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  1. 1. Textbook of LAPAROSCOPIC UROLOGY DK994x_C000a.indd 1 08/18/2006 8:08:05 AM
  2. 2. DK994x_C000a.indd 2 08/18/2006 8:08:06 AM
  3. 3. Textbook of LAPAROSCOPIC UROLOGY Edited by Inderbir S. Gill, MD, MCh Vice Chairman and Professor of Surgery Head, Section of Laparoscopic and Robotic Surgery Director, Center for Advanced Study Glickman Urological Institute Cleveland Clinic Foundation Cleveland, Ohio, U.S.A. New York London DK994x_C000a.indd 3 08/18/2006 8:08:06 AM
  4. 4. Informa Healthcare USA, Inc. 270 Madison Avenue New York, NY 10016 2006 by Informa Healthcare USA, Inc. Informa Healthcare is an Informa business No claim to original U.S. Government works Printed in the United States of America on acidfree paper 10 9 8 7 6 5 4 3 2 1 International Standard Book Number10: 0849339944 (Hardcover) International Standard Book Number13: 9780849339943 (Hardcover) This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use. No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access ( or contact the Copyright Clearance Center, Inc. (CCC) 222 Rosewood Drive, Danvers, MA 01923, 9787508400. CCC is a notforprofit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation with out intent to infringe. Library of Congress CataloginginPublication Data Textbook of laparoscopic urology / edited by Inderbir S. Gill. p. ; cm. Includes bibliographical references and index. ISBN13: 9780849339943 (hardcover : alk. paper) ISBN10: 0849339944 (hardcover : alk. paper) 1. Genitourinary organsLaparoscopic surgery. 2. Endourology. I. Gill, Inderbir S. [DNLM: 1. Laparoscopy. 2. Urologic Surgical Proceduresmethods. WJ 168 T3552 2006] RD572.T49 2006 617.460597dc22 2006049524 Visit the Informa Web site at and the Informa Healthcare Web site at DK994x_C000a.indd 4 08/18/2006 8:08:06 AM
  5. 5. To the loving memories of my father, my mother, and my younger brother and to my family (Tania, Karan, and Neeti) and my team at work for the love, inspiration, and strength.
  6. 6. v PREFACE Laparoscopy is now a major domain in urologic surgery. The past decade has witnessed a literally logarithmic increase in the application and appropriateness of minimally inva- sive techniques for an entire spectrum of urologic surgical conditions. These advances have been fueled by many factors. Foremost is the natural order of change and progress. Change must not be adopted just because it is new or different. The reference standard, the tried and trusted open surgery, must not be cast aside until its novel, minimally inva- sive alternative has undergone a thorough, due-diligence evaluation. As such, laparoscopy is being incorporated into main-stream urology with appropriate caution and constructive critique. Second, the explosion of technological advances and novel imaging modalities have made possible minimally invasive techniques hitherto consid- ered in the realm of science fiction. Finally, the surgical patient at the dawn of the 21st cen- tury, awash with information gleaned from the cyber-media, now has a better understanding of the available therapeutic options, rightfully leading to heightened expectations. This is only as it should be. The result is the emergence of a new surgical mentality, wherein the big surgeons make big incisions mindset is now aptly giving way to the minimally invasive, maximally effective mindset. For minimally invasive oncologic surgeons, our work has only just begun. For laparoscopy to conclusively supplant open surgery where appropriate, stringent comparative analyses and joint research efforts need to occur in a spirit of healthy cooperation. These are ongoing. In this regard, combining the strengths of the two respected societies, the Society of Urologic Oncology and the Endourology Society, will go a long way towards advancing both fields. Our future is together. This textbook aims to provide comprehensive, state-of-the-art information about the field of urologic laparoscopic surgery. Encyclopedic in scope, its 101 chapters have been organized into eleven distinct sections: Basic Considerations; Equipment; Laparoscopy: General Techniques; Adult Laparoscopy: Benign Disease; Laparoscopic Urologic Oncology; Pediatric Laparoscopy; Hand-Assisted Laparoscopy; Laparoscopy: Developing Techniques; Laparoscopic Complications: Etiology, Prevention, Management; Laparoscopy: Select Aspects; and The Future. Depending on the individ- ual topic, emphasis has been placed on basic concepts, patient selection, laparoscopic technique and caveats, published outcomes, controversies, and future horizons. To enhance readability, important information has been graphically represented in a stand-alone manner in the left-hand column of the page. For certain chapters, invited commentaries have been solicited to stimulate debate, providing a broader perspec- tive. Schematic figures, multiple tables, and thorough bibliographies combine to pro- vide the reader a complete picture within one cover. This will benefit the novice as well as the experienced urologist. Leading authorities have provided their opinions and thoughts herein. Collectively, these distinguished authors, each selected for recognized expertise and pre-eminence, comprise the Whos Who in the discipline. It is our hope that the Textbook of Laparoscopic Urology will mature into the standard reference text in the field. Future editions will keep pace with the rapidly changing land- scape of minimally invasive urology. Personally, it has been a true privilege to be able to edit the textbook. I am deeply grateful. Inderbir S. Gill
  7. 7. vii ACKNOWLEDGMENTS IoweheartfeltgratitudetoMassimilianoSpaliviero,M.D.,JoseRobertoColombo,Jr.,M.D., and the editorial staff at Informa Healthcare U.S.A., Inc. Dr. Spaliviero did yeoman work in all the nuts and bolts aspects of putting together this textbook: cataloging author information and manuscripts and logging innumerable hours of just plain hard work. Dr. Colombo provided invaluable assistance in galley proof editing and tracking down last-minute illustrations and author data. The Informa editorial staff made it all come together seamlessly. Special and heartfelt thanks to Vanessa Sanchez, Joseph Stubenrauch, and Sandra Beberman, the outstanding team at Informa, and Joanne Jay, at The Egerton Group Ltd., who provided the many innovative suggestions and technical support to bring the book to its final form.
  8. 8. SECTION I: BASIC CONSIDERATIONS CHAPTER 1: HISTORY OF LAPAROSCOPY: AN ODYSSEY OF INNOVATIONS 3 Sergio G. Moreira, Jr., Raul C. Ordorica, and Sakti Das References 11 CHAPTER 2: LAPAROSCOPIC ANATOMY: UPPER ABDOMEN 13 Dinesh Singh Introduction 13 Right Kidney 13 Left Kidney 14 Right Adrenal Gland 15 Left Adrenal Gland 16 CHAPTER 3: LAPAROSCOPIC ANATOMY OF THE MALE PELVIS 19 Bertrand Guillonneau, Karim A. Touijer, and Jeffery W. Saranchuk Introduction 19 Intra-Abdominal Anatomy of the Pelvis 19 The Retropubic Space 22 Prostatic Fascia and Prostatic Pedicles 24 Sphincteric Complex 26 Conclusion 27 References 27 CHAPTER 4: PHYSIOLOGIC ASPECTS OF LAPAROSCOPY 29 J. Stuart Wolf, Jr. Introduction 29 Physiologic Factors 29 Physiologic Responses 32 Physiologic Complications 35 References 41 CHAPTER 5: MODERN ABDOMINAL IMAGING: IMPLICATIONS FOR LAPAROSCOPIC SURGERY 47 Erick M. Remer, Joseph C. Veniero, and Brian R. Herts Introduction 47 Computed Tomography 48 Computed Tomography Protocol for Laparoscopic Surgical Planning 48 Magnetic Resonance Imaging 49 Magnetic Resonance Protocol for Laparoscopic Surgical Planning 51 Image Interpretation and Three-Dimensional Volume Rendering 52 Radiologic Guidance During Laparoscopic Surgery 55 Postoperative Imaging 59 Conclusion 62 References 63 ix CONTENTS Preface v Acknowledgments vii Contributors xxvii
  9. 9. x Contents SECTION II: EQUIPMENT CHAPTER 6: LAPAROSCOPIC INSTRUMENTATION 67 Mihir M. Desai Introduction 67 Laparoscopic Instrumentation 67 Operating Room Setup 73 Conclusion 74 References 75 CHAPTER 7: AUDIOVISUAL EQUIPMENT AND THE OPERATING ROOM OF THE FUTURE 77 James O. LEsperance and Glenn M. Preminger Introduction 77 Digital Imaging 77 Video Endoscopy (AKA Chip on A Stick) 79 Digital Imaging, Video Documentation, and Editing 80 Illumination 81 Image Display Systems and High-Definition Video Systems 82 Three-Dimensional Video Endoscopic/Laparoscopic Systems 83 Virtual Reality Endoscopic/Laparoscopic Simulation 84 Internet and Telemedicine 85 The Operating Rooms of the FutureToday 86 Conclusion 88 References 88 CHAPTER 8: BIOADHESIVE TECHNOLOGY 91 Andrew B. Joel and Marshall L. Stoller Introduction 91 Hemostasis 92 Topical Biologic Agents: Pharmacologic 93 Topical Biologic Agents: Physical 96 Urologic Laparoscopic Applications 97 Potential Complications 100 Topical Synthetic Agents 101 Conclusion 101 References 102 CHAPTER 9: SURG