ischemic hypothermia | 1045 | ||
| Postoperative care | 1045 | ||
| Complications | 1045 | ||
| Pyelolithotomy | 1045 | ||
| Preoperative evaluation, patient preparation, and incision | 1045 | ||
| Exposure of renal pelvis | 1045 | ||
| Stone removal | 1045 | ||
| Closure of pyelotomy and wound closure | 1046 | ||
| Postoperative care | 1046 | ||
| Complications | 1046 | ||
| 159 Laparoscopic simple nephrectomy | 1047 | ||
| Preoperative considerations | 1047 | ||
| Patient positioning | 1047 | ||
| Primary access | 1047 | ||
| Trocar positioning | 1047 | ||
| Reflection of the colon | 1047 | ||
| Medial dissection of the kidney | 1048 | ||
| Identification of the proximal ureter | 1048 | ||
| Superior dissection | 1049 | ||
| The renal hilum | 1049 | ||
| Lateral and inferior dissection | 1049 | ||
| Specimen retrieval and removal | 1049 | ||
| Hemostasis and closure | 1050 | ||
| Postoperative course | 1050 | ||
| Postoperative complications | 1050 | ||
| Retroperitoneal simple nephrectomy | 1050 | ||
| Morcellation | 1051 | ||
| 160 Laparoscopic transperitoneal radical nephrectomy | 1053 | ||
| Patient selection and contraindications | 1053 | ||
| Preoperative preparation | 1053 | ||
| Patient positioning and protection | 1053 | ||
| Establishing and regulating pneumoperitoneum (veress, hasson) | 1053 | ||
| Port placement for left and right nephrectomy | 1054 | ||
| Steps for left nephrectomy | 1055 | ||
| Steps for right nephrectomy | 1056 | ||
| Hilar dissection | 1057 | ||
| Methods to ligate renal artery and vein | 1058 | ||
| Adrenal gland | 1059 | ||
| Adrenal removal | 1059 | ||
| Adrenal sparing | 1059 | ||
| Ureteral dissection, occlusion, and division | 1059 | ||
| Specimen entrapment (endocatch VS lapsac) | 1060 | ||
| Specimen removal (morcellation or intact removal) | 1060 | ||
| Technique of hemostatic inspection | 1060 | ||
| Port-site closure (carter thomason device) or none | 1060 | ||
| Postoperative care | 1060 | ||
| Identifying procedure-specific complications | 1061 | ||
| Right side: adrenal, liver, caval, right colon, or duodenal injury | 1061 | ||
| Left side: spleen, pancreas, colon, aorta, superior mesenteric artery, and stomach | 1061 | ||
| 161 Laparoscopic heminephrectomy | 1063 | ||
| Indications | 1063 | ||
| Patient preparation | 1063 | ||
| Instruments | 1063 | ||
| Approach | 1063 | ||
| Cystoscopy/stent placement | 1063 | ||
| Patient positioning/port placement | 1063 | ||
| Exposure | 1064 | ||
| Mobilization of ureter | 1064 | ||
| Excision of upper pole moiety | 1065 | ||
| Management of distal ureter | 1065 | ||
| Removal of specimen | 1065 | ||
| 162 Laparoscopic partial nephrectomy | 1067 | ||
| 163 Laparoscopic nephroureterectomy | 1071 | ||
| Indications and contraindications | 1071 | ||
| Patient positioning and operating room configuration | 1071 | ||
| Insufflation and trocar placement | 1072 | ||
| Procedure | 1075 | ||
| Colon mobilization | 1075 | ||
| Nephrectomy | 1075 | ||
| Distal ureteral dissection | 1075 | ||
| Organ entrapment and extraction | 1078 | ||
| Management of distal ureter/bladder cuff | 1079 | ||
| Post operative considerations | 1080 | ||
| Complications | 1080 | ||
| 164 Laparoscopic pyelolithotomy | 1081 | ||
| Technique of laparoscopic transperitoneal pyelolithotomy | 1081 | ||
| Technique of retroperitoneoscopic pyelolithotomy | 1083 | ||
| Simultaneous pyeloplasty | 1083 | ||
| 165 Laparoscopic caliceal diverticulectomy | 1085 | ||
| 166 Laparoscopic renal cyst ablation | 1087 | ||
| Position | 1087 | ||
| Port placement | 1087 | ||
| Exposure of renal cyst | 1088 | ||
| Aspiration of renal cyst | 1088 | ||
| Excision of cyst wall | 1088 | ||
| Inspection of cyst wall and biopsy of base of renal cyst | 1088 | ||
| Fulguration of base of renal cyst | 1089 | ||
| Closure of renal cyst defect | 1089 | ||
| Wound closure | 1089 | ||
| Postoperative care | 1089 | ||
| 167 Percutaneous resection of upper tract urothelial carcinoma | 1091 | ||
| XXIII Adrenal excision | 1095 | ||
| 168 Adrenal anatomy and preparation for adrenal surgery | 1097 | ||
| Anatomy and embryology | 1097 | ||
| Anatomic relationships | 1098 | ||
| Preparation for adrenal excision | 1100 | ||
| Diagnostic procedures and patient preparation | 1100 | ||
| 169 Open approaches to the adrenal gland | 1103 | ||
| Adrenal surgery | 1103 | ||
| Posterior approach | 1103 | ||
| Modified posterior approach | 1104 | ||
| Flank approach | 1106 | ||
| Thoracoabdominal approach | 1108 | ||
| Transabdominal approach | 1108 | ||
| Partial adrenalectomy | 1110 | ||
| Summary | 1110 | ||
| 170 Laparoscopic approaches to the adrenal gland | 1111 | ||
| Anatomy of the peritoneal membrane and fascias | 1111 | ||
| Transperitoneal approach to the adrenal gland | 1111 | ||
| Left adrenal gland | 1112 | ||
| Right adrenal gland | 1114 | ||
| Extraperitoneal approach to the adrenal gland | 1116 | ||
| Left adrenal gland | 1116 | ||
| Right adrenal gland | 1119 | ||
| Index | 1123 | ||
| A | 1123 | ||
| B | 1123 | ||
| C | 1126 | ||
| D | 1126 | ||
| E | 1127 | ||
| F | 1128 | ||
| G | 1129 | ||
| H | 1129 | ||
| I | 1130 | ||
| K | 1131 | ||
| L | 1133 | ||
| M | 1135 | ||
| N | 1136 | ||
| O | 1137 | ||
| P | 1137 | ||
| R | 1141 | ||
| S | 1143 | ||
| T | 1144 | ||
| U | 1146 | ||
| V | 1150 | ||
| W | 1151 | ||
| Y | 1151 |