tailieunhanh - Essential Urologic Laparoscopy - part 2

Các đầu dò siêu âm nội soi ổ bụng có thể đánh giá thận mức độ khối u hoặc tổn thương đồng bộ trong nephrectomy một phần. Nó cũng được sử dụng theo sự hình thành băng trong phương pháp áp lạnh. Các thiết bị Carter-Thomason là tuyệt vời cho vị trí của chỉ khâu đóng cửa fascial trong các trang web cổng 10 mm | 20 Lowry and Nakada Fig. 12. The diamond flex triangle retractor Genzyme . Inset shows the retractor after deployment. Fig. 13. The Peer retractor Jarit . Inset shows retractor after deployment. Available in 0 and 30 they offer improved optics and somewhat larger viewing angle than the 2-mm scopes 10 . ADJUNCT INSTRUMENTS The laparoscopic ultrasound probe can evaluate the kidney for tumor extent or synchronous lesions in partial nephrectomy. It is also used to follow the ice formation during cryotherapy. The Carter-Thomason device is excellent for placement of sutures for fascial closure in 10-mm port sites 11 . For removal of specimens the entrapment sacks are used to catch the organ and then pull it toward a port or incision for removal Fig. 14 . If planning to morcelate a Chapter 2 Laparoscopic Instrumentation 21 Fig. 14. Endocatch device. Insets show device prior to introduction of the endocatch bag and after partial introduction of the endocatch bag. Note arrows which point to the open end of the bag. specimen one must be aware that not all sacs are impermeable to cells. Morcellation can only be performed with specimen bags that are impermeable to fluid and tissue. Currently the LapSac Cook Urological Bloomington IA is the only available sac impermeable to tumor cells. Combination aspiration irrigation systems allow for bleeding and clot formation to be washed away and cleared. The instrument may also be used as a dissector or retractor. MORCELLATION Morcellation using an impermeable entrapment sac is performed using instruments such as a Vanderbilt Serat or ring forceps to break up the specimen into pieces small enough to allow the sac to be pulled through the 10-mm port. Alternatively an electrically driven device when pressed against the specimen will suck out 10-mm cores of tissue until the specimen is small enough to be brought out through the trocar site. ROBOTIC SURGERY Recently robotic systems have been successfully trialed for all types of .