Laparoscopic Transperitoneal Radical Nephrectomy

Published on 16/04/2015 by admin

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Last modified 16/04/2015

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Chapter 53

Laparoscopic Transperitoneal Radical Nephrectomy

Patient Positioning and Trocar Placement

For a left radical nephrectomy, the patient is placed in the right lateral decubitus position with the left flank up (Fig. 53-1, B). The patient is centered over the break in the bed. The lower leg is bent and the top leg straight, and the dependent hip, knee, and ankle padded appropriately. Pillows can be placed between the legs. An axillary roll should be placed under the axilla, to protect from nerve damage. The patient’s lower arm is placed straight out on an arm board, and the upper arm should be secured to an upper arm board. The upper arm must be safely positioned away from the working field to ensure full access to laparoscopic instrumentation.

It is important to secure the patient to the table with heavy tape wrapped around the patient (preferably directly to skin) and table several times, to prevent the patient from moving or sliding during surgery. For the transperitoneal approach, the patient can be rotated posteriorly just before being secured to the table. It is also helpful to plan for the extraction site, marking it before positioning and including it in the prepped and draped area.

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