Speciality
Spotlight

 




 

Urology

 

 




Uro
Laparoscopy

    

  • D. D. Gaur, S. S. Rathi, A. V. Ravandale and M. Gopichand (Bombay Hospital Institute of Medical Sciences, Bombay, India)

    A Single-Centre Experience of Retroperitoneoscopy Using the Balloon Technique

    BJU Intl. May 2001 Vol. 87 (7) Pg. 602-606

        


    Methods : There were 172 renal, seven adrenal, 97 ureteric, 50 gonadal, 13 lymphatic, 3 vesical, 2 autonomic nervous system and 7 vertebral retroperitoneal laparoscopic procedures (RLPs).

        


    Results : RLP was successful in 318 of the 351 procedures (90.6%). The operative duration was 0.5-5.5 h. The overall incidence of complications was 12.9% but decreased to 9% for the last 100 procedures.

        


    These were 5 major complications viz. avulsion of ureter, torn renal pelvis, colonic injury and severe hypotension, but none were related to balloon dissection. 

        


    The mean blood loss was 37.7 ml. The mean duration of analgesic use was 2.5 days, the hospital stay 3 days and return to work 14 days.

        


    Conclusion : The efficiency and safety of RLPs depend more on experience than on the type of access technique, type of balloon or medium used to inflate the balloon. 

        


    Expansion of up to 800 mL is safe in adults. The use of nitrous oxide for use in retroperitoneal is safe.

        


    Comments : Laparoscopic renal surgery appears to be a good alternative in simple nephrectomy, radical nephrectomy, live donor nephrectomy. However, lesser invasive procedures with lesser post operative stay in the hospital and lesser analgesic use and thus overall reduced morbidity are available for renal, calculus disease. This has been the experience of most urologists in upper tract
    endourology.

         


    Also residency training programs cannot offer the requisite experience due to lesser cases.

           

  • M. Kumar, R. Kumar, A. K. Hemal and N. P. Gupta (Department of Urology, All India Institute of Medical Sciences, New Delhi, India) 

    Complications of Retroperitoneoscopic Surgery at One Centre

    BJU Intl. May 2001 Vol. 87 (7) Pg. 607-612

       


    Methods : The procedural details and complications were analyzed retrospectively in 316 patients (aged 4-88 years) who underwent retroperitoneoscopic urological surgery between March 1994 and January 2000 at the authors centre.

       


    Results : The mean operative duration was 104.9 min, the blood loss 130.86 and the hospital stay 3.2 days.

       


    3.5% of patients had a major complication including seven vascular injuries, five of which required immediate conversion to open surgery.

        


    Four patients had other major complications including
    colonic injury, retroperitoneal collections and
    incisional hernia. 

        


    There were 50 minor complications of which peritoneal tears were the commonest. Port-site infections and subcutaneous emphysema contributed to 2.2% each.

        


    Conclusions : As the stages of retroperitoneoscopic surgery became standardized and the outcome predictable, it is rapidly becoming accepted as an important method of treatment. Increasing experience leads to decreasing complication rates.

        


    Comments : In this series of 316 patients 40 underwent laparoscopic procedures for ureteral calculi impacted in the upper or midureter and 7 underwent pyelolithotomy for large pelvic stones. One wonders if less morbid procedures like PCNL(Percutaneous Nephrolithotomy) or ureteroscopy including antegrade URS(Ureterorenoscopy) could have been possible in these cases.

         

 



 

  

Speciality Spotlight

 

 
Urology
 

 

Uro Laparoscopy
    

  • D. D. Gaur, S. S. Rathi, A. V. Ravandale and M. Gopichand (Bombay Hospital Institute of Medical Sciences, Bombay, India)
    A Single-Centre Experience of Retroperitoneoscopy Using the Balloon Technique
    BJU Intl. May 2001 Vol. 87 (7) Pg. 602-606
        
    Methods : There were 172 renal, seven adrenal, 97 ureteric, 50 gonadal, 13 lymphatic, 3 vesical, 2 autonomic nervous system and 7 vertebral retroperitoneal laparoscopic procedures (RLPs).
        
    Results : RLP was successful in 318 of the 351 procedures (90.6%). The operative duration was 0.5-5.5 h. The overall incidence of complications was 12.9% but decreased to 9% for the last 100 procedures.
        
    These were 5 major complications viz. avulsion of ureter, torn renal pelvis, colonic injury and severe hypotension, but none were related to balloon dissection. 
        
    The mean blood loss was 37.7 ml. The mean duration of analgesic use was 2.5 days, the hospital stay 3 days and return to work 14 days.
        
    Conclusion : The efficiency and safety of RLPs depend more on experience than on the type of access technique, type of balloon or medium used to inflate the balloon. 
        
    Expansion of up to 800 mL is safe in adults. The use of nitrous oxide for use in retroperitoneal is safe.
        
    Comments : Laparoscopic renal surgery appears to be a good alternative in simple nephrectomy, radical nephrectomy, live donor nephrectomy. However, lesser invasive procedures with lesser post operative stay in the hospital and lesser analgesic use and thus overall reduced morbidity are available for renal, calculus disease. This has been the experience of most urologists in upper tract endourology.
         
    Also residency training programs cannot offer the requisite experience due to lesser cases.
           

  • M. Kumar, R. Kumar, A. K. Hemal and N. P. Gupta (Department of Urology, All India Institute of Medical Sciences, New Delhi, India) 
    Complications of Retroperitoneoscopic Surgery at One Centre
    BJU Intl. May 2001 Vol. 87 (7) Pg. 607-612
       
    Methods : The procedural details and complications were analyzed retrospectively in 316 patients (aged 4-88 years) who underwent retroperitoneoscopic urological surgery between March 1994 and January 2000 at the authors centre.
       
    Results : The mean operative duration was 104.9 min, the blood loss 130.86 and the hospital stay 3.2 days.
       
    3.5% of patients had a major complication including seven vascular injuries, five of which required immediate conversion to open surgery.
        
    Four patients had other major complications including colonic injury, retroperitoneal collections and incisional hernia. 
        
    There were 50 minor complications of which peritoneal tears were the commonest. Port-site infections and subcutaneous emphysema contributed to 2.2% each.
        
    Conclusions : As the stages of retroperitoneoscopic surgery became standardized and the outcome predictable, it is rapidly becoming accepted as an important method of treatment. Increasing experience leads to decreasing complication rates.
        
    Comments : In this series of 316 patients 40 underwent laparoscopic procedures for ureteral calculi impacted in the upper or midureter and 7 underwent pyelolithotomy for large pelvic stones. One wonders if less morbid procedures like PCNL(Percutaneous Nephrolithotomy) or ureteroscopy including antegrade URS(Ureterorenoscopy) could have been possible in these cases.
         

 

 

By |2022-07-20T16:42:37+00:00July 20, 2022|Uncategorized|Comments Off on Uro-Laparoscopy

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