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SocietyLapSurgeons uploaded a new video
(3 weeks ago)
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SocietyLapSurgeons uploaded a new video
(1 month ago)
Part One / SLS Website Tour
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SocietyLapSurgeons uploaded a new video
(4 months ago)
TITLE: Video Demonstration of Robotic and Laparoscopic Partial Nephrectomy Without Vascular Clamping and Renal Ischemia
Objective: Robotic and lap...
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TITLE: Video Demonstration of Robotic and Laparoscopic Partial Nephrectomy Without Vascular Clamping and Renal Ischemia
Objective: Robotic and laparoscopic partial nephrectomy is a treatment option for small renal masses (less than 4cm). During the procedure, clamping of the renal vessels is required to minimize bleeding. This video presents a technique utilizing hemostatic hydrodissection and bipolar and radio frequency coagulation to avoid renal vascular clamping and renal ischemia.
Methods: Review of 22 cases from January 2006 to October 2007. Fourteen patients underwent hemostatic hydrodissection (Helix HydroJet), bipolar coagulation (Erbe BiClamp Coagulator), and radio frequency coagulation of the margin (RITA Habib RFA probe). Renal hilum was dissected in all cases so that renal vascular clamping could be performed if bleeding was encountered. Postoperative follow-up ranged from 1 month to 21 months.
Results: None of the 14 cases required vascular clamping. Mean patient age was 61 years (range, 37 to 70), mean renal mass size was 2.6cm (range, 1.1 to 3.7), mean estimated blood loss was 162cc (range, 20 to 500), and mean operative time was 198 minutes (range, 120 to 300). All resection margins were negative for malignancy. One patient had a horseshoe kidney. Eight patients had the transperitoneal approach, and 6 had the retroperitoneal approach. Mean hospital duration of stay was 4 days (range, 2 to 6). Two delayed urine leaks occurred that were treated conservatively. All patients had no significant change from baseline serum creatinine. Final pathology was as follows: 6 renal cell carcinomas, 2 angiomylipomas, 1 oncocytoma, and 5 complex hemorrhagic cysts.
Conclusions: This new technique for robotic and laparoscopic partial nephrectomy appears to be a safe technique that avoids renal vascular clamping and renal ischemia. Further testing and follow-up will determine longer-term outcomes.
Abs# 8304
Authors: Carl Bischoff, Miranda J. Hardee, Benjamin K. Canales, Chester B. Algood, Charles J. Rosser, Philipp Dahm, Johannes W. Vieweg, Sijo J. Parekattil
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SocietyLapSurgeons uploaded a new video
(4 months ago)
TITLE: Balloon Retention Facilitates Transgastric Laparoscopic Cysto-gastrostomy in Treatment of Pancreatic Pseudocyst
Objective: This presentation...
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TITLE: Balloon Retention Facilitates Transgastric Laparoscopic Cysto-gastrostomy in Treatment of Pancreatic Pseudocyst
Objective: This presentation demonstrates intragastric balloon retention facilitating a transgastric laparoscopic cysto-gastrostomy for pancreatic pseudocyst.
Methods: Via endoscopic and laparoscopic methods, 3 balloon-tipped operating trocars were inserted into the stomach. Transgastric identification of a pancreatic pseudocyst was accomplished with drainage of the pseudocyst via a permanent cysto-gastrostomy, created laparoscopically. Pseudocyst drainage was confirmed endoscopically and laparoscopically, as were the operating gastrostomies after laparoscopic closure.
Results: The patient was discharged home on day 4 after this 3-hour procedure. This is the second of 2 such procedures performed at this institution. The first lasted 3.5 hours, and the patient was discharged on postoperative day 2. Each has been followed for a year postoperatively with an uneventful recovery and full resolution of their pancreatic pseudocysts.
Conclusion: Acute fluid collections occur in 30% to 50% of severe pancreatitis cases. After 4 weeks to 6 weeks, these fluid collections may coalesce into a formal pseudocyst that typically is extrapancreatic and in the lesser sac. Complications of pancreatic pseudocyst include infection evolving into a pancreatic abscess, rupture leading to pancreatic ascites, erosion into the thorax creating a pancreaticopleural fistula, or production of a mass effect with gastric or duodenal obstruction and pain. Various methods of pseudocyst treatment have been described including endoscopic, percutaneous, laparoscopic, open, or combinations of the above. We demonstrate with video and still images a combined technique using an endoscope and the transgastric laparoscope with balloon-retained trocars inside the stomach to improve visualization and facilitate the minimally invasive approach to the pancreatic pseudocyst.
Abs# 8376GS
Authors: Todd A. Nickloes, DO, Matt Jones, MD, Craig S. Swafford, MD
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