Rosacea More Condition_treatment

Emicolectomia e Nefrectomia destre

patient 59 years old, medium build, 80 Kg weight around. Good condition.
tumor of the right colon at the hepatic flexure and cancer of the right kidney. A number of lymph node metastases.

The operating table was to make the first right hemicolectomy, enclosing the surgical specimen in a endobag, before moving to the right nephrectomy, removing both anatomical parts and then proceed to the ileo-colic anastomosis latero-lateral, all in laparoscopic.

• Container Container Container
• standard laparoscopic conversion laprotomica

Instruments extra

• Thermos
• needle holder
• clipper + video clip big Haemo-lock

Wire Suture & Blades

• Lama 10 x 20 x 1 and 1 for open-access laparoscopy and laparotomy pubic service
• atraumatic braided absorbable 3 / 0 for anastomosis and closing the gap peritoneal
• 0 monofilament absorbable August 26 suprapubic laparotomy for closure of the peritoneum
• braided absorbable atraumatic Aho 0 5 / 8 x 3 for closing the laparotomy
• range of skin-absorbable 3 / 0

• Endo GIA staplers Covidien + Refills endogenous 45 and 60 Blue section of colon anastomosis and packaging
• Refills White 30 mm. vascular section of the renal vein

Garrison

• Trocar 10 x 2 + 1 spindle
• Trocar 5 x 2 + 1 spindle
• Covidien Trocar 15 mm. dell'endobag big step for
• Copritelecamera
• Ligasure 5
• September disposable suction pump for irrigation + Cable MTP
• bag from washing 2000 ml.
• 500-ml bag of saline with 10 ml of Poviderm
• laminar Drainage + bag collection

bed and Positions

• lithotomy position with a thickness on the right side of the patient to highlight the lumbar
• initial horizontal leveling then progressive moderate left lateralization
• right arm abducted to venous access
• Cushion Pak Vac Vacuum and patient positioned on the extreme left edge of the bed
• Monitor places the head and right side of the patient. Touchscreen instrument side cover with a sterile operation of cameras, recordings and accessories from room
• Three surgeons at the patient's left, for the time colic, operator between the legs for the time renal
• Instrument and anastomotic end of the lower right

Description of variables and

1. Positioning of trocars: 10 umbilical, 10 in left hypochondriac region, 5 in the left lower quadrant, 5 in the right hypochondriac region
2. Exploring the repertoire of the cavity and marked with the tumor, with two
3. Johannes Treitz and Repertoire of the loop of the repertoire of vascular elements with Ligasure and Johanne (before patch)
4. Chamber of vascular elements with Clips violet (photo) Ligasure and (photo)
5. Given the many lymph node metastases present, the surgeon proceeded to dissect the first transverse colon (endogenous Covidien with charging 60 Blue) and then managed to unplugged the hepatic flexure of the colon and to effect the posting of the same shower right parieto-colic. All with bipolar Ligasure (second patch)
6. section of the loop ileostomy to about 2 cm from the ileocecal valve with charging 60 with endogenous Covidien Blu
7. placement of suprapubic trocar Covidien 15 mm. dell'endobag and introduction of 15 mm. Insertion of the same anatomical part and its repositioning in the right iliac fossa of the right ureter
8. Search with Ligasure Bipolar and, to be used as a marker for the detection of vascular elements (right renal artery and vein)
9. Section ureter after application of clips Haemo-Lock 10 mm. and section with Ligasure
10. vsscolari Identification of the elements. Section on the left main renal artery, with the use of Haemo-Lock Clips 10 mm. and section with Ligasure.
    The renal vein was conspicuous dimensions so that, after her finding with Vesseloop set with red clip, the surgeon has dissected with endogenous Covidien charging with 30 mm vascular.
11. Isolation and mobilization of the right kidney with perirenal fat and capsule, with Ligasure, Johanne and Bipolar
12. Inserting new EndoBag large and "capture" of the kidney.
13. Minilaparatomia suprapubic and extraction of the two anatomical parts with the help of pliers ring
14. single layer closure of the peritoneal (0 monofilament absorbable August 26) of minilaparatomia
15. Recovery Room and peritoneal removal of the gauze.
    During the operation one of these Garzino (from 7.5 mm x 7.5 mm) has migrated into the region left parieto-colic, managing to disguise themselves.
    The ability of these principals to take very small and apparently migrate into regions not affected by abdominal surgical operations - per share of flows abdominal surgical actions and the repositioning of the patient - must insist on the maintenance a high level of attention.
    After a thorough search, has been removed. Be careful!
16. Packaging ileo-colic anastomosis latero-lateral
    1. Application of first countertraction
    2. Inserting gauze Poviderm
    3. Execution of two Tomie - with scissors - on the ileal and colonic loops for introduction of the stapler
    4. Insertion of the stapler (Covidien with endogenous charging Blue 45 mm.) packaging and the anastomosis
    5. extraction and control of haemostasis endoluminal stapler
    6. Closing the gap with anastomotic points braided absorbable 3 / 0 Aug. 26 mm. length of about 18 cm.
17. hemostasis control, peritoneal toilet, laminar positioning of drainage in the right renal loggia
18. count of instruments and garzame
19. Removing trocars and closing of the accesses.