Laparoscopic ureteral reimplantation: technique and outcomes.
ABSTRACT We describe our experience with laparoscopic ureteral reimplantation in 45 adults, and report success rates and complications at intermediate term followup.
We performed a retrospective chart review of 45 patients who underwent laparoscopic ureteral reimplantation between 1997 and 2007. Demographics, clinicopathological parameters, perioperative course, complications and followup studies were analyzed.
Elective laparoscopic ureteral reimplantation was performed in 35 female and 10 male patients with a mean followup of 24.1 months (range 1 to 76). All patients presented with distal ureteral stricture with a mean stricture length of 3 cm and a mean +/- SD preoperative serum creatinine of 0.91 +/- 0.04 mg/dl. Mean patient age was 47.8 +/- 2.2 years (range 17 to 87). Mean American Society of Anesthesiologists score was 2 (range 1 to 3). Median estimated blood loss was 150 ml. The overall success rate, defined as radiographic evidence of no residual obstruction, symptoms, renal deterioration or need for subsequent procedures, was 96%. Two patients had recurrent strictures and 1 underwent nephrectomy for flank pain and preexisting chronic pyelonephritis.
According to intermediate followup data laparoscopic ureteral reimplantation can be performed with an excellent success rate and low morbidity. Our data substantiate this technique as an effective method for managing distal ureteral stricture.
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ABSTRACT: Influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures To assess the influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures in our adult patient population. Single surgeon operative experience in two institutes. Retrospective analysis. All patients were worked up in detail. All patients underwent cystoscopy and retrograde pyelography prior to laparoscopic approach. Patients were categorised into two groups: early repair (within seven days of inciting event) and delayed repair (after two weeks). Operative parameters and postoperative events were recorded. Postprocedure all patients were evaluated three monthly. Follow-up imaging was ordered at six months postoperatively. Improvement in renal function, resolution of hydronephrosis and unhindered drainage of contrast through the reconstructed unit on follow-up imaging was interpreted as a satisfactory outcome. Mean, standard deviation, equal variance t test, Mann Whitney Z test, Aspin-Welch unequal variance t test. Thirty-six patients (37 units, 36 unilateral and 1 simultaneous bilateral) underwent laparoscopic ureteral reconstruction of lower ureteric stricture following iatrogenic injury - 21 early repair (Group I) and 15 delayed repair (Group II). All patients were hemodynamically stable at presentation. Early repair was more technically demanding with increased operation duration. There was no difference in blood loss, operative complications, postoperative parameters, or longterm outcome. In hemodynamically stable patients, laparoscopic repair of iatrogenically induced lower ureteric strictures can be conveniently undertaken without undue delay from the inciting event. Compared to delayed repairs, the procedure is technically more demanding but morbidity incurred and outcome is at par.Indian Journal of Urology 10/2011; 27(4):465-9.
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ABSTRACT: Introduction: Ureteroneocystostomy can be used for the treatment of a wide variety of ureteral pathology. Over the last decade, robotic surgery has become more commonly used as a minimally invasive approach for reconstructive upper urinary tract procedures. The aim of this study is to present our experience with robotic ureteroneocystosctomy (RUNC) with a comparison to that of open ureteroneocystosctomy (OUNC). Patients and Methods: Medical records of 25 patients who underwent RUNC and 41 patients who underwent OUNC or at our institution between 2000 and 2010 were retrospectively analyzed. Perioperative and postoperative data including demographics, surgical outcomes and clinical and radiographic findings at postoperative follow-up were considered in the comparative analysis. Descriptive statistics were used to present the data. The significance of difference between variables were evaluated using Wilcoxon rank sum test for continuous and Fisher Exact test for categorical variables. Results: No significant differences were detected in terms of baseline patient characteristics between the two groups. The OUNC procedures were performed with a shorter median operative time (200 vs. 279 min., p=0.0008) whereas RUNC patients had a shorter hospital stay (median 3 versus 5, p=0.0004), less narcotic pain requirement (morphine equivalent, mg 104.6 versus 290, p=0.0001) and less estimated blood loss ( 100 versus 150mL, p=<0.0002). No significant difference in rate of reoperation between groups, RUNC 2/25 (7.6 %) vs. OUNC 4/41 (9.7 %) p=0.8. Limitations include the retrospective nature of the study and the difference in indications for surgery. Conclusion: RUNC provides excellent outcomes with shorter hospital stay, less narcotic pain requirement, and decreased blood loss when compared to the open procedure. Advantages of the robotic platform for dissection and suturing can be useful for complex minimally invasive urologic reconstructive procedures.Journal of endourology / Endourological Society 09/2012; · 1.75 Impact Factor
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ABSTRACT: An experimental refrigeration system based on a two-stage steam ejector was set-up in the Thermodynamics and Heat Transfer Laboratory of our Department. The system optimization and realization have been described elsewhere (Grazzini and Mariani, 1998; Grazzini and Rocchetti, 2008). In both stages, primary flows are highly supersonic and reach low pressure and temperature levels. As usual in the literature, an ideal gas model was used during the design process. This paper is intended to check the validity of this assumption. In order to understand the actual working condition of our system, several models have been compared. The presence of high flow speed suggests the existence of metastable conditions. To set the border for the metastable region, the spinodal curve has been drawn. Isentropic expansion of vapour through the nozzle, modelled as ideal gas, seems well within the metastable zone. However, the Classic Nucleation Theory shows that the Wilson line is crossed at the nozzle throat. Condensation produces a marked difference in the conditions at the nozzle exit. Results coming from the present analysis will be used in further optimization of the experimental ejector design.International Journal of Refrigeration-revue Internationale Du Froid - INT J REFRIG. 01/2011; 34(7):1641-1648.