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VIDEO
cases, an additional 5mm port on the right side
is used for liver elevation with a grasper. Posterior
peritoneum and Gerota´s fascia are opened. The
tumour is detected and verified by a laparoscopic
ultrasound probe (we define the borderline be-
tween tumour and parenchyma/renal sinus). After
tumour verification, dissection of the renal hilar
vessels is performed. Next the renal artery/arter-
ies, or in rare instances only selected branch, are
clamped using a laparoscopic bulldog endoclamp.
In the case of tumour invasion into the sinus, we
use a venous bulldog endoclamp to clamp the
renal vein. In cases with a small extrarenal tumour
we do not clamp the renal hilum. In cases with
a complex renal hilum, where it is difficult to se-
lectively dissect the vessel, it is possible to use
extracorporeal clamping (inserted through the ab-
dominal wall). This is followed by tumour resection
into a healthy surgical margin using scissors. The
specimen is inserted into the EndoCatch
®
Gold. In
cases with a close resection margin, the resetected
bed is managed by bipolar or Argon coagulation
(the latter is contactless, but more expensive). The
resected bed (vessels or opened collecting system)
is sutured with Vicryl® or more recently V-Loc 90
TM
(both absorbable), with the sutures tightened with
Hem-o-lok clips
TM
ML. The same suture is used for
closing of the parenchyma. Clips provide (even for
V- Loc
TM
) better tightening of kidney tissue and pre-
vent the risk of kidney tearing. Hilar vessels are than
released. Possible residual bleeding is managed by
another suture or sometimes covered by oxidized
cellulose. Suturing of the posterior peritoneum
and Gerota´s fascia is done with V-Loc 90
TM
. An
easyflow drain is placed through lateral 5mm port.
The specimen is removed through incision of the
12mm port, which is slightly enlarged. The spec-
imen margin is marked black for the pathologist.
Conclusion
: LR is a standardized method that
enables us to treat almost one third of kidney tu-
mours.
KEY WORDS
Kidney tumour, renal carcinoma, resection, lapa-
roscopy.
LITERATURA
1. Hora M, Klečka J, Ürge T, Ferda J, Hes O, Eret V.
Laparoskopická resekce tumorů ledvin (Laparoscopic
resection of renal tumours), Ces Urol 2006; 10(1): 32–39.
2. Hora M, Eret V, Ürge T, et al.
Results of laparoscopic resection of kidney tumour in everyday clinical
practice, CEJU (Central European Journal of Urology), 2009; 62(3): 160–166.
3. Hora M, Eret V, Stránský P, et al.
Evoluce operační techniky laparoskopické resekce nádorů ledvin
(Evolution of surgical technique of laparoscopic resection of kidney tumors), Ces urol 2010; 14(1): 24–31.