Evaluation of efficacy of four laparoscopic needle drivers.

Introduction: To evaluate the impact of needle driver design on laparoscopic suturing skills by experts and novices.

Methods: Three experienced laparoscopic surgeons and 3 novice junior residents were asked to perform a fixed set of suturing tasks in a laparoscopic pelvic-trainer. The laparoscopic needle drivers compared were (1) the Ethicon driver (E 705R), (2) Karl Storz (KS) pistol grip (26173 KC), (3) KS finger grip (26167 SK), and (4) KS palm grip (26173 ML).

Case report: renal infarct mimicking renal mass: further rationale for minimally invasive management.

A 55-year-old man presented with an exophytic asymptomatic right renal lower-pole mass simulating a renal-cell carcinoma. He underwent retroperitoneoscopic partial nephrectomy, and histopathologic examination revealed a chronic renal infarct with calcifications. We report this case to stimulate the inclusion of focal chronic renal infarct in the differential diagnosis of asymptomatic renal masses, as well as to advocate a minimally invasive approach to appropriate renal lesions.

Novel technique of knotless hemostatic renal parenchymal suture repair during laparoscopic partial nephrectomy.

Free-hand parenchymal suturing during warm-ischemia, laparoscopic partial nephrectomy is a complex and time-sensitive task. We describe a relatively simpler technique of achieving renal parenchymal hemostasis during laparoscopic partial nephrectomy using a polymer self-locking (Hem-o-Lok) clip.

Novel technique for removal of misdirected laparoscopic Weck clips.

The Weck clip has emerged as an attractive option for laparoscopic vascular control. It is secure and easy to use. However, once fired, the clip can be difficult to remove.

Novel device to assist urethrovesical anastomosis during laparoscopic radical prostatectomy.

We evaluated a novel urethral sound (Benique sound-Karl Storz) to assist suturing during laparoscopic radical prostatectomy. This sound provides for a more secure grip compared with the traditional sound, thereby affording controlled traction of the gland during the procedure and smooth coordinated movements of the sound during the anastomosis.

Transperitoneal versus retroperitoneal laparoscopic partial nephrectomy: patient selection and perioperative outcomes.

Purpose: We compared the results of transperitoneal (T) and retroperitoneal (R) approaches to laparoscopic partial nephrectomy (LPN) in regard to perioperative outcomes and technical considerations, thereby, identifying patient selection guidelines for each approach.

Materials And Methods: The choice of approach was dictated primarily by tumor location, that is TLPN for anterior or lateral lesions and RLPN for posterior or posterolateral lesions. The approaches differed primarily by the hilar control technique.

Impact of intraoperative heparin on laparoscopic donor nephrectomy.

Purpose: At many centers systemic heparinization is performed during laparoscopic donor nephrectomy because of concerns regarding graft thrombosis. However, no consensus exists in this regard. We evaluated the impact of intraoperative heparin on donor and recipient outcomes.

Dismembered percutaneous endopyeloplasty: a new procedure.

Purpose: We recently described a novel technique of percutaneous non-dismembered endopyeloplasty (Fenger type). Herein, we extend this transrenal technique further and report percutaneous dismembered endopyeloplasty (Anderson-Hynes type).

Materials And Methods: In five pigs with unilateral ureteropelvic junction (UPJ) obstruction created 3 to 6 weeks earlier, percutaneous dismembered endopyeloplasty was performed.

Improved hemostasis during laparoscopic partial nephrectomy using gelatin matrix thrombin sealant.

Objectives: To evaluate whether using a biologic hemostatic sealant facilitates hemostasis during laparoscopic partial nephrectomy. Secure and durable parenchymal hemostasis is a critical requirement during laparoscopic partial nephrectomy.

Methods: Since September 1999, laparoscopic partial nephrectomy has been performed in more than 300 patients by a single surgeon, duplicating open surgical principles.

The impact of warm ischaemia on renal function after laparoscopic partial nephrectomy.

Unlabelled: Authors from Cleveland assessed the impact of warm ischaemia on renal function, using their large database of laparoscopic partial nephrectomies for tumour. While agreeing that renal hilar clamping is essential for precise excision of the tumour, and other elements of the operation, the authors indicate that warm ischaemia may potentially damage the kidney. However, they found that there were virtually no clinical sequelae from warm ischaemic of up to 30 min.

Complications of laparoscopic partial nephrectomy in 200 cases.

Purpose: We analyzed complications of the initial 200 cases treated with laparoscopic partial nephrectomy for a suspected renal tumor.

Materials And Methods: Since August 1999, 200 consecutive patients have undergone laparoscopic partial nephrectomy. Mean patient age was 61.

Laparoscopic radical nephrectomy for large (greater than 7 cm, T2) renal tumors.

Purpose: Laparoscopic radical nephrectomy has emerged as a standard of care in appropriate candidates with clinical stage T1 renal tumors (7 cm or less). Herein we present our experience with laparoscopic radical nephrectomy for clinical stage T2 tumors (greater than 7 cm).

Materials And Methods: Patients undergoing laparoscopic radical nephrectomy between September 1997 and July 2003 were retrospectively subdivided into group LAPT1-166 with tumor size 7 cm and group LAPT2-65 with tumor size greater than 7 cm.

Histopathologic confirmation of complete cancer-cell kill in excised specimens after renal cryotherapy.

We present the first case of complete documentation of total cancer ablation in a previously cryoablated human renal tumor. A 61-year-old patient with metachronous bilateral renal cell carcinoma was treated with open partial nephrectomy and subsequently laparoscopic cryoablation. His renal function deteriorated, prompting bilateral radical nephrectomy before renal transplantation.

Laparoscopic nephron-sparing surgery for two or more ipsilateral renal tumors.

Objectives: To review our experience with laparoscopic nephron-sparing surgery in the management of two or more synchronous, ipsilateral renal masses. Minimally invasive nephron-sparing procedures are increasingly used for the treatment of select patients with a single, small renal tumor.

Methods: Since 1998, we have performed laparoscopic nephron-sparing surgery in 288 consecutive patients, including laparoscopic partial nephrectomy (n = 200) and renal cryotherapy (n = 88).

Critique of laparoscopic lymphadenectomy in genitourinary oncology.

Regional lymphadenectomy is prognostic and selectively therapeutic in urologic oncology. The role of lymphadenectomy continues to be defined with the evolving multimodal management of genitourinary malignancies. Laparoscopy is playing a greater role in the management of genitourinary malignancies and thus, it is germane to critique the role of laparoscopic lymphadenectomy in the management of these tumors.

Real-time transrectal ultrasonography during laparoscopic radical prostatectomy.

Purpose: We describe the technical aspects of real-time transrectal ultrasound (TRUS) monitoring and guidance during laparoscopic radical prostatectomy (LRP). Furthermore, we describe the TRUS visualized anatomy of periprostatic structures during LRP.

Materials And Methods: In 25 consecutive patients undergoing transperitoneal LRP, baseline preoperative, real-time intraoperative and immediate postoperative TRUS evaluations were performed.

Thoracic complications during urological laparoscopy.

Purpose: We documented thoracic related complications during urological laparoscopic surgery.

Materials And Methods: A total of 1129 patients underwent major urological laparoscopic procedures in a 5-year period. Operative reports and postoperative radiographic reports were retrospectively reviewed to identify patients with thoracic related medical and surgical sequelae.

Laparoscopic radical adrenalectomy with adrenal vein tumor thrombectomy: technical considerations.

Purpose: We describe the technique of adrenal vein tumor thrombectomy during laparoscopic radical adrenalectomy for cancer.

Materials And Methods: During laparoscopic adrenalectomy for a heterogeneous 7 cm left adrenal mass an adrenal vein thrombus was detected intraoperatively. Laparoscopic ultrasonography was used to delineate precisely the tumor thrombus and its extension into the left main renal vein.

Laparoscopic live donor nephrectomy in the presence of circumaortic or retroaortic left renal vein.

Purpose: Laparoscopic live donor nephrectomy is now an accepted alternative to open surgery in donors with normal renal vasculature. However, the suitability of laparoscopy for donors with anomalous vasculature is less well known. We compared the donor and recipient outcome data of 16 patients with circumaortic or retroaortic left renal vein to 20 recent patients with normal left renal venous anatomy undergoing laparoscopic donor left nephrectomy.

Laparoscopic nephron-sparing surgery in the presence of renal artery disease.

Introduction: To describe the technical considerations of laparoscopic nephron-sparing surgery in 3 complicated cases involving kidneys with renal arterial disease.

Technical Considerations: Three candidates for nephron-sparing surgery each had a renal mass, measuring 5.0, 3.

Laparoscopic upper pole partial nephrectomy with concomitant en bloc adrenalectomy.

Objectives: To report our experience with laparoscopic partial nephrectomy for renal tumor with concomitant adrenalectomy. An upper pole renal tumor may contiguously involve the adrenal gland, requiring concomitant adrenalectomy. Although commonly performed in the setting of laparoscopic radical nephrectomy, concomitant adrenalectomy has not been described during laparoscopic partial nephrectomy.

Ureteral tissue balloon expansion for laparoscopic bladder augmentation: survival study.

Background And Purpose: The search for the perfect urinary bladder substitute continues. Despite their inherent limitations, intestinal segments remain the commonest material for bladder reconstruction. The ureter, with its transitional epithelium, may be the ideal tissue to augment the bladder.

Prospective comparison of 3-dimensional volume rendered computerized tomography and conventional renal arteriography for surgical planning in patients undergoing laparoscopic donor nephrectomy.

Purpose: We prospectively assessed the accuracy of 3-dimensional (3-D) volume rendered computerized tomography (CT) and conventional renal arteriography to visualize renovascular anatomy in patients undergoing laparoscopic donor nephrectomy.

Materials And Methods: A total of 60 consecutive patients undergoing laparoscopic donor nephrectomy (left side in 46 and right side in 14) prospectively underwent 3-D CT and renal angiography. A short videotape of 3-D CT was prepared using volume rendering software that demonstrated the anatomical location, number, anomalies and spatial interrelationships of the renal arteries and veins.

Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience.

Purpose: We describe a novel technique of laparoscopic renal hypothermia with intracorporeal ice slush during partial nephrectomy as well as clinical experience with the initial 12 patients.

Materials And Methods: A total of 12 select patients with an infiltrating renal tumor who were candidates for nephron sparing surgery underwent transperitoneal laparoscopic partial nephrectomy with renal hypothermia. An Endocatch II (United States Surgical Corp.