Showing papers in "Journal of Endourology Part B, Videourology in 2015"
TL;DR: This is the first ever study to evaluate the role of an innovative intraoperative tool, near-infrared fluorescence (NIRF) technology in conjunction with intravenous indocyanine green (ICG) in identification of this “Landmark Artery” during NS RARP.
Abstract: Introduction and Objectives: The “Landmark Artery” has been shown to be a valuable landmark during nerve-sparing (NS) robot assisted radical prostatectomy (RARP) in improving the quality of the neurovascular bundle (NVB) preservation. Sometimes, this landmark can be challenging to find due to inexperience of the surgeon or anatomical challenges. We performed the first ever study to evaluate the role of an innovative intraoperative tool, near-infrared fluorescence (NIRF) technology in conjunction with intravenous indocyanine green (ICG) in identification of this “Landmark Artery” during NS RARP. We demonstrate our technique in this video. Methods: Ten patients underwent NS RARP. Before clamping the pedicle or dissection of the NVB, 0.75 ml of ICG was given. The NIRF technology was engaged on the robotic console and a period of 20–40 seconds was allowed for the ICG to enter the vascular system. The landmark artery was then observed bilaterally. After this time period, we switched back to the non-NI...
12 citations
TL;DR: A novel grading system designed to standardize and simplify the description of renal papillary appearance in stone formers at the time of endoscopy has considerable clinical and academic utility.
Abstract: Introduction: An overlooked finding at the time of renal endoscopy for patients with nephrolithiasis is the appearance of the renal papillae. Recent work has demonstrated that it is possible to distinguish specific stone-forming phenotypes by endoscopic patterns of papillary appearance alone.1–4 These variable expressions are likely to have clinical significance; yet, the ability to pursue such research efforts remains limited by the lack of a standardized system to describe these findings. Herein, we describe a novel grading system designed to standardize and simplify the description of renal papillary appearance in stone formers at the time of endoscopy. Materials and Methods: Since 1999, 342 patients have been prospectively enrolled and given consent to be part of an NIH funded project studying the pathogenesis of stone formation at a single institution (Methodist Hospital, Indiana University Health). Patients have been treated and studied using both percutaneous and retrograde ureteroscopic ...
4 citations
TL;DR: A technique avoiding this infectious risk is demonstrated by passing the biopsy needle through the perineum using a freehand technique under ultrasound monitoring.
Abstract: Introduction: Approximately 1 million prostate biopsies are performed yearly, the vast majority of which are performed transrectally.1 Passing biopsy needles through the rectal wall introduces bacteria into the prostate parenchyma.2 The resistance of coliform bacteria to fluoroquinolone antibiotics is as high as 22%,2,3 and the infectious complications have increased to as high as 7% with hospitalization risk as high as 4%.4 I demonstrate a technique avoiding this infectious risk by passing the biopsy needle through the perineum using a freehand technique under ultrasound monitoring. Materials and Methods: All procedures were performed in the Ambulatory Urology Surgical Center (Cumberland, MD) by one urologist. Patients requiring prostate biopsy, in accordance with accepted standards of urologic care, were offered the option of sedation and/or local anesthesia. Patients did not receive bowel preparation, prior rectal swab, or pre-/postoperative antibiotics. Intravenous access was obtained for a w...
4 citations
TL;DR: This work sought to invent a novel technique of suctioning flexible URS with an intelligent control of RPP by computerized real-time recording and monitoring of R PP through pressure feedback, ensuring a stable RPP.
Abstract: Introduction: Flexible ureteroscopy (URS) is becoming a first-line therapy for many patients with renal and ureteral calculi rapidly.1 Current commonly used medical infusion devices can only monitor the infusion flow and infusion pressure, but not the renal pelvic pressure (RPP).2,3 We sought to invent a novel technique of suctioning flexible URS with an intelligent control of RPP. Materials and Methods: We performed flexible URSs for patients with the help of a self-designed intelligent system, including an irrigation and suctioning platform and a transparent ureteral access sheath (UAS) with a pressure-sensitive tip, which can precisely regulate the infusion flow and control the vacuum suctioning by computerized real-time recording and monitoring of RPP through pressure feedback, ensuring a stable RPP. The outer body diameter of the UAS was 15F; the diameter of the working channel was 11.55F; and the length of the UAS was 20 to 45 cm. On the platform, RPP control value was set at −2 mm Hg, RPP ...
3 citations
TL;DR: GreenLEP was conducted effectively in all but one case, necessitating a conversion into open surgery for adenoma and clot removal, and perioperative complications included perforation of the prostatic capsule in five cases.
Abstract: Objectives: To describe 532-nm Green laser enucleation of the prostate (GreenLEP) and assess its feasibility, safety, and short-term outcomes. Patients and Methods: Thirty consecutive patients with a prostate volume >80 cc and who underwent GreenLEP (by one surgeon) between July 2013 and March 2014 were prospectively evaluated. GreenLEP was conducted using the GreenLight HPS™ device (AMS, Minnetonka, MN), and morcellation was conducted using a Wolf™ morcellator. Clinical data on preoperative assessment, operative characteristics, and postoperative assessments of 6- to 12-month functional outcomes and complications were entered into a database. Results: GreenLEP was conducted effectively in all but one case, necessitating a conversion into open surgery for adenoma and clot removal. The median operative time was 60 minutes (range: 50–100). Perioperative complications included perforation of the prostatic capsule in five cases. The median hospital stay was 2 days (range: 2–5). Nine-month follow-ups ...
3 citations
TL;DR: Morbidity associated with traditional reconstruction of complex Ureteral strictures has led to interest in applying the success of buccal graft urethroplasty to the ureter, and this work aims to extend that interest to other types of grafts.
Abstract: Introduction: Morbidity associated with traditional reconstruction of complex ureteral strictures has led to interest in applying the success of buccal graft urethroplasty to the ureter. C...
2 citations
TL;DR: This is the first reported study evaluating the early quality of life outcomes after placement of dHAM on the neurovascular bundle (NVB) during nerve-sparing robot-assisted radical prostatectomy (RARP).
Abstract: Introduction and Objectives: Allografts of dehydrated human amniotic membrane (dHAM) have cytokines and growth factors that have been shown to reduce the inflammatory response during tissue healing and promote nerve regeneration This is the first reported study evaluating the early quality of life outcomes after placement of dHAM on the neurovascular bundle (NVB) during nerve-sparing robot-assisted radical prostatectomy (RARP) We demonstrate our technique in this video Methods: From March 2013 to July 2014, 58 preoperatively potent (Sexual Health Inventory for Men score >19) and continent patients underwent full nerve-sparing RARP, followed by intraoperative dHAM placement at our institution In each patient, the dHAM was wrapped around the NVB following the RARP procedure We performed propensity matching using our prospective database in matched nongrafted patients from the same time period Pre-, peri-, and postoperative outcomes were analyzed between patient groups, including the time to r
2 citations
TL;DR: Holmium laser enucleation of the prostate (HoLEP) is an endoscopic procedure that was first introduced in 1998 by Peter Gilling and Numerous studies have since confirmed that the technique is efficacious with durable outcomes, and many investigators now consider HoLEP the new gold standard.
Abstract: Holmium laser enucleation of the prostate (HoLEP) is an endoscopic procedure that was first introduced in 1998 by Peter Gilling. Numerous studies have since confirmed that the technique is efficacious with durable outcomes, and many investigators now consider HoLEP the new gold standard. The surgeon searches for the capsular plane by making two incisions at the 5- and 7-o'clock positions beginning at the bladder neck and ending at the verumontanum. It is important at this stage to proceed one layer at a time while opening the bladder neck until the circular fibers of the neck are exposed. The surgeon should then proceed from the neck to the verum, deepening and widening the incision by separating the lateral lobe from the median portion. The surgeon should take care at this stage to push laterally with the whole instrument in the apex region detaching the adenoma from the capsule with the laser turned off, thus creating an apical incision along the cleavage plane causing subsequent detachment of ...
2 citations
TL;DR: Robotic surgery allows meticulous anastomotic dissection due to benefits of magnification, three-dimensional vision, and enhanced seven degrees of freedom of the robotic instruments, which may increase the chances of graft preservation.
Abstract: Introduction: Renal tumors in allografts are rare but a serious condition. It presents a challenging clinical scenario where proper radiologic evaluation is commonly hindered by the suboptimal renal function. When surgical intervention is indicated, nephron sparing approaches are confronted with a risk of metastasis in an immunocompromised host, whereas graft nephrectomy results in significant postoperative morbidity and mortality as dialysis is reinitiated. Regardless of the surgical plan, graft surgery can be associated with significant vascular morbidities secondary to the dense desmoplastic reaction surrounding the anastomotic areas. Robotic surgery allows meticulous anastomotic dissection due to benefits of magnification, three-dimensional vision, and enhanced seven degrees of freedom of the robotic instruments. This may increase the chances of graft preservation. Moreover, it offers the benefits of minimally invasive surgery with less pain, shorter hospitalization, and less blood loss if to...
1 citations
TL;DR: A reproducible 12-step instruction on robot-assisted laparoscopic donor nephrectomy (RALDN) is provided and results of the initial experience are provided.
Abstract: Introduction: Robot-assisted laparoscopic donor nephrectomy (RALDN) is an emerging minimally invasive technique for procuring living renal allografts for transplantation. As an alternative to traditional laparoscopy, robotics provides optical magnification and instrument articulation, which can be used in intricate dissection of the vessels and obtaining maximum length for the graft. We provide a reproducible 12-step instruction on our standard left RALDN and results of our initial experience. Methods: The patient is placed in the right lateral decubitus position and the robotic ports are placed. The 12 steps of our standard left RALDN include medial reflection of the descending colon, complete mobilization of the spleen, exposure of the gonadal and renal vein, ligation of the adrenal, gonadal, and lumbar vein, mobilization of the kidney laterally and posteriorly, dissection of the adrenal off the upper pole/superior mobilization, dissection of the renal hilum, medial rotation of the kidney and p...
1 citations
TL;DR: A modified technique named transurethral vapor enucleation of the prostate (TVEP), with a novel button-like electrode, which was described as a safe and effective option for the treatment of benign prostatic hyperplasia (BPH).
Abstract: Introduction: During the last decade, a bipolar plasmakinetic vaporization system with a novel button-like electrode has emerged and was described as a safe and effective option for the tr...
TL;DR: During robot-assisted radical cystectomy, urinary diversions are often performed extracorporeally, but an optimized minimally invasive technique is possible with total hystectomy.
Abstract: Introduction: During robot-assisted radical cystectomy, urinary diversions are often performed extracorporeally. However, an optimized minimally invasive technique is possible with total i...
TL;DR: The technique of intrarenal dissection to salvage difficult cases using standard PCNL instruments is presented and this novel technique was performed in nine patients with staghorn stones or impacted caliceal stones.
Abstract: Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) remains the mainstay modality for large burden kidney stone management. Access to the pelvicaliceal system is the key step for success of PCNL for complete stone clearance and minimal complication. However, many times in cases of impacted stones, staghorn calculi, nondilated pelvicaliceal systems, or thin renal cortex, it becomes difficult to establish a tract into the calix after initial puncture and the procedure may have to be abandoned. In this video, we present our technique of intrarenal dissection to salvage difficult cases using standard PCNL instruments. Methods: We performed this novel technique in nine patients with staghorn stones or impacted caliceal stones. As per the standard PCNL protocol, fluoroscopic-guided puncture and guidewire placement into the collecting system are performed; then, the tract is dilated with a balloon or Amplatz Dilators and a sheath is placed. A nephroscope is passed under direct vision and an...
TL;DR: Ultra-minimally invasive PNL (UMP) was first described by Desai and colleagues using a novel 6F mini nephroscope through an 11F to 13F metal sheath to perform holmium:YAG laser lithotripsy.
Abstract: Introduction: To eliminate the disadvantages of conventional percutaneous nephrolithotomy (PNL), smaller diameters of instruments had been invented, and Helal and colleagues described minimally invasive percutaneous nephrolithotomy (miniPNL). They performed sequential dilatation up to 16F and used for pediatric population in 1997.1 In 1998, Jackman and colleagues performed 13F miniPNL first in adult patients with smaller sheaths and instruments.2 Today, the miniPNL is generally defined for the PNL procedure performed through the access tract smaller than 18F.3 Ultra-minimally invasive PNL (UMP) was first described by Desai and colleagues using a novel 6F mini nephroscope through an 11F to 13F metal sheath to perform holmium:YAG laser lithotripsy.4 Foreign bodies such as forgotten ureteral J stents especially upper parts of the stents can be removed through percutaneous access. UMP can be the safest method if ureterorenoscopy is not useful. Materials and Methods: In this video, we present a 32-yea...
TL;DR: The objective of this study was to present the techniqistan of a laser en bloc resection of bladder tumors using Ho:YAG using thulium as a new source for laser devices.
Abstract: Introduction: Today, transurethral resection of superficial bladder cancer is the standard therapy. Assessing the correct penetration depth is crucial. Reasons for the high rates of local recurrence are under investigation. Potential disadvantages of the standard technique are thermal damage of adjacent tissue, the “incise and scatter” technique that causes fragmentation of the tumor and leads to a high amount of exfoliated cancer cells, and the difficulty of accurate pathological evaluation of fragmented tissue.1 En bloc resection techniques are an emerging issue.2–4 The first description of a laser en bloc resection of bladder tumors using Ho:YAG (holmium laser resection of bladder tumors [HoLRBT]) was published by Das et al.5 With the introduction of thulium as a new source for laser devices, several studies were published dealing with en bloc resection techniques of bladder cancer (Thulium laser resection of bladder [TmLRBT]).6,7 Methods: The objective of this study was to present our techniq...
TL;DR: This work has reported the ability to perform robotic single-site pyeloplasty safely and effectively using crossed robotic 5 mm articulating instruments.
Abstract: Introduction: Previously, we have reported the ability to perform robotic single-site pyeloplasty safely and effectively using crossed robotic 5 mm articulating instruments. A recent cohor...
TL;DR: Morcellation of enucleated prostate tissue was developed as a means to remove large specimens transurethrally without the need for a separate extraction site, but however, morcel...
Abstract: Introduction: Morcellation of enucleated prostate tissue was developed as a means to remove large specimens transurethrally without the need for a separate extraction site. However, morcel...
TL;DR: LU has been shown in small series to have the highest stone-free rate when comparing to extracorporeal shockwave lithotripsy (SWL) in the management of upper ureteral stone of >1 cm.
Abstract: Introduction: With the improvement in endoscopic techniques and shockwave lithotripsy, the role of laparoscopic ureterolithotomy (LU) has changed significantly over the past decade.1 LU remains a viable option for patients with large impacted upper ureteric stone which are less well treated by endoscopic methods. LU has been shown in small series to have the highest stone-free rate when comparing to extracorporeal shockwave lithotripsy (SWL) in the management of upper ureteral stone of >1 cm.2 In addition, LU has shorter hospitalization, shorter convalescence, and better analgesic profile compared with open ureterolithotomy.1 Various methods of intraoperative ureteric stent insertion during LU have been described but with varying reports on safety or efficacy.3–6 One of the challenges during LU is the laparoscopic insertion of ureteric stent into a small ureteric incision. This can be time consuming and technically challenging. Slippage of the guidewire or stent occurs commonly and their prolonge...
TL;DR: An updated version of the previously validated robotic partial nephrectomy (RPN) training model is presented which includes the reconstructive part of the procedure in addition to the original model.
Abstract: Introduction: We present an updated version of our previously validated robotic partial nephrectomy (RPN) training model,1,2 which includes the reconstructive part of the procedure in addi...
TL;DR: Transvesical laparoendoscopic single-site surgery (T-LESS) is a novel minimally invasive approach that has been introduced to decrease the morbidity related to laparoscopic multiport placement and to improve cosmetic results.
Abstract: Introduction: Transvesical laparoendoscopic single-site surgery (T-LESS) is a novel minimally invasive approach that has been introduced to decrease the morbidity related to laparoscopic m...
TL;DR: Transurethral resection of the prostate (TURP) has been considered the standard treatment for decades and during the past 20 years, laser technology played an increasing role in this treatment.
Abstract: Introduction: Transurethral resection of the prostate (TURP) has been considered the standard treatment for decades.1,2 During the past 20 years, laser technology played an increasing role...