Experimental studies for clinical standardization of transabdominal laparoscopic nephrectomy

In keeping with the maxim that minimal invasiveness is the present working trend in most areas of surgery, we investigated the possibility of laparoscopically removing a diseased human kidney. Before any actual clinical attempt could be made in this direction, an experimental study was set up in order to determine the most beneficial methods and techniques which would guide us through our first clinical cases. This step-by-step training program consists of: (1) initial familiarization with different laparoscopic instruments, bimanual dissection, ligation and coagulation techniques, camera handling and trocar placement as well as organ retrieval systems using the lap simulator; (2) laparoscopic removal of the kidney and ureter of the pig either as short- or long-term study, and (3) laparoscopic simulation with the lap tent during open surgery.