ABSTRACT: To compare running and interrupted suturing techniques for porcine vesicourethral anastomosis with regard to procedure time, histopathologic effects, and leakage.
Twelve domestic pigs were randomized to a running (N = 6) or an interrupted (N = 6) vesicourethral anastomosis with polyglycolic acid sutures. In each case, the bladder was drained for 7 days. A cystogram was performed immediately after completion of each anastomosis and on postoperative days 7 and 30. Animals were sacrificed on postoperative day 30, and the area of the anastomosis was excised en bloc for histopathologic evaluation.
All procedures were completed laparoscopically. The mean operative time for continuous and interrupted suturing were 27.5 and 36.8 minutes, respectively (P = 0.3324). A significant learning curve was noted for both anastomoses, with operative times decreasing with experience in both groups. There was no difference in anastomotic leakage. Histopathology examination revealed more muscle-layer fibrosis in the interrupted- suture group than in the continuous-suture group, with a mean score of 2.17 and 1.67, respectively (P = 0.0325).
Both continuous and interrupted vesicourethral anastomoses are feasible. In this in-vivo porcine comparison, there was no difference with respect to procedure time or anastomotic leakage. However, histopathologic grading demonstrated greater muscle fibrosis in the interrupted-suture group.
Journal of Endourology 12/2005; 19(9):1109-13. · 1.85 Impact Factor
ABSTRACT: To evaluate the effects of renal vascular control and intrarenal cooling on the size of renal lesions attainable with a 3.4-mm cryoprobe.
Three groups of pigs underwent unilateral laparoscopic renal cryoablation with a 3.4-mm cryoprobe inserted to a depth of 1 cm. An 8-minute double-freeze cycle was used. One week later, an acute contralateral cryolesion was created before killing the animal. In group 1 (n = 6), bilateral cryolesions were created without hilar clamping or intrarenal cooling. In group 2 (n = 6), the cryolesions were created after hilar clamping alone. In group 3 (n = 6), the cryolesions were created after both hilar clamping and application of intrarenal cooling with saline ice-slush infused into the renal pelvis. After nephrectomy, the gross diameters were determined for each cryolesion. The mean diameters of the zones of complete and partial necrosis were determined by histopathologic examination.
In group 3, the cortex cooled from 36.9 degrees C to a mean of 24.8 degrees C. Acutely, no statistically significant difference was found between the lesions produced with clamping alone (37.6 mm) and intrarenal cooling (40.4 mm); however, both were significantly larger than the control cryolesions (28.7 mm). At 1 week, the area of complete necrosis produced with intrarenal cooling (34.3 mm) was significantly larger than the areas of necrosis produced by clamping alone (27.8 mm) or conventional cryoablation (23.9 mm; alpha = 0.05, Tukey's honestly significantly different [HSD] test).
Enhanced cryolesion necrosis was achieved with intrarenal cooling with a 3.4-mm cryoprobe. Intrarenal cooling may be a valuable adjunct to cryoablation in selected cases.
Urology 07/2004; 63(6):1209-12. · 2.43 Impact Factor
ABSTRACT: We describe the technique and initial clinical results with application of a novel method to achieve renal parenchymal hypothermia using retrograde ureteral access. A 38-year-old man was scheduled to undergo an open right partial nephrectomy for renal cell carcinoma. Before the open procedure, a ureteral access sheath was advanced to the ureteropelvic junction under fluoroscopic guidance; through the access sheath, a 7.1F pigtail catheter was also advanced. After clamping the renal artery and vein, ice-cold saline (-1.7 degrees C) was circulated through the access sheath and drained via the 7.1F pigtail catheter; renal cortical and medullary parenchymal temperatures were measured using thermocouples. This technique of intrarenal cooling achieved a renal cortical temperature of 24 degrees C and a medullary temperature of 21 degrees C. The endoscopic procedure required an additional 35 minutes of operation time to complete. Histopathologic investigation of the specimen revealed no associated damage to the ureteral urothelium from access sheath placement or to the collecting system urothelium from exposure to ice-cold saline irrigation. Retrograde endoscopic renal hypothermia is feasible and effective. The technique requires no novel equipment or special surgical skills. This method can be applied to patients undergoing open or laparoscopic complex renal ablative and reconstructive procedures that require renal hypothermia.
Urology 06/2003; 61(5):1023-5. · 2.43 Impact Factor