Bảng 2 thiết bị cần thiết cho nephrectomy nội soi cầm tay, hỗ trợ tay thiết bị hỗ trợ 30 ° đơn vị máy ảnh của điệu dao đốt điện đơn vị Weck Hem-o-lock clip và nội soi stapler applier tuyến tính với hộp mực mạch máu góc phải người mổ xẻ Maryland người mổ xẻ Endoshears nội soi needleholder Ringless mở bụng miếng trocar | 148 Kessler and Shichman Table 2 Essential Equipment for Hand-Assisted Laparoscopic Nephrectomy Hand-assist device 30 camera Harmonic scalpel unit Electrocautery unit Weck Hem-o-lock clips and applier Endoscopic linear stapler with vascular cartridges Right-angle dissector Maryland dissector Endoshears Laparoscopic needleholder Ringless laparotomy pads Trocars 5-mm 10- 12-mm Liver retractor Neuro armrest 2-inch cloth tape 3 rolls Pillows and gel pads Upper and lower body warming blankets Pneumatic anti-embolic stockings selection depends on surgeon preference location of hand incision body habitus and patient s history of prior abdominal surgery. TROCAR AND HAND-PORT CONFIGURATION We have used the following hand incision and trocar configurations successfully in more than 300 cases with little modification necessary. Numerous factors must be considered when determining the optimal positioning of trocars and the hand incision. These factors include the specific operation being performed the patient s anatomy the surgeon s experience and the surgeon s hand and forearm size. Although the operation is performed in the flank postion at the start of the case the table is rolled so that the patient is in a near supine position. Placement of the hand incision and trocars is made with the patient in this position because this allows for easier access to the peritoneal cavity and ensures better cosmetic results. The midline should always be marked which aids in trocar placement as well as providing a quick and accurate guide if emergent laparotomy is necessary. The use of 12-mm trocars in all port sites enables the camera and endoscopic stapler to be placed through any trocar to allow maximum flexibility. For a right-sided nephrectomy a 5-mm trocar is used in the right upper quadrant for placement of a liver retractor since a camera or stapler would never be used at this site. The length of the hand incision in centimeters is usually equal to the surgeon s glove size. Once .
