Median followup was 57 weeks (IQR 28, 83).
Results: The lowest recorded renal temperature during ischemia check details was 14C. Median tumor size was 4.0 cm (IQR 2.7, 6.2). Median estimated blood loss was 150 cc (IQR 100, 275). Median ischemia time was 35 minutes (IQR 26, 41). Doppler echography identified intrarenal arterial
blood flow postoperatively in all cases. The median change in the estimated glomerular filtration rate from preoperatively to postoperative day 2 was 4 ml per minute (IQR -29, 19). Two months postoperative in 20 patients the median change was 3.5 ml per minute (IQR -6, 16.5). At last followup in 31 patients the overall change in the estimated glomerular filtration rate was -0.5 ml per minute (IQR -6, 6). Six complications developed in a total of 5 patients, of which 5 were grade 2 or less. One grade 3 postoperative hemorrhage from an arteriovenous
fistula at the tumor click here resection site was treated with angiography and selective embolization.
Conclusions: Cold intravascular perfusion during laparoscopic partial nephrectomy can achieve renal hypothermia below 15C. It is not associated with an immediate risk of renal vascular injury or thrombosis, as measured by Doppler echography in this series. Early changes in postoperative estimates of renal function appear minimal.”
“Purpose: For the treatment of ureteropelvic junction obstruction laparoscopic dismembered pyeloplasty and open pyeloplasty have similar outcomes. We present our experience with robot assisted laparoscopic dismembered pyeloplasty.
Materials and Methods: We retrospectively reviewed all adult robot assisted laparoscopic dismembered pyeloplasties
performed at our institution between November 2002 and July 2009. Preoperative evaluation included abdominal computerized tomography angiogram to assess for crossing vessels and diuretic renal scan to quantify the degree of obstruction. Followup with diuretic renal scan and a patient pain analog scale was performed 3, 6 and 12 months after surgery. If the study was normal at 12 months, the patient was followed with ultrasound of the kidneys and bladder to Vasopressin Receptor look for ureteral jets. Absent ureteral jets, worsening hydronephrosis or patient complaint of pain necessitated repeat diuretic renogram.
Results: A total of 61 robot assisted laparoscopic dismembered pyeloplasties were performed in 21 men and 40 women. Followup was available for 57 patients with an average +/- SD age of 35 +/- 16 years and average followup of 18 +/- 15 months. Mean operative time was 335 +/- 88 minutes and estimated blood loss was 61 +/- 48 ml. Average hospitalization time was 2 +/- 0.9 days and the average postoperative analgesia requirement was 13 +/- 9.6 mg morphine sulfate equivalents. The overall success rate was 81% based on a normal diuretic renogram and lack of pain using a validated pain scale. There were 3 grade III Clavien complications for a 4.9% major complication rate.