LAPAROSCOPlCNEPHRONSPARlNGANOTlSSUEABLATlONTECHNlQUESOFRENALTUMOURS Saturday, 27 March,15.15-16.45, Hall C/ Red level 765
ARE THERE RISK FACTORS FOR THE DEVELOPMENT OF BLADDER NECK STENOSIS AFTER TRANSURETHRAL PROSTATECTOMY?
LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR RENAL WITH AND WITHOUT ISCHEMIA - A RETROSPECTIVE SON INCLUDING 130 PATIENTS
Jeschke K. iI Wakonig
.I.‘, Meixl H. ‘, Peschel R.Z, Bar&h
‘General Hospital Klagenfurt, Department of Urology, Innsbruck, Department of Urology, Innsbruck, Austria
INTRODUCTION & OBJECTIVES: Bladder neck stenosis (BNS) is an uncommon but well known complication of transurethral resection of the prostate (TURP). BNS is characterized by a high rate of recurrence making it a serious TURP complication. The aim of our study was to evaluate possible risk factors for the development of BNS in TURP patients. MATERIAL & METHODS: 16 cases of BNS following TURP with surgical treatment were identified. These patients were retrospectively analysed concerning preoperative and perioperative parameters and compared to a contemporary consecutive TURP series at our institution without postoperative BNS (n=92). Factors analysed were IPSS, prostate volume, flow rate, PSA, urinary tract infections, resected weight, blood transfusions, resection time, secondary surgical interventions, catheter time, comorbidity (ASA score, diabetes, coronary heart disease) and experience of the surgeon.
INTRODUCTION & OBJECTIVES: The technique of laparoscopic partial nephrectomy for renal tumours is still evolving. We retrospectively compared patients operated with and without hilar clamping in terms of complications and patients outcome. & METHODS: Between 211996 and 7/2001 we performed 68 laparoscopic partial nephrectomies in patients with renal tumours without hilar clamping. A reboperitoneal approach was predominant. The resection itself was done by simultaneous cutting and coagulating with bipolars or harmonic scalpel. No endoscopic suturing was applied and haemostasis was achieved by coagulation and fibrin glue. From 7/2001 in 62 patients laparoscopic partial nephrectomy for renal tumours was done with hilar clamping, mainly by a retroperitoneal approach. In 5 of these patients we did additional parenchymal cooling by in situ perfusion of the kidney via arterial Seldinger catheter placed preoperatively. Tumour excision was done sharply with endoscalpel and shears. The collecting system was sutured if necessary and haemostasis was achieved either by central sutures and fibrin glue, or by closing the defect with parenchymal sutures. There was no difference in both groups in terms of patients mean age (61 Years) tumour location and tutor size (2.3 cm).
None of the operations had to be converted to open surgery. Mean operating time was 116 (70 - 200) minutes without and 77 (50 150) minutes with hilar clamping. Major complications occurred in 8 patients (12%) in group 1 (4 postoperative bleedings and 4 urinary tistulas), that required open reoperation in 5 patients. In group 2 we observed major complications in 3 patients (4.8%). None of them had an open reintervention. Histology showed RCC in 55 cases (80%) in group 1. One patient had a positive margin and had subsequent nephrectomy. In the group with hilar clamping RCC was found in 54 patients (87%), all with negative margins. Median follow up in group 1 is 38 (25 - 81) months and 11 (1 - 25) months in group 2. All patients show NED so far.
of BNS was undertaken
Significant differences patients with BNS and time was lower in the comorbidity was not analysed were also not
were seen in the resected weight of prostatic tissue between without (15.3 g vs. 30.4g, p
New techniques in laparoscopic partial nephrectomy, mimicking open surgery, as hilar clamping, parenchymal cooling by in situ perfusion, endoscopic suturing of the collecting system and parenchymal sutures for haemostasis make the procedure more clear and reduce perioperative morbidity, operating time and risk for positive surgical margins.
CONCLUSIONS: The identifiable risk factor for the development of BNS after TURP is a small prostate with a low resection weight. Relatively prolonged resection time with excessive coagulation may also be of importance.
766 ROBOTIC -,Peschel
LAPAROSCOPIC R.‘, Bartsch
Blute M.Z, Gettman
‘University Hospital Innsbruck, Department of Urology, Innsbruck, *Mayo Clinic, Department of Urology, Rochester, United States
INTRODUCTION & OBJECTIVES: The Da Vinci system has been introduced with the goal of simplifying complex laparoscopic procedures. We reviewed our initial clinical results with the Da Vinci assisted partial nephrectomy. MATERIAL & METHODS: From February 2003 through August 2003 13 patients with renal tumours underwent Da Vinci partial nephrectomy. Tumour size was 2 - 6 cm (mean 3.5). After exposure of the kidney and the tumour via either a transperitoneal or retroperitoneal approach the renal artery was clamped. In 8 cases a renal cooling via an intra-arterial catheter was performed. The tumour was excised with cold scissors and the vessels and the collecting system were suture repaired. A surgical cushion was fixed with interrupted sutures and the renal artery was unclamped. RESULTS: In 9 cases the whole procedure was done by the Da Vinci system. In 4 cases the exposure of the kidney and the hilum was done with conventional laparoscopy. The mean operative time including placement of the renal artery catheter was 215 min (130 - 262). Warm ischaemia time was 22 min (15-29). Cold ischaemia time ranged from 18 to 43 min. The mean estimated blood loss was 170 cm (50 - 300) Postoperative hospital stay was 4.3 days (2 -7). The pathology showed oncocytoma in two cases, benign cyst in 1 case, all others were RCC. In one case of a 6 cm lower pole tumour a positive margin occurred despite negative frozen sections; laparoscopic tumour nephrectomy was performed showing no evidence of tumour. CONCLUSIONS: The initial results for the robotic assisted laparoscopic partial nephrectomy are encouraging. An experienced scrubbed assistance is mandatory for this technique. The 3D-vision and the ability of perfect intracorporeal suturing allow a repair of the kidney as in open surgery. European
No. 2, pp. 194
767 LAPAROSCOPIC TRANSPERITONEAL A REMOTE-CONTROLLED ROBOTIC (DA [email protected]
). 31 CASES
Hubert -> CHU
J. Feuillu Nancy
INTRODUCTION & OBJECTIVES: Laparoscopic nephrectomy is a challenging procedure which requires a long learning curve. The Da [email protected]
robotic system provides an enhanced surgical endocorporeal dexterity with its endowristed instruments and a three-dimensional vision. It enables the surgeon to apply more easily his open surgical technique to the laparoscopic approach. We report the experience with robotic laparoscopic nephrectomy in a team with no previous prominent experience in laparoscopy (less than 10 nephrectomies). MATERIAL & METHODS: From November 2001 to August 2003 we performed 3 1 transperitoneal laparoscopic robotic-assisted nephrectomies in 24 patients (13 right, 18 left): 7 transplanted patients with tumours on their native kidneys underwent bilateral nephrectomies, 7 nephrectomies for renal tumour, 8 live donor nephrectomies and 2 for complicated atrophic kidneys. 5 ports were used: 3 for the robotic arms and 2 for the assistant. Renal artery was clipped and renal vein was stappled with an endo-GIA after the ureter and renal dissection had been completed. The kidney was removed through a supra-pubic Pfannenstiel incision. Mean patient age: 45 years (18-67). Sex ratio: 13 men and 11 women. RESULTS: All but one procedure were performed laparoscopically. One patient had to be converted in open surgery due to a venous tear (previous vena cava thrombosis, BMI=27). Mean operative time was 131 min (70-270). Mean renal weight 170 g (39-450). There was no significant blood loss. Mean hospital stay was 6.2 days (3-9). There was one parietal abscess (case converted to open surgery) but no other morbidity. CONCLUSIONS: The development of remote-controlled robotic surgical system allows surgeons with moderate experience in laparoscopic surgery to perform more easily complex laparoscopic procedures such as nephrectomies. Robotics will probably propel forward laparoscopy in the near future.