Port Placement

An incision is made at the infraumbilical crease, and a disposable 10-mm port with occluding balloon and cuff is introduced under direct vision into the peritoneal cavity. A 10-mm, 0° laparoscope is introduced and the subsequent ports are introduced under visual guidance. For the right-handed surgeon, the right-sided 10 mm and left-sided 5 mm ports are inserted bilaterally at the lateral borders of the rectus muscle at the level of the umbilicus (Fig. 1). Most of the operative suturing takes place via the two paraumbilical ports. The 10-mm port not only facilitates the introduction of sutures on large needles but also is useful for extracorporeal knot tying. Additional 5mm ports are inserted bilaterally at the level of the anterior superior iliac spines. Other ports may be placed depending on the bowel mobilization required and surgeon's preference.

A relative contraindication specific to laparoscopic bladder augmentation is the presence of extensive intraabdominal and pelvic adhesions that would preclude a laparoscopic bowel dissection.

Patients with neurologic diseases have chronic constipation and may need more time for an adequate bowel preparation.

In laparoscopic ileocystoplasty, the initial step is identification of the ileocecal junction.

In laparoscopic sigmoidocystoplasty, a loop of sigmoid colon is selected using similar techniques.

0 0

Post a comment