Laparoscopic and open retroperitoneal lymph-node dissection for clinical stage I nonseminomatous germ-cell testis tumors.

Background And Purpose: Laparoscopic retroperitoneal lymph node dissection (L-RPLND) has been reported as efficacious for staging of the retroperitoneum in patients with stage I nonseminomatous germ-cell testis tumors (NSGCT). However, reports are limited to a few centers, and this procedure has yet to be widely accepted as an alternative to open retroperitoneal lymph node dissection (O-RPLND). Thus, we compared our contemporary open and laparoscopic experience with RPLND.

Telemedicine and surgical robotics: urologic applications.

Medical treatment can be improved through integration and application of advances in technology, computers, and engineering. Accuracy and reliability are essential characteristics of any mechanical system, and with the evolution of machines capable of precise movements, the integration of medicine and machine is achievable. Early mechanical devices were effective in performing simple, repetitive tasks but were not sophisticated enough for independent function.

Laparoscopic decision making: impact of preoperative reading and laparoscopic experience.

Purpose: A competent laparoscopic surgeon requires good technical skills and good surgical judgment. The assessment of technical skills using bench models and simulators has been well studied. However, there has been a paucity of studies examining the cognitive aspects of surgery.

The influence of clinical and pathological stage discrepancy on cancer specific survival in patients treated for renal cell carcinoma.

Purpose: We compared clinical and pathological staging in a contemporary, consecutive series of patients treated with partial or radical nephrectomy for renal cell carcinoma and we determined the effect of clinical and pathological stage discrepancy on outcomes.

Materials And Methods: We collected retrospective clinical, pathological and survival data on 264 consecutive patients with clinical T1-3 renal cell carcinoma who were treated with laparoscopic or open partial or radical nephrectomy at a single institution from 1994 to 2003.

Results: Pathological up staging occurred in 44 of 264 patients (17%) patients.

Radiofrequency ablation of renal tumors: intermediate-term results.

Background And Purpose: Needle ablative therapies are being offered to patients presenting with small renal masses, but long-term outcomes are currently unavailable. We report our intermediate-term results (1-4 years) after radiofrequency ablation (RFA) of small (<4-cm) renal masses.

Patients And Methods: At our institution, all renal tumors treated using RFA since May 2001 have been recorded in a prospective database.

Imaging associated with percutaneous and intraoperative management of renal tumors.

As new minimally invasive treatment options for small renal tumors such as laparoscopic partial nephrectomy (LPN), radiofrequency ablation (RFA), and cryoablation(CA) have been developed, the reliance upon imaging technologies, both intraoperatively and postoperatively, has expanded greatly. CT, MRI, and ultrasonography (US)have proven themselves extremely useful in this regard, but their utility requires a thorough understanding of each modality's limitations, proper intraoperative use, and expected postoperative findings. This article discusses intraoperative use of US for LPN,RFA, and CA.

Large-volume laparoscopic partial nephrectomy using the potassium-titanyl-phosphate (KTP) laser in a survival porcine model.

Objectives: Laparoscopic partial nephrectomy (LPN) remains a technically challenging procedure primarily because of difficulties with hemostasis. In an attempt to develop a hemostatic cutting instrument for laparoscopic partial nephrectomy, we evaluated the potassium-titanyl-phosphate (KTP) laser for use during large-volume laparoscopic partial nephrectomy in a porcine model.

Methods: Transperitoneal lower pole laparoscopic partial nephrectomy was performed in six pigs.

Assessment of basic human performance resources predicts performance of ureteroscopy.

Background: Our objective was to predict endoscopic performance in a cadaver model using basic performance resources (BPRs) measurements.

Methods: Medical students (n = 16) underwent intense ureteroscopic training on a virtual reality ureteroscopy trainer and were rated on performing ureteroscopy on a cadaver. The medical students also underwent 13 validated BPR measurements.

Effect of multisite radiofrequency ablation on porcine renal function.

Background And Purpose: The acute and long-term effects of radiofrequency ablation (RFA) on kidney function have not been well studied. The functional change when RFA is used in combination with renal ischemia is likewise unknown. Our goal was to determine the change in renal function caused by various volumes of RFA on a porcine kidney model and the effect cold ischemia had on the results.

Efficacy of ablative high-dose-per-fraction radiation for implanted human renal cell cancer in a nude mouse model.

Objectives: Stereotactic body radiation therapy (SBRT) is a new therapeutic paradigm that uses a very large dose per fraction treatments (ablative hypofractionation). We investigated the use of ablative hypofractionation in treating human renal cell carcinoma using a nude mouse model.

Methods: Nude mice were injected subcutaneously with A498 human renal carcinoma cells.

Resorbable clip migration in the collecting system after laparoscopic partial nephrectomy.

A complication is reported in which Lapra-Ty absorbable suture clips (Ethicon EndoSurgery) migrated from a laparoscopic partial nephrectomy bed into the collecting system, causing renal colic. During surgery performed with hilar occlusion, visual inspection did not reveal collecting system entry. Transected vessels were oversewn with absorbable suture secured with Lapra-Tys.

Comparison of basic elements of human performance scores between urologists with various extents of experience.

Background And Purpose: An objective evaluation of innate ability and its ability to predict potential success as a surgical trainee is an appealing concept for the selection process of residency applications. The objective of this study was to evaluate whether basic elements of performance (BEP) could discriminate among resident applicants and urologists with various extents of surgical experience.

Subjects And Methods: One hundred forty-five participants were divided into four study groups: group A, 57 urology residency applicants to the 2002 and 2003 interview process; group B, 8 post-internship urology residents; group C, 19 urologists tested with BEP within 10 years of graduation from their residency training program; and group D, 61 urologists who had graduated from their residency training program more than 10 years prior to testing.

Magnetic resonance imaging characteristics of renal tumors after radiofrequency ablation.

Objectives: The interpretation of radiographic findings in renal tumors treated with minimally invasive modalities, such as radiofrequency ablation (RFA), is critical for assessing treatment adequacy. Magnetic resonance imaging (MRI) is commonly used for patients with renal insufficiency or contrast allergy. Because the MRI experience with renal RFA is limited, we reviewed our experience and report the unique MRI characteristics of RFA-treated renal tumors.

Serum laboratory values following uncomplicated laparoscopic urological surgery.

Purpose: Presentation of complications following laparoscopic surgery can be different from corresponding open surgical complications. While leukopenia has been identified as a common finding in patients with unrecognized bowel injury following laparoscopy, to our knowledge no study has determined if leukopenia or other serum abnormalities are unique to patients with laparoscopic complications. We present an analysis of postoperative laboratory values from patients after uncomplicated urological laparoscopic surgery.

Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy.

Background And Purpose: Factors that adversely affect early recovery after major laparoscopic procedures include ileus, pain, nausea, emesis, and fatigue. The objective of this randomized controlled study was to evaluate the impact of a multimodal fast-track (FT) rehabilitation program on recovery and length of hospital stay after laparoscopic nephrectomy.

Patients And Methods: Thirty patients undergoing laparoscopic nephrectomy received either conventional care (control) or an FT recovery program.

Training for renal ablative technique using an agarose-based renal tumour-mimic model.

Objective: To assess whether a recently developed porcine tumour-mimic model can serve as a training model for radiofrequency ablation (RFA) of renal masses, as the increased diagnosis of small occult renal masses has led to the development of nephron-sparing treatments, including RFA, and the techniques required for effective tumour ablation can be difficult to master.

Materials And Methods: Tumour mimics were created by injecting 0.7 mL of an agarose mixture into the parenchyma of a porcine kidney, producing 1-cm spherical lesions which were hyperechoic on ultrasonography (US).

Cytokine response to surgical stress: comparison of pure laparoscopic, hand-assisted laparoscopic, and open nephrectomy.

Background And Purpose: Laparoscopic surgery has been shown to induce less immune suppression than open surgery, presumably because there is less tissue trauma, a factor that may impact oncologic-disease control. The objective of this study was to compare the cytokine and stress response associated with pure laparoscopic, hand-assisted laparoscopic (HAL), and open nephrectomy.

Material And Methods: Fifteen female farm pigs (45-50 kg) underwent transperitoneal laparoscopic, handassisted (HAL), or open nephrectomy (N = 5 in each group).

Effect of warmed, humidified insufflation gas and anti-inflammatory agents on cytokine response to laparoscopic nephrectomy: porcine model.

Purpose: We evaluated the effects of warmed, humidified CO2 and anti-inflammatory agents on the local and systemic cytokine response after laparoscopic nephrectomy.

Materials And Methods: A total of 15 pigs were randomized to undergo standard laparoscopic nephrectomy, laparoscopic nephrectomy with warmed, humidified CO2 gas or laparoscopic nephrectomy with perioperative administration of intravenous dexamethasone and oral rofecoxib. At baseline, and 1, 4, 24 and 48 hours after surgery duplicate blood and peritoneal samples were drawn to analyze cortisol, glucose, tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta and IL-6 via a microassay technique.

Renal radiofrequency ablation: technique and results.

Laparoscopic or percutaneous radiofrequency ablation has become a viable treatment option for small renal tumors. Although long-term results are not yet available, intermediate results show promise for the treatment of select renal lesions. Here, we describe the basics of radiofrequency ablation technology, outline techniques used for both percutaneous and laparoscopic treatment routes, and provide a brief review of clinical results to date.

Cost comparison of laparoscopic versus radical retropubic prostatectomy.

Objectives: To determine the cost of laparoscopic radical prostatectomy (LRP) versus open radical retropubic prostatectomy (RRP) in an actual clinical setting, we analyzed the cost data from a single institution comparing LRP and RRP. LRP is increasing in prevalence, yet questions remain regarding its higher cost versus open RRP.

Methods: A chart and cost review was performed for consecutive patients undergoing LRP (n = 30) and RRP (n = 67) between May 2003 and August 2004.

Application of novel hemostatic agent during laparoscopic partial nephrectomy.

Purpose: We determined if QuikClot, a novel hemostatic agent made of a granulated mineral substance, could be used to control renal parenchymal bleeding and collecting system leakage during open and laparoscopic partial nephrectomy.

Materials And Methods: After obtaining renal hilar vascular control 2 domestic female pigs underwent bilateral open and 4 underwent unilateral laparoscopic partial nephrectomy. After excision of the lower pole without cautery the hemostatic agent was applied to the cut surface of the kidney and hilar vascular control was released.

Retrograde renal cooling during radio frequency ablation to protect from renal collecting system injury.

Purpose: We evaluated the protective effect of continuous retrograde irrigation of ice-cold saline on the renal collecting system during central parenchymal temperature based radio frequency ablation (RFA).

Materials And Methods: In 10 domestic pigs bilateral, centrally located renal parenchymal RFA lesions (intended 2 cm in diameter) were created that intentionally involved the collecting system. RFA probe placement was guided by fluoroscopy with retrograde collecting system opacification and simultaneous direct laparoscopic visualization.

International comparison of cost effectiveness of medical management strategies for nephrolithiasis.

Although medical therapy is known to reduce the risk of kidney stone recurrence, the cost effectiveness of medical prophylaxis is controversial. We evaluated medical treatment strategies including dietary measures (conservative), empiric medical therapy (empiric) or directed medical therapy (directed) based on comprehensive metabolic evaluation (CME) for patients with recurrent kidney stones, and compared the costs of these strategies using cost data from ten different countries. We previously established rates of stone formation in recurrent stone-formers, risk reduction of medical therapy, sensitivity of CME and rates of spontaneous stone passage from a comprehensive literature search (Lotan et al.

Short-term efficacy of temperature-based radiofrequency ablation of small renal tumors.

Objectives: To present our experience using radiofrequency ablation (RFA) for the treatment of small renal tumors. Our objective was to assess the short-term (1 to 3 years) oncologic efficacy of RFA.

Methods: Consecutive renal tumors treated since May 2001 with a minimal follow-up of 6 months were included.