Long-Term Body Mass Index Trends After Living-Donor Nephrectomy.

Objectives: As the demand for kidney transplant allografts has increased, many centers are expanding the upper limit of acceptable body mass index for kidney donors. However, obesity is a risk factor for developing renal disease. Our goal was to quantify body mass index trends in donor nephrectomy patients and to institute nutrition counseling to promote sustainable weight loss to reduce the risk of metabolic syndrome-derived renal dysfunction.

Trends in Body-Mass Index After Donor Nephrectomy.

The link between obesity and diabetes, hypertension, and eventual kidney dysfunction is well recognized. To evaluate trends in the body-mass index (BMI) of donor nephrectomy patients, the BMI was evaluated in 532 donors over 11 years from 2002 to 2012. Measurements were made preoperatively, at 1 year, and at the present time.

A comparison of running suture versus figure-8 sutures as the initial step in achieving hemostasis during laparoscopic partial nephrectomy.

Background And Purpose: During laparoscopic partial nephrectomy, the importance of the initial suture placed under warm ischemic conditions cannot be underestimated. Inadequate hemostasis may lead to further surgical complications. Our goal was to determine which method of suture ligation (running vs figure-8 interrupted) provides better initial hemostasis when performing partial nephrectomy in an ex-vivo porcine model.

Percutaneous biopsy of renal cell carcinoma underestimates nuclear grade.

Objectives: To assess the accuracy of renal biopsy for predicting the final nuclear grade and histologic subtype. Small renal masses can be safely observed in select patients who are poor surgical candidates. Renal biopsy may help identify patients who are candidates for observation.

Urolithiasis in adults with congenital megaureter.

The primary presentation of congenital megaureter in adults is rare. Development of urolithiasis may lead to this unusual underlying diagnosis. Urinary tract stones can form either within the dilated ureteral segment or in a part of the upper urinary tract proximal to the abnormal ureteral segment.

Enlargement of accessory spleen after splenectomy can mimic a solitary adrenal tumor.

We report on a 72-year-old woman who had previously undergone splenectomy and subsequently presented with an incidental 5-cm adrenal mass. Laparoscopic adrenalectomy was performed, and the mass was identified to be an accessory spleen. Remaining accessory splenic tissue may undergo compensatory hypertrophy after splenectomy.

Adrenal metastasis with inferior vena cava tumor thrombus through adrenal vein.

A 69-year-old woman was evaluated for anemia. Abdominal ultrasonography showed a large right renal mass. Magnetic resonance imaging revealed a 12-cm renal mass and a separate 7.

Delayed hematuria secondary to bleeding papilla--potential complication of laparoscopic partial nephrectomy.

The complications of partial nephrectomy include hemorrhage, urinary leak, infection, formation of urinary fistula, and the development of renal insufficiency. We report a unique case of a patient who was found to have necrotic-appearing, bleeding, renal papillae after undergoing laparoscopic partial nephrectomy. A 66-year-old man was diagnosed with a left-sided, solid, enhancing, 2.

Video rounding system: a pilot study in patient care.

Background And Purpose: Integration of information technology (IT) with health care improvement is ever increasing. National initiatives, such as Transforming Care at the Bedside, and physician-nurse collaboration committees use IT to enhance patient care. We sought to determine the impact of "video rounding" on the post-operative care of endourologic inpatients.

Laparoscopic nephrectomy outcomes of elderly patients in the 21st century.

Background And Purpose: As life expectancy continues to increase, we will be faced with the need to counsel older patients on the risks and benefits of undergoing surgery. It is clear that laparoscopic renal surgery has significant benefits over open renal surgery. However, contemporary data on whether these benefits carry over to the elderly is less robust.

Simultaneous bilateral retrograde intrarenal surgery for stone disease in patients with significant comorbidities.

Background And Purpose: Advances in endoscopic equipment have allowed urologists to access stones in virtually any location in the upper tracts. Where clinically appropriate, this approach may represent the preferred treatment option, regardless of stone size. We report the first description of simultaneous bilateral retrograde intrarenal surgery (SB-RIRS) in patients with both significant upper-tract stone burdens and comorbidities such as morbid obesity or heart disease.

Multi-institutional validation study of neural networks to predict duration of stay after laparoscopic radical/simple or partial nephrectomy.

Purpose: We developed models to predict post-laparoscopic radical or simple nephrectomy (LapNx) and post-laparoscopic partial nephrectomy (LapPNx) hospital duration of stay (DOS).

Materials And Methods: We performed a retrospective review (design group) of all 726 patients (July 1997 to April 2004) who underwent LapNx or LapPNx at the Cleveland Clinic Foundation (CCF). Preoperative findings were recorded.

Bladder reconstitution with bone marrow derived stem cells seeded on small intestinal submucosa improves morphological and molecular composition.

Purpose: Tissue engineering has been used for bladder augmentations with small intestinal submucosa (SIS). Although favorable short-term outcomes have been reported, long-term followup has been poor. We investigate whether tissue engineering with stem cells improves the morphological and genetic composition.

Looped silk tie: surgical technique for management of the renal vein during laparoscopic live-donor nephrectomy.

Laparoscopic live-donor nephrectomy has revolutionized the field of kidney transplantation and has been adopted in many tertiary centers as the method of choice in procuring kidneys. While standard techniques for laparoscopic live-donor nephrectomy have been well described in the literature, there continues to be ample discussion about renal-vein ligation. Endo-GIA and other commonly used vascular stapling devices can be costly and prone to mechanical failures and may not be applicable in certain anatomic situations.

Simultaneous bilateral retrograde intrarenal surgery for bilateral complex upper tract stone disease.

Recent advances in retrograde endoscopy have greatly expanded the role of minimally invasive surgery in addressing upper tract stone disease. In an attempt to decrease patient morbidity further, we present our initial experience with simultaneous bilateral retrograde intrarenal surgery in a patient with complex bilateral upper tract stones.

Newly designed laparoscopic retractable dissector and suture passer.

We introduce a novel laparoscopic instrument that performs as a dissector and retractable suture passer in preparation for intracorporeal knot tying. The newly designed instrument was developed at our institution to duplicate techniques of vessel ligation in open surgery.

Laparoscopic dismembered pyeloureteroplasty: a single institution's 3-year experience.

Purpose: To review our most recent experience with laparoscopic dismembered pyeloureteroplasty (LDP) as treatment for ureteropelvic junction (UPJ) obstruction.

Patients And Methods: All patient charts from March 1, 2000, through March 1, 2003, were reviewed to identify individuals who had undergone LDP. Twenty-two consecutive procedures were performed on 21 patients.

Spontaneous, unremitting gross hematuria occurring one week after laparoscopic donor nephrectomy.

Complications associated with the ureteral stump after nephrectomies rarely occur, especially after donor nephrectomies. The potential for the slippage of clips is a well-known event associated with vascular ligations. We report on the first case of clip slippage from the ureter and describe diagnosis and management of the most extreme of morbid presentations.

Laparoscopic skills training using a webcam trainer.

Purpose: Many sophisticated and expensive trainers have been developed to assist surgeons in learning basic laparoscopic skills. We developed an inexpensive trainer and evaluated its effectiveness.

Materials And Methods: The webcam laparoscopic training device is composed of a webcam, cardboard box, desk lamp and home computer.

Early experience with laparoscopic cryoablation in patients with small renal tumors and severe comorbidities.

Purpose: To present our preliminary experience with laparoscopic renal cryoablation in patients with small renal tumors and severe comorbidities.

Patients And Methods: Eight patients with a mean age of 75.6 years (range 68-82 years) who had small (mean 2.

Endoscopic surgery for renal calculi.

Purpose Of Review: Endoscopic surgery plays an important role in the treatment of renal calculi, especially for the more complex cases. Recent advancements have improved the efficacy of procedures, and increasing surgeon experience is associated with low complication rates. This article will review recent literature pertinent to endoscopic surgery for renal calculi.

Hand-assisted and conventional laparoscopic live donor nephrectomy: a comparison of two contemporary techniques.

Background And Purpose: Laparoscopic nephrectomy may make kidney donation more attractive. Modifications such as hand assistance may improve surgical outcomes. We compared our initial experience with hand-assisted laparoscopic nephrectomy with that of the conventional laparoscopic technique.