Technique

As with any procedure, the setting can require a modification of the technique. In a private-practice setting, operative time can be more of a factor than in an academic institution. Willingness toward early open conversion for failure to progress will build confidence in tackling more challenging procedures, thereby expanding the pool of potential laparoscopic cases.

Specific technical modifications are often appropriate for the community urologist. For instance, in the absence of a motivated intern, the task of holding the camera is often best handled by the surgeon.

In this series, the surgeon holds the camera greater than 50% and 90% of the operative time for radical prostatectomy and a retroperitoneal nephrectomy, respectively. This modification reduces both surgeon and assistant fatigue. In reality, with the exception of suturing, only one hand is usually used at a time for surgical maneuvers; the TABLE 9 ■ Postprostatectomy Erectile secondary hand usually holds a retractor, a task easily accomplished by the assistant. Function In any case, the multitude of steps involved in any procedure should be a collection of techniques used by others, molded into one's own style.

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