Pl 0 LAPAROSCOPY Thursday,March13,13.45-15.15hrs, Room N107 LAPAROSCOPIC
DISMEMBERED
Decker S.. Roigas J.. Willc A., Loening
Chanti Hospital. Urology,
Hcrlin,
173
PYELOPLASTY S.. Tiirk
174 ROBOTIC-ASSISTED CLINICAL RESULTS
I
LAPAROSCOPIC
PYELOPLASTY:
1NlTlAL
Peschel R.,, Gettman M.‘. Neururet- K.‘. Haltsch G.’
Germany.
Ilniversity of Innsbruck. Urology, Innsbruck. Rochester. Umted States of America
INTRODUCTION & OBJECTIVES: We report our experience of 49 consccutivc pycloplastics that were all laparoscopically performed with an intracorporeally sutured anastomosis. WC describe the operative tcchniquc. complications and outcomc. MATERIAL & METHODS: Forty-nine palien& underwent a laparoscopic dismembcrcd pycloplasty because of primary urctcropclvic junction (UPJ) obstruction with hydronephrosis in each cast. The preoperative evaluation included an evaluation for pain. an excretory urography (IVP). renal scan and sometimes CT angiography to evaluate for crossing vessels. Follow-up studies Included an IVP. renal scan and renal ultrasound 4 weeks postoperatively and every 3 months thereafter. Success was considered as improvement of the pain score and IVP (less hydronephrosis. visible UPJ and/or normalization of drainage) or absence of an ohs(ructive pattern during the washou( phase of a I-cnal scan. RESULTS: There was no comcrslor to open surgery. The mean opcrnti\c time was 165mm (range 90-24Omm). Blood loss was negllylhlc. crossing vcsscls were noted in 57.1% of the patients. Postoperative hospital stay was 3.7 days. One patient had a leakage ofthc anastomosis on postoperatlve day I and needed to undergo laparoscopic repair. The mean follow-up is 23.2 months (range l-53 months). There was only one late failure. This patient underwent an open pyeloplasty. In all other patients (48/49), the obstruction was rcsolvcd 01 significantly improved. The long-term success rate is 97.7%. CONCLUSIONS: The results of dlsmcmhered laparoscopic pycloplastics compare facourahly with those achieved by open pyeloplastics with less perioperatlvc morbidity and discomfort. We do believe that laparoacopic dismembered pycloplasty with an intracorporcal anabtomosib ib (he method of choice in the treatmenl of the UPJ obstruction m the presence uf an onlargcd renal pel\ 1s and crossing vessels.
Austria.
‘Mayo
C’limc. Urology,
INTRODUCTION Sr OBJECTIVES: The daVinci I-ohotlc system has been introduced ulth a goal of simplifying complex laparoscopic tasks like intracorporeal buturing. Laparoscopic pycloplasty is an cffcctivc treatment modality for ureteropelvic junction obstruction. hut intracorporeal suturing may limit clinical applicability. We reviewed our initial clinical results with davinciassisted laparoscopic pycloplasty. hlATERIAL & RIETHODS: From June 2001 through August 2002. 19patients with symptomatic ureteropel\ ic junchon obstruction (UPJO) underwent dnVinciaaaisted laparoscoplc pyeloplasty using a 4-pot-t transperitoneal approach. Anderson-Hynes and nondismembered pyeloplasty were performed in 15 and 4 patients, respectively. All steps of laparoscopic pyeloplasty were performed by the surgeon from a remote control umt and a scrubbed assistant surgeon. Perioperatibe results and radloglnphic follow-up data xvcrc retrospectively re\ie\vcd. RESULTS: All steps of robotic-aaslsted Andes-son-Hynes and nondtsmembered pyeloplasties were successfully performed. Optimal robotic function Irequired careful positioning and alignment takmg inm account mdl\ Idual variations at the l_TPJO. The scrubbed assistant surgeon was also critical to the success of the t-obotlc-asristed procedure. The mean operatiLe times for Anderson-Hynes and nondismembered pyeloplaaty uerc I25 mmutes (range 90-I X0 mmutcs) and 95 minutea (range 75-130 minutes), respectively. The mean lengths of stay fat 2ndcrson-Hynes and nondismembered pyeloplasty wcrc 4.7 days (range 3-7) and 3.5 days (range 3.6), respectively. Estimated blood loss was c 50 cc in all cases. No intraopcrativc comphcations were observed related to the robotic device. One access-related bowel injury in the nondismembered cohort Irequired open conversion and repair. Postoperatively. open exploration was required in one patient in the Anderson-Hynec cohort to repair a defect in the renal pelvis. At a mean follow-up of IO months (range 3 I5 months), the overall objective buccebs rate w’as I OO”/u. CONCL,USIONS: The initial clinical results for robotic-asaiated Anderson-Hyncs and nondlamembercd pycloplasty appear encouraging. A coordmatcd approach hv the surgeon and ~crubbcd aa\lstant is required for optimal function of the robot& device. Although all cases were fcaslhle. addtttonal clmical experience IS requncd to detennme the Imost effectlvc port placement and robotic positioning on the hasla 01‘anatomy of the UPJO.
175 MANAGEMENT OFADULT LEYDIC CELLTESTICULAR TUMOURS: ASSESSING THE ROLE OF LAPAROSCOPIC RETROPERITONEAL LI’MPH NODE DISSECT101 I’cschel R.
, (iettmanIv.‘. Steiner
II.
Neururer
University of Innsbruck. Urology. Innsbruck. Rochcater. UnIted Slaleb of America INTRODUCTION
& OBJECTIVES:
Lcydig
R
. Unrrsch
Au\trla.
G.
Mayo
ccl1 lumours
C‘linic.
Lit-ology.
represent ‘:5?/, of
testicular tumours m men. Orchiectomy 1s curatlve in approximately 90% of‘ cases, however remaining men can develop metastasis refractory to chemotherapy and radiation. We evaluated the role of laparoscopic rctropcritoneal lymph node dissection (RPLND) in adulr Leydig cell tumours. MATERIAL & METHODS: Between 1999 and 2001, laparoscopic RPLND was performed with 4 tranaperitoneal ports within a unilateral template for 6 patients with pm-c Lcydig ccl1 tumours. Presenting signs and symptoma. operative tlmc. blood loss, lntraoperati\c complications, postoperatIve complications. length of hospitalization. pathology rcportq. cjaculatoty function. and surGval M err retruapecti\,ely ret iewed. RESULTS: I.aparoscopic RPLND was successfully performed wllhout open conversions or reinterventions. Two intraoperativc vascular injuries occurred during dissection: additional intraoperati8 complications wcrc not observed. Postoperatively, I patient developed erysipelas but other postoperative complications were recorded. Mean operative time was I90 minutes (range 150 225 minutes) and mean length of hospitalisation was 4.3 days (range 3 7 days). Pathologic analysis of lymph nodes revealed no evidence of metastatic Leydig cell tumour. At 12 months mean follow-up (range 3 - 29), no recurrence5 have occurred.
In group A, there was an mjury to the bowel in one procedure nece\sltatmg reoperatlon. In group B there were 3 rectal injuries: the first patient had necrosis of the amenor wall of the rectum, due to an excessive bipolar cauterlsatlon in an obese patlent This patient presented with pentonitis on day 5 and a colostomy was performed. The second patient had a I75 gm prostate and the third patient had a prevmus low anterior resection for a rectal carcmoma. Laparoscopic primary repair \has successfully pcrl‘*rmr;l in the 2 last patients.
CONCLUSIONS: L.aparoscopic RPLND was a safe. minimally invasive procedure for Lcydig cell tumours. Additional clinical experience ih required to evaluate the effectiveness laparoscopic RPLND for pathologic stage II tumours and determine if a therapeutic advantage can be realized with a protocol rmploymg laparoscopic RPLND for adult Leydlg cell tumours.
C‘ONCLUSIONS: Ihl\ \erle\ ofpatxntb ha5 been perl’ormed by a x~rgron lrorking with a trained team, makmg his leammg curve shorter. Because these operations were performed in a referral oentre, only laparoscoplc procedures were offered to patients. The absence of selection can explain the important number of rectal m~unes. After 40 procedures, there were 110 major comphcations and no improvemrm in terms of operating tnne and blood loss. Hence. it appears in thla .rtudy that the learnmg curve fol I.aparohcopic Kad~cal I’ro\tattxtomy lb -!O procedure\
European Urology Supplements
2 (2003) No. 1, pp. 46