Retroperitoneal access
Access to the retroperitoneum in the operating room has traditionally been through a flank or posterior incision to avoid violation of the peritoneal cavity. This approach provides urologists the most…
Stapling and reconstruction
Since the introduction of the laparoscopic nephrectomy in 1991 by Clayman and colleagues, advancements in minimally invasive surgical equipment have expanded the application of laparoscopic techniques to several reconstructive urologic…
Insufflators and the pneumoperitoneum
Indications and contraindications Pneumoperitoneum is an essential component in any transperitoneal laparoscopic or robotic-assisted surgery. Instillation of gas into the peritoneum allows distention of the peritoneal space to safely visualize…
Laparoscopic/robotic camera and lens systems
Introduction It has been said that the key to a successful open surgery is exposure. Similarly, the imaging modality used in endoscopic surgery, whether it is laparoscopic or robotic-assisted laparoscopic…
Perioperative management: Pain and other considerations for enhanced recovery after surgery (ERAS)
Advances in laparoscopic, and later robotic urologic, surgery, came about in quantum leaps, ignited by the first laparoscopic radical nephrectomy in 1990. These advances resulted in a sudden rush to…
Robotic surgical systems
Introduction Robotic-assisted surgical devices (RASDs) have revolutionized minimally invasive surgery since 1994. The market leader, Intuitive Surgical, reports their product involvement in over 7.2 million procedures worldwide, and in 2018,…
Anesthetic considerations for laparoscopic and robotic-assisted surgery
Introduction Laparoscopic and robotic-assisted laparoscopic procedures are widely used in urologic surgery, conferring significant benefits to patients and improving outcomes. Benefits include reduced postoperative pain, faster recovery, shorter hospital stay,…
Considerations for the assistant
Trends in health care predict increased use of assistants, or advanced practice providers (APPs), by physicians in the treatment and care of patients. For the urologist in the operating room,…
Basic instrumentation
The ubiquitous adoption of laparoscopic, and more recently, robotic surgery in many surgical disciplines has resulted in a wide variety of laparoscopic and robotic instruments. Herein we describe commonly used…
Patient preparation and positioning for laparoscopic and robotic urologic surgery
Introduction Appropriate patient selection, thorough preparation, and careful patient positioning are essential in achieving a safe and successful outcome in laparoscopic surgery. Regardless of a particular surgeon’s technical expertise, inadequate…
