Effect of pneumoperitoneum on renal tissue oxygenation and blood flow in a rat model.

Objectives: To determine the correlation between the renal blood flow (RBF) and tissue oxygenation (PO(2)) at varying intra-abdominal pressures (IAPs) and to compare the effects on renal blood flow from carbon dioxide-induced pneumoperitoneum.

Methods: Carbon dioxide pneumoperitoneum was established in Sprague-Dawley rats (n = 6). Licox oxygen/temperature tissue probes were laparoscopically inserted into the renal parenchyma, with the renal PO(2) and RBF recorded every 30 seconds while the IAP was gradually increased.

Impact of arterial and arteriovenous renal clamping with and without intrarenal cooling on renal oxygenation and temperature in a porcine model.

Background: As laparoscopic partial nephrectomy increases in prominence, more needs to be understood about the combined effect of the pneumoperitoneum and renal ischemia during tumor resection. The purpose of this study is to investigate the effect of combined renal hilar clamping (arterial only versus arteriovenous) and retrograde intrarenal cooling on renal temperature and oxygenation in a porcine laparoscopic partial nephrectomy model.

Materials And Methods: Under general anesthesia, laparoscopic access with intra-abdominal pressure of 15 mm Hg to the left renal hilum was obtained.

Practical comparison of four nitinol stone baskets.

Background And Purpose: The use of stone baskets for repositioning of stones or removal of fragment in conjunction with ureterorenoscopy has become widespread. We tested the performance of the ACMI Sur-Catch NT, Bard Dimension, Boston Scientific Zero-tip, and Cook N-Circle in a pig kidney model of flexible ureterorenoscopy.

Materials And Methods: Opening characteristics of the basket were measured with mechanical calipers at 1-mm increments and compared with published reports to ensure the tested baskets were representative.

Intraoperative laparoscopic renal ultrasonography: use in advanced laparoscopic renal surgery.

Objectives: To highlight the use of intraoperative laparoscopic ultrasonography (ILUS) in complex renal surgery, as well its impact on management. ILUS has been used to facilitate advanced laparoscopic surgery, but only limited descriptions of the indications for its use have been published.

Methods: All patients undergoing laparoscopic renal procedures requiring ILUS from October 2001 to March 2005 were reviewed.

Laparoscopic management of advanced renal cell carcinoma with level I renal vein thrombus.

Objectives: To present our series of laparoscopic radical nephrectomy in patients with level I tumor thrombus. The existence of renal vein tumor thrombus presents a technical challenge in securing hilar control during the resection of a renal mass. To our knowledge, this experience represents one of the largest series of laparoscopic nephrectomy for renal cell carcinoma associated with a macroscopic renal vein thrombus.

The laparoscopic experience of recently trained Canadian urologists.

Objective: While laparoscopy represents an increasingly important aspect of operative urology, the experience of Canadian urology trainees is poorly defined. The purpose of this study was to determine the level of laparoscopic training of Canadian urology trainees during residency as well as their comfort level with various laparoscopic techniques.

Methods: An e-mail-and web-based questionnaire was administered to the two most recent cohorts of Canadian-trained urologists (residencies completed in 2003 or 2004).

Laparoscopic simple prostatectomy.

Classically, surgical options for very large prostate glands, not amenable to transurethral resection, include suprapubic or retropubic simple prostatectomy and Holmium laser enucleation of the prostate (HoLEP). We present a case managed with a laparoscopic simple prostatectomy. Technical considerations are discussed as well as possible advantages of this approach including decreased blood loss, faster patient recovery and improved visualization.

Erectile dysfunction: management update.

Dramatic advances in the management of erectile dysfunction have occurred over the past decade. Oral therapy with vasoactive agents has emerged as first-line treatment and has transformed both the manner in which the public views erectile dysfunction and the way health care providers deliver care. Whereas an extensive investigation was previously common in the management of erectile dysfunction, recent treatment guidelines promote a more minimalist, goal-oriented approach.