Lateral Transperitoneal Technique Equipment and Theatre SetUp

Tables 5 and 6 list the equipment used. The operating table is placed obliquely in the operating theatre with the anesthetic equipment at the head of the table and the camera stack system, containing the insufflator, monitor, light source, and camera system, at the foot (Fig. 1). In this position, the scrub nurse can easily view the monitor. The diathermy machine is placed next to the stack system. Because we prefer to operate with a larger image, we use a 5-foot projector screen placed in the far corner of the operating theatre, with a projector placed on the opposite side to the surgeon close to the head of the table. If available, a plasma screen is also suitable. The patient is placed in the lateral decubitus position. The surgeon stands in front of the patient with the assistant on the surgeon's left and the Mayo table on his/her right. The Mayo table is useful to place frequently used instruments such as the clip applier, hook diathermy, and diathermy scissors in easy reach of the surgeon. The scrub nurse's tables are on the opposite side to the surgeon adjacent to the diathermy machine. It is useful for the nurse to be seated so as not to block the surgeon's view of the screen. Similarly, it is useful for either the assistant to be seated or to stand on a platform, or the surgeon to stand on a platform; this places the surgeon's arms and assistant's arms at different levels to avoid clashing.

TABLE 5 ■ Standard Laparoscopic Equipment

Olympus SX2-3 chip camera Eschmann MR operating table Warming mattress Gel mattress Bair hugger

Urology stack system with insufflator, light source, and monitor Valley lab diathermy

Reported series have not consistently demonstrated significant differences in analgesic requirement, time to oral intake, ambulation, length of stay, convalescence, conversion rates, and complication rates between the transperitoneal and retroperitoneal approaches.

Tumor size, obesity, and the learning curve are the most important factors influencing operative outcome .

TABLE 6 ■ Specific Laparoscopic Adrenalectomy Equipment

No. 11 scalpel blade 2 Langenbeck retractors 0° Laparoscope

4 X 5-11 Autosuture Versaseal ports with spring grip (Tyco Healthcare, Mansfield, U.S.A.)

5 mm Electrosurgical scissors 5 mm Electrosurgical hook

10 mm Autosuture Endoretracta 10 mm ML Endoclipa 10 mm Endocatcha bag Tonsil swabs

5 mm laparoscopic suction probe Camera sleeve

Sterile flask filled with hot water to warm laparoscope Endo-GIA 30 with reloads Projection screen and projector Mayo table

5 mm Maryland dissecting forceps

2 X Laparoscopic needle holders

3/0 Prolene vascular suture on a round-bodied needle

Have available-laparotomy set with vascular clamps and 4 Xsmall bulldog clips

FIGURE 1 ■ Operating theatre set-up for right-sided laparoscopic adrenalectomy. Abbreviations: D, diathermy; ST, scrub table; SN, scrub nurse; P, projector; A, assistant; S, surgeon; MT, Mayo table; LQ, long quiver for sucker; SQ, short quiver for hand-held diathermy.

FIGURE 1 ■ Operating theatre set-up for right-sided laparoscopic adrenalectomy. Abbreviations: D, diathermy; ST, scrub table; SN, scrub nurse; P, projector; A, assistant; S, surgeon; MT, Mayo table; LQ, long quiver for sucker; SQ, short quiver for hand-held diathermy.

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