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V909 ROBOTIC FLAP PYELOPLASTY FOR AN EXTENDED LENGTH URETERAL STRICTURE NON-AMENABLE TO DISMEMBERED PYELOPLASTY
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THE JOURNAL OF UROLOGY姞
CONCLUSIONS: Double implant of penile prosthesis and artificial urinary sphincter through unique incision is a safe and effective option in patient with loss of quality of life after radical prostatectomy. Candidates must be properly informed and motivated. Source of Funding: None
V907
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
performed with a fully robot-assisted approach as shown in this video. The operative time was 122 minutes. Estimated blood loss was 50cc. There were no intraoperative complications. CONCLUSIONS: This video demonstration illustrates that robot-assisted transperitoneal ureteroureterostomy for retrocaval ureter repair can be done safely and efficiently. This procedure is a feasible approach for surgeons experienced with robotic renal and ureteral operations and demonstrates the potential for advanced reconstructive urological surgery using robot-assisted laparoscopy. Source of Funding: None
A NOVEL USE OF ICG-NIRF DURING ROBOTIC ASSISTED PARTIAL ADRENALECTOMY Manish Patel*, Theodore Manny, Ashok Hemal, Winston Salem, NC INTRODUCTION AND OBJECTIVES: Indocyanine green (ICG) has been previously described in the urologic literature using an intravenous technique during robotic partial nephrectomy. During parital nephrectomy, the dye is administered allowing visualization of the vascular anatomy of the renal hilum, as well as allowing visualization of the tumor margins due to differential fluorescence of the mass relative to the normal parenchyma. We hypothesized that the same rational could be applied to the management of adrenal lesions. We describe our technique of intravascular injection of ICG in a patient with an adrenal pheochromocytoma to help delineate adrenal vascular anatomy and further visualize the tumor-normal adrenal margin. METHODS: We utilize intravascular injection of 2ml of ICG dye with a concentration of 2.5mg/ml to help us assess the the visualization of the adrenal tumor and its differential fluorescence to assist us in performing partial adrenalectomy. RESULTS: Administration of the dye allowed successful distinction of the adrenal tumor from surrounding structures. The tumor was hypo fluorescent relative to the liver and normal adrenal gland. This allowed us to successfully perform partial adrenalectomy with negative tumor margins. CONCLUSIONS: In conclusion, we demonstrate our technique of robotic assisted adrenalectomy with utilization of intravascualar indocyanine green for identification of tumor margins to aid in excision of difficult masses. Source of Funding: None
V908 TECHNIQUE OF ROBOT-ASSISTED TRANSPERITONEAL URETEROURETEROSTOMY FOR RETROCAVAL URETER REPAIR
V909 ROBOTIC FLAP PYELOPLASTY FOR AN EXTENDED LENGTH URETERAL STRICTURE NON-AMENABLE TO DISMEMBERED PYELOPLASTY John Ling*, Jason C Sea, Chandru P Sundaram, Indianapolis, IN INTRODUCTION AND OBJECTIVES: Repair of Ureteropelvic junction (UPJ) obstruction is traditionally done either by dismembered pyeloplasty or a non-dismembered flap pyeloplasty. Dismembered pyeloplasty requires the division and re-anastomosis of the ureter. This procedure has a very high success rate but is unsuitable for obstructions that involve long strictures. Conversely non-dismembered flap pyeloplasty requires the incision of the ureter along the length of the stenosis and creation of a broad flap from the renal pelvis, and subsequent anastomosis of this flap. While this procedure is more complex, it allows correction of relatively long ureteral narrowing. METHODS: In this video a 19 y/o female patient with a proximal ureteric stricture 4-5 cm in length causing left hydronephrosis was taken to the operating room for robotic assisted non-dismembered flap pyeloplasty. The da Vinci surgical system was used for dissection and repair of the UPJ obstruction. The obstructed ureter was first incised along the length of the stricture. A vertical flap from the anterior renal pelvis was then used to tubularize the proximal ureter. A tension free water tight anastomosis was created. RESULTS: The patient successfully underwent the procedure without complications and experienced minimal blood loss. She convalesced without issue and was discharged post-operative day 2. At 1 month follow up the patient had fully recovered and was asymptomatic. CONCLUSIONS: This video demonstrates that robotic assisted non-dismembered flap pyeloplasty can be effectively used for longer strictures that would preclude use of the traditional dismembered approach. Source of Funding: None
LaMont Barlow*, Gina Badalato, Trushar Patel, Maria Ordonez, Ketan Badani, New York, NY INTRODUCTION AND OBJECTIVES: Retrocaval ureter is a rare entity that can lead to chronic obstructive symptoms as well as recurrent infections. Traditional surgical repair for this condition has been from an open approach, and limited reports of laparoscopic procedures have been described. Given the improved dexterity and visualization of robot-assisted laparoscopy as well as increasing experience with robotic renal and ureteral surgery, there is a potential to utilize this technology for more advanced reconstructive procedures. We now present the first complete report with accompanying video of a patient undergoing a robot-assisted transperitoneal ureteroureterostomy for repair of a retrocaval ureter. METHODS: A 47 year-old woman with longstanding right flank pain and recurrent pyelonephritis was diagnosed with a retrocaval ureter via CT scan. Retrograde pyelogram demonstrated a tortuous right ureter with delayed drainage of contrast proximal to the retrocaval portion. A double-J ureteral stent was placed with subsequent partial relief of pain. The decision was made to undergo definitive surgical repair. RESULTS: A standard medial camera port placement template was utilized in a fashion similar to routine robotic renal and ureteral procedures. Transperitoneal ureteroureterostomy was successfully
V910 A STANDARDIZED TECHNIQUE FOR LAPAROSCOPIC REPAIR OF URETEROILEAL ANASTOMOSIS STRICTURE Antoni Rosales*, Josep Maria Gaya, Josep Salvador, Humberto Villavicencio, Barcelona, Spain INTRODUCTION AND OBJECTIVES: Ureteroileal anastomotic stricture after radical cystectomy (RC) and urinary diversion is a late complication and sometimes can have a difficult surgical management. The aim of this video is to present a standardized technique to repair this complication using a laparoscopic approach. METHODS: We present a 73 years old man who underwent a radical cystectomy and ileal conduit because of muscle invasive bladder cancer, with no carcinoma in situ in the distal ureters. Nine months after surgery, the patient developed a bilateral ureteroileal anastomotic stricture with unsuccessful endourological management. Based in our initial experience we describe a standardized technique for laparoscopic repair of ureteroileal anastomotic strictures after RC and ileal conduit urinary diversion.
THE JOURNAL OF UROLOGY姞
CONCLUSIONS: Double implant of penile prosthesis and artificial urinary sphincter through unique incision is a safe and effective option in patient with loss of quality of life after radical prostatectomy. Candidates must be properly informed and motivated. Source of Funding: None
V907
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
performed with a fully robot-assisted approach as shown in this video. The operative time was 122 minutes. Estimated blood loss was 50cc. There were no intraoperative complications. CONCLUSIONS: This video demonstration illustrates that robot-assisted transperitoneal ureteroureterostomy for retrocaval ureter repair can be done safely and efficiently. This procedure is a feasible approach for surgeons experienced with robotic renal and ureteral operations and demonstrates the potential for advanced reconstructive urological surgery using robot-assisted laparoscopy. Source of Funding: None
A NOVEL USE OF ICG-NIRF DURING ROBOTIC ASSISTED PARTIAL ADRENALECTOMY Manish Patel*, Theodore Manny, Ashok Hemal, Winston Salem, NC INTRODUCTION AND OBJECTIVES: Indocyanine green (ICG) has been previously described in the urologic literature using an intravenous technique during robotic partial nephrectomy. During parital nephrectomy, the dye is administered allowing visualization of the vascular anatomy of the renal hilum, as well as allowing visualization of the tumor margins due to differential fluorescence of the mass relative to the normal parenchyma. We hypothesized that the same rational could be applied to the management of adrenal lesions. We describe our technique of intravascular injection of ICG in a patient with an adrenal pheochromocytoma to help delineate adrenal vascular anatomy and further visualize the tumor-normal adrenal margin. METHODS: We utilize intravascular injection of 2ml of ICG dye with a concentration of 2.5mg/ml to help us assess the the visualization of the adrenal tumor and its differential fluorescence to assist us in performing partial adrenalectomy. RESULTS: Administration of the dye allowed successful distinction of the adrenal tumor from surrounding structures. The tumor was hypo fluorescent relative to the liver and normal adrenal gland. This allowed us to successfully perform partial adrenalectomy with negative tumor margins. CONCLUSIONS: In conclusion, we demonstrate our technique of robotic assisted adrenalectomy with utilization of intravascualar indocyanine green for identification of tumor margins to aid in excision of difficult masses. Source of Funding: None
V908 TECHNIQUE OF ROBOT-ASSISTED TRANSPERITONEAL URETEROURETEROSTOMY FOR RETROCAVAL URETER REPAIR
V909 ROBOTIC FLAP PYELOPLASTY FOR AN EXTENDED LENGTH URETERAL STRICTURE NON-AMENABLE TO DISMEMBERED PYELOPLASTY John Ling*, Jason C Sea, Chandru P Sundaram, Indianapolis, IN INTRODUCTION AND OBJECTIVES: Repair of Ureteropelvic junction (UPJ) obstruction is traditionally done either by dismembered pyeloplasty or a non-dismembered flap pyeloplasty. Dismembered pyeloplasty requires the division and re-anastomosis of the ureter. This procedure has a very high success rate but is unsuitable for obstructions that involve long strictures. Conversely non-dismembered flap pyeloplasty requires the incision of the ureter along the length of the stenosis and creation of a broad flap from the renal pelvis, and subsequent anastomosis of this flap. While this procedure is more complex, it allows correction of relatively long ureteral narrowing. METHODS: In this video a 19 y/o female patient with a proximal ureteric stricture 4-5 cm in length causing left hydronephrosis was taken to the operating room for robotic assisted non-dismembered flap pyeloplasty. The da Vinci surgical system was used for dissection and repair of the UPJ obstruction. The obstructed ureter was first incised along the length of the stricture. A vertical flap from the anterior renal pelvis was then used to tubularize the proximal ureter. A tension free water tight anastomosis was created. RESULTS: The patient successfully underwent the procedure without complications and experienced minimal blood loss. She convalesced without issue and was discharged post-operative day 2. At 1 month follow up the patient had fully recovered and was asymptomatic. CONCLUSIONS: This video demonstrates that robotic assisted non-dismembered flap pyeloplasty can be effectively used for longer strictures that would preclude use of the traditional dismembered approach. Source of Funding: None
LaMont Barlow*, Gina Badalato, Trushar Patel, Maria Ordonez, Ketan Badani, New York, NY INTRODUCTION AND OBJECTIVES: Retrocaval ureter is a rare entity that can lead to chronic obstructive symptoms as well as recurrent infections. Traditional surgical repair for this condition has been from an open approach, and limited reports of laparoscopic procedures have been described. Given the improved dexterity and visualization of robot-assisted laparoscopy as well as increasing experience with robotic renal and ureteral surgery, there is a potential to utilize this technology for more advanced reconstructive procedures. We now present the first complete report with accompanying video of a patient undergoing a robot-assisted transperitoneal ureteroureterostomy for repair of a retrocaval ureter. METHODS: A 47 year-old woman with longstanding right flank pain and recurrent pyelonephritis was diagnosed with a retrocaval ureter via CT scan. Retrograde pyelogram demonstrated a tortuous right ureter with delayed drainage of contrast proximal to the retrocaval portion. A double-J ureteral stent was placed with subsequent partial relief of pain. The decision was made to undergo definitive surgical repair. RESULTS: A standard medial camera port placement template was utilized in a fashion similar to routine robotic renal and ureteral procedures. Transperitoneal ureteroureterostomy was successfully
V910 A STANDARDIZED TECHNIQUE FOR LAPAROSCOPIC REPAIR OF URETEROILEAL ANASTOMOSIS STRICTURE Antoni Rosales*, Josep Maria Gaya, Josep Salvador, Humberto Villavicencio, Barcelona, Spain INTRODUCTION AND OBJECTIVES: Ureteroileal anastomotic stricture after radical cystectomy (RC) and urinary diversion is a late complication and sometimes can have a difficult surgical management. The aim of this video is to present a standardized technique to repair this complication using a laparoscopic approach. METHODS: We present a 73 years old man who underwent a radical cystectomy and ileal conduit because of muscle invasive bladder cancer, with no carcinoma in situ in the distal ureters. Nine months after surgery, the patient developed a bilateral ureteroileal anastomotic stricture with unsuccessful endourological management. Based in our initial experience we describe a standardized technique for laparoscopic repair of ureteroileal anastomotic strictures after RC and ileal conduit urinary diversion.