Search

AbstractPurpose:The goal of this study is to demonstrate the feasibility of transurethral radical prostatectomy in the canine model. We describe the surgical procedure for natural orifice translumenal endoscopic surgery-radical prostatectomy (NOTES-RP).Materials and Methods:NOTES-RP was performed on six nonsurvival male canines. The 100 watt holmium:yttrium-aluminum-garne laser, 550 μm end-firing fiber, 28F laser resectoscope, 7F stabilizing catheter, and continuous irrigation were used to radically resect the prostate. A Vest vesicourethral anastomosis was performed using a laparoscopic suture device that was delivered through the nephroscope. In the initial cases, the prostate was removed manually; for the last two cases, the prostate was removed endoscopically with a tissue morcellator.Results:NOTES-RP was successfully executed in all canines. Visualization was not obscured by bleeding. Dissection times ranged from 40 to 120 minutes. Fluid absorption was problematic in cases lasting more than 1 hour, because of the intraperitoneal location of the canine prostate and bladder.Conclusions:The feasibility and technique of NOTES-RP was successfully demonstrated in the living canine model. [ABSTRACT FROM AUTHOR]

AbstractBackground and Purpose:Innovations in minimally invasive surgery have led to the proposal of incision-free natural orifice translumenal endoscopic surgery (NOTES™). The purpose of this manuscript is to describe the initial technique of natural orifice translumenal endoscopic surgical radical prostatectomy (NOTES-RP).Materials and Methods:NOTES-RP was performed on four male cadavers in a surgical simulation laboratory setting. The 100 W holmium:yttrium-aluminum-garnet laser, 550 μm end-firing laser fiber, 26F resectoscope, 7F laser stabilizing catheter, and continuous irrigation were used to radically resect and deliver the prostate of each cadaver into the bladder. The neurovascular bundles were preserved bilaterally, as well as the dorsal venous complex, bladder neck, and external sphincter. The entire resection was performed with the laser, while a rigid offset 27F nephroscope was used to perform the vesicourethral anastomosis using a laparoscopic suture device and knot pusher in an interrupted fashion. The prostate tissue was removed endoscopically with a tissue morcellator. After the initial NOTES-RP, a pelvic exploration with biopsy of neurovascular bundles, bladder, and urethral margins was performed.Results:NOTES-RP was successfully executed in the cadaveric model. Pathologic evaluation of tissue demonstrates complete removal of all prostate tissue with preservation of the neurovascular bundles bilaterally as well as the external urinary sphincter.Conclusion:The present work demonstrates the feasibility of NOTES-RP in the cadaver model. While further testing and instrument modification are necessary before clinical application, this concept demonstrates the evolving nature of minimally invasive surgery and what could be possible for patients. [ABSTRACT FROM AUTHOR]

Background and PurposeThe role of laparoscopic radical nephrectomy (LRN) for very large renal tumors remains to be defined. We review our experience with LRN for very large (≥10 cm) renal malignancies.Patients and MethodsA retrospective analysis of 360 consecutive patients who underwent LRN for renal tumors between October 1999 and May 2007 in a tertiary academic center identified 11 patients with malignancies ≥10 cm.ResultsMedian age was 67 years (range 48–80 y), operative time was 170 minutes (range 80–240 min), estimated blood loss was 150 mL (range 50–300 mL), and length of stay was 2 days (range 1–6 d). There were two minor postoperative complications (acute renal insufficiency and ileus). Median tumor size was 12 cm (range 10–21 cm). Pathologic stage for patients with renal cell carcinoma was T2, T3a, T3b, and T4, in five, three, two, and one patient(s), respectively. One patient died after brain metastasis developed. Two patients in whom pulmonary metastases developed were still alive at last follow-up.ConclusionsLRN was successfully performed in patients with renal tumors up to 21 cm. Important considerations when performing LRN include the individual clinical picture, surgeon experience, tumor location, and patient well-being. LRN for very large tumors is feasible in properly selected patients and can have significant benefits in the palliative setting. [ABSTRACT FROM AUTHOR]

Background and PurposeMicroporous polysaccharide hemospheres (MPH) are hemostatic beads engineered from purified plant starch. MPH accelerates the natural clotting cascade by concentrating clotting factors and proteins on their surface while absorbing aqueous and low molecular weight components from blood. The purpose of this study was to determine the efficacy of MPH in achieving hemostasis in the setting of laparoscopic renal injury.Materials and MethodsIn four domestic pigs, 16 laparoscopic renal trocar injuries were created (8 each of 12 and 5 mm). A standard hand-assisted laparoscopic approach was used to each kidney so that two lesions per kidney were randomly created. MPH was applied to each treatment lesion with light pressure maintained for 60 seconds. Four of the 16 lesions, two each of 12 and 5 mm, were allowed to bleed as controls. Hemostasis was defined as no active bleeding or oozing. The animals were sacrificed at the conclusion of the procedure.ResultsThe mean time to hemostasis for the 12-mm MPH and control lesions was 196.2 ± 53.3 and 372.0 ± 225.6 seconds, while the average blood loss was 8.3 ± 3.7 and 12.0 ± 4.9 g, respectively. For the 5-mm MPH and control lesions, the average time to hemostasis was 100.2 ± 24.8 and 247.0 ± 134.4 seconds, while the average blood loss was 8.3 ± 3.8 and 9.0 ± 0.7 g, respectively. The median number of applications of the MPH for the 5- and 12-mm injuries was 1 and 2, respectively.ConclusionsMPH provided a rapid and effective means of hemostasis for laparoscopic renal parenchymal injuries in this model. Additional evaluation is warranted, however, before general application is advisable. [ABSTRACT FROM AUTHOR]

Purpose Advances in the field of surgery have recently developed a number of devices and materials to improve surgical hemostasis. The effects of one such device, saline-cooled monopolar radiofrequency electrocautery, has been well scrutinized in splenic and hepatic applications. Despite the utilization of this device in urologic surgery, the classification of the thermal effects has been poorly characterized to date. The purpose of this study was to discern the thermal characteristics of the device in the laparoscopic environment when used on renal parenchyma.Materials and Methods After institutional approval, four domestic swine were randomized to receive laparoscopic renal lesions randomly generated by either saline-cooled (25 W with saline flow rate of 4 mLmin) or standard monopolar radiofrequency electrocautery. The energy source was applied for between 1 and 11 seconds for each device in order to create a total of 64 renal lesions. Each kidney was harvested and examined by a genitourinary pathologist blinded to the treatment interval.Results The saline-cooled device provided a greater depth of coagulation effect compared to standard monopolar electrocautery at all points in time (P< 0.05). The diameter of the lesions created using saline-cooled monopolar electrocautery was greater than those created with standard electrocautery (P< 0.05).Conclusions The saline-cooled monopolar electrocautery provided an improved coagulation effect compared to standard electrocautery in the laparoscopic setting. Recognition of the time and resultant thermal consequences can help the laparoscopic surgeon plan surgical approaches for renal lesions and improve hemostasis. [ABSTRACT FROM AUTHOR]

Introduction: The objective was to analyze the diagnostic value of multiparametric magnetic resonance imaging (MRI) prostate lesion volume (PLV) and its correlation with the subsequent MRI–ultrasound (MRI-US) fusion biopsy results. Materials and Methods: Between March 2014 and July 2016, 150 men underwent MRI-US fusion biopsies at our institution. All suspicious prostate lesions were graded according to the Prostate Imaging Reporting and Data System (PIRADS) and their volumes were measured. These lesions were subsequently biopsied. All data were prospectively collected and retrospectively analyzed. The PLV of all suspicious lesions was correlated with the presence of cancer on the final MRI-US fusion biopsy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: There were 206 suspicious lesions identified in 150 men. The overall cancer detection rate was 102/206 (49.5%). The mean PLV for benign lesions was 0.63 ± 0.94 cm3 versus 1.44 ± 1.76 cm3 for cancerous lesions (P < 0.01). There was a statistically significant difference between the PLV of PIRADS 5 lesions when compared to PIRADS 4, 3, and 2 lesions (P < 0.0001, < 0.0001, and 0.006, respectively). The area under the curve for volume in predicting prostate cancer (PCa) was 0.66. The optimal volume for predicting PCa was 0.26 cm3 with a sensitivity, specificity, PPV, and NPV of 80.7%, 42.7%, 41.2%, and 74.6%, respectively. Conclusion: PLV may serve as a useful measure to triage patients prior to MRI-US fusion biopsy and help better understand the limits of this technology for individual patients.

Xp11.2 translocation tumor is a rare but aggressive form of renal cell carcinoma that predominantly occurs in children but also may be found in young adults. Because this type of cancer is diagnosed via histologic and chromosomal analysis, clinicians should consider translocation tumor in the differential diagnosis of patients with renal lesions and gross hematuria.