- Email: [email protected]
V1715 SINGLE SCROTAL INCISION ORCHIDOPEXY: BIANCHI PROCEDURE
Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011
Source of Funding: None
V1716 PEDIATRIC ROBOTIC PYELOPLASTY USING THE V-LOC BARBED SUTURE Daniel Su*, Murali Ankem, Joseph Barone, New Brunswick, NJ INTRODUCTION AND OBJECTIVES: Dismembered pyeloplasty is the gold standard for treatment of symptomatic ureteropelvic junction obstruction (UPJO) in the pediatric population. Traditionally, delay absorbable sutures are used in running or interrupted fashion for the creation of a watertight pelvic closure. With the advancement in
Length of hospital stay
INTRODUCTION AND OBJECTIVES: Orchidopexy for the cryptorchid testis, is one of the most frequent operations performed in pediatric urologic practice. Most undescended testes are palpable and are located distal to the external inguinal ring. Historically orchidopexy for such testes, has been performed through 2 separate incisions, an inguinal and scrotal counter-incision. Over the last two decades, a single scrotal incision technique, the “Bianchi Procedure”, has gained popularity. This video demonstrates a modification of this technique. METHODS: A case of a 6 month old, otherwise healthy boy with a left palpable undescended testis was reviewed and is presented as an instructional video in the technique of a single incision orchidopexy, the “Bianchi Procedure”. RESULTS: Left orchidopexy was performed as follows. After the penis was retracted with a stay suture, the median raphe and a high scrotal skin fold were marked. An incision was made through the scrotal mark. Then dartos fascia was incised with electrocautery and a subdartos pouch (inferior envelope) was created caudally. Through the same skin incision, a separate more cranial dartos incision was performed, through which the superficial inguinal area was accessed (superior envelope). This thus created 2 distinct dartos envelopes, sharing a common wall. Gubernacular and cremasteric attachments were dissected free, exposing the external ring. The hernia sac was isolated, suture ligated, and divided. A hemostat was passed from the inferior envelope, through the common wall, into the superior envelope where the gubernaculum was grasped & relocated into the inferior envelope through the noose that had been created in the common wall. This obviated the need for additional fixation sutures beeing placed through the testis. The wound was closed and cyanoacrylate glue applied to the skin. The duration of the procedure was 12 minutes. The patient was discharged home with immediate return to full activity & bathing, on a 48 hour alternating regimen of acetamenophen and ibuprofen. 12 weeks postoperatively, both testes were equal in size, in the dependent scrotum. CONCLUSIONS: The Bianchi approach to the palpable undescended testis is a minimally invasive, safe and effective method to perform orchidopexy for the palpable undescended testis. It maintains the surgical principles of a 2 incision orchidopexy, but spares making a separate inguinal incision. Using the noose technique, fixation sutures to maintain scrotal position are avoided.
Days to JP removal
Martin Koyle*, Micah Jacobs, Natalya Lopushnyan, David Bolnick, Seattle, WA
Operating time (min)
SINGLE SCROTAL INCISION ORCHIDOPEXY: BIANCHI PROCEDURE
1
Y
RIGHT
150
1
2
2
Y
Left
167
1
3
3
Y
Left
184
1
2
4
N
Right
177
1
2
5
N
Left
165
2
3
6
N
Left
152
1
3
Laterality of UPJO
V1715
robotic surgery, pyeloplasty is performed frequently with robotic assistance. In this study we evaluate a new barbed suture for robotic pyeloplasty (RPP). Due to the presence of barbs, this suture does not requiring knot tying and is able to maintain tight closure during running sutures without added tension. We propose this is a safe and effective suture for RPP with the added advantage of maintaining a watertight closure at all times and convenience of not having to tie knots. METHODS: We review a series of 3 pediatric RPP during which the V-Loc suture was used. We compare this series to a matched series of 3 pediatric RPP during which 3-0 Vicryl suture was used. All six patients are ages between 3 and 12, all had symptomatic UPJO with the finding of hydronephrosis on renal ultrasound and obstruction on MAG-3 Renal Scan. All patients underwent Cystoscopy with the placement of a multilength ureteral stent on the affected side prior to port placement. Pyeloplasty was done in the standard fashion with the assistance of the Da Vinci Robotic System. Postoperative all patients had a foley catheter in place, this was removed on postoperative day 1. A Jackson-Pratt drain was also left adjacent to the renal pelvis, this drain was removed once output was ⬍ 30 cc/ day. A JP creatinine was not checked in any patients. Patients were followed with a renal ultrasound 2 weeks postop. RESULTS: Using V-Loc suture did not seem to affect OR time, JP removal time or LOHD in our series. All postop ultrasound showed reduced hydronephrosis. CONCLUSIONS: The Covidien V-Loc suture is a safe and effective suture for use in pediatric RPP. It offers the convenience of not requiring knots thus adding surgeon ease and offers the advantage of a watertight closure at all times without added tension. This is a small series and will need to verified by larger, prospective studies. Comparison of the actual surgical time required using Vicryl sutures to V-Lock sutures may provide additional advantage in using this suture.
V-Loc
Source of Funding: None
e689
Patient
RESULTS: The patient had an uneventful evaluation and remains continent with catheterization intervals of 4 hours. The stoma and incision have a nice cosmetic aspect with a 8 months followup. CONCLUSIONS: The RPM technique is an alternative approach for minimal invasive strategy for the Mitrofanoff principle. Longterm follow-up is however necessary to confirm the excellent initial results.
THE JOURNAL OF UROLOGY姞
Source of Funding: None
V1717 ROBOT-ASSISTED LAPAROSCOPIC URETERAL REIMPLANTATION: THE VIDEO Marcelo Orvieto*, Gautam Jayram, Mohan Gundeti, Chicago, IL INTRODUCTION AND OBJECTIVES: Robot-assisted laparoscopic ureteral reimplantation (RALUR) is slowly gaining acceptance as an alternative to the gold standard open repair. We herein describe our extravesical technique and evaluate early outcomes. METHODS: Between November 2008-September 2010, 16 patients (13 females, 3 males) (6 bilateral cases) underwent RALUR at our institution. All cases were performed by a single surgeon utilizing an extravesical technique. Technique: The DaVinci S system, was used via a transperitoneal approach and utilizing a 4 port configuration. The patient was placed in a modified Trendelenburg position. After docking,the ureter is identified in relation to the vas or the uterine artery according gender. The ureter is dissected distal to these structures and tented up with an umbilical tape. The bladder is elevated with a stay suture through the abdominal wall. A 4cm detrusorotomy is performed.
Source of Funding: None
V1716 PEDIATRIC ROBOTIC PYELOPLASTY USING THE V-LOC BARBED SUTURE Daniel Su*, Murali Ankem, Joseph Barone, New Brunswick, NJ INTRODUCTION AND OBJECTIVES: Dismembered pyeloplasty is the gold standard for treatment of symptomatic ureteropelvic junction obstruction (UPJO) in the pediatric population. Traditionally, delay absorbable sutures are used in running or interrupted fashion for the creation of a watertight pelvic closure. With the advancement in
Length of hospital stay
INTRODUCTION AND OBJECTIVES: Orchidopexy for the cryptorchid testis, is one of the most frequent operations performed in pediatric urologic practice. Most undescended testes are palpable and are located distal to the external inguinal ring. Historically orchidopexy for such testes, has been performed through 2 separate incisions, an inguinal and scrotal counter-incision. Over the last two decades, a single scrotal incision technique, the “Bianchi Procedure”, has gained popularity. This video demonstrates a modification of this technique. METHODS: A case of a 6 month old, otherwise healthy boy with a left palpable undescended testis was reviewed and is presented as an instructional video in the technique of a single incision orchidopexy, the “Bianchi Procedure”. RESULTS: Left orchidopexy was performed as follows. After the penis was retracted with a stay suture, the median raphe and a high scrotal skin fold were marked. An incision was made through the scrotal mark. Then dartos fascia was incised with electrocautery and a subdartos pouch (inferior envelope) was created caudally. Through the same skin incision, a separate more cranial dartos incision was performed, through which the superficial inguinal area was accessed (superior envelope). This thus created 2 distinct dartos envelopes, sharing a common wall. Gubernacular and cremasteric attachments were dissected free, exposing the external ring. The hernia sac was isolated, suture ligated, and divided. A hemostat was passed from the inferior envelope, through the common wall, into the superior envelope where the gubernaculum was grasped & relocated into the inferior envelope through the noose that had been created in the common wall. This obviated the need for additional fixation sutures beeing placed through the testis. The wound was closed and cyanoacrylate glue applied to the skin. The duration of the procedure was 12 minutes. The patient was discharged home with immediate return to full activity & bathing, on a 48 hour alternating regimen of acetamenophen and ibuprofen. 12 weeks postoperatively, both testes were equal in size, in the dependent scrotum. CONCLUSIONS: The Bianchi approach to the palpable undescended testis is a minimally invasive, safe and effective method to perform orchidopexy for the palpable undescended testis. It maintains the surgical principles of a 2 incision orchidopexy, but spares making a separate inguinal incision. Using the noose technique, fixation sutures to maintain scrotal position are avoided.
Days to JP removal
Martin Koyle*, Micah Jacobs, Natalya Lopushnyan, David Bolnick, Seattle, WA
Operating time (min)
SINGLE SCROTAL INCISION ORCHIDOPEXY: BIANCHI PROCEDURE
1
Y
RIGHT
150
1
2
2
Y
Left
167
1
3
3
Y
Left
184
1
2
4
N
Right
177
1
2
5
N
Left
165
2
3
6
N
Left
152
1
3
Laterality of UPJO
V1715
robotic surgery, pyeloplasty is performed frequently with robotic assistance. In this study we evaluate a new barbed suture for robotic pyeloplasty (RPP). Due to the presence of barbs, this suture does not requiring knot tying and is able to maintain tight closure during running sutures without added tension. We propose this is a safe and effective suture for RPP with the added advantage of maintaining a watertight closure at all times and convenience of not having to tie knots. METHODS: We review a series of 3 pediatric RPP during which the V-Loc suture was used. We compare this series to a matched series of 3 pediatric RPP during which 3-0 Vicryl suture was used. All six patients are ages between 3 and 12, all had symptomatic UPJO with the finding of hydronephrosis on renal ultrasound and obstruction on MAG-3 Renal Scan. All patients underwent Cystoscopy with the placement of a multilength ureteral stent on the affected side prior to port placement. Pyeloplasty was done in the standard fashion with the assistance of the Da Vinci Robotic System. Postoperative all patients had a foley catheter in place, this was removed on postoperative day 1. A Jackson-Pratt drain was also left adjacent to the renal pelvis, this drain was removed once output was ⬍ 30 cc/ day. A JP creatinine was not checked in any patients. Patients were followed with a renal ultrasound 2 weeks postop. RESULTS: Using V-Loc suture did not seem to affect OR time, JP removal time or LOHD in our series. All postop ultrasound showed reduced hydronephrosis. CONCLUSIONS: The Covidien V-Loc suture is a safe and effective suture for use in pediatric RPP. It offers the convenience of not requiring knots thus adding surgeon ease and offers the advantage of a watertight closure at all times without added tension. This is a small series and will need to verified by larger, prospective studies. Comparison of the actual surgical time required using Vicryl sutures to V-Lock sutures may provide additional advantage in using this suture.
V-Loc
Source of Funding: None
e689
Patient
RESULTS: The patient had an uneventful evaluation and remains continent with catheterization intervals of 4 hours. The stoma and incision have a nice cosmetic aspect with a 8 months followup. CONCLUSIONS: The RPM technique is an alternative approach for minimal invasive strategy for the Mitrofanoff principle. Longterm follow-up is however necessary to confirm the excellent initial results.
THE JOURNAL OF UROLOGY姞
Source of Funding: None
V1717 ROBOT-ASSISTED LAPAROSCOPIC URETERAL REIMPLANTATION: THE VIDEO Marcelo Orvieto*, Gautam Jayram, Mohan Gundeti, Chicago, IL INTRODUCTION AND OBJECTIVES: Robot-assisted laparoscopic ureteral reimplantation (RALUR) is slowly gaining acceptance as an alternative to the gold standard open repair. We herein describe our extravesical technique and evaluate early outcomes. METHODS: Between November 2008-September 2010, 16 patients (13 females, 3 males) (6 bilateral cases) underwent RALUR at our institution. All cases were performed by a single surgeon utilizing an extravesical technique. Technique: The DaVinci S system, was used via a transperitoneal approach and utilizing a 4 port configuration. The patient was placed in a modified Trendelenburg position. After docking,the ureter is identified in relation to the vas or the uterine artery according gender. The ureter is dissected distal to these structures and tented up with an umbilical tape. The bladder is elevated with a stay suture through the abdominal wall. A 4cm detrusorotomy is performed.