Journal of endourology
-
Journal of endourology · Dec 2003
Comparative StudyBipolar radiofrequency ablation of the kidney: comparison with monopolar radiofrequency ablation.
We report initial ex vivo and in vivo studies using bipolar radiofrequency (RF) ablation of porcine kidneys. An internal ground electrode is positioned in the kidney opposite the RF electrode, resulting in ablation of all the intervening renal tissue. ⋯ As shown by ex vivo data, bipolar RF can create larger lesions than does monopolar RF. In vivo, at 48 hours, both blanched and hemorrhagic gross lesions were seen using RF. In this model, blanched lesions predominated when performing bipolar RF.
-
Journal of endourology · Nov 2003
Comparative StudyUrinary stone size: comparison of abdominal plain radiography and noncontrast CT measurements.
To compare urinary stone size as measured by abdominal plain radiography (AXR) with stone size as measured by noncontrast three-dimensional spiral CT in patients with acute renal colic. ⋯ A CT scan provides estimates of stone size that are consistently greater than those of AXR in both the longitudinal and transverse axes. However, for stones between 2 and 13 mm in maximum diameter, these differences do not attain significance. In patients with a history of radiopaque stones in this size range, therefore, AXR may provide useful size data for clinical decision-making without concern about significant disparities between the two modalities. As AXRs are more expeditiously obtained, incur less direct costs, and expose patients to significantly lower doses of radiation than CT scans, they remain a useful adjunctive study in the work-up of nephrolithiasis.
-
Complications related to laparoscopic donor nephrectomy (LDN) have been similar to those associated with open renal donor nephrectomy (ODN). However, during clinical follow-up, we noted a group of male patients who developed acute ipsilateral orchialgia after LDN. In an effort to assess the incidence of this problem, determine the etiology, and adapt preventive measures, we reviewed our experience. ⋯ Laparoscopic donor nephrectomy has proven to be an effective and safe surgical procedure. However, further evaluation has demonstrated a complication not previously reported, namely ipsilateral orchialgia. The etiology remains unclear but may be injury to the sensory nerves of the testicle during dissection of the periureteral tissue or transection of the spermatic cord. Further anatomic and physiological studies are needed to elucidate the pathophysiology of this problem.
-
Journal of endourology · Jun 2003
Comparative StudyLaparoscopic inferior vena cava and right atrial thrombectomy utilizing deep hypothermic circulatory arrest.
Surgery for renal cancer associated with a level III or IV tumor thrombus often involves cardiopulmonary bypass, deep hypothermia, and exploration of the right atrium and inferior vena cava (IVC). This major open operation necessitates a large median sternotomy incision and a midline abdominal or chevron incision. Herein, we investigate the feasibility of purely laparoscopic IVC and right atrial thrombectomy utilizing deep hypothermic circulatory arrest. ⋯ Laparoscopic radical nephrectomy with thrombectomy for level III or IV tumor thrombi utilizing deep hypothermic circulatory arrest is feasible in the calf model using minimally invasive techniques exclusively. The procedure is technically complex and requires the combined efforts of expert urologic and cardiac operative teams. Survival studies are planned.
-
Journal of endourology · Apr 2003
Comparative StudySingle-center comparison of purely laparoscopic, hand-assisted laparoscopic, and open radical nephrectomy in patients at high anesthetic risk.
The laparoscopic approach for management of high-risk patients with renal-cell carcinoma (RCC) may reduce perioperative and postoperative morbidity. The aim of this study was to compare the outcome of purely laparoscopic radical nephrectomy (LRN), hand-assisted laparoscopic radical nephrectomy (HALRN), and open radical nephrectomy (ORN) for renal tumors in a population of patients at high risk for perioperative complications. ⋯ Both LRN and HALRN can be performed safely in patients with significant comorbid conditions. Careful preoperative preparation, intraoperative monitoring, and awareness of laparoscopy-induced oliguria can preclude inadvertent overhydration, hemodilution, and congestive heart failure. Both LRN and HALRN result in less pain medication requirement and faster return to oral intake than ORN, and LRN results in fewer perioperative complications than HALRN or ORN in patients at high perioperative risk. The LRN technique has a 21% lower total cost than both HALRN and ORN.