- Email: [email protected]
PD-06.04
PODIUM SESSIONS
sist® is a unique robot that is controlled by simple head movement by the surgeon which allows for complete autonomy over camera movement. A head-mounted infrared emitter executes movement; the sensor is placed above the monitor and picks up any operator executed head movements. The foot clutch ensures that there is no unnecessary travel when movement is not required. At the time of submission, data was available for 25 urological procedures performed using the EndoAssist®. The procedures performed included radical and simple nephrectomy, pyeloplasty, radical prostatectomy and radical cystoprostatectomy. A 300 laparoscope was used for the renal surgery and a 00 scope was used for the pelvic surgery. The Harmonic® scalpel (Ethicon Endosurgery, Bracknell, UK), the Olympus SonoSurg® (Keymed, Southend, UK) or the Lotus (SRA Developments, Ashburton, UK) were used to aid circumferential specimen mobilisation. Hemolok® (Weck, High Wycombe, Bucks, UK) clips were used as appropriate for securing pedicles. The surgeon noted the extent of body comfort and muscle fatigue in each case. Other parameters documented were the ease of scope movement, necessity to clean the telescope, and whether it was necessary to change the position of the arm during the surgery. Results: All 3 surgeons involved with the evaluation felt comfortable throughout all procedures, with no loss of autonomy. It was, however, obvious that the large arc generated whilst doing a nephrectomy led to more episodes of lens cleaning, and that the arm had to be relocated on some occasions. There were fewer problems encountered whilst performing pelvic surgery or pyeloplasty, perhaps due to the fact that the arc of movement was smaller. Conclusion: The EndoAssist® is an effective, easy to use device for robotic camera driving, which reduces the constraint of having to have an experienced camera driver for optimal visualisation during laparoscopic urological procedures. PD-06.03 Laparoscopic pyeloplasty in secondary ureteropelvic junction obstruction due to failed open surgery: a comparative clinical trial Basiri A, Behjati S, Hosseini Moghaddam S, Beigi FMA Urology and Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran Introduction: We compared laparoscopic pyeloplasty in patients with secondary
20
ureteropelvic junction obstruction (UPJO) due to failed open surgery and those with primary UPJO. Methods: We performed laparoscopic pyeloplasty for 15 patients with secondary UPJO due to failed open surgery (group I) and 15 with primary UPJO (group II). The mean follow-up was 11.8 months and 14.1 months in groups I and II, respectively (P ⫽ .2). Results: No intraoperative complication occurred. The mean operative time and hospital stay in groups I and II were 262⫾88 minutes versus 185⫾47 minutes (P ⫽ .007) and 7.7 days versus 5.3 days (P ⫽ .02), respectively. After laparoscopic pyeloplasty, improvement in renal function was 100 % and 86% in groups I and II, respectively (P ⫽ .2). Before and after surgery, number of patients with 50% washou in DTPA scan 10 minutes after furosmide injection was 0 and 4 in group I , and 2 and 7 in group II (P ⫽ .3). Six and 5 patients in groups I and II had urinary tract infection before operation while these values decreased to 0 and 1 after operation, respectively (P ⫽ .3). In groups I and II, 13 and 6 patients had severe hydronephrosis that decreased postoperatively to 3 and 1, respectively (P ⫽ .7). Conclusion: Secondary UPJO in patients who have undergone open surgery can be repaired using laparoscopic pyeloplasty, and success rate seems to be equal to primary UPJO. PD-06.04 General surgeons have a role to play in urological laparoscopic training Engledow A, Tozer P, Hussain M, Warren S, Webster G Chase Farm Hospital, The Ridgeway, Enfield, London, UK Introduction: Laparoscopic training opportunities in general surgery are increasing rapidly in the United Kingdom. This is not necessarily the case in Urology. Many trainees are required to seek training opportunities abroad and junior consultants are forced to seek mentors who are in short supply. We suggest that combined operating, utilising the laparoscopic skills of the general surgeons, will advance laparoscopic urology in the UK. Methods: A combined operating list was set up for a newly appointed consultant urologist, and an experienced laparoscopic colorectal surgeon. 10 laparoscopic nephrectomies were performed as a combined procedure followed by 56 consecutive laparoscopic nephrectomies performed by the urologist alone. Data entered prospectively into a database in-
cluded age, sex, indications for surgery, operative time, intra and post-operative complications, in hospital stay, conversion to an open procedure and histological resection margins for malignant resections. Results: 66 patients were included (31 female). Median age 64 years (range 3388). Indications for surgery were suspected malignancy (56) and non-functioning kidney (10). Median operative time 177 mins (range 75-266). Median in hospital stay 5 days (range 36 hours to 50 days). Five patients (7%) developed complications. Two patients had post-operative myocardial infarction. Clostridium difficile diarrhoea was treated successfully in one patient with oral metronidazole, one sub hepatic collection required radiological drainage and one patient required re-operation for bleeding from an epigastric vessel at the extraction site. 13 (19%) procedures were converted to an open procedure, 10 through technical difficulties and failure to progress, and 3 for laparoscopically uncontrollable bleeding. There was one death. Final histology for the malignant cases showed 55 renal cell carcinomas and one squamous carcinoma all with clear resection margins in all cases. There were no significant differences between the combined cases and the operations performed by the urologist alone. Conclusion: Laparoscopic urology is becoming more widely practiced. Co-operation between specialties may aid in skill acquisition. There may be a place for trainee laparoscopic urologists spending a period of training with established laparoscopic general surgeons to gain the necessary skills prior to consultant appointment. PD-06.05 Outcomes of hand-assisted laparoscopic nephrectomy in technically challenging cases Tornero J, Prieto A, Lopez-Cubillana P, Escudero F, Go ´ mez G, Perez-Albacete M Virgen de la Arrixaca University Hospital, Murcia, Spain Objective: To evaluate the outcomes of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. Methods: Retrospective review of 100 hand-assisted laparocopic nephrectomies completed at a single institution from 2001 to 2005. Patients with a history of extensive abdominal surgery or prior procedures on the affected kidney, evidence of perirrenal inflammation, renal lesions
UROLOGY 68 (Supplement 5A), November 2006
sist® is a unique robot that is controlled by simple head movement by the surgeon which allows for complete autonomy over camera movement. A head-mounted infrared emitter executes movement; the sensor is placed above the monitor and picks up any operator executed head movements. The foot clutch ensures that there is no unnecessary travel when movement is not required. At the time of submission, data was available for 25 urological procedures performed using the EndoAssist®. The procedures performed included radical and simple nephrectomy, pyeloplasty, radical prostatectomy and radical cystoprostatectomy. A 300 laparoscope was used for the renal surgery and a 00 scope was used for the pelvic surgery. The Harmonic® scalpel (Ethicon Endosurgery, Bracknell, UK), the Olympus SonoSurg® (Keymed, Southend, UK) or the Lotus (SRA Developments, Ashburton, UK) were used to aid circumferential specimen mobilisation. Hemolok® (Weck, High Wycombe, Bucks, UK) clips were used as appropriate for securing pedicles. The surgeon noted the extent of body comfort and muscle fatigue in each case. Other parameters documented were the ease of scope movement, necessity to clean the telescope, and whether it was necessary to change the position of the arm during the surgery. Results: All 3 surgeons involved with the evaluation felt comfortable throughout all procedures, with no loss of autonomy. It was, however, obvious that the large arc generated whilst doing a nephrectomy led to more episodes of lens cleaning, and that the arm had to be relocated on some occasions. There were fewer problems encountered whilst performing pelvic surgery or pyeloplasty, perhaps due to the fact that the arc of movement was smaller. Conclusion: The EndoAssist® is an effective, easy to use device for robotic camera driving, which reduces the constraint of having to have an experienced camera driver for optimal visualisation during laparoscopic urological procedures. PD-06.03 Laparoscopic pyeloplasty in secondary ureteropelvic junction obstruction due to failed open surgery: a comparative clinical trial Basiri A, Behjati S, Hosseini Moghaddam S, Beigi FMA Urology and Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran Introduction: We compared laparoscopic pyeloplasty in patients with secondary
20
ureteropelvic junction obstruction (UPJO) due to failed open surgery and those with primary UPJO. Methods: We performed laparoscopic pyeloplasty for 15 patients with secondary UPJO due to failed open surgery (group I) and 15 with primary UPJO (group II). The mean follow-up was 11.8 months and 14.1 months in groups I and II, respectively (P ⫽ .2). Results: No intraoperative complication occurred. The mean operative time and hospital stay in groups I and II were 262⫾88 minutes versus 185⫾47 minutes (P ⫽ .007) and 7.7 days versus 5.3 days (P ⫽ .02), respectively. After laparoscopic pyeloplasty, improvement in renal function was 100 % and 86% in groups I and II, respectively (P ⫽ .2). Before and after surgery, number of patients with 50% washou in DTPA scan 10 minutes after furosmide injection was 0 and 4 in group I , and 2 and 7 in group II (P ⫽ .3). Six and 5 patients in groups I and II had urinary tract infection before operation while these values decreased to 0 and 1 after operation, respectively (P ⫽ .3). In groups I and II, 13 and 6 patients had severe hydronephrosis that decreased postoperatively to 3 and 1, respectively (P ⫽ .7). Conclusion: Secondary UPJO in patients who have undergone open surgery can be repaired using laparoscopic pyeloplasty, and success rate seems to be equal to primary UPJO. PD-06.04 General surgeons have a role to play in urological laparoscopic training Engledow A, Tozer P, Hussain M, Warren S, Webster G Chase Farm Hospital, The Ridgeway, Enfield, London, UK Introduction: Laparoscopic training opportunities in general surgery are increasing rapidly in the United Kingdom. This is not necessarily the case in Urology. Many trainees are required to seek training opportunities abroad and junior consultants are forced to seek mentors who are in short supply. We suggest that combined operating, utilising the laparoscopic skills of the general surgeons, will advance laparoscopic urology in the UK. Methods: A combined operating list was set up for a newly appointed consultant urologist, and an experienced laparoscopic colorectal surgeon. 10 laparoscopic nephrectomies were performed as a combined procedure followed by 56 consecutive laparoscopic nephrectomies performed by the urologist alone. Data entered prospectively into a database in-
cluded age, sex, indications for surgery, operative time, intra and post-operative complications, in hospital stay, conversion to an open procedure and histological resection margins for malignant resections. Results: 66 patients were included (31 female). Median age 64 years (range 3388). Indications for surgery were suspected malignancy (56) and non-functioning kidney (10). Median operative time 177 mins (range 75-266). Median in hospital stay 5 days (range 36 hours to 50 days). Five patients (7%) developed complications. Two patients had post-operative myocardial infarction. Clostridium difficile diarrhoea was treated successfully in one patient with oral metronidazole, one sub hepatic collection required radiological drainage and one patient required re-operation for bleeding from an epigastric vessel at the extraction site. 13 (19%) procedures were converted to an open procedure, 10 through technical difficulties and failure to progress, and 3 for laparoscopically uncontrollable bleeding. There was one death. Final histology for the malignant cases showed 55 renal cell carcinomas and one squamous carcinoma all with clear resection margins in all cases. There were no significant differences between the combined cases and the operations performed by the urologist alone. Conclusion: Laparoscopic urology is becoming more widely practiced. Co-operation between specialties may aid in skill acquisition. There may be a place for trainee laparoscopic urologists spending a period of training with established laparoscopic general surgeons to gain the necessary skills prior to consultant appointment. PD-06.05 Outcomes of hand-assisted laparoscopic nephrectomy in technically challenging cases Tornero J, Prieto A, Lopez-Cubillana P, Escudero F, Go ´ mez G, Perez-Albacete M Virgen de la Arrixaca University Hospital, Murcia, Spain Objective: To evaluate the outcomes of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. Methods: Retrospective review of 100 hand-assisted laparocopic nephrectomies completed at a single institution from 2001 to 2005. Patients with a history of extensive abdominal surgery or prior procedures on the affected kidney, evidence of perirrenal inflammation, renal lesions
UROLOGY 68 (Supplement 5A), November 2006