Hydrogels for tissue engineering: scaffold design variables and applications.

Prostate Specific Antigen Best Practice Statement: 2009 Update

OBJECTIVE

To develop a technique of nerve-sparing robot-assisted radical cystoprostatectomy (RRCP) for patients with bladder cancer.



PATIENTS AND METHODS

Robotic assistance should enhance the ability to preserve the neurovascular bundles during laparoscopic radical cystectomy. Thus we undertook RRCP and urinary diversion using a three-step technique. First, using a six-port approach and the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), one surgeon carried out a complete pelvic lymphadenectomy and cystoprostatectomy using a technique developed specifically for robotic surgery. The neurovascular bundles were easily identified and dissected away, the specimen entrapped in a bag and removed through a 5–6 cm suprapubic incision. Second, a different surgical team exteriorized the bowel through this incision and created a neobladder extracorporeally. Third, the neobladder was internalized, the incision closed and the primary surgeon completed the urethro-neovesical anastomosis with robotic assistance.



RESULTS

RRCP was carried out in 14 men and three women by the primary surgeon (M.M.). The form of urinary reconstruction was ileal conduit in three, a W-pouch with a serosal-lined tunnel in 10, a double-chimney or a T-pouch with a serosal-lined tunnel in two each. The mean operative duration for robotic radical cystectomy, ileal conduit and orthotopic neobladder were 140, 120 and 168 min, respectively. The mean blood loss was < 150 mL. The number of lymph nodes removed was 4–27, with one patient having N1 disease. The margins of resection were free of tumour in all patients.



CONCLUSIONS

We developed a technique for nerve-sparing RRCP using the da Vinci system which allows precise and rapid removal of the bladder with minimal blood loss. The bowel segment can be exteriorized and the most complex form of orthotopic bladder can be created through the incision used to deliver the cystectomy specimen. Performing this part of the operation extracorporeally reduced the operative duration.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1464-410X.2003.04329.x

Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion

OBJECTIVE: This study compares an initial group of patients undergoing laparoscopic live donor nephrectomy to a group of patients undergoing open donor nephrectomy to assess the efficacy, morbidity, and patient recovery after the laparoscopic technique. SUMMARY BACKGROUND DATA: Recent data have shown the technical feasibility of harvesting live renal allografts using a laparoscopic approach. However, comparison of donor recovery, morbidity, and short-term graft function to open donor nephrectomy has not been performed previously. METHODS: An initial series of patients undergoing laparoscopic live donor nephrectomy were compared to historic control subjects undergoing open donor nephrectomy. The groups were matched for age, gender, race, and comorbidity. Graft function, intraoperative variables, and clinical outcome of the two groups were compared. RESULTS: Laparoscopic donor nephrectomy was attempted in 70 patients and completed successfully in 94% of cases. Graft survival was 97% versus 98% (p = 0.6191), and immediate graft function occurred in 97% versus 100% in the laparoscopic and open groups, respectively (p = 0.4961). Blood loss, length of stay, parenteral narcotic requirements, resumption of diet, and return to normal activity were significantly less in the laparoscopic group. Mean warm ischemia time was 3 minutes after laparoscopic harvest. Morbidity was 14% in the laparoscopic group and 35% in the open group. There was no mortality in either group. CONCLUSIONS: Laparoscopic live donor nephrectomy can be performed with morbidity and mortality comparable to open donor nephrectomy, with substantial improvements in patient recovery after the laparoscopic approach. Initial graft survival and function rates are equal to those of open donor nephrectomy, but longer follow-up is necessary to confirm these observations.

Comparison of open and laparoscopic live donor nephrectomy.

On February 12, 1992, a laparoscopic partial nephrectomy was performed on a woman with a lower-pole caliceal diverticulum containing a stone. By incorporating the laparoscopic argon beam coagulator and a tourniquet device, the procedure was completed in 6 hours and 10 minutes. The postoperative course and period of convalescence was markedly improved over that expected from open surgery. This laparoscopic intervention demonstrates the expanding horizons of minimally invasive surgery and the remarkable development of new laparoscopic devices.

John A. Boullier

Papers

Laparoscopic Cystectomy: Initial Report on a New Treatment for the Retained Bladder

Staging laparoscopic pelvic lymph node dissection: comparison of results with open pelvic lymphadenectomy.

Comparison Between Standard Flank Versus Laparoscopic Nephrectomy for Benign Renal Disease

Transurethral Collagen Injections in the Therapy of Post-Radical Prostatectomy Stress Incontinence

Traumatic posterior urethral injury and early primary endoscopic realignment: evaluation of long-term follow-up.