Lower extremity neuropathies after robot-assisted laparoscopic prostatectomy on a split-leg table.

Background And Purpose: Lower extremity neuropathies from prolonged lithotomy positioning have been well documented. When we initiated our robot-assisted laparoscopic prostatectomy (RALP) program in December 2002, we chose to use the split-leg table that allows patient support in a more anatomic position, hypothesizing that this would reduce risk of neurologic compression injuries. We report our incidence of lower extremity neuropathies associated with RALP using split-leg positioning and review patient and surgical variables associated with this complication.

Laparoscopic warm-up exercises improve performance of senior-level trainees during laparoscopic renal surgery.

Background And Purpose: Surgery is a high-stakes "performance." Yet, unlike athletes or musicians, surgeons do not engage in routine "warm-up" exercises before "performing" in the operating room. We study the impact of a preoperative warm-up exercise routine (POWER) on surgeon performance during laparoscopic surgery.

Current minimally invasive practice patterns among postgraduate urologists.

Purpose: To determine laparoscopic and robotic surgical practice patterns among current postgraduate urologists.

Materials And Methods: There were 9,095 electronic surveys sent to practicing urologists with e-mail addresses registered with the American Urological Association.

Results: Responses were received from 864 (9.

Successful outcomes of older donors in laparoscopic donor nephrectomy.

Background And Purpose: Healthy older living donors (> 50 years) are helping meet increasing demands for kidney transplantation. Live donor grafts perform better than cadaveric donor grafts; however, concern surrounds the expected nephron loss of the donors as well as the relative safety to the donor. We examined the effect age had on living laparoscopic donor and recipient outcomes at a single institution.

Lessons learned from a case of calf compartment syndrome after robot-assisted laparoscopic prostatectomy.

Robot-assisted laparoscopic prostatectomy is rapidly gaining favor as a minimally invasive method to surgically address prostate cancer. The sophisticated equipment and unique positioning requirements of this technology require exceptional preparation and attention to detail to minimize the chance of surgical complications. We present the case of a 57-year-old man who developed left calf compartment syndrome after (robot-assisted laparoscopic prostatectomy) requiring fasciotomies.

Complications of laparoscopic renal surgery.

Purpose: Laparoscopic renal surgery has become a standard of care over the past decade worldwide. Although more complex laparoscopic renal procedures are being routinely performed worldwide today, complications can occur with any laparoscopic operation. Intraoperative and postoperative complications may occur in patients undergoing laparoscopic renal procedures by urologic surgeons with all degrees of laparoscopic experience.

Robotic-assisted laparoscopic reconstruction of the upper urinary tract: tips and tricks.

Objectives: To examine whether simple tips and tricks provided in this manuscript and video make robotic reconstruction of the urinary tract possible from the renal calyx to the bladder. The da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) has been widely accepted by urologists for complex reconstructive maneuvers such as radical prostatectomy and pyeloplasty.

Laparoscopic management of caliceal diverticulum.

Introduction: Minimally invasive approaches for the treatment of symptomatic caliceal diverticula have become the standard of care. Laparoscopy has been embraced by many urologists and now accounts for many commonly performed approaches to urologic surgery. The laparoscopic approach to treating symptomatic caliceal diverticula adds yet another tool in the urologist's armamentarium for this pathologic entity.

Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons.

Purpose: With the exponential growth of robotic urological surgery, particularly with robot assisted radical prostatectomy, guidelines for safe initiation of this technology are a necessity. Currently no standardized credentialing system exists to our knowledge to evaluate surgeon competency and safety with robotic urological surgery performance. Although proctoring is a modality by which such competency can be evaluated, other training tools and guidelines are needed to ensure that the requisite knowledge and technical skills to perform this procedure have been acquired.

Laparoscopic renal tumor cryoablation: appropriate application of real-time ultrasonographic monitoring.

Background And Purpose: Many authors who report outcomes of laparoscopic cryoablation for renal tumors comment that real-time intracorporeal ultrasonographic monitoring of the ice-ball formation is imperative. In our experience, ultrasonographic monitoring of the ice-ball formation necessitates significantly more mobilization of the kidney, and the images are difficult to interpret because of artifact and the cryoablation effect on the tissue. We report our intermediate outcomes for laparoscopic cryoablation without real-time ultrasonographic monitoring of the ice ball.

Robot-assisted laparoscopic excision and ureteroureterostomy for congenital midureteral stricture.

Congenital ureteral strictures most commonly occur at the proximal and distal segments of the ureter. Congenital midureteral stricture is a rare entity that is usually detected by prenatal ultrasonography and repaired in infants. We present the case and video of a congenital midureteral stricture in a 20-year-old woman who presented with a severe episode of pyelonephritis.

Hurdles to helium gas laparoscopy and a readily available alternative.

Background And Purpose: Although multiple series of helium insufflation-assisted laparoscopic surgery are reported, we encountered difficulty at many levels when arranging a laparoscopic nephrectomy with helium insufflation. We present our experience with attempting to use helium gas as an insufflant and our successful use of argon gas as an adjunct to CO(2) insufflation with a case report as illustration.

Materials And Methods: The patient is a 66-year-old man with a progressively enlarging 3.

Laparoscopic donor nephrectomy.

Since it first was performed in 1995, laparoscopic donor nephrectomy (LDN) has grown to be the standard of care in most transplant centers in the United States. This article reviews the current indications, selection criteria, surgical approaches, outcomes, and complications of LDN.

Prospective evaluation of factors affecting operating time in a residency/fellowship training program incorporating robot-assisted laparoscopic prostatectomy.

Background And Purpose: A current dilemma is how to incorporate robot assisted laparoscopic radical prostatectomy (RALP) into residency/fellowship programs while containing costs and maintaining acceptable operative times. We prospectively analyzed factors that affect the time of nine separate RALP steps performed in a residency/fellowship training program incorporating the da Vinci robot.

Materials And Methods: A prospective evaluation of 50 consecutive RALP performed by a single surgeon while incorporating trainees was completed.

Robotics in urology: past, present, and future.

The modern-day urologist is continually armed with new instruments and technology aimed at decreasing the overall invasiveness of urologic procedures. Robotic technology is aimed at improving clinical outcomes by correcting human technical inadequacies such as hand tremors and imprecise suturing. The first reported use of robotics to assist with surgery was in 1985, and the first use of robotics in urology was published in 1989.

Fellowship in endourology, the job search, and setting up a successful practice: an insider's view.

The field of endourology, which encompasses genitourinary endoscopy and percutaneous, laparoscopic, and robotic surgery, has advanced rapidly over the past quarter century, causing endourology to be considered a subspecialty of urology. The Endourological Society, which is recognized by the American Urological Association, offers numerous clinical and research fellowship opportunities throughout the world. The decision to seek postresidency fellowship training in endourology is complex as is the process of seeking subsequent employment.

Systemic and cell-specific immune response to laparoscopic and open nephrectomy in porcine model.

Purpose: To determine differences in the systemic and cell-specific immune response to open and laparoscopic nephrectomy in the porcine model.

Materials And Methods: Twenty male pigs (25-40 kg) were vaccinated with human adenovirus containing ovalbumin (Ova) and 3 weeks later underwent a sham procedure (N = 4), laparoscopic nephrectomy (LN)(N = 8), or open nephrectomy (ON) (N = 8). Blood was collected after anesthesia induction and immediately and 24 and 48 hours postoperatively and assayed for complete blood count (CBC), cortisol, and C-reactive protein (CRP).

State-of-the-art surgical management of renal cell carcinoma.

There is a recognizable increase in the incidence of renal cell carcinoma and a parallel rise in the surgical management of renal cell carcinoma has occurred. However, recent literature shows that not all small, suspected renal cell carcinoma needs to be treated surgically, especially in elderly patients or those with multiple medical comorbidities. The surgical options for renal cell carcinoma have expanded from traditional open nephrectomy to partial nephrectomy and, at present, more recent outcomes data are available for the laparoscopic versions of these surgeries.

Laparoscopic management of bilateral page kidneys.

Hyper-reninemic hypertension as a result of renal compression is often referred to as a "Page" kidney. We present a case of a patient with bilateral Page kidneys from subcapsular hematomas as a complication of extracorporeal shock wave lithotripsy. After several attempts at percutaneous and laparoscopic drainage of the fluid collections, she was referred for definitive management with laparoscopic decortication and capsulotomy.

Multi-institutional survey of laparoscopic ureterolysis for retroperitoneal fibrosis.

Objectives: Medical therapy often fails to cure benign retroperitoneal fibrosis (RPF), necessitating a surgical approach. Preoperative and postoperative adjuvant medical therapy and the timing of surgical intervention are not well-established. We surveyed centers of laparoscopic excellence to determine the current practices in the treatment of RPF.

Robotic-assisted laparoscopic ureteropyelostomy for treatment of prostatitis secondary to ectopic ureteral insertion of a completely duplicated collecting system.

Symptomatic presentation of a completely duplicated collecting system with upper-pole ectopic ureteral insertion is rare in the adult. We present a case of a 52-year-old man with recurrent prostatitis and hematuria secondary to an ectopic ureteral insertion from a left upper-pole moiety in a completely duplicated collecting system. He underwent a robot-assisted laparoscopic ureteropyelostomy with good results.

Laparoscopic augmentation cystoplasty: a comparison between native ileum and small intestinal submucosa in the porcine model.

Objectives: To determine the feasibility of laparoscopic augmentation cystoplasty (LAC) in the porcine model and to compare LAC using standard bowel vs a small intestinal submucosa (SIS) allograft.

Materials And Methods: Fourteen female pigs underwent LAC; six had standard ileal AC and eight AC with SIS. All the pigs had limited cystometrogram studies before surgery to determine bladder capacity.

Robotic computer-assisted pyeloplasty versus conventional laparoscopic pyeloplasty.

Background And Purpose: Laparoscopic pyeloplasty (LP) for the repair of ureteropelvic junction (UPJ) obstruction provides results similar to those of open pyeloplasty with less morbidity, but its use has been limited, as it requires advanced laparoscopic skills. Robotic computer-assisted pyeloplasty (RAP) has the potential to reduce the technical challenges of the reconstructive portion of the operation. We compare our RAP experience with our recent LP cases.

Survey of residency training in laparoscopic and robotic surgery.

Purpose: We determined the current status of residency training in laparoscopic and robotic surgery in the United States and Canada.

Materials And Methods: A total of 1,188 surveys were sent via the Internet to all 1,056 current urology residents and 132 program directors with an Internet address registered with the American Urological Association.

Results: Responses were received from 372 residents (35%) and 56 program directors (42%).