[Laparoscopic nephrectomy. Animal experiment and clinical application].
Laparoscopic nephrectomy was carried out on 6 sows in order to develop the procedures of clinical laparoscopic nephrectomy and the equipment necessary for this operation. Based on the animal experiments, it was shown that (1) retroperitoneal approach was difficult due to narrow space. (2) there must be at least 5 cm distance between each trocar and 4 or 5 trocar 1 cm in diameter were basically required. (3) The procedure consisted of incision and dissection of the peritoneum around the kidney, cutting and ligation of the ureter, dissection along the medial side of the ureter to approach the renal pedicle and clipping and cutting of the renal vessels. (4) The equipment required for this surgery must be functionally equivalent to those used in the open surgery. (5) In addition, the specifically designed equipment, such as a morcellator and an instrument to ligate renal vessels are necessary. The first clinical case of laparoscopic nephrectomy was a 34 years old man with a right non-functioning hydronephrosis due to ureteropelvic junction stricture. The surgery was successfully performed with a 110 ml blood loss. It took 7 and half hours because of abundant peri-renal fatty tissue and large extra-renal pelvis. The convalescence was uneventful. Laparoscopic nephrectomy can be applied on selected cases and the development of equipment will make the surgery more popular.
Higashihara
E
E
Department of Urology, Faculty of Medicine, University of Tokyo.
Kameyama
S
S
Tanaka
Y
Y
Horie
S
S
Sayama
T
T
Kano
M
M
Asakage
H
H
Nutahara
K
K
Minowada
S
S
Aso
Y
Y
D000818:Animals; D002404:Catheterization; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D020706:Laparoscopes; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D013552:Swine