Technique Transperitoneal Access

Initial steps are similar to any transperitoneal laparoscopic procedure performed on the kidney: (i) Reflection of the colon: The peritoneum is divided lateral to the ascending or descending colon in the line of Toldt using the monopolar scissors. (ii) Dissection of the pelvis and the upper ureter: Once the colon is reflected, the lower renal pole is visualized and minimal dissection is performed untill identification of the ureter laying parallel to the gonadal vessels. The ureter is dissected upward proximally toward the uretero pelvic junction, maintaining generous periureteral fat to maintain its blood supply. The renal pelvis is mobilized posteriorly for pyelolithotomy and circumferentially for pyeloplasty in conjunction with pyelolithotomy.

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