V496

OB TAPE SUBURETHRAL SLING FOR STRESS URINARY INCONTINENCE

Sunday, May 22, 2005

Salim I Hawatmeh*, Daniel S Elliott, Rochester, MN

INTRODUCTION AND OBJECTIVE: Demonstrate surgical technique of Ob Tape suburethral sling for the treatment of stress urinary incontinence.

METHODS: This narrated video demonstrates the surgical technique of Ob tape suburethral sling in the treatment of a 58 year-old female with urethral hypermobility and intrinsic sphincter deficiency by history, physical exam, and urodynamics.

RESULTS: Successful surgical outcome based on resolution of symptoms in short-term follow-up.

CONCLUSIONS: Ob Tape suburethral sling is a technically feasible, outpatient procedure for the treatment of stress urinary incontinence.

V885

ENDOSCOPIC TREATMENT FOR THE RETAINED CALCIFIED DOUBLE J STENT

Monday, May 23, 2005

Jorge A Campos Castellanos*, Mexico, Mexico

INTRODUCTION AND OBJECTIVE: In patients with high tendency to lithiasis, care should be observed in how long a double "J" stent is left after a ureteroscopic procedure, since calcification producing difficult retrieval might occur. The presentation’s objective is to provide the urologist a safe management with no damage to the urinary system.

METHODS: A 32-year-old female that after a ureteroscopic stone retrieval, a double "J" stent was left in place. After a three-week period, during catheter extraction, it was retained due to calcification for which a semi rigid ureteroscopy had to be carried out. The lithoclast was the preferred in situ lithotripter since produces cold fragmentation and no damage to the already inflamed ureteral walls.

RESULTS: Successful catheter extraction was achieved with no damage to the ureteral wall. A year later after this episode, the patient developed another urinary stone in the same side and we had the opportunity for a second look, observing the ureteral wall was intact.

CONCLUSIONS: Although it is uncertain when a catheter will be calcified close follow up is required. The lithoclast provides an excellent in situ cold lithotripsy to achieve our goal. The video will demonstrate tricks of the trade to be successful in such difficult cases.

V1152

URETERAL TISSUE BALLOON EXPANSION FOR LAPAROSCOPIC BLADDER AUGMENTATION: CLINICAL EXPERIENCE

Tuesday, May 24, 2005

Ali Moinzadeh*, Mihir M Desai, Mauricio Rubinstein, Osamu Ukimura, Sidney Abreau, Massimiliano Spaliviero, Antonio Finelli, Inderbir S Gill, Cleveland, OH

INTRODUCTION AND OBJECTIVE: Given its transitional cell lining and other important characteristics, the ureter may serve as an ideal substitute instead of intestine for bladder augmentation. In this video, we present our percutaneous technique of ureteral tissue balloon expansion of the distal ureter with subsequent laparoscopic bladder augmentation in two human subjects.

METHODS: Two female patients (age 65 and 14 years old) with severely decreased bladder capacity underwent ureteral balloon expansion and laparoscopic bladder augmentation. The ureteral dilating balloon is inserted percutaneously under fluoroscopic guidance. The device allows for in-line dilation of the ureter with concomitant drainage of the kidney. Incremental expansion of the balloon is performed over a 4 week period. The dilated distal ureter is then used for a laparoscopic augmentation ureterocystoplasty. All steps are presented in this video.

RESULTS: The procedure was performed in a completely minimally invasive fashion without conversion to open surgery. No intraoperative complications were noted. With early follow-up, the augmented bladder capacity appears maintained.

CONCLUSIONS: This minimally invasive technique has the potential to provide native transitional cell epithelial lined tissue for augmentation of the urinary bladder.

V1153

LAPAROSCOPIC NERVE SPARING RETROPERITONEAL LYMPH NODE DISSECTION

Tuesday, May 24, 2005

James R Porter*, Brian C Fong, Can Obek, Paul H Lange, Seattle, WA

INTRODUCTION AND OBJECTIVE: Retroperitoneal lymph node dissection (RPLND) is a surgical option for high risk Stage I non-seminomatous germ cell tumours (NSGCT). The traditional open approach may result in morbidity such as bowel dysfunction and prolonged hospital stay. Laparoscopic RPLND has been applied by some investigators to decreased the morbidity of open surgery while maintaining the anatomic and oncologic principles of this technique. We present our technique of laparoscopic nerve sparing RPLND.

METHODS: Indications for laparoscopic RPLND included patients with clinical Stage I NSGCT with negative tumor markers or normalized markers post-orchiectomy. Nerve-sparing was peformed in selected Stage I NSGCT patients with negative abdominal CT and chest x-rays, and high risk features such as >50% embryonal carcinoma, lympho-vascular invasion, pathologic stage T2 or greater with a need for bilateral node dissection.

RESULTS: In our series between June 1999 and April 2004, there were 43 procedures in 39 patients. Hight risk Stage I constituted majority of patients. 51% had positive nodes. The video presented is a case of a 29 year old male with T1 right testicular cancer composed of 95% embyronal carcinoma without lympho-vascular invasion. Pre-orchiectomy makers were AFP 36, beta HCG negative, and normal LDH. Markers normalized by half-life post-orchiectomy. Operative time was 5 hours, estimated blood loss was 150cc and there were no complications. The patient was discharged on POD#2 with return to normal activity in 2 weeks. Pathology was negative for disease in 22 nodes. Ejaculatory function was normal post-operatively.

CONCLUSIONS: Laparoscopic nerve sparing RPLND can be offered to patients with high risk Stage I NSGCT. It is technically feasible and recreates the results of open RPLND by following established anatomic and oncologic principles. Decreased morbidity and convalescence with preservation of ejaculation can be accomplished through laparoscopic nerve sparing RPLND.

V1590

LAPAROSCOPIC PARTIAL NEPHRECTOMY WITHOUT HILAR VESSELS CLAMPING

Wednesday, May 25, 2005

Ruben Urena, Freddy Mendez-Torres, Michael M Woods, Raju Thomas*, Rodney Davis, New Orleans, LA

INTRODUCTION AND OBJECTIVE: Laparoscopic Partial Nephrectomy (LPNx) is a minimally invasive technique for treating small solid renal masses. Herein, we present a video of a laparoscopic partial nephrectomy for a solid renal mass without clamping the renal vasculature using a monopolar device that employs radiofrequency (RF) energy and low-volume saline irrigation for blunt dissection, hemostatic sealing and coagulation of the renal parenchyma (TissueLink™ technology).

METHODS: Gerota’s fascia was incised and the kidney was dissected until the tumor was identified, leaving intact the perinephric fat overlying it. The renal hilum was dissected; however, the renal vasculature was not clamped. The resection margin was scored first and then the procedure completed with the TissueLink™. After complete tumor was resected any bleeding was controlled with the TissueLink™. Multiples biopsies of the tumor base were then taken for frozen analysis. Perinephric fat covering with intracorporeal suturing was used to close the tumor bed defect.

RESULTS:From September 2002 to January 2004, 16 patients had undergone transperitoneal LPNx for solid renal masses without clamping the renal vasculature using the TissueLink™ technology. Average: Age 54.6 years (range: 42 to 72), tumor size 3.9cm (range: 2.1-8), peripheral location in 13 and central in 3, O.R. time 232 minutes (range: 144-280), 1 patient had blood transfusion, all tumor margins were negative. Two patients had prolonged urine leak from the lower pole calyx managed with ureteral stenting and Foley, hospital stay was 1.3 days (range: 1-3), pain medications usage was minimal.

CONCLUSIONS: The TissueLink™ assisted laparoscopic partial nephrectomy is a new technique that allows complete tumor resection and provides adequate parenchymal hemostatis without clamping the renal vasculature.

Read Video Abstracts Selected Abstracts - Part 1

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