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Milech V, Caye P, Nascimento Antunes B, DA Silva Rappeti JC, Carra Perera S, Gehrcke MI, Cozza Dos Santos T, Conte C, DE Vargas Arigony Braga F, Albuquerque DE Oliveira Cavalcanti G, Veloso Brun M. Laparoscopic nephron-sparing surgery for the treatment of canine dioctophymosis. J Vet Med Sci 2022; 84:618-623. [PMID: 35264495 PMCID: PMC9096035 DOI: 10.1292/jvms.21-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This paper reports on two cases of laparoscopic nephrotomy employed in the treatment of
canine dioctophymosis, which is considered a unusual procedure and a new treatment
proposal heretofore not performed in veterinary medicine. Two patients were treated, one
with a history of hematuria and the other with incidental finding of the parasite in the
abdominal cavity during elective ovariohysterectomy. Both dogs were subjected to abdominal
ultrasound, which produced images indicating the presence of the parasite in the right
side kidney, but with partial parenchymal preservation. The patients were therefore
subjected to laparoscopic nephrotomy. The surgical procedure was effective in treating
dioctophymosis and enabled minimum tissue invasion during surgery, in addition to
preservation of the kidney.
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Affiliation(s)
- Vanessa Milech
- Graduate Program in Veterinary Medicine, Federal University of Santa Maria-UFSM
| | - Pâmela Caye
- Graduate Program in Veterinary Medicine, Federal University of Santa Maria-UFSM
| | | | | | - Soliane Carra Perera
- Graduate Program in Veterinary Medicine, Federal University of Pelotas-UFPel, Campus Universitário
| | - Martielo Ivan Gehrcke
- Associate Professor of the Department of Clinical Veterinary Medicine, Federal University of Pelotas-UFPel, Campus Universitário
| | - Thaís Cozza Dos Santos
- Multiprofessional Residency in Veterinary Medicine, Federal University of Pelotas-UFPel, Campus Universitário
| | - Camila Conte
- Multiprofessional Residency in Veterinary Medicine, Federal University of Pelotas-UFPel, Campus Universitário
| | - Fabrício DE Vargas Arigony Braga
- Associate Professor of the Department of Clinical Veterinary Medicine, Federal University of Pelotas-UFPel, Campus Universitário
| | | | - Maurício Veloso Brun
- Associate Professor of the Department of Clinical Small Animal Medicine, Federal University of Santa Maria-UFSM
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Chen X, Wang Y, Gao L, Song J, Wang JY, Wang DD, Ma JX, Zhang ZQ, Bi LK, Xie DD, Yu DX. Retroperitoneal vs transperitoneal laparoscopic lithotripsy of 20-40 mm renal stones within horseshoe kidneys. World J Clin Cases 2020; 8:4753-4762. [PMID: 33195643 PMCID: PMC7642540 DOI: 10.12998/wjcc.v8.i20.4753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Horseshoe kidney (HK) with renal stones is challenging for urologists. Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports, the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.
AIM To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.
METHODS This was a retrospective study of 12 patients with HK and a limited number (n ≤ 3) of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy (June 2012 to May 2019). The perioperative data of both groups were compared including operation time, estimated blood loss, postoperative fasting time, perioperative complications and stone-free rate (SFR).
RESULTS No significant difference was observed for age, gender, preoperative symptoms, body mass index, preoperative infection, hydronephrosis degree, largest stone diameter, stone number and isthmus thickness. The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29 ± 0.49 and 2.40 ± 0.89 d, respectively (P = 0.019). There was no significant difference in operation time (194.29 ± 102.48 min vs 151.40 ± 39.54 min, P = 0.399), estimated blood loss (48.57 ± 31.85 mL vs 72.00 ± 41.47 mL, P = 0.292) and length of hospital stay (12.14 ± 2.61 d vs 12.40 ± 3.21 d, P = 0.881) between the retroperitoneal and transperitoneal groups. All patients in both groups had a complete SFR and postoperative renal function was within the normal range. The change in estimated glomerular filtration rate (eGFR) from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was -3.86 ± 0.69 and -2.20 ± 2.17 mL/(min·1.73 m2), respectively (P = 0.176). From the preoperative stage to the 3-mo follow-up, the absolute change in eGFR values for patients in the retroperitoneal group and the transperitoneal group was -3.29 ± 1.11 and -2.40 ± 2.07 mL/(min·1.73 m2), respectively (P = 0.581).
CONCLUSION Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.
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Affiliation(s)
- Xin Chen
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Yi Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg 66421, Germany
| | - Jin Song
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Jin-You Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Deng-Dian Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Jia-Xing Ma
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Zhi-Qiang Zhang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang-Kuan Bi
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Dong-Dong Xie
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - De-Xin Yu
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
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Adam A, Reddy D. "Vaginal Delivery": A Novel Extraction Route for Large Renal Calculi Encountered During Laparoscopic Pyeloplasty. Curr Urol 2019; 12:104-110. [PMID: 31114468 DOI: 10.1159/000489427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/10/2018] [Indexed: 11/19/2022] Open
Abstract
Background To describe a simple, novel stone extraction technique using the transvaginal route for large renal calculi encountered during laparoscopic/robotic pyelolithotomy. Methods After a standard approach laparoscopic pyelolithotomy in a patient with a large (42 × 36 mm) pelvic calculus, Anderson-Hynes pyeloplasty was performed. A transverse posterior colpotomy was performed laparoscopically with the assistance of the Colpassist Vaginal Positioning Device (Boston Scientific) and the calculus was extracted, intact, through the vagina with the aid of an endoscopic retrieval bag. The vaginal incision was then closed intra-corporeally. A systematic review on the topic was also performed. Results The stone was removed in its entirety through an occult vaginal incision. There were no complications reported and the patient was stone free at follow-ups. Conclusions This simple, novel technique is an easily reproducible method, for the removal of large urinary calculi during either traditional laparoscopic or robotic-assisted laparoscopic stone surgery in the appropriate female patient. It avoids the need for additional abdominal incisions or complex techniques involving lithotripsy which may be more complicated and time consuming. All previously published stone extraction techniques for large calculi (greater than 20 mm) within this systematic review are also critically appraised.
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Affiliation(s)
- Ahmed Adam
- Department of Urology, Helen Joseph Hospital, Johannesburg, South Africa.,Department of Paediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital, Johannesburg, South Africa.,Wits Donald Gordon Medical Centre, Johannesburg, South Africa.,Division of Urology, Department of Surgery, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Deshin Reddy
- Department of Urology, Helen Joseph Hospital, Johannesburg, South Africa.,Department of Paediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital, Johannesburg, South Africa
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Huang L, Lin Y, Tang Z, Lie D, Wang Z, Chen H, Wang G. Management of upper urinary tract calculi in crossed fused renal ectopic anomaly. Exp Ther Med 2018; 15:371-376. [PMID: 29375692 DOI: 10.3892/etm.2017.5382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 07/07/2017] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to summarize the management of upper urinary tract calculi in crossed fused renal ectopia (CFRE). Two patients were retrospectively studied in Xiangya Hospital (Changsha, China) and all relevant literature published in English between 1996 and 2016 was reviewed. All patients, including those reported in the literature, were characterized by age, sex, manifestation, therapy history, ectopic side, stone location, surgery and outcome. The patients had a mean age of 42.3±18.5 years, a male: Female ratio of 5:4 and the ratio of renal ectopic side was 9:8 (left:right). All patients suffered from different degrees of pain on the affected side, with or without hematuria. Up to 89% of patients presented with renal stones. These patients received treatments including conservative management in 2, extracorporeal shock wave lithotripsy (ESWL) in 2, percutaneous nephrolithotomy (PCNL) in 11, laparoscope nephrolithotomy in 1 and retrograde intrarenal surgery (RIRS) in 3. Complete stone clearance was achieved in 14 patients (73.7%). In addition, 3 patients had a history of failed ESWL. No obvious intraoperative or postoperative complications occurred. The results suggested that, for the treatment of CFRE with upper urinary tract calculi, conservative treatment and ESWL are insufficient. PCNL is a safe and effective treatment for renal calculus, and laparoscopic nephrolithotomy is an alternative choice for treating large or staghorn renal stones. RIRS may become the first line of treatment for renal stones (≤3.5 cm) due to its multiple merits, including higher stone-free rates, minimal invasion and fewer complications.
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Affiliation(s)
- Liang Huang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yong Lin
- Institute for Virology, University Hospital of Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Zhengyan Tang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Dongjie Lie
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Zhao Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Guilin Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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5
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Çakici ÖU, Ener K, Keske M, Altinova S, Canda AE, Aldemir M, Ardicoglu A. Open stone surgery: a still-in-use approach for complex stone burden. Cent European J Urol 2017; 70:179-184. [PMID: 28721286 PMCID: PMC5510339 DOI: 10.5173/ceju.2017.1205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/02/2017] [Accepted: 02/13/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Urinary stone disease is a major urological condition. Endourologic techniques have influenced the clinical approach and outcomes. Open surgery holds a historic importance in the management of most conditions. However, complex kidney stone burden may be amenable to successful results with open stone surgery. In this article, we report our eighteen cases of complex urinary stone disease who underwent open stone removal. Material and methods A total of 1701 patients have undergone surgical treatment for urinary stone disease in our clinic between July 2012 and July 2016, comprising eighteen patients who underwent open stone surgery. Patients’ demographic data, stone analysis results, postoperative clinical data, and stone status were evaluated retrospectively. The choice of surgical approach is mostly dependent on the surgeon’s preference. In two patients, open surgery was undertaken because of perioperative complications. Results We did not observe any Clavien-Dindo grade 4 or 5 complications. Three patients were managed with a course of antibiotics due to postoperative fever. One patient had postoperative pleurisy, one patient had urinoma, and two patients had postoperative ileus. Mean operation time was 84 (57–124) minutes and mean hospitalization time was 5.5 (3–8) days. Stone-free status was achieved in 15 patients (83.3%). Conclusions Endourologic approaches are the first options for treatment of urinary stone disease. However, open stone surgery holds its indispensable position in complicated cases and in complex stone burden. Open stone surgery is also a valid alternative to endourologic techniques in all situations.
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Affiliation(s)
| | - Kemal Ener
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Murat Keske
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Serkan Altinova
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Abdullah Erdem Canda
- Department of Urology, Yildirim Beyazit University, School of Medicine, Ankara Ataturk Training & Research Hospital, Ankara, Turkey
| | - Mustafa Aldemir
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Arslan Ardicoglu
- Department of Urology, Yildirim Beyazit University, School of Medicine, Ankara Ataturk Training & Research Hospital, Ankara, Turkey
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Pastore AL, Palleschi G, Silvestri L, Leto A, Ripoli A, Fuschi A, Al Salhi Y, Autieri D, Petrozza V, Carbone A. Combined laparoscopic pyelolithotomy and endoscopic pyelolithotripsy for staghorn calculi: long-term follow-up results from a case series. Ther Adv Urol 2016; 8:3-8. [PMID: 26834835 DOI: 10.1177/1756287215607417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Staghorn renal stones are a challenging field in urology. Due to their high recurrence rates, particularly those associated with an infective process, a complete removal is the ultimate goal in their management. We report our experience with a combined approach of laparoscopic pyelolithotomy and endoscopic pyelolithotripsy, the stone clearance rate, and long-term, follow-up outcomes. METHODS From June 2012 to October 2014, nine adult patients with large staghorn renal calculi (mean size, 7.2 cm; range, 6.2-9.0 cm) underwent a combined laparoscopic and endoscopic approach. The technique comprised laparoscopic pyelolithotomy and holmium-YAG laser stone fragmentation with the use of a flexible cystoscope introduced through a 12 mm trocar. RESULTS The average operative time was 140 min (range, 90-190 min). The mean estimated hemoglobin loss was 0.6 mmol/l (range 0.5-0.7 mmol/l). None of the patients required an open- surgery conversion. The mean hospital stay was 4 days (range, 2-6 days). A computed tomography urogram control at 6 months of follow up did not show any stone recurrence. CONCLUSIONS Laparoscopic pyelolithotomy combined with endoscopic pyelolithotripsy could be a therapeutic option in cases where mini-invasive procedures, that is, extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy (PCNL) have failed. This technique has a high stone-clearance rate (75-100%) comparable with open surgery and PCNL. However, it could be technically demanding and should be performed by skilled laparoscopy surgeons.
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Affiliation(s)
- Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Via Franco Faggiana 1668, Latina 04100, Italy
| | - Giovanni Palleschi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy and Uroresearch, No Profit Association for Scientific Research in Urology, Latina, Italy
| | - Luigi Silvestri
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonino Leto
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Andrea Ripoli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Andrea Fuschi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Yazan Al Salhi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Domenico Autieri
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonio Carbone
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy and Uroresearch, No Profit Association for Scientific Research in Urology, Latina, Italy
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Skolarikos A, Dellis A, Knoll T. Ureteropelvic obstruction and renal stones: etiology and treatment. Urolithiasis 2015; 43:5-12. [PMID: 25362543 DOI: 10.1007/s00240-014-0736-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/23/2014] [Indexed: 12/20/2022]
Abstract
The simultaneous surgical management of ureteropelvic junction obstruction (UPJO) with concomitant renal stones has evolved the last 20 years; hence, the ideal minimally invasive technique is still controversial. Laparoscopic and robot-assisted laparoscopic operations allow precise surgical maneuvers and were thought to simplify the reconstruction steps of the procedure, especially in the treatment of complex cases with large stones. The aim of this study was to summarize the available perioperative and functional outcomes of minimally invasive available techniques. A non-systematic review of the literature was performed using a free-text protocol in the MEDLINE database. The terms used were "ureteropelvic junction obstruction," "renal calculi" and "renal stones." Furthermore, other significant relevant studies cited in the reference lists of the selected papers were also evaluated in the structure of this review. Currently, available evidence suggests that both laparoscopic and robotic-assisted techniques offer excellent surgical solutions in the field of UPJO reconstruction and renal stones removal. In the hands of experienced surgeons, laparoscopic and robotic pyeloplasty with concomitant stone removal is a safe procedure with high stone-free rates and UPJ patency. Minimally invasive pyeloplasty should constitute the first choice of treatment for concomitant renal stones and ureteropelvic junction obstruction.
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Affiliation(s)
- Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece
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8
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Jung JH, Cho SY, Jeong CW, Jeong H, Son H, Woo SH, Kim DK, Min SH, Oh SJ, Kim HH, Lee SB. Laparoscopic stone surgery with the aid of flexible nephroscopy. Korean J Urol 2014; 55:475-81. [PMID: 25045447 PMCID: PMC4101118 DOI: 10.4111/kju.2014.55.7.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 06/16/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy. Materials and Methods A retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed. Results The patients' mean age was 54.7±13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4±9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0±63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed. Conclusions Laparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications.
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Affiliation(s)
- Jae Hyun Jung
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Jeong
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Seung Hyo Woo
- Department of Urology, Eulji University School of Medicine, Daejeon, Korea
| | - Dae Kyung Kim
- Department of Urology, Eulji University School of Medicine, Daejeon, Korea
| | - Sun-Ho Min
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon-Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Seung Bae Lee
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
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9
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Myint M, Luke S, Louie-Johnsun M. Laparoscopic pyelolithotomy and pyeloplasty in a horseshoe kidney. ANZ J Surg 2013; 85:492-3. [PMID: 24251980 DOI: 10.1111/ans.12458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Michael Myint
- Department of Urology, Gosford District Hospital, Gosford, New South Wales, Australia
| | - Serge Luke
- Department of Urology, Gosford District Hospital, Gosford, New South Wales, Australia
| | - Mark Louie-Johnsun
- Department of Urology, Gosford District Hospital, Gosford, New South Wales, Australia
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10
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Haggag YM, Morsy G, Badr MM, Al Emam ABA, Farid M, Etafy M. Comparative study of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in the management of large renal pelvic stones. Can Urol Assoc J 2013; 7:E171-5. [PMID: 23589752 PMCID: PMC3612403 DOI: 10.5489/cuaj.490] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could be used to manage large renal pelvic stones, generally considered excellent indications for percutaneous nephrolithotomy (PNL). METHODS This study was performed from May 2009 to March 2012 at Al-Azhar University Hospitals (Assiut and Cairo), Egypt. It included two groups of patients with large renal pelvic stones; only patients with stones 2.5 cm(2) or greater were included. Group 1 included 40 patients treated by PNL and Group 2 included 10 patients treated by LPL. The differences between the two procedures were compared and analyzed. RESULTS There was no difference between the two groups regarding patient demographics and stone size. There was a statistically significant difference between the groups regarding mean estimated blood loss (65 ± 12.25 [range: 52.75-77.25] vs. 180 ± 20.74 [range: 159.26-200.74] mL, p ≤ 0001), mean hospital stay (2.3 ± 0.64 [range: 1.66-2.94] vs. 3.7 ± 1.4 [range: 2.3-5.1] days, p ≤ 0.006), rate of postoperative blood transfusion (0% vs. 4.8%, p ≤ 0.0024), and stone-free rate (80% vs. 78.6%, p ≤ 0.23). The mean operative time was significantly longer in Group 2 (LPL) (131 ± 22.11 [range: 108.89-153.11) vs. 51.19 ± 24.39 [range: 26.8-75.58] min, p ≤ 0001), respectively. CONCLUSION Although PNL is the standard treatment in most cases of renal pelvic stones, LPL is another feasible surgical technique for patients with large renal pelvic stones.
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Abstract
The surgical management of urolithiasis has undergone a remarkable clinical evolution over the past three decades. The once common practice of open stone surgery has nearly been relegated to historical interest by modern technology. The introduction of minimally invasive techniques, laparoscopy and robot-assisted surgery, have emerged to complete the urologist's armamentarium. The benefits to patients when other endourologic procedures have failed include less pain, shorter hospitalization and convalescence, and improved cosmesis. This chapter explores the historical shift from open to minimally invasive management for stone disease and the unique risks and outcomes associated with these procedures in modern urology.
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12
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Richard P, Bettez M, Martel A, Ponsot Y, Sabbagh R. Laparoscopic management of a large staghorn stone. Can Urol Assoc J 2012; 6:E121-4. [PMID: 22709883 DOI: 10.5489/cuaj.11027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urinary calculi are prevalent and result in significant morbidity, with a marked economic impact. Various therapeutic options exist, from medical to surgical management according to stone size. Laparoscopic pyelolithotomy is a viable option for significant staghorn renal stones. We report the case of a laparoscopic pyelolithotomy performed on a 48-year-old man with a left recurrent staghorn renal stone secondary to an ureteropelvic junction obstruction following a grade IV renal trauma several years ago.
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Affiliation(s)
- Patrick Richard
- Division of Urology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Université de Sherbrooke, Sherbrooke, QC
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13
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[Laparoscopic repair of vesico-vaginal fistula without intentional cystotomy and guided by vaginal transillumination]. Actas Urol Esp 2012; 36:252-8. [PMID: 22188749 DOI: 10.1016/j.acuro.2011.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 10/10/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Repair of vesico-vaginal fistula (VVF) by laparoscopy provides excellent exposure, which facilitates their implementation through small cystotomy. In some cases is difficult to locate the fistula without the prior opening of the bladder. We present a maneuver using vaginal transillumination to locate the fistula and to reduce the size of the opening bladder during laparoscopic repair without intentional cystotomy. MATERIAL AND METHODS A total of 4 patients with supra-trigonal FVV produced post-hysterectomy received laparoscopic repair. All patients underwent physical examination, dye test, urethrocystoscopy and intravenous pyelography. Fistula was located using a cystoscope inserted through vagina and placed over the fistula. The emitted light guide laparoscopic dissection in to the plane between the vagina and the bladder just above the fistula, without previous intentional cystotomy. RESULTS The mean age of patients was 42 (38-47) years. Bladder opening size did not reach 2cm. The mean operative time was 160 (120-186) minutes and catheterization time was 10 days. There were no recurrences. CONCLUSIONS The laparoscopic repair of VVF without intentional cystotomy, by direct dissection of the fistulous tract guided by vaginal transillumination is effective; because it quickly locates the fistula in all cases, reduces the size of the bladder opening, shortens operative times and reduces irritative symptoms.
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García-Seguí A, Gascón-Mir M. Nephroscopy with carbon dioxide in combination with laparoscopy in the treatment of urinary stones. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.acuroe.2012.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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García-Seguí A, Gascón-Mir M. [Nephroscopy with carbon dioxide in combination with laparoscopy in the treatment of urinary stones]. Actas Urol Esp 2012; 36:186-90. [PMID: 21963051 DOI: 10.1016/j.acuro.2011.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 07/19/2011] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Laparoscopy in combination with nephroscopy is rarely used for the treatment of complex urinary stones or anatomical abnormalities with difficult access stones. During the nephroscopy, in an opened renal pelvis, large amounts of fluid leaks and collects in the peritoneal cavity and can be a drawback. In these cases, the nephroscopy with use of carbon dioxide (CO2) can be an alternative. We present our experience in with this technique. MATERIAL AND METHOD We performed surgeries using the 3-port transperitoneal technique. Five patients with urolithiasis were included. Three patients had concomitant ureteropelvic junction stenosis, one with stones in ectopic kidney, and the third had a large stone impacted in the proximal ureter. Patients were treated by pyelolithotomy or ureterolithotomy combined with flexible nephroscopy using CO2 and dismembered pyeloplasty was performed in appropriate cases. A flexible cystoscope was passed through a port and guided laparascopically through the opening in the renal pelvis. The gas cannula was connected to the irrigation channel of the endoscope to insufflate CO2 and calculi were extracted with a nitinol basket. RESULTS Median age was 45 years (24-58). Mean operative time of nephroscopy was 22.4 minutes (range 15-48). Mean intra-operative blood loss was inestimable. There were no complications or conversion. Residual lithiasis requiring ureteroscopy was present in one patient. CONCLUSIONS Flexible nephroscopy using CO2 in combination with laparoscopy is a feasible and effective technique for the treatment of urinary stones in selected cases to avoid accumulation of fluid in the peritoneal cavity.
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Tefekli A, Tepeler A, Akman T, Akçay M, Baykal M, Karadağ MA, Muslumanoglu AY, de la Rosette J. The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones. ACTA ACUST UNITED AC 2012; 40:549-55. [PMID: 22307365 DOI: 10.1007/s00240-012-0463-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 01/19/2012] [Indexed: 12/30/2022]
Abstract
The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large (>4 cm(2)) renal pelvic stones were treated by LPL and their charts were compared to 26 match-paired patients treated with PNL during the same period. The patients were matched for age, BMI, stone size and location as well as presence of congenital anomalies. Perioperative and postoperative findings were compared. The mean age, mean stone size, rate of congenital anomalies, history open renal surgery and shock wave lithotripsy were similar in both groups (p > 0.05). The mean operation time was 138.40 ± 51.19 (range 70-240) min in LPL group as compared to 57.92 ± 21.12 (range 40-110) min in PNL group (p < 0.0001). There was one (3.8%) open conversion in the LPL group due to dense perirenal adhesions making the dissection difficult. The ureteropelvic junction (UPJ) obstruction concomitant to pelvic stones was successfully repaired laparoscopically in two cases. The mean drop in postoperative hemoglobin level was 0.9 ± 0.6 (range 0-2) g/dl in LPL group and 1.7 ± 1.1 (range 0-4) g/dl in PNL group (p = 0.024). Hospitalization was significantly shorter in PNL than LPL group (p = 0.0001). Stone-free rates were similar. Laparoscopic pyelolithotomy is associated with a longer operation time, is more invasive, and requires more skills when compared to PNL. However, LPL is associated with less blood loss. Laparoscopic pyelolithotomy is indicated for congenitally anomalous kidneys and especially in patients with concomitant UPJ.
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Affiliation(s)
- Ahmet Tefekli
- Department of Urology, Haseki Teaching and Research Hospital, 34360 [corrected] Istanbul, Turkey.
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Chander J, Gupta N, Lal P, Lal P, Ramteke VK. Retroperitoneal laparoscopic pyelolithotomy versus extra corporeal shock-wave lithotripsy for management of renal stones. J Minim Access Surg 2011; 6:106-10. [PMID: 21120067 PMCID: PMC2992658 DOI: 10.4103/0972-9941.72596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 07/01/2010] [Indexed: 11/24/2022] Open
Abstract
AIM: The purpose of this study was to evaluate the role of retroperitoneal laparoscopic pyelolithotomy (RPPL) and its comparison with extra corporeal shock wave lithotripsy in the management of renal calculi. MATERIALS AND METHODS: The study was carried out in the Department of surgery, Maulana Azad Medical College, New Delhi, India. The study included 86 cases of solitary renal calculi in the retroperitoneoscopic (RPPL) group and 82 cases in the shock wave lithotripsy (SWL) group. The parameters compared were stone clearance, hospital stay, number of postoperative visits, mean time to resume normal activities, number of man days lost, and analgesic requirement. RESULTS: The RPPL group showed better stone clearance, fewer hospital visits, low analgesic requirement, fewer number of man days lost, and early resumption of normal activities, as compared to the SWL group. CONCLUSIONS: Shock wave lithotripsy, being a noninvasive modality, is an established procedure all over the world. However RPPL achieves comparable or better results in high volume centers.
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Affiliation(s)
- Jagdish Chander
- Department of Surgery, Maulana Azad Medical College, New Delhi - 110 002, India
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Al-Hunayan A, Khalil M, Hassabo M, Hanafi A, Abdul-Halim H. Management of solitary renal pelvic stone: laparoscopic retroperitoneal pyelolithotomy versus percutaneous nephrolithotomy. J Endourol 2011; 25:975-8. [PMID: 21612433 DOI: 10.1089/end.2010.0467] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Percutaneous nephrolithotomy (PCNL) is considered the main management option for large single renal pelvic stones; however, laparoscopic retroperitoneal pyelolithotomy (LRP) can be used as an alternative management procedure. We compare both procedures in the management of solitary large renal pelvic stones. PATIENTS AND METHODS Between June 2002 and July 2010, 105 patients with solitary large renal pelvic stones were selected and randomly divided into two groups; group 1 included 55 patients who were treated by LRP and group 2 included 50 patients who were treated by PCNL. The differences between the two procedures were compared and analyzed. RESULTS There was no difference between the two groups regarding patient demographics and stone size. There was no statistically significant difference between LRP and PCNL regarding mean estimated blood loss (166.4±98.3 mL vs 178±102.4 mL), mean hospital stay (4.5±1.9 d, vs 4.4±1.4 d), mean time of postoperative analgesia (2.2±0.9 d vs 2.4±0.9 d), rate of postoperative blood transfusion (5.5% vs 6%), and stone-free rate (100% vs 96%). The mean operative time was significantly longer in the LRP group (130.6±38.7 min vs 108.5±18.7 min), respectively. There was only one (1.8%) case from the laparoscopy group converted to open surgery because of uncontrolled bleeding. CONCLUSION RLP is a suitable surgical technique for patients with large renal pelvic stones but with good selection of cases; however, PCNL remains the standard treatment in most cases.
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Affiliation(s)
- Adel Al-Hunayan
- Department of Surgery (Division of Urology), Kuwait University, Kuwait, Kuwait.
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Elbahnasy AM, Elbendary MA, Radwan MA, Elashry OM, Taha MR. Laparoscopic pyelolithotomy in selected patients with ectopic pelvic kidney: a feasible minimally invasive treatment option. J Endourol 2011; 25:985-9. [PMID: 21568695 DOI: 10.1089/end.2010.0521] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Ectopic pelvic kidney is a rare congenital anomaly. It carries more risks for obstruction and stone formation than a normal located kidney. The treatment of renal stones in these patients is challenging. We present our experience with laparoscopic pyelolithotomy for treatment of selected patients with large and multiple renal stones in ectopic pelvic kidneys. PATIENTS AND METHODS After insertion of a ureteral catheter, pneumoperitoneum was achieved by Veress needle, and the kidney was exposed. The renal pelvis was identified, dissected, and opened. The stones were extracted using laparoscopic forceps. The rigid nephroscope was used to extract any caliceal stones. The renal pelvis was sutured, and the stones were removed from the peritoneal cavity. The procedure was concluded after placement of an intraperitoneal drain. RESULTS A total of 11 patients with large renal pelvic and/or multiple stones underwent laparoscopic transperitoneal pyelolithotomy. A transmesenteric approach was used in eight patients while the colon was mobilized off the kidney in three patients. All stones were removed except one that needed Double-J stent placement and one session of shockwave lithotripsy. After one auxiliary procedure, the stone-free rate was 100%. There were no major intraopertive or postoperative complications. Within a mean follow-up period of 23 months, no stone recurrence occurred. CONCLUSIONS Laparoscopic pyelolithotomy for large and multiple stones in ectopic pelvic kidneys is a feasible minimally invasive treatment option. The technique allows removal of all the stones without fragmentation, which may decrease the possibility for rapid stone recurrence.
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Schatloff O, Weintraub Y, Leibovici D. Carbon dioxide-based nephroscopy during laparoscopic pyeloplasty provides suboptimal view when stones are located in the lower calices. J Endourol 2010; 25:97-9. [PMID: 21091221 DOI: 10.1089/end.2010.0403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Flexible nephroscopy while using carbon dioxide to insufflate the collecting system has been described as a "good trick" to remove caliceal stones during laparoscopic pyelolithotomy. We found this true only for those calices with undisturbed urine drain into the renal pelvis, while it provided suboptimal view of stones that were located in dependent lower pole calices. We describe how we dealt successfully with a group of lower pole caliceal stones during laparoscopic pyeloplasty.
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Affiliation(s)
- Oscar Schatloff
- Department of Urology, Assaf Harofeh Medical Center, Zerifin, Israel.
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Afshari E, Najarian S, Simforoosh N, Hajizade Farkoush S. Design and fabrication of a novel tactile sensory system applicable in artificial palpation. MINIM INVASIV THER 2010; 20:22-9. [PMID: 20977388 DOI: 10.3109/13645706.2010.518739] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Force and position feedback are the two important parameters that are employed in different medical diagnoses and more specifically surgical operations. Furthermore, during different minimally invasive procedures, the ability of touch and force and position feedback are absent. In this regard, artificial palpation is a new technology that is employed to obtain tactile data in situations where physicians/surgeons cannot use their tactile sense. One of the most valuable achievements of artificial palpation are tactile sensory systems that have various applications in the detection of hard objects inside the soft tissue. Considering the present problems and limitations of kidney stone removal laparoscopy, the aim of this research is to design and fabricate a novel tactile sensory system capable of determining the exact location of stones during laparoscopy. This new tactile sensory system consists of four main parts: The sensory part, the mechanical part, the electrical part, and the display part. In this new system, due to the use of both displacement and force sensors, the usage limitations of previous tactile sensory systems are eliminated. The new tactile sensory system is well capable of finding the stone in the laboratory models through physical contact with the model's surface.
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Affiliation(s)
- Elnaz Afshari
- Biomedical Engineering, Artificial Tactile Sensing and Robotic Surgery Laboratory, Biomedical faculty, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
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Skolarikos A, Papatsoris AG, Albanis S, Assimos D. Laparoscopic urinary stone surgery: an updated evidence-based review. ACTA ACUST UNITED AC 2010; 38:337-44. [DOI: 10.1007/s00240-010-0275-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 04/06/2010] [Indexed: 11/24/2022]
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