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By Andrew C. Novick, Inderbir S. Gill, Eric A. Klein, Raymond Rackley, Jonathan H. Ross

Greater than fifty full-time urological clinicians and surgeons from the the world over acclaimed Cleveland medical institution Glickman Urological Institute describe the most typical in addition to the main cutting edge urological techniques from the perspective of the cutting-edge, because it is practiced at one of many world's most sensible associations. Their accomplished atlas of urological surgical procedure deals a special marriage of informative textual content with terrific illustrations to supply precise, step by step descriptions of the entire frequently played inpatient and outpatient urological operations, together with more moderen ways, reminiscent of laparoscopic and minimally invasive surgical procedure. Highlights contain robot and laparoscopic prostatectomy, open and lapaoscopic partial nephrectomy, renal transplantation, the male sling, and minimally invasive remedies for urological stipulations.

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The dissection of the peri-aortic and peri-caval lymph nodes is then carried downward en bloc to the origin of the inferior mesenteric artery. The sympathetic ganglia and nerves are removed together with the lymphatic tissue. The cisterna chyli is identified medial to the right crus, and entering lymphatic vessels are secured to prevent the development of chylous ascites. A thoracoabdominal incision is preferable when performing radical nephrectomy for a large upper pole tumor. Once the liver has been retracted upward into the chest, the hepatic flexure of the colon and the duodenum are reflected medially to expose the anterior surface of the kidney and great vessels (Fig.

Decannulation takes place, and protamine sulfate is administered to reverse the effects of the heparin. Platelets, fresh-frozen plasma, desmopressin acetate, or their combination may be provided when coagulopathy is suspected. Aprotinin has also proven effective in reversing the coagulopathy associated with cardiopulmonary bypass but may induce thrombotic complications. Mediastinal chest tubes are placed but the abdomen is not routinely drained. In patients with nonadherent supradiaphragmatic vena caval tumor thrombi that do not extend into the right atrium, veno-venous bypass in the form of a caval-atrial shunt is a useful technique (18,19 ( 9).

These cannulas are connected to a primed pump to maintain adequate flow from the vena cava to the right heart (Fig. 13). This avoids the obligatory hypotension associated with temporary occlusion of the intrapericardiac and infrarenal vena cava. Following the initiation of veno-venous bypass, the abdominal vena cava is opened and the thrombus is removed. If bleeding from the hepatic veins is troublesome during extraction of the thrombus, the porta hepatis may also be occluded (Pringle maneuver).

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