Complications of the first 235 cases of laparoscopic nephrectomy

P12

209 HOECHST DYE EFFLUX - A NOVEL METHOD FOR THE ISOLATION AND EVALUATION OF PROSTATIC STEM CELLS Bhatt Ruuesh’ , Hart Claire’, Collins Ann”, Ramani Clarke Noel’

Vijay’, George Nicholas’.

iAPAR0sc0PYII

210

Sunday,Febmary24,15.30-17.00 hrs,Room B

COMPLICATIONS NEPHRECTOMY

OF THE FIRST

23.5 CASES

OF LAPAROSCOPIC

Lianos E., Esposito M., Lalak N., Tolley D. Scottish Lithotriptor Centre. Western General Hospital, Edinburgh, United Kingdom

‘Department of Experimental Haematology, CRC Paterson Institute, Christie Hospital, Manchester, United Kingdom, 2Department of Surgery, University of Newcastle, Newcastle, United Kingdom

INTRODUCTION & OBJECTIVES: Laparoscopic nephrectomy is a technically demanding procedure, which requires considerable experience and training. We present the complications of the first 235 laparoscopic nephrectomies and attempt to define risk factors for complications and conversion to open surgery.

INTRODUCTION & OBJECTIVES: Prostate cancer cells are believed to have a stem cell like phenotype but research has been limited due to the lack of definitive stem cell markers. Primitive cells have been found to posses the ability to efflux Hoechst 33342 stain defining a subpopulation of Hoechst ‘low’ cells termed side population (SP cells). Such cells from murine skeletal muscle can repopulate the haemopoietic lineages in the mouse (Jackson et al., PNAS 1999: 96: 14482.6). We have optimised this method and isolated a SP population from human prostatic epithelial cells (PEC).

MATERIAL & METHODS: Between September 1992 and September 2001, 235 patients who underwent a laparoscopic nephrectomy were entered into the study. Indications for laparoscopic nephrectomy included patients requiring nephrectomy for benign pathology ( 177). nephroureterectomy for TCC of the upper urinary tract (33) and radical nephrectomy for RCC (25). No tumour had evidence from CT of lymphatic, vascular or perirenal invasion.

MATERIAL & METHODS: PEC from I9 men were identified using the BerEP4 epithelial marker and SP cells isolated using dual-wavelength Flow Cytometry after staining with Hoechst 33342. The cells were characterised immunohistochemically with basal integrins, PSMA and pp32 found in stem cells. They were further evaluated by in vitro cell culture. RESULTS: Results show that a SP of Hoechst low cells exists in the prostate and these can be isolated reliably and consistently. Isolation curves for PEC’s had similar characteristics to those from haematopoietic lines known to yield stem cells. These SP cells comprise 1.38% kO.28 of the PEC population and are viable in vitro for over twelve weeks. CONCLUSIONS: We have shown that it is possible to isolate SP cells from prostatic tissue which are similar to stem cells previously identified from haemopoietic, liver, lung, muscle and brain tissue. This technique will enable further study and characterisation of human prostatic stem cells.

RESULTS: The overall complication rate was 22.94%, of which 3.8% were major and 19.14% were minor. The major complications included 4 vascular injuries, 1 perforated duodenal ulcer in a patient with Zollinger Ellison Syndrome, 1 fatal penoperative myocardial infarction, I splenic infarct following an intraoperatively recognised splenic artery clipping, 1 non-fatal pulmonary embolus and I renal bed haematoma. There was a trend for the major complication rate to decrease with time. Minor complications included pyrexia in eleven, wound infections in eight, cardiac arrhythmia in five, pneumonitis in eight, urinary retention in three. urinary tract infection in three, minor renal bed haematoma in three, one duodenal haematoma, one port-site bleeding, and ileus in two patients. The minor complication rate remained much the same with time. suggesting that these complications may not be solely related to operator experience. Fifteen cases were converted to open surgery (6.3%). There were four emergency conversions and eleven elective conversions. All 4 patients with a preoperative diagnosis of xanthogranulomatous pyelonephritis (XGP) were electively converted. Twenty patients (8.5%) required transfusion. CONCLUSIONS: Laparoscopic nephrectomy for benign and malignant disease can be effectively performed with reasonable safety. Proper patient selection with strict adherence to basic laparoscopic surgical principles helps to reduce complications and conversions during laparoscopic renal surgery. A preoperative diagnosis of XGP is a contraindication to laparoscopic nephrectomy. The complications and conversion rates are acceptable and we feel that many patients undergoing ablative renal surgery should be offered the laparoscopic

approach.

211 LAPAROSCOPIC RENAL SURGERY IN POPULATION: THE BRAZILIAN EXPERIENCE

THE

PEDIATRIC

Tibor D., Castilho F.L.N., Queiros e Silva F.A.. Giron A.M., Arap S.

212 LAPAROSCOPIC NEPHROPEXY FOR SYMPTOMATIC NEPHROPTOSIS: LONG-TERM FOLLOW-UP OF A TECHNIQUE INCORPORATING INTRACORPOREAL SUTURES AND FIBRIN GLUE

Urologic Clinic, SBo Paulo University Medical School Hospital. SBo Paula, Brazil

Peschel Reinhard, Gettman Matthew, Neururer Richard, Bartsch Georg

INTRODUCTION & OBJECTIVES: Laparoscopic renal surgery is not widely accepted in children, due to concerns about its usefulness and safety in this population. Since 1997 we used this technique to perform renal ablative procedures in paediatric patients. The objective of this work is to present our experience in the laparoscopic treatment of benign renal disease in children.

Urology, University

MATERIAL & METHODS: Since 1997, 57 children aged 2 months to I6 years (mean 4.8 years) presented with the following diagnoses: pyelo-ureteral junction obstruction (UPJ) with severely damaged kidneys in 15. renal cystic disease in I I, vesico-ureteral reflux to atrophic kidneys in 9, pyelo-ureteral duplication with upper pole hydronephrosis in 9, ureterohydronephrosis due to megaureter. ectopia and ureterocele in 6, renovascular hypertension with contracted kidneys in 6 and nephrotic syndrome in one. They were submitted to the following laparoscopic procedurec: 3 I unilateral and one bilateral nephrectomies, IO complete nephroureterectomies (2 of them with associated open correction of ipsilateral ureterocele), 9 upper pole nephrectomies, 4 partial nephroureterectomies, and 2 cyst marsupializations. All procedures were performed transperitoneally, except in one patient with bilateral renovascular disease and previous episodes of peritonitis associated to peritoneal dialysis. Three to four trocars were employed. in most cases 2x5 mm plus I or 2x10 mm. In the left side, most procedures required only 3 trocars. Associated laparoscopic procedures were contralateral ureteral reimplantation (Gregoir-Lich procedure) in I, ipsilateral orchiopexy in 1, bilateral Fowler-Stephens procedure in 2 and ipsilateral orchiectomy in 2. Non-laparoscopic associated procedures were 2 open transvesical ureterocelectomies and bladder reconstruction. RESULTS: Duration of the procedures varied from 30’ to 270’ (mean 95‘). including initial cases and those performed by residents. There were neither peri or postoperative complications nor blood transfusion. Conversion to a minilaparotomy was required to perform an isthmic resection in a patient with unilateral UPJ in a horseshbe kidney. Postoperative analgesia was mintma in most cases, and hospital stav varied from I to 5 davs (mean I .7 davs). Patients and oarents were satisfied with the’cosmetic results and &e short hospital siay. CONCLUSIONS: Laparoscopic renal procedures present less postoperative pain and shorter hospital stay than open surgeries, with smaller surgical scars. After the learning curve, the operative time and complication rate are also smaller with the laparoscopic technique, particularly in cases of nephroureterectomy and polar nephrectomy. In our service. open surgery has been replaced by laparoscopy in renal ablative procedures in children of all ages.

of Innsbruck,

Innsbruck,

Austria

INTRODUCTION & OBJECTIVES: Nephroptosis, defined as the descent of the kidney by greater than 5 cm in the standing position, is a relatively uncommon condition occurring predominantly in thin females. A variety of open procedures have been described, but all are associated with increased disability and prolonged recovery. Given the known advantages of minimally invasive surgery, laparoscopic nephropexy has emerged as a treatment of choice for symptomatic nephroptosis. We evaluate the long-term results of our technique for laparoscopic nephropexy in patients with symptomatic nephroptosis. MATERIAL & METHODS: Between I992 and 2001,4 1 patients (all female) with symptomatic nephrotosis underwent laparoscopic pyeloplasty using a 3 or 4 port transperitonal technique. The lower pole of the mobilised kidney was initially fixed to the psoas muscle using two interrupted sutures (3-O PDS) that were placed through cauterised areas on the renal capsule and psoas musculature, tied extracorporeally, and positioned intracorporeally with a knot pusher. In all cases, fibrin glue (2 cc) was additionally applied at the site of suture fixation. RESULTS: The overall mean operative time was 72 minutes (range 50.120 minutes). The mean length of stay was 3.7 days (range 2-4 days). The only intraoperative complication was a ureteral injury that was successfully managed with laparoscopic techniques and placement of a double pigtail stent. No postoperative complications were recorded. At a mean follow-up of 40 months (range 4 to 72 months), the success rate was 95% (39 of 41 patients). Both patients with an unsuccessful initial result were successfully salvaged with a second laparoscopic procedure at 6 and 1 I months, respectively. CONCLUSIONS: Laparoscopic nephropexy is an effective, minimally invasive treatment for patients with symptomatic nephroptosis. The technique of laparoscopic nephropexy incorpomting 2 interrupted sutures and fibrin glue provided excellent durability at long-term follow-up. European

Urology Supplements

1 (2002)

No. 1, pp. 55