Sự cần thiết phải chuẩn bị ruột trước phẫu thuật phụ thuộc vào độ khó dự đoán của vụ án. Nếu thận là không tham gia vào một quá trình viêm (ví dụ, teo thận với tăng huyết áp renovascular kết quả, hoặc thận hydronephrotic gây đau), bệnh nhân được đặt trên | 84 Kuo Siqueira and Shalhav The need for preoperative bowel preparation depends on the anticipated difficulty of the case. If the kidney is not involved in an inflammatory process . atrophic kidney with resultant renovascular hypertension or hydronephrotic kidney causing pain the patient is placed on a clear liquid diet the day before surgery and the bowel prep omitted. Another option is a limited bowel preparation protocol consisting of a clear liquid diet and a bottle of magnesium citrate the day before surgery. If significant difficulty in dissection is likely however the patient should undergo a full mechanical bowel preparation along with antibiotics consisting of neomycin 1 g and erythromycin base 500 mg which are given at 2 4 and 6 PM the day prior to surgery. If the kidney is suspected to be chronically infected pyonephrosis struvite calculi appropriate antibiotics should be given for at least 1 wk prior to surgery. All other patients should be given a parenteral antibiotic usually a first-generation cephalosporin such as cefazolin in the preoperative holding area. Transperitoneal Simple Nephrectomy The transperitoneal route is considered the traditional laparoscopic approach to renal surgery. The main advantages of this approach include good anatomic landmarks within the peritoneal cavity and a large working space that allows for optimal port placement. These advantages can be important when treating enlarged kidneys or those involved with a generalized massive inflammatory process. Disadvantages to this approach include the need to retract or dissect other intraabdominal organs such as the liver spleen and bowel away from the kidney to provide adequate exposure. In addition previous intraabdominal surgery can often make trocar placement difficult. Procedure Essential equipment for laparoscopic transperitoneal simple nephrectomy is as follows 15 blade scalpel 10-mm 0 laparoscope 10-mm 30 laparoscope 5-mm 0 laparoscope 5-mm 30 laparoscope 14-gauge Veress
