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To present the initial experience in laparoscopic radical prostatectomy performed exclusively through an umbilical incision using a single three-channel port and specially designed flexible laparoscopic instrumentation.Since November 26, 2007, we have performed single-port laparoscopic radical prostatectomy in 4 patients diagnosed with prostate cancer. Patients with early-stage prostate cancer (T1c),...
To present the initial report of single-port transvesical enucleation of the prostate in 3 patients with large-volume benign prostatic hyperplasia.Single-port transvesical enucleation of the prostate was performed in 3 patients with large-volume (187, 93, and 92 g) benign prostatic hyperplasia. A novel single-port device (r-Port) was introduced percutaneously into the bladder through a 2.5-cm incision...
Previous renal surgery has been considered a relative contraindication to laparoscopic partial nephrectomy (LPN) because of perirenal surgical adhesions. We present our experience with LPN in patients with previous ipsilateral renal surgery.Of 679 patients undergoing LPN for a renal mass from September 1999 to November 2006, 25 (3.7%) had undergone previous ipsilateral open or percutaneous renal procedures...
To describe a novel flexible robotic system for performing retrograde intrarenal surgery.Remote robotic flexible ureterorenoscopy was performed bilaterally in 5 acute swine (10 kidneys). A novel 14F robotic catheter system, which manipulated a passive optical fiberscope mounted on a remote catheter manipulator was used. The technical feasibility, efficiency, and reproducibility of accessing all calices...
To present our initial experience with single-port laparoscopic urologic surgery using the Uni-X Single Port Access Laparoscopic System, a single port, multichannel cannula, with specially designed curved laparoscopic instrumentation.We performed single-port laparoscopic surgery in 10 patients, including renal cryotherapy in 4, wedge kidney biopsy in 1, radical nephrectomy in 1, and abdominal sacrocolpopexy...
As experience with laparoscopic partial nephrectomy (LPN) expands, inevitably tumor-bearing kidneys with anomalous renal vasculature will be subjected to LPN. We evaluated LPN in kidneys with multiple arteries and compared those outcomes with the LPN outcomes in patients with conventional renal arterial anatomy.Since September 1999, we have performed LPN for tumors in 333 patients. From this prospectively...
To describe our experience with laparoscopic ureteral reconstruction in the adult patient with benign ureteral stricture disease.We retrospectively compared laparoscopic (n = 12) and open (n = 34) ureteroureterostomy, ureteroneocystostomy, and Boari flap procedures conducted from January 1999 to November 2005 for benign stricture disease. The demographic, operative, complication, and outcome data...
To describe technical modifications to the laparoscopic Boari flap ureteroneocystostomy procedure.Removal of ureteral stents with conversion to percutaneous nephrostomy drainage before surgery allowed for optimization of tissue quality and visualization during operative repair. Adherence to specific dimensional ratios during flap excision consistently provided for adequate tissue for successful Boari...
To evaluate the effect of pyeloplasty for the treatment of ureteropelvic junction (UPJ) obstruction on adult renal function in the setting of a solitary kidney.Since 1989, 312 patients have undergone operative intervention for UPJ obstruction. Of these, 13 patients (5 men and 8 women), aged 17 to 76 years (median 44.5), had a solitary kidney and were available for postoperative surveillance. Treatment...
Over the past decade, a number of probe ablative therapies have emerged for the treatment of patients with localized renal tumors. Cryoablation and radiofrequency ablation (RFA) have been studied in the greatest detail. We present the results of 164 laparoscopic cryoablations and 82 percutaneous RFAs performed in our institution and compare them retrospectively in terms of complications, impact on...
To determine the long-term clinical and radiographic success of holmium laser endoureterotomy for nonobliterative benign ureteral strictures. A total of 19 patients (12 women and 7 men, mean age 47.5 years) underwent holmium laser endoureterotomy for iatrogenic ureteral strictures (seven proximal, seven mid, and five distal) using semirigid ureteroscopy and a 360-μm fiber at 1 J and 10 Hz. Success...
We sought to compare perioperative and short-term outcomes of laparoscopic partial nephrectomy versus laparoscopic cryoablation in patients with peripheral small renal tumors. Prospectively accrued data of patients with a small renal tumor (≤3 cm) undergoing laparoscopic partial nephrectomy (group 1, n = 153) or laparoscopic cryoablation (group 2, n = 78) were compared retrospectively. Patients undergoing...
To assess the feasibility of ambulatory laparoscopic pyeloplasty. Laparoscopic pyeloplasty aims to reproduce the excellent functional outcomes of open pyeloplasty while diminishing procedural morbidity. Six patients fulfilled specific inclusion criteria for outpatient laparoscopic pyeloplasty: informed consent, body mass index of 40 kg/m 2 or less, primary ureteropelvic junction obstruction,...
To evaluate whether using a biologic hemostatic sealant facilitates hemostasis during laparoscopic partial nephrectomy. Secure and durable parenchymal hemostasis is a critical requirement during laparoscopic partial nephrectomy. Since September 1999, laparoscopic partial nephrectomy has been performed in more than 300 patients by a single surgeon, duplicating open surgical principles. Recently,...
To present our experience with laparoscopic heminephrectomy. We defined heminephrectomy as excision of 30% or more of the renal parenchyma. Laparoscopic partial nephrectomy has typically been performed for smaller, exophytic tumors. With growing experience, we have performed more extensive resections for larger tumors, when indicated. Since August 1999, we have performed laparoscopic partial nephrectomy...
A 61-year-old man with bilateral Gleason score 7 (3+4) clinical Stage T1c prostate cancer was treated with laparoscopic bilateral pelvic lymphadenectomy and radical prostatectomy. The left obturator nerve was inadvertently transected during left obturator lymph node dissection and repaired by laparoscopic reapproximation.
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