Advantages Of Laparoscopy

As the open surgical procedure requires extensive mobilization within the retroperitoneum over a large area, it necessitates a large flank or midline incision. The objectives of open surgery can be easily met with minimally invasive technique of laparoscopy (Table 4) (11-13).

Laparoscopy provides optical magnification that facilitates the identification of small lymphatics easily, thus increasing the chances of success with lesser blood loss and operative time.

Postoperative recovery is rapid and hospital stay is short (11-13).

TABLE4 ■ Laparoscopic Lymphatic Disconnection Reported by Various Authors

No. of renoureteral

Study (Ref.)

units

Approach

Technique

Results

Follow-up

Comments

Zhang et al.

7

RP

Nephrolympholysis

100%

2-12 mo

Used 3 ports

(11)

Hilar stripping Ureterolympholysis

(mean 6.7 + 4)

Jiang et al.

6

RP

Nephrolympholysis

100%

1-1.6 yr

(20)

Hilar stripping Ureterolympholysis

Hemal and

11

RP

Nephrolympholysis

Initially chyluria

6 mo-4.5 yr

lprolonged drainage

Gupta (12)

Ureterolympholysis

Fasciectomya

Nephropexy21

subsided in all cases Recurred in two cases because of contralateral side at 1 and 9 mo, respectively which was treated successfully

linadvertent clipping of a branch of posterior. segmental artery

Gomella et al.(3)

1

RP

Removal of fascia Gerota Stripping of renal hilum

Chyluria subsided

2 yr

Used 4 ports

Chui et al. (2)

1

TP

Ligation and division of lymphatics of hilum and ureter (hilar stripping and ureterolympholysis)

Chyluria subsided

2 yr

Used 5 ports

aOptional.

Abbreviations: RR retroperitoneal; TP transperitoneal.

Laparoscopy provides optical magnification that facilitates the identification of small lymphatics easily, thus increasing the chances of success with lesser blood loss and operative time.

Retroperitoneal laparoscopic lympholy-sis has an obvious advantage, because the peritoneum is not transgressed at any level thus avoiding the potential complications such as bowel injury and prolonged ileus.

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