Operative Pediatric Urology

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Catalog Record: Operative pediatric urology | HathiTrust Digital Library

Blackburn in Lexington. If you a question related to surgery scheduling or insurance authorization, please contact Tina Boone at our Lexington office. If you need medical records, please contact the office location where you have been receiving care. Monday — Friday. Baptist Health Lexington.

Kosair Childrens Hospital. Baptist Physicians Surgery Center. Lexington Surgery Center.


Kentucky Surgery Center. Louisville Surgery Center. The close approximation of robotic techniques to their open counterparts facilitates the transition to the minimally invasive option. Pyeloplasty can be performed with either transperitoneal or retroperitoneal access and offers the advantage of using smaller suture material, as fine as 7. Results in children older than 1 year are similar to those of laparoscopy. The robotic system helps to overcome the problem of precise intracorporeal suturing by making suturing easier thus shortening the learning curve.

Similar overall operative times depend on longer robotic set-up. The recommended instruments for paediatric pyeloplasty are all 8 mm sizes:. The use of curved scissors is limited by the lack of cautery in the 5 mm version of this instrument. Curved scissors or round tip scissors are used for transection of the renal pelvis and the ureter, whilst round tip scissors facilitates spatulation even of a small ureter with its straight tips.

Two needle drivers are generally used to perform the anastomosis or alternatively, one needle driver and one grasping instrument. While robotic surgery can be used for ureteral reimplantation, nephrectomy, heminephrectomy and orchidopexy, simple laparoscopy is usually sufficient for these procedures. Robotic surgeries may take longer than other types of minimally invasive surgeries due to time needed for positioning the instruments and other equipment.

Instruments and camera cross within the Single-site Figures 53 , 54 and use remote centre technology to minimize cannula collisions, arm interference and port-site movements.

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Sigle site port: 5-lumen port, 1. There has been a continued expansion in the application if laparoscopy in the paediatric population. Improvements in optics and instrumentation and the use of robotic assistance have brought new dimensions to the use of MIS in the paediatric population. Laparoscopy has provided a unique opportunity for paediatric urologists to work in a small space around and inside the urinary bladder.

It has also allowed exploration of the complete urinary system, from kidney to bladder with just a rotation of axis of trocars, holding the laparoscope and the working instruments, thus aiding to deal with all major paediatric urologic diseases in minimally invasive fashion. Smaller scars, less pain, and quicker recovery are all potential benefits of laparoscopy, but there is also the potential of causing harm if the application of minimally invasive technique is not done properly, particularly because of lack of adequate experience in this field.

Technically most complex reconstructions in children have been achieved with the use of laparoscopic technique, but their reproducibility has yet to be proved. It is therefore important to have proper clinical trials that can objectively evaluate the use of these technically demanding techniques in children. Disclaimer: Karl Storz-Endoskope has authorized the publication of figures representing some of the instruments they produce for the paediatric surgical population.

Figure 2 Operative paediatric cystoscope.

Guide to Pediatric Urology and Surgery in Clinical Practice

A Removable instrument ports offer a choice between single or dual working channels; B the reduced outer diameter ensures minimal patient discomfort. Figure 5 Grasping and biopsy forceps, flexible, 3 and 5 Fr. Figure 6 Hook electrode, unipolar, 3 Fr for both 8 and 9. Figure 7 Knife, triangular tip, 3 Fr for 8 and 9. Figure 8 Grasping forceps, 5 Fr, only for 9. Figure 9 Pediatric operating cysto-urethroscopes. Figure 10 Kit for paediatric urethrotomies.

A Resectoscope 9 Fr : cutting by means of a spring in the rest position, the electrode tip is inside the sheath ; B accessory instruments for the 8 Fr urethrotome; C accessory instruments for the 9 Fr resectoscope. Figure 11 The flexible system to access some of the most challenging areas the bladder neck and the entire intrarenal collecting system. A Cystourethrofiberscope; B tip deflection. Figure 12 Ultrathin uretero-renoscope 7 Fr sheath, 43 cm L, distal tip 6. Figure 13 Flexible uretero-renoscope Storz Flex-X2. Figure 14 Hopkins telescopes for laparoscopy. Figure 15 Trocars for laparoscopy.

A Trocar sizes: 2.

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Figure 16 Minitrocars. Figure 17 Self-retained minitrocars. Figure 18 Available instruments. A Click-line; B Scissors serrated, curved; C dissecting and grasping forceps fenestrated jaws ; D dissecting and grasping forceps right angle jaws ; E grasping forceps fenestrated with atraumatic serration; F dissecting and grasping forceps Kelly ; G bowel grasper.


Figure 19 Electrodes. Size 3 mm, for use with trocar 3. L-shaped, insulated, length 20—30 mm. Figure 20 Suction and irrigation instruments. A Size 3 mm, length 20 and 30 cm, trocar size 3. Figure 21 For extracorporeal knotting, size 3 mm, length 20 cm or 30 cm , Trocar size 3. Figure 22 Endobag. Figure 23 Endoloop. Figure 24 Endoclip. Figure 25 2 ultra micro and 3 mm, for use with trocar size 2. Figure 26 Hasson trocar Ethicon.

Figure 27 Hasson balloon trocar Covidien. Figure 28 Cohen procedure. Figure 29 Landmarks and boundaries of the renal space and port position for retroperitoneoscopic nephrectomy. Figure 30 Laparoscope 5. Figure 31 Bipolar forceps for varicocelectomy. Figure 36 Gelpoint. Figure 37 SILS. Figure 38 Platform instrumentation. Figure 39 da Vinci operating room OR.

Innovations in Minimal Access Pediatric Surgery and Technology

Figure 40 Needle driver. Figure 41 Round tip scissors. Figure 42 Curved scissors. Figure 43 Monopolar cautery hook tip.

Figure 44 Monopolar cautery spatule tip. Figure 45 Harmonic ACE curved scissors. Figure 46 Endowrist instruments.