Open Access”Polar flip” technique for transperitoneal laparoscopic partial nephrectomy – Evolution of a novel technique for posterior hilar tumors
Author(s) -
Mallikarjuna Chiruvella,
Syed Mohammed Ghouse,
Ashwin Sunil Tamhankar
Publication year - 2019
Publication title -
indian journal of urology/indian journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.333
H-Index - 30
eISSN - 1998-3824
pISSN - 0970-1591
DOI - 10.4103/iju.iju_235_18
Subject(s) - medicine , dissection (medical) , nephrectomy , ligation , renal sinus , laparoscopy , surgery , renal artery , kidney
Posterior hilar renal tumor extirpation by partial nephrectomy is a unique challenge for transperitoneal laparoscopy. We describe our novel technique of "polar flip" for these tumors. Kidney is rotated by around 45 -60 degrees after mobilisation so that lower pole faces anteriorly and upper pole faces posteriorly, thereby exposing the posterior surface for maneuverability. Technical highlights are hilar control, complete kidney mobilisation, initial flipping with dissection in Gil Vernet's plane to clip posterior segmental renal artery, en mass hilar clamping in normal lie, polar flipping, dissection in Gil Vernet's plane till renal sinus fat, completion of tumor excision, selective vascular ligation, renorhaphy and nephropexy.