Adrenal and renal laparoscopic surgery

Vol. 169, No.4, Supplement, Saturday, April 26, 2003

THE JOURNAL OF UROLOGY®

function and response to Sildenafil of patients with known posterior urethral injuries due to pelvic fractures. METHODS: All patients referred to our department for posterior urethral reconstruction, for strictures due to pelvic fractures, were prospectively evaluated. Preoperatively patients underwent Nocturnal Penile Tumescence - NPT testing. If NPT results were abnormal, penile Duplex US with intra cavernous injection and arteriography were performed, when indicated, to diagnose the etiology of ED. Patients were specifically questioned concerning their erectile function every three months after surgery and if they complained of ED they were offered Sildenafil 100Mg. Patients followed for at least 18 months after surgery are included in this report. RESULTS: 29 consecutive patients were evaluated. 22 (76%) of them had ED preoperatively by NPT criteria. Follow up of 18 months or longer was available for 15 of the patients with ED. 47% of these patients responded favorably to treatment with Sildenafil. All but one of the patients that responded to Sildenafil had neurogenic ED. In 33% of the patients ED resolved within the follow up period. All patients with spontaneous resolution of ED previously responded to Sildenafil (71% of Sildenafil responders). CONCLUSIONS: In patients with ED after an urethral injury associated with pelvic fractures favorable response to Sildenafil may predict spontaneous resumption of normal erectile function. Source of Funding: None.

71

19

METHODS: We reviewed the available records and radiographs of all patients undergoing such bulbar urethroplasties from January 1991 to March 2002. We analyzed patient demographics and outcomes, etiology and length of stricture, and prior treatments. RESULTS: 114 such urethroplasties were performed with a mean follow up of 58.8 months. Strictures ranged from 1.5 to 8 (mean 4.1) ern .. There were 53 augmented anastomotic repairs and 61 dorsal onlay repairs. Twenty-one of 114 (18.4%) urethroplasties failed at an average of 19.5 months. Dorsal onlay repairs suffered the highest failure rate, 14/61 (22.9%) at 18 months, while 7/53 (13.2%) augmented anastomotic repairs failed at 21.5 months. Age, stricture etiology, length, location, and prior treatments did not correlated with failure. All 21 failures were successfully treated. CONCLUSIONS: The failure rate for penile skin onlay urethroplasty has been reported to be < 10% at 23 months. With longer follow up we show an increase to 18.4% at 58.8 months. This exceeds reports using buccal mucosal graft. Dorsal onlay repairs have a higher rate of failure than augmented anastomotic repairs. This difference may be due to removal of the dominant portion of the stricture in the latter, and also to the fact that simple onlay repairs tend to be performed on longer strictures. While seemingly less successful than buccal graft repairs, long term results of the latter must be awaited and other factors influencing the outcome (stricture excision and ventral vs dorsal onlay) must be considered in the analysis. We still consider the use of penile skin in augmented repairs a viable option in urethroplasty surgery. Source of Funding: None.

LONG-TERM FOLLOW-UP OF BUCCAL MUCOSAL GRAFTS FOR ANTERIOR URETHRAL RECONSTRUCTION Daniel Kellner*, John A Fracchia, Noel Armenakas, New York, NY INTRODUCTION AND OBJECTIVE: During the past 10 years buccal mucosal grafts have secured an important place in our armamentarium of substitution urethroplasty for the treatment of congenital and acquired anterior urethral disease. We present our long-term experience with buccal mucosal grafts for the treatment of anterior urethral strictures. METHODS: Twenty-three patients with anterior urethral strictures underwent urethral reconstruction using buccal mucosa as a ventral onlay graft. Eighteen grafts were placed in the bulbar and five in the penile urethra. All operations were performed in one-stage by a single surgeon. Mean graft length was 4.9 ern (range 3 to 12 em). IPSS and uroflowmetry were obtained preoperatively, and at 3, 6 and 12 months postoperatively, and annually thereafter. Urethral imaging was obtained preoperatively, at the time of catheter removal, and at 6 months postoperatively. Disease specific quality of life was assessed with the BPH Impact Index. Failure was defined as obstructive voiding symptoms with radiographic or endoscopic confirmation of recurrent stricture. RESULTS: Patients were followed for a mean of 41 months (range 9 to 82 months). Etiology of the strictures was instrumentation (n=9), idiopathic (n=9), prior hypospadias repair (n=2), urethritis (n=2), and trauma (n=I). Twenty-one of the 23 patients (91%) were previously treated for their urethral strictures, with a total of 59 procedures (mean 2.8 procedures/patient). Success, defined as normal voiding without any need for subsequent urethral manipulation, was achieved in 20/23 patients (87%). The remaining three patients developed a distal anastomotic stricture, each managed with one internal urethrotomy; one of these patients continues to require monthly self-dilation. There were no graft sacculations or fistulas. CONCLUSIONS: Our series, with long-term follow-up, confirms the durability of ventrally placed buccal mucosal grafts for the treatment of anterior urethral strictures. This proven procedure results in a high success rate with few complications. Results shown asmean

24.8

3mos 5.5

5.1

24.3

Pre-op IPSS Uroflow (mllsec) BPHII

6mos 9 24.9

12mos 6.3

>24 mos 5.4

26

22 1.3

1.7

Adrenal and Renal Laparoscopic Surgery Video Session Saturday, April 26, 2003

1:00-3:00 PM

V73 LAPAROSCOPIC BILATERAL PARTIAL ADRENALECTOMY FOR PHEOCHROMOCYTOMA Sidney C Abreu*, Inderbir S Gill, Jihad Kaouk, Surena Matin, Cleveland, OH INTRODUCTION AND OBJECTIVE: In this video, we describe the technique of transperitoneal laparoscopic bilateral synchronous partial adrenalectomy in a patient with bilateral adrenal pheochromocytoma. METHODS: An Sf-year-old female, ASA 3, who presented with bilateral adrenal masses incidentally diagnosed on a body MRI. The right adrenal tumor measured 2.5 x 1.8 em and a left adrenal tumor 4 x 2.8 ern. Both glands revealed increased signal intensity on T2 suggesting pheochromocytoma. With the patient in a 45-degree left flank position, a 3-port transperitoneal approach was employed with an additional port for liver retraction during right partial adrenalectomy. Laparoscopic flexible ultrasonography was invaluable for localizing the adrenal tumor and for precise planning of the line of tumor excision and preservation of a normal appearing adrenal cortical remnant. The right main adrenal vein was preserved. Dissection and enucleation of the adrenal tumor and parenchymal hemostasis was achieved effectively using harmonic scalpel (U.S. Surgical, Norwalk, CT). RESULTS: Total operative time was 2 and 2.5 hours for the left and right adrenal gland, respectively. No major intraoperative hemodynamic instability was noted. Total blood loss was 150cc and hospital stay was 4 days. Pathology confirmed bilateral adrenal pheochromocytoma. CONCLUSIONS: Laparoscopic partial adrenalectomy for pheochromocytoma is safe and technically feasible. Laparoscopic intraoperative ultrasonography and harmonic scalpel are helpful tools to precisely localize the tumor and to achieve adequate hemostasis, respectively. Source of Funding: None.

Source of Funding: None.

72 DORSAL ONLAY URETHROPLASTY USING PENILE SKIN: A MULTI-INSTITUTIONAL REVIEW OF LONG TERM RESULTS Andrew C Peterson*, Fernando Delvecchio, Durham, NC; Enzo Palminteri, Massimo Lazzeri, Giorgio Guazzoni. Guido Barbagli, Arezzo, Italy; George D Webster, Durham, NC INTRODUCTION AND OBJECTIVE: Recently the repair of long bulbar urethral stricture using a ventral or dorsal onlay of full thickness penile skin has been superceded by the use of buccal mucosa. This has been supported by good short-term results in the latter. We review a lO-year combined experience of simple dorsal onlay (no stricture excision) and augmented anastomotic (up to 2 em. of stricture excised) bulbar urethroplasties using penile skin in an attempt to establish the durability of this type of graft.

V74 LAPAROSCOPIC PARTIAL NEPHRECTOMY WITH CONCOMITANT ADRENALECTOMY: THE TECHNIQUE Wilson R Molina*, Cleveland, OH INTRODUCTION AND OBJECTIVE: Small upper pole renal tumors can occasionally abut the adrenal gland, raising concern for malignant adrenal involvement. Laparoscopic partial nephrectomy, an attractive treatment option for select patients with a small renal tumor, can be performed in the clinical setting of suspected concomitant ipsilateral adrenal gland pathology. In this video we present our technique for laparoscopic partial nephrectomy with concomitant ipsilateral adrenalectomy. METHODS: A 59-year-old clinically asymptomatic man was diagnosed on CT scan to have an upper pole enhancing cystic renal tumor with calcification distorting the ipsilateral adrenal gland, raising suspicion of local adrenal

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involvement. Laparoscopic partial nephrectomy with concomitant adrenalectomy was performed by a four port transperitoneal approach: (I) - port placement, (2) mobilization of the liver and right colon, (3) renal hilum dissection, (4) completion of adrenalectomy, (5) upper pole kidney dissection, (6) renal hilum clamping, (7) adrenal gland and upper pole tumor excision en bloc, (8) collecting system repair, (9) parenchymal hemostatic suturing. Herein, we also present data of the 4 patients who underwent partial nephrectomy and concomitant adrenalectomy at our institution. RESULTS: Table I CONCLUSIONS: Laparoscopic partial nephrectomy with concomitant ipsilateral adrenalectomy is feasible, safe and effective for patients with renal tumor and radiologically suspected adrenal gland involvement. Table 1• Results 2 Case l' ORTime (min) 300 260 Blood Loss 75 150 (cc) Hospital Slay 4 5 (days) adult mesoblastic Kidney Pa· benign thology cortical cyst nephroma Adrenal Pafreeofdisfree ofdisease thology ease 'case shown during video presentation

3 260 75

4 270 150

5 renal cell carcinoma 4cmcortical adenoma

chronic inftammation, dystrophic calcification

freeof disease

Source of Funding: None.

V75 LAPAROSCOPIC PARTIAL NEPHRECTOMY: IMPACT OF 3D CT AND INTRAOPERATIVE ULTRASONOGRAPHY Anup P Romani", Cleveland, OH INTRODUCTION AND OBJECTIVE: Volume rendered 3D CT in the video format provides excellent details of kidney parenchyma, vasculature and collecting system. As such 3D CT is routinely used at our institute prior to a laparoscopic partial nephrectomy. Intraoperative ultrasound is also used routinely to delineate precisely the extent and depth of parenchymal invasion by the tumor, which guides laparoscopic resection. Used in tandem, they facilitate the performance of laparoscopic partial nephrectomy. METHODS: Volume rendered 3D CT was performed preoperatively in 175 patients undergoing laparoscopic partial nephrectomy for renal tumor. Volume rendered 3D reconstruction was recorded in video format. Data obtained included number and retationships of arteries and veins, collecting system and soft tissue structures. Intraoperative ultrasound was performed using a flexible, steerable, color-doppler laparoscopic probe just before resection. Ultrasound demarcated the size, extent and depth of tumor, which guided resection in partial nephrectomy. RESULTS: 3D CT 3mm cuts provided vital preoperative data regarding tumor invasion, vascular anatomy and surrounding structures which helped intraoperative planning. Intraoperative ultrasound was used to accurately delineate and score the margins of resection. CONCLUSIONS: Volume rendered 3D CT and intraoperative ultrasonography in combination. provide an essential roadmap for the precise planning and reliable performance of laparoscopic partial nephrectomy. In our hands, these two modalities are an integral part of laparoscopic partial nephrectomy. Source of Funding: None.

V76 LAPAROSCOPIC NEPHRON SPARING SURGERY: A STEPWISE BRAZILIAN WAY OF USING NO DISPOSABLES AT ALL YET BEING SAFE AND EFFECTIVE. SPENDING TIME PRACTICING IS SAVING COSTS! Cassio Andreoni*, Alexandre Bomfim, Nelson Gattas, Homero Arruda, Miguel Srougi, Sao Paulo-SP, Brazil INTRODUCTION AND OBJECTIVE: Laparoscopic nephron-sparing surgery (LNSS)remains challenging because of some technical difficulties due to an increased probability of conversion to open surgery and postoperative complications, as such urinary fistula and bleeding. Several different tools with different techniques have been used in order to improve the outcomes, however, none of them have proven to be safe and effective. The author attempted to perform LNSS in the same manner the open cases are performed in our institution using no disposables at all. METHODS: From November 2000 to October 2002 LNSS was performed in 12 patients. All procedures were performed transperitoneally with four trocars and with temporary renal arterial occlusion; both the renal artery and the renal vein were dissected individually; the kidney was dissected and the fat around the tumor was spared. A laparoscopic bulldog (Aesculap, TuttiingeniGermany) was used to clamp the renal artery after 10 min Manitol was given; the renal pole was transected using a laparoscopic knife 1 em away from the tumor and closure of the 'Presenting author.

parenchyma and the collecting system, separetly,was begun with free hand intracorporeal suturing using interrupted absorbable stitches; the laparoscopic bulldog was removed after 30 minutes whether or not the suture was completed and Manitol was given again. More stitches were applied if necessary and the perirenal fat was sewed over the parenchyma. The specimen was removed intact in an endobag. A drain was left in place. RESULTS: The procedures were concluded laparoscopicaly and no conversions occurred. The procedures included 10 partial nephrectomies, 1 wedge resection and 1 enucleation. The mean OR time was 3.3 hours, mean EBL was 300 cc.mean hospital stay was 4 days,mean warm ischemia time was 28.9 minutes. No reoperations were necessary and no fistula occurred. No patient developed renal insufficiency. Histopathological analysis revealed no positive margins. CONCLUSIONS: The description of this technique reproduces the open technique performed at our institution; it is feasible, safe and does not require expensive disposable tools but a permanent laparoscopic bulldog. However, mastering intracorporeal suturing is indispensable. Also, the use of a bulldog clamp instead of a Satinsky clamp allowed for saving one port throughout the procedure and perhaps a better preservation of the parenchyma due to venous reflux. Source of Funding: None.

V77 TECHNIQUE OF LAPAROSCOPIC RENAL HYPOTHERMIA FOR PARTIAL NEPHRECTOMY Sidney C Abreu*, Inderbir S cut. Christopher Ng, Desai Mihir, Andrew Steinberg, Anup Ramani, Jihad Kaouk, Cleveland, OH INTRODUCTION AND OBJECTIVE: We developed a novel technique of laparoscopic renal hypothermia for partial nephrectomy. METHODS: Between May and August 2002, 12 patients underwent a transperitoneal laparoscopic partial nephrectomy with intracorporeal renal hypothermia. Initially, the renal artery and vein are circumferentially mobilized en bloc. The kidney is then completely mobilized within Gerota s fascia. Laparoscopic ultrasonography is performed to delineate the tumor and to score the proposed line of resection. The inferior pararectal port is removed, and an Endocatch-II bag is inserted, opened, and carefully positioned around the kidney. The drawstring is pulled thus, detaching the bag from the metallic ring. Further cinching of the drawstring, and placement of Week clips were necessary to gently snug the mouth of the bag around the intact renal hilum. The pre-positioned Satinsky clamp is closed around the hilun, thus initiating renal ischemia. The bottom of the engaged bag is grasped and delivered outside the abdomen, for this purpose the inferior pararectal trocar is removed. The exteriorized bottom of the bag is opened and secured with hemostats. Using previously loaded 30 cc syringes,ice-slush is rapidly inserted into the bag thus, completely surrounding the kidney with ice. The cut end of the bag is closed with a tie, and the bag is re-inserted into the abdomen. A IOmm Bluntip balloon cannula is secured at this port-site, and pneumoperitoneum is reestablished. After approximately 10 minutes, the bag is incised and the ice-slush is removed from around the tumor site only. The tumor is ressected with an adequate margin of healthy tissue. Any pelvicalicial entry is identified and suture repaired. Sutures are placed over surgicel bolsters to achieve parenchymal hemostasis, thus completing partial nephrectomy. RESULTS: Time to deploy the bag around the kidney was 7 minutes (5-20), volume of ice-slush introduced was 600 cc (300-750), and time taken to insert ice-slush was 4 minutes (3-10). Total ischemia time was 43.5 minutes (25-55). Nadir core renal temperature range from 5C - 19C, and the drop in systemic temperature was 0.6C (0.3-0.9). Intraoperative complications included partial slippage of the bag (1), and malfunction of Satinsky clamp (1). CONCLUSIONS: A novel technique of laparoscopic renal hypothermia using ice-slush was developed, replicating open surgery. By achieving cold ischemia, this technique has the potential to extend the scope of laparoscopic partial nephrectomy to more deeply infiltrating or complicated renal tumors. Source of Funding: None.

V78 NEW TECHNIQUE: HAND-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY WITH HYPOTHERMIA S Duke Herrell", Nashville, TN; D Duane Baldwin, Lorna Linda, CA; Jason K Sprunger, Nashville, TN; Peter Langenstroer, Madison, WI; Jake Porter, Kansas City, KS INTRODUCTION AND OBJECTIVE: Open approaches for complex partial nephrectomy typically utilize temporary vascular occlusion with hypothermia to protect against ischemic damage while allowing meticulous dissection and reconstruction. Initiallaparoscopic reports in the literature have not recreated these advantages. METHODS: After isolation and temporary occlusion of the renal hilum, the kidney was cooled to appropriate temperatures(-15 degrees C). Complex partial nephrectomy with sutured closure of the collecting system and parenchyma was performed in a bloodless field.

Vol. 169, No.4, Supplement, Saturday, April 26, 2003

RESULTS: Laparoscopic partial nephrectomy with hypothermia was performed in 7 patients (8 renal units). Identification of the hilar vessels followed by clamping and cooling allowed meticulous dissection and removal of the renal tumor in a bloodless field. Suture closure of the collecting system was also performed. Complications consisted of a single post-operative stroke, and one transient urine leak which sealed spontaneously following stent placement. Surgical margins were negative in each patient. CONCLUSIONS: This video illustrates a novel surgical technique which allows laparoscopic partial nephrectomy to be meticulously performed in a bloodless field. Some previously reported techniques for laparoscopic partial nephrectomy do not provide optimal conditions for resection. Laparoscopic partial nephrectomy of intraparenchymal lesions without vascular control risks significant bleeding. Hemorrhage may obscure vision of the surgical field compromising the margin status. Performing partial nephrectomy with warm ischemia requires significantfacility with intracorporeal suturing, and time pressure constraints may compromise margin status and risk renal deterioration. Our new technique recreates the advantages of the open procedure while maintaining a minimally invasive approach. Source of Funding: None.

V79 NON-EXOPHYTIC RENAL CELL CANCER; A DIFFICULT CASE FOR RETROPERITONEAL LAPAROSCOPIC PARTIAL NEPHRECTOMY -SUCCESSFUL ASSISTANCE WITH POWER DOPPLER ULTRASONOGRAPHY- Hidenori Zakoji", Kazuhiko Shiiki, Yasuhisa Furuya, Takayuki Tsuchida, Isao Araki, Yoshio Takihana, Nobuaki Tanabe, Masayuki Takeda, Yamanashi, Japan INTRODUCTION AND OBJECTIVE: Laparoscopic partial nephrectomy for non-exophytic renal tumor is challenging procedure because of difficulty in detecting tumor. We report a male case of non-exophytic renal cancer for which identification with endoscope was difficult, but he successfully underwent retroperitoneal laparoscopic partial nephrectomy assisted by intraoperative ultrasonography. METHODS: Using retroperitoneal laparoscopic technique, the kidney was identified and separated from perirenal fat to explore the tumor. Only slightly protruding area of renal surface was seen, but could not be comfirmed endoscopically. Sonographical monitoring in IOMHz frequency was performed to evaluate location and size of the tumor. Power Doppler ultrasoundwas very helpful in recognizingtumor and its blood flow. Laparoscopic partial nephrectomy could be performed using microwave tissue coagulator and argon beam coagulator for hemostasis. RESULTS: Operative time was 202 minutes. Blood loss was lOamI. There were no complications during 9-day-hospital stay. Pathological diagnosis was renal cell carcinoma, and the surgical margin was negative. CONCLUSIONS: Intraoperative ultrasonography is very helpful for laparoscopic partial nephrectomy, even in non-exophytic renal tumors. Source of Funding: None.

V80 LAPAROSCOPIC RADICAL NEPHRECTOMY FOR CANCER WITH LEVEL I RENAL VEIN THROMBUS Anup P Romani", CLEVELAND, OH INTRODUCTION AND OBJECTIVE: Renal cell carcinoma(RCC) is associated with thrombus extending into the venous system in 5-10% cases. In patients with organ-confined disease, open radical nephrectomy with concomitant thrombectomy is considered the treatment of choice. Laparoscopic radical nephrectomy is rapidly becoming a standard of care for a majority of patients with Tl-T2 cancers. With growing experience, we have applied laparoscopy to select patients with T3b RCC with level I renal vein thrombus. METHODS: We present a video of a 82 year old patient with a pre-operative diagnosis of renal cancer with renal vein thrombus who underwent laparoscopic radical nephrectomy at our institution. The tumor size was 5 cms. Laparoscopy was carried out by a 4-port transperitoneal approach. The renal vein was secured with an endo -GIA stapler proximal to the thrombus. To date we have performed laparoscopic radical nephrectomy in 16 patients having cancer with a renal vein thrombus. These data are also presented. RESULTS: The total operative time was ISO minutes. The blood loss was 150cc. Intra-operative urine output was 775cc. The specimen weight was 867 grams. There were no complications. The patient was ambulating and on oral liquids by 24 hours. At 2 month follow up there was no local recurrence or metastasis. For the 16 cases done to date, the mean blood loss was 363cc, mean operative time was 3.2 hours, mean follow up was 14.5 months and 3 patients had recurrence of tumor. CONCLUSIONS: Laparoscopic radical nephrectomy is feasible and safe in patients with renal cell carcinoma with level I thrombus. With growing experience, laparoscopy may potentially be applied to more extensive venous involvement in the future. Source of Funding: None.

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V8l LAPAROSCOPIC RADICAL NEPHRECTOMY WITH VENA CAVAL AND RIGHT ATRIAL THROMBECTOMY UTILIZING DEEP HYPOTHERMIC CIRCULATORY ARREST- THE VIDEO Anoop M Meraney*, Mihir Desai, Gyung Tak Sung, Anup Ramani, Sidney Abbreu, Hiroaki Harasaki, Manabu Sato, Jihad Kaouk, lnderbir Gill, cleveland, OH INTRODUCTION AND OBJECTIVE: In patients with renal cel1cancer with level 3 or 4 tumor thrombi, conventional treatment comprises surgical exploration through a median sternotomy and large midline or chevron abdominal incision, for performance of radical nephrectomy followed by inferior vena cava and right atrial thrombectomy under deep hypothermic circulatory arrest. Recently, advances in minimally invasive surgery have enabled the application of these techniques for the performance of technically advanced surgical procedures. This video demonstrates laparoscopic radical nephrectomy and minimally invasive level 4 thrombectomy utilizing deep hypothermic circulatory arrest in the calf model. METHODS: The procedure was performed in 6 male calves weighing 70-80 kg. Initially, the neck vessels were cannulated for subsequent cardiopulmonary bypass. Next, a laparoscopic team performed right radical nephrectomy and exposed the intra abdominal inferior vena cava (IVC). Simultaneously, thoracoscopic access to the right atrium was obtained by a second group of laparoscopic surgeons. Subsequently, cardio-pulmonary bypass, cardiac arrest under deep hypothermic conditions, and complete exsanguination were performed. A level 4 coagulum thrombus was created by needle injection. Combined laparoscopic and thoracoscopic IVC and right atrial thrombectomy were performed in a bloodless field. An angioscope was employed to visually confirm complete thrombus clearance. Laparoscopic and thoracoscopic techniques were then utilized for suture repair of the IVC and right atrium. Cardiopulmonary bypass was re-established, and the animal was gradually re-warmed. Once sinus rhythm was re-established at normal body temperature, the animal was weaned off the pump. RESULTS: Average operative time was 494.5 mins (range, 355 to 705 mins), average time to achieve core cooling was 63.5 mins (range, 50 to 120 mins), and average time to rewarm the animal was 101.8 mins (range, 70 to 130 mins). Following ciculatory arrest, the average blood volume drained into the bypass pump was 2633.3 cc (range, 1400 to 3200 cc). The average estimated blood loss was 350 cc (range, 200 to 750 cc). CONCLUSIONS: Laparoscopic radical nephrectomy with IVC and right atrial thrombectomy is feasible in the calf model. The technique can be performed utilizing minimally invasive techniques exclusively. Source of Funding: None.

V82 PERCUTANEOUS RENAL CRYOABLATION

William B Shingleton», Patrick E Sewell, Jackson, MS INTRODUCTION AND OBJECTIVE: Renal tumor cryoablation can be performed via a percutaneous approach with minimal morbidity and technical success. This videotape will demonstrate the technique utilizing magnetic resonance image (MRI) guidance. METHODS: A 75 year old male with a biopsy proven renal cell carcinoma measuring 4.5 ern in diameter underwent percutaneous cryoablation. The image guidance system was an interventional MRI unit and the cryoablation instrument was the Galil Medical Cryohit System.® RESULTS: This videotape illustrated the complete procedure required for percutaneous renal cryoablation. CONCLUSIONS: Renal cryoablation can be successfully performed percutaneously with MRI guidance. There is minimal morbidity associated with this procedure. This treatment technique will require continued follow-up to assess the durability of response. Source of Funding: None.

Adrenal, Kidney, Ureteral Surgery (II) Moderated Poster Saturday, April 26, 2003

3:30-5:30 PM

84 LAPAROSCOPIC AND OPEN PARTIAL NEPHRECTOMY IN 200 CASES lnderbir S Gill, Cleveland, OH; Surena F Matin", Houston, TX; Mihir M Desai, Andrew Steinberg, Jihad H Kaouk, Edward Mascha, Julie Thorton, Brenda Strzempkawski, Mahmoud Sherief, Andrew C Novick, Cleveland, OH INTRODUCTION AND OBJECTIVE: We compare the perioperative outcomes after laparoscopic and contemporary open nephron sparing surgery (NSS) for patients with a solitary renal tumor -:57 em.