Technique Of Retroperitoneoscopic Laparoscopic Lymphatic Disconnection

After induction of general anesthesia, the patient is catheterized and placed in kidney position. A 2-cm incision is given below and posterior to the tip of 12th rib. The incision is deepened down to the retroperitoneal space through dorsolumbar fascia. Through this wound, finger dissection is performed to create more retroperitoneal space. A homemade balloon (made from two finger stalks of a 7-1/2 glove, sleeved one over the other and tied over a 16 French red rubber catheter) or commercially available balloon is placed in the retroperitoneal space. The balloon is inflated for five minutes each time with instillation of about 500 mL of saline once directed cranially and then caudally to help create adequate retroperitoneal space. Hasson canula is put through this wound in to the retroperitoneal space, and two stay sutures are taken at the port site through the skin, subcutaneous tissue, muscles, and dorsolumbar fascia and tied around the canula in order to prevent surgical emphysema. Carbon dioxide pneumoretroperitoneum is created to a pressure of 15 mmHg, and laparoscope is introduced. Under laparoscopic vision,

FIGURE4 ■ Schematic diagram for the port placement for right- FIGURE5 ■ Opening of Gerota's fascia posteriorly to dissect out side lymphatic disconnection. the kidney.

FIGURE4 ■ Schematic diagram for the port placement for right- FIGURE5 ■ Opening of Gerota's fascia posteriorly to dissect out side lymphatic disconnection. the kidney.

a second port (10 mm) is inserted in the same line 2 cm above the iliac crest. A third (10/5 mm) canula is inserted in midaxillary line, 2 cm below the costal margin (Fig. 4). The procedure of laparoscopic lymphatic disconnection includes five important steps (2,7,11-13):

1. Nephrolympholysis

2. Stripping of hilar vessels

3. Ureterolympholysis

4. Fasciectomy

5. Nephropexy

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