Chiruvella Mallikarjuna, Ghouse Syed Mohammed, Tamhankar Ashwin Sunil
Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India.
Indian J Urol. 2019 Jul-Sep;35(3):230-231. doi: 10.4103/iju.IJU_235_18.
Posterior hilar renal tumor extirpation by partial nephrectomy is a unique challenge for transperitoneal laparoscopy. We describe our novel technique of "polar flip" for these tumors. Kidney is rotated by around 45 -60 degrees after mobilisation so that lower pole faces anteriorly and upper pole faces posteriorly, thereby exposing the posterior surface for maneuverability. Technical highlights are hilar control, complete kidney mobilisation, initial flipping with dissection in Gil Vernet's plane to clip posterior segmental renal artery, en mass hilar clamping in normal lie, polar flipping, dissection in Gil Vernet's plane till renal sinus fat, completion of tumor excision, selective vascular ligation, renorhaphy and nephropexy.
经腹膜腹腔镜下进行肾门后肾肿瘤的部分肾切除术是一项独特的挑战。我们描述了针对这些肿瘤的“极翻转”新技术。在游离肾脏后将其旋转约45 - 60度，使下极朝前，上极朝后，从而暴露后表面以便操作。技术要点包括肾门控制、肾脏完全游离、在吉尔·韦尔内平面进行初步翻转并解剖以夹闭后段肾动脉、在正常位置进行整块肾门阻断、极翻转、在吉尔·韦尔内平面解剖直至肾窦脂肪、完成肿瘤切除、选择性血管结扎、肾缝合术和肾固定术。
