Journal of endourology
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Journal of endourology · Nov 2004
Hand-assisted laparoscopic nephrectomy: the transfer of experience to a new academic center.
Hand-assisted laparoscopic nephrectomy (HALN) has become widely used for the management of localized renal masses and for simple nephrectomy [corrected] Centers of excellence have slowly disseminated this surgical approach throughout academic institutions and private practices. The transfer of this technique to inexperienced surgeons and centers has not been well studied. We examined our outcomes for HALN with an experienced surgeon (DMA) [corrected] at a new academic center. We also examined the effectiveness of the transfer of these techniques as trainees go out into practice [corrected] ⋯ The HALN techniques can be transferred quickly and efficiently between [corrected]one center and [corrected] another under the guidance of an experienced surgeon. Operative times are acceptable, with complication rates comparable to [corrected] previously reported series. Our data show that exposure during residency markedly increases the likelihood that surgeons will carry the techniques into their practices [corrected]
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Journal of endourology · Nov 2004
Review Case ReportsLaparoscopic nephrectomy for renal-cell carcinoma during pregnancy.
Renal-cell carcinoma (RCC) during pregnancy is rare. Laparoscopic nephrectomy has been used effectively and safely in nonpregnant patients with RCC. We report a case of a 34-year-old pregnant woman with RCC, which we believe to be the first such case to be managed by laparoscopic nephrectomy.
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Journal of endourology · Oct 2004
Factors affecting blood loss during percutaneous nephrolithotomy: prospective study.
Bleeding is a major concern during percutaneous nephrolithotomy (PCNL), especially with the use of multiple tracts. This prospective study aimed to identify factors affecting blood loss during PCNL. ⋯ Diabetes, multiple-tract procedures, prolonged operative time, and the occurrence of intraoperative complications are associated with significantly increased blood loss. Atrophic parenchyma and past ipsilateral intervention are associated with reduced blood loss. On the basis of this evidence, maneuvers that may reduce blood loss and transfusion rate include ultrasound-guided access, use of Amplatz or balloon dilatation systems, reducing the operative time, and staging the procedure in cases of a large stone burden or intraoperative complications. Reducing the tract size in pediatric cases, nonhydronephrotic systems and those with a narrow infundibulum, and secondary tracts in a multiple-tract procedure may also reduce blood loss during PCNL.
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Journal of endourology · Aug 2004
Renal capsular block: a novel method for performing percutaneous nephrolithotomy under local anesthesia.
Most of the pain of percutaneous nephrolithotomy is caused by dilatation of the renal capsule and parenchymal tract. We evolved a technique to block renal capsular sensations by infiltration of lignocaine (lidocaine) at the site of renal entry, permitting the procedure to be done with local anesthesia.
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Journal of endourology · Aug 2004
Case ReportsHand-assisted laparoscopic heminephrectomy in horseshoe kidney.
Horseshoe kidneys are the most common renal fusion anomalies. In surgery on normal kidneys, the use of minimally invasive techniques has decreased morbidity and improved postoperative care. However, aberrant vasculature, abnormal kidney location, and the renal isthmus present technical challenges to the laparoscopic management of horseshoe kidneys. We describe a case of heminephrectomy using hand-assisted laparoscopic techniques. ⋯ Hand-assisted laparoscopic heminephrectomy provides a safe treatment option for patients with an atrophic, obstructed moiety in a horseshoe kidney.