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).

Intravesical Weck clip migration after laparoscopic radical prostatectomy.

Multiple modalities are used for hemostasis during laparoscopic radical prostatectomy. We report an instance of migration of a hemostatic clip into the bladder leading to stone formation. As such, these devices should be used with caution in the region of the vesicourethral anastomosis.

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.

In vitro evaluation of ureteral perforation forces.

Objectives: Ureteroscopy has become a very effective treatment option for ureteral and upper tract abnormalities. The reported complication rates have ranged from 1.5% to 13% for perforations and have been less than 1% for avulsions.

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.

A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy.

Objective: To evaluate the effect of the early use of the vacuum erection device (VED) on erectile dysfunction (ED) and penile shortening after radical retropubic prostatectomy (RP), as these are important concerns for men choosing among treatment alternatives for localized prostate cancer.

Patients And Methods: Twenty-eight men undergoing RP were randomized to early intervention (1 month after RP, group 1) or a control group (6 months after RP, group 2) using a traditional VED protocol. An International Index of Erectile Function (IIEF) score of >11 (no, mild or mild to moderate ED) was required as a baseline criterion for inclusion in the study.

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.

A new spin on the entrapped ureteral calculus.

We describe ureteroscopic lithotripsy using a revolving 1.5F tipless basket. After passing a laser fiber alongside the basket and performing lithotripsy, one uses a rotary wheel at the base of the basket handle to spin the stone to a different area for further fragmentation.

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.

Laparoscopic ureterectomy for the management of painful calculi in a ureteral stump.

We present a rare case of a laparoscopic ureterectomy for the treatment of unusual chronic pain from a large retained stone in a ureteral stump. The history of long-term co morbidities from retained ureteral stumps is reviewed, as well as a discussion on the possible etiology of the pain for this particular patient. An argument for the change of the standard of care for the management of ureters in relation to nephrectomies is also made in regard to adult patients with a history of stone disease.

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.

Radial dilation of ureteral balloons: comparative in vitro analysis.

Background And Purpose: The dynamics of ureteral balloon expansion may differ with increasing extrinsic compressive forces and inflation pressures. This study compared the ability of ureteral balloons to expand under different conditions.

Materials And Methods: The balloons tested were the Cook Accent, Ascend, Ascend AQ, and Pursuit; the Bard 195503 and UroForce; and the Boston Scientific Microvasive UroMax Ultra.

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.

A novel dual-diameter ureteroscope working channel: impact on irrigant flow.

Objectives: To compare irrigant flow characteristics through standard working channels (3.6F to 4.5F) and a dual-diameter working channel.

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.