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Ultrasound-guided dissection of the ureter during complicated colon resection
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Scientific Poster Presentations: 2015 Clinical Congress
CONCLUSIONS: In comparison to patients who did not have classic bladder exstrophy confirmed on prenatal ultrasound, those who had a confirmatory ultrasound experienced no improvement in success of initial closure, time to initial closure, or time to successful closure, calling into question the utility of prenatal diagnosis in classic bladder exstrophy patients. Salvage extirpative surgery for recurrent disease following laparoscopic renal cryoablation for T1 renal masses Steven Kheyfets, Heinric Williams, MD, Waleed Eisa, John Walton, Jacob Baber, MD Geisinger Medical Center, Danville, PA INTRODUCTION: This study presents the clinicopathologic outcomes of patients undergoing salvage surgery for local recurrence following renal cryoablation (RCA). METHODS: Patients who experienced ipsilateral tumor recurrence following RCA between January 1, 2000 and December 31, 2013 and managed with extirpative surgery were identified, and their clinico-pathologic features and surgical outcomes were characterized. RESULTS: A total of 17 patients with recurrent disease following RCA as defined by an enhancing lesion with interval growth were managed with partial (1) or total (16) nephrectomy. The median age was 65 years. Mean tumor size at initial RCA was 3.78 cm and 5.94 cm at salvage surgery. Tumor histology was clear cell carcinoma in all cases. 3 low grade cases, 8 intermediate and 6 high grade cases were identified. Median time from RCA to salvage surgery was 29 months. Radical nephrectomy was performed in robotic laparoscopic (12) or open (3) fashion; 2 robotic cases required open conversion. Overall, median operative time was 233 minutes, and median blood loss was 200 mL. Three patients experienced postoperative complications, including ileus, acute blood loss and wound infection. During a median follow-up of 58.5 months, 2 patients developed metastases, and 7 died (2 from disease, 5 from other causes). The metastatic free, cancer specific and overall survival was 88%, 94% and 82%, respectively.
J Am Coll Surg
CONCLUSIONS: Salvage extirpative surgery for recurrent disease following primary RCA provides good renal functional and oncologic outcomes. Minimally invasive surgery can be performed in most cases, but can be complicated by perirenal fibrosis and scarring associated with RCA. Ultrasound-guided dissection of the ureter during complicated colon resection John V Agapian, MD, FACS, Sarvanaz Nouri, MD, Brian S Hernandez, Aron Depew, MD, Afshin Molkara, MD, FACS, Dan Ludi, MD, FACS Riverside Regional Medical Center, Moreno Vallley, CA; University of California, Riverside, CA, Loma Linda, CA INTRODUCTION: Various techniques have been tried to avoid ureteral injuries during emergency open colectomy, such as preoperatively placed ureteral stents. However, stents in and of itself do not necessarily prevent injuries from happening; they only help to identify an injury after it has already occurred. Ultrasound technology has been proving itself as a powerful tool to the Trauma/Acute Care Surgeon, and novel new uses for it are continuously evolving. METHODS: We used an Ultrasound (US) with a 10MHz transducer probe in real time to visualize silicone based ureteral stents placed pre-operatively in patients with extensive pelvic inflammation/adhesions secondary to acute diverticulitis or advanced colon cancer requiring emergency surgery. RESULTS: Although the stents could not be readily palpable secondary to dense adhesions and inflammatory tissue, real time ultrasound images allowed us to visualize the stented ureters, and to gauge our depth of dissection into a cement pelvis, thus to avoid injuring the ureters. CONCLUSIONS: The use of real time visualization of stented ureters using ultrasound can be a useful tool to help identify and safely dissect the ureters during complicated colon resections with dense adhesions, as with perforated diverticulitis or cancer. We encourage future studies to help determine if routine use of ultrasound during difficult pelvic dissection can help reduce the incidence of ureter injury.
Scientific Poster Presentations: 2015 Clinical Congress
CONCLUSIONS: In comparison to patients who did not have classic bladder exstrophy confirmed on prenatal ultrasound, those who had a confirmatory ultrasound experienced no improvement in success of initial closure, time to initial closure, or time to successful closure, calling into question the utility of prenatal diagnosis in classic bladder exstrophy patients. Salvage extirpative surgery for recurrent disease following laparoscopic renal cryoablation for T1 renal masses Steven Kheyfets, Heinric Williams, MD, Waleed Eisa, John Walton, Jacob Baber, MD Geisinger Medical Center, Danville, PA INTRODUCTION: This study presents the clinicopathologic outcomes of patients undergoing salvage surgery for local recurrence following renal cryoablation (RCA). METHODS: Patients who experienced ipsilateral tumor recurrence following RCA between January 1, 2000 and December 31, 2013 and managed with extirpative surgery were identified, and their clinico-pathologic features and surgical outcomes were characterized. RESULTS: A total of 17 patients with recurrent disease following RCA as defined by an enhancing lesion with interval growth were managed with partial (1) or total (16) nephrectomy. The median age was 65 years. Mean tumor size at initial RCA was 3.78 cm and 5.94 cm at salvage surgery. Tumor histology was clear cell carcinoma in all cases. 3 low grade cases, 8 intermediate and 6 high grade cases were identified. Median time from RCA to salvage surgery was 29 months. Radical nephrectomy was performed in robotic laparoscopic (12) or open (3) fashion; 2 robotic cases required open conversion. Overall, median operative time was 233 minutes, and median blood loss was 200 mL. Three patients experienced postoperative complications, including ileus, acute blood loss and wound infection. During a median follow-up of 58.5 months, 2 patients developed metastases, and 7 died (2 from disease, 5 from other causes). The metastatic free, cancer specific and overall survival was 88%, 94% and 82%, respectively.
J Am Coll Surg
CONCLUSIONS: Salvage extirpative surgery for recurrent disease following primary RCA provides good renal functional and oncologic outcomes. Minimally invasive surgery can be performed in most cases, but can be complicated by perirenal fibrosis and scarring associated with RCA. Ultrasound-guided dissection of the ureter during complicated colon resection John V Agapian, MD, FACS, Sarvanaz Nouri, MD, Brian S Hernandez, Aron Depew, MD, Afshin Molkara, MD, FACS, Dan Ludi, MD, FACS Riverside Regional Medical Center, Moreno Vallley, CA; University of California, Riverside, CA, Loma Linda, CA INTRODUCTION: Various techniques have been tried to avoid ureteral injuries during emergency open colectomy, such as preoperatively placed ureteral stents. However, stents in and of itself do not necessarily prevent injuries from happening; they only help to identify an injury after it has already occurred. Ultrasound technology has been proving itself as a powerful tool to the Trauma/Acute Care Surgeon, and novel new uses for it are continuously evolving. METHODS: We used an Ultrasound (US) with a 10MHz transducer probe in real time to visualize silicone based ureteral stents placed pre-operatively in patients with extensive pelvic inflammation/adhesions secondary to acute diverticulitis or advanced colon cancer requiring emergency surgery. RESULTS: Although the stents could not be readily palpable secondary to dense adhesions and inflammatory tissue, real time ultrasound images allowed us to visualize the stented ureters, and to gauge our depth of dissection into a cement pelvis, thus to avoid injuring the ureters. CONCLUSIONS: The use of real time visualization of stented ureters using ultrasound can be a useful tool to help identify and safely dissect the ureters during complicated colon resections with dense adhesions, as with perforated diverticulitis or cancer. We encourage future studies to help determine if routine use of ultrasound during difficult pelvic dissection can help reduce the incidence of ureter injury.