Robotic Partial Nephrectomy: Difference between revisions

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**** '''On the right side, the right triangular ligament may be divided to lift the liver off the upper pole.'''

***** On the right lobe of the liver, the anterior and posterior layers of the coronary ligament of the liver join to form the right triangular ligament.[https://www.kenhub.com/en/library/anatomy/liver-ligaments]

***** ~~The falciform~~ ligament runs along the anterior surface of the liver~~. Superiorly, the falciform ligament~~ is attached to the ~~visceral aspect of~~ the ~~anterior abdominal wall.[https://www.kenhub~~.~~com/en/library/anatomy/liver-ligaments]~~

***** [[wikipedia:Falciform_ligament|Falciform ligament]] runs along the anterior surface of the liver and is attached on one end to the peritoneum behind the right rectus abdominis muscle and the diaphragm.

*** '''Identify ureter and gonadal vein'''. Use 30 degrees up camera. Use the 4th arm to retract the kidney laterally after sufficient medialization of the bowel. The mid-ureter is identified along the anterior aspect of the psoas, just inferior to the lower pole of the kidney. If too inferior, ureter will be medial and goal is to get under it so better to approach closer to lower pole. Once the ureter is identified, dissect a plane medial and parallel to the ureter +/- gonadal vein.

**** At times, especially early in the experience, the psoas tendon or the iliac artery may be confused with the ureter. It is important to look for the peristalsis of the ureter in case of confusion.

@@ Line 187: / Line 187: @@
 **** '''On the right side, the right triangular ligament may be divided to lift the liver off the upper pole.'''
 ***** On the right lobe of the liver, the anterior and posterior layers of the coronary ligament of the liver join to form the right triangular ligament.[https://www.kenhub.com/en/library/anatomy/liver-ligaments]
-***** The falciform ligament runs along the anterior surface of the liver. Superiorly, the falciform ligament is attached to the visceral aspect of the anterior abdominal wall.[https://www.kenhub.com/en/library/anatomy/liver-ligaments]
+***** [[wikipedia:Falciform_ligament|Falciform ligament]] runs along the anterior surface of the liver and is attached on one end to the peritoneum behind the right rectus abdominis muscle and the diaphragm.
 *** '''Identify ureter and gonadal vein'''. Use 30 degrees up camera. Use the 4th arm to retract the kidney laterally after sufficient medialization of the bowel. The mid-ureter is identified along the anterior aspect of the psoas, just inferior to the lower pole of the kidney. If too inferior, ureter will be medial and goal is to get under it so better to approach closer to lower pole. Once the ureter is identified, dissect a plane medial and parallel to the ureter +/- gonadal vein.
 **** At times, especially early in the experience, the psoas tendon or the iliac artery may be confused with the ureter. It is important to look for the peristalsis of the ureter in case of confusion.