Urology video journal最新文献

{"title":"Single port, radical nephroureterectomy with radical cystoprostatectomy and pelvic lymphadenectomy","authors":"Mohammed Almoflihi,&nbsp;Reuben Ben-David,&nbsp;Peter Wiklund,&nbsp;Reza Mehrazin","doi":"10.1016/j.urolvj.2024.100323","DOIUrl":"10.1016/j.urolvj.2024.100323","url":null,"abstract":"<div><h3>Objective</h3><div>To present a surgical video showing the feasibility of single-port radial nephroureterectomy with radial cystoprostatectomy and pelvic lymphadenectomy.</div></div><div><h3>Patients and surgical procedure</h3><div>53-year-old male with renal failure on hemodialysis secondary to adult polycystic kidney disease and past surgical history of right nephrectomy and right hemicolectomy for colon cancer. He was diagnosed with high-volume bladder cancer and a 6 × 5 cm left enhancing renal mass (Image 1).</div></div><div><h3>Results</h3><div>Console time was 215 min, with an estimated blood loss of 500 mL. There were no intraoperative and postoperative complications, and the patient was discharged on postoperative day 5.</div></div><div><h3>Conclusion</h3><div>SP robotic surgery can be safely utilized for complex multiquadrant urological surgeries on selected patients in the hands of experienced robotic surgeons.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100323"},"PeriodicalIF":0.0,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted off-clamp enucleation of endophytic tumor in solitary functioning kidney","authors":"Riccardo Bertolo ,&nbsp;Filippo Migliorini,&nbsp;Alessandro Veccia,&nbsp;Luca Roggero,&nbsp;Greta Pettenuzzo,&nbsp;Francesco Ditonno,&nbsp;Francesco Artoni,&nbsp;Claudio Brancelli,&nbsp;Alessandro Antonelli","doi":"10.1016/j.urolvj.2024.100321","DOIUrl":"10.1016/j.urolvj.2024.100321","url":null,"abstract":"<div><h3>Objective</h3><div>To report a case of an off-clamp robot-assisted enucleation of endophytic renal mass performed in a patient with a solitary functioning kidney.</div></div><div><h3>Patient and surgical procedure</h3><div>The patient underwent a contrast-enhanced CT scan following a syncopal episode, which showed a right renal mass of 3 cm at the hilum with a RENAL score of 9. Hypoperfusion of the contralateral kidney was observed due to renal artery stenosis. A radionuclide renal scan confirmed the poor contribution of the left kidney to renal function. The patient was counseled for robot-assisted partial nephrectomy. The arterial vascular pedicle was dissected at the extra-parenchymal level, guided by 3D reconstruction. After identifying the tributary branch of the area of interest, a branch of the renal artery was suspended on a vascular loop with the help of ischemia simulation on the 3D model. Tumor resection was initiated without clamping the renal artery, identifying the plane of the tumor pseudocapsule. Dissection was conducted circumferentially around the lesion to reduce tractions and the likelihood of tumor rupture. After liberating the lateral margins of the lesion, the enucleation of the more endophytic portion was completed. A hybrid cortico-medullary suture was performed using the \"sliding clips\" technique.</div></div><div><h3>Results</h3><div>The surgery was uneventful. Console time was 65 min. Blood loss was 300 ml. The final pathology showed a papillary renal cell carcinoma, grade 2, with negative margins. Functional follow-up showed no immediate impact of the intervention, and at a three-month follow-up, there were no variations in serum creatinine levels and glomerular filtration rate.</div></div><div><h3>Conclusions</h3><div>Our approach combined an off-clamp technique with anatomical resection and minimal renorrhaphy. Given the case's complexity, the arterial pedicle was selectively prepared according to the 3D model to be ready for selective clamping on demand. Our experience emphasizes the importance of advanced imaging and simulation in complex surgical planning and execution.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100321"},"PeriodicalIF":0.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muco-mucosal anastomotic non-transecting augmentation (MANTA) ureteroplasty","authors":"Jonathan Kam,&nbsp;Anthony Emmanuel,&nbsp;Francesco Del Giudice,&nbsp;Majed Shabbir,&nbsp;Rajesh Nair","doi":"10.1016/j.urolvj.2024.100320","DOIUrl":"10.1016/j.urolvj.2024.100320","url":null,"abstract":"<div><h3>Introduction &amp; Objectives</h3><div>Revision ureteric reconstruction is often very challenging due to limited ureteric length and compromised blood supply. We aimed to describe a technique of a non-transecting augmentation ureteroplasty with buccal mucosal graft for a patient with a recurrent ureteric stricture. This technique was adapted from the urethroplasty literature and applied to upper tract reconstruction.</div></div><div><h3>Methods</h3><div>A 70 year old male had previously underwent a diverticulectomy and boari flap reimplantation for urothelial cancer. The anastomosis strictured and a revision ureteric reimplantation was performed which also subsequently strictured. A stent was not able to be placed across the stricture so the patient was nephrostomy dependent. A buccal mucosal graft augmentation was performed using a muco-mucosal anastomotic non-transecting augmentation (MANTA) technique adapted from the urethroplasty literature</div></div><div><h3>Results</h3><div>The patient recovered well and was discharged day 3. A cystogram was performed and catheter removed at 4 weeks. The stent was removed at 6 weeks and a retrograde pyelogram showed a normal ureteric caliber. A MAG-3 renogram at 3 months showed no obstruction</div></div><div><h3>Conclusions</h3><div>We describe a novel technique for difficult revision upper tract reconstruction cases.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100320"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted post-radiotherapy left adrenal metastasectomy from renal cell carcinoma","authors":"Valerio Santarelli ,&nbsp;Francesco Del Giudice ,&nbsp;Jan Łaszkiewicz ,&nbsp;Jaemin Lee ,&nbsp;Vincenzo Asero ,&nbsp;Benjamin I. Chung","doi":"10.1016/j.urolvj.2024.100316","DOIUrl":"10.1016/j.urolvj.2024.100316","url":null,"abstract":"","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100316"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low anterior access for single port (SP) retroperitoneal partial nephrectomy: Technique and outcomes","authors":"Shirin Razdan ,&nbsp;Laura Zuluaga ,&nbsp;Burak Ucpinar ,&nbsp;Ketan K Badani","doi":"10.1016/j.urolvj.2024.100311","DOIUrl":"10.1016/j.urolvj.2024.100311","url":null,"abstract":"<div><h3>Introduction</h3><div>Single Port (SP) robotic partial nephrectomy (RPN) can be performed via retroperitoneal and transperitoneal approach. We aim to describe low anterior access (LAA) with outcomes and compare outcomes to lateral flank approach (LFA).</div></div><div><h3>Materials and Methods</h3><div>We performed a retrospective study of patients who underwent SP retroperitoneal RPN from 2018 -2023 as part of a large multi-institute collaboration (SPARC). Baseline demographic, clinical, tumor-specific characteristics, and perioperative outcomes were compared using χ2, <em>t</em>-test, Fisher exact test, and Mann–Whitney U test. Multivariable analyses were conducted using robust and logistic regressions.</div></div><div><h3>Results</h3><div>A total of 70 patients underwent SP retroperitoneal RPN, with 44 undergoing LAA. The LAA group exhibited significantly lower median RENAL scores (8 vs. 5, <em>p</em> &lt; 0.001) and more varied tumor locations (<em>p</em> = 0.002). When controlling for other variables, LAA was associated with shorter ischemia time (<em>p</em> = 0.005) than LFA, but there was no significant difference in operative time (<em>p</em> = 0.348) and length of stay (<em>p</em> = 0.122).</div></div><div><h3>Conclusion</h3><div>Both LAA and LFA are acceptable approaches for SP retroperitoneal RPN with comparable perioperative outcomes.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100311"},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted partial nephrectomy for totally endophytic tumor","authors":"Antonio Andrea Grosso,&nbsp;Fabrizio Di Maida,&nbsp;Sofia Giudici,&nbsp;Francesco Lupo Conte,&nbsp;Vincenzo Salamone,&nbsp;Luca Mazzola,&nbsp;Andrea Mari,&nbsp;Andrea Minervini","doi":"10.1016/j.urolvj.2024.100319","DOIUrl":"10.1016/j.urolvj.2024.100319","url":null,"abstract":"","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100319"},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142742867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted Uretero-ileal reimplantation in ileal conduit","authors":"Simone Albisinni,&nbsp;Luca Orecchia,&nbsp;Giuseppe Farullo","doi":"10.1016/j.urolvj.2024.100322","DOIUrl":"10.1016/j.urolvj.2024.100322","url":null,"abstract":"<div><div>We herein present a video of a robotic-assisted uretero-ileal reimplantation in an ileal conduit. The patient was a 74 year old male who had undergone robotic assisted radical cystectomy with intracorporeal ileal conduit in 2022. Pathology showed urothelial cell carcinoma pT2N0. In amrch 2023 the patient was admitted in our clinic with left side flank pain and sepsis. A CT scan showed severe lefthydronephrosis on a left sided uretero-ileal stricture. A nephrostomy tube was patient and, after management of sepsis, an endoscopic balloon dilatation of the stricture was performed in may 2023. Patient experienced a stricture recurrence in September 2023. We thus decided to perform robotic assisted uretero-ilal reimplantation.</div><div>Patient was positions in dorsal decubitus and robotic trocarts were positioned as for radical cystectomy. Extensive adhesiolysis was performed. A stay suture was then positioned on the ileal conduit to traction it towards the abdominal wall. Dissection of the retroperitoneum was then performed medial to the ileal conduit, in order to identify the left ureter. The right ilac vessels are exposed to avois inadvertent injury. ICG is instilled via the left nephrostomy, helping the surgeon to identify the left ureter. Gven the massive fibrosis of the ureter, this structure is not mobilized and the ileal loop is brought down to the ureter. A side to side anastomosis is performed using 4/0 vycril. A 7F monoJ catheter is positioned and externalized using a foley catheter as carrier. OR time was 155 minuted and estimated blood loss 50cc. Post operative course was uneventful and patient was discharged on POD 2.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100322"},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Angiomyolipoma with triple vessel in right donor kidney: An innovative approach in robot-assisted kidney transplant","authors":"Swapnil Singh Kushwaha,&nbsp;Amit Aggarwal,&nbsp;Karandeep Guleria,&nbsp;Samit Chaturvedi,&nbsp;Anant Kumar,&nbsp;Ruchir Maheshwari","doi":"10.1016/j.urolvj.2024.100309","DOIUrl":"10.1016/j.urolvj.2024.100309","url":null,"abstract":"<div><h3>Introduction</h3><div>Kidney transplantation remains the gold standard treatment for patients with end-stage renal disease. While open surgery has long been the traditional approach, robot-assisted kidney transplant (RAKT) has emerged as a viable alternative. One of the key challenges in RAKT is managing multiple vessel renal allografts. Successful transplantation of an angiomyolipoma (AML)-affected kidney has been reported after its excision on the bench. However, it is still often seen, as a relative contraindication to transplantation. In this video, we demonstrate our innovative technique and share the outcome of managing AML and triple vessel allograft in RAKT using an internal iliac artery autograft.</div></div><div><h3>Materials and Methods</h3><div>A 50-year-old male patient was planned for RAKT. Pre-operative workup of the donor revealed two renal arteries on the left side and three renal arteries on the right side. Also, there was a 3 × 3 cm mass in the right kidney, which, on computed tomography, was characteristic of AML. Radio-isotope renogram study revealed equal function of both kidneys, 54.2 and 45.2 mL/min on the right and left side, respectively. A decision was made to take the right kidney laparoscopically for transplantation and remove the mass at bench dissection. The surgery was divided into three distinct steps. Step 1 was the robotic retrieval of the internal iliac artery autograft from the recipient. Step 2 involved bench dissection, which included ex-vivo vascular reconstruction to anastomose three renal arteries with internal iliac artery autograft, and excision of AML with renorrhaphy. Two upper polar arteries were anastomosed in pantaloon fashion, and this pantaloon was then anastomosed end-to-end with the autograft. The lower polar artery was reimplanted in an end-to-side fashion on the autograft. Step 3 is the anastomosis of this autograft-allograft complex with the external iliac vessels of the recipient.</div></div><div><h3>Results</h3><div>By creating the autograft-allograft complex, we were able to fashion a single arterial ostium that subsequently led to a single arterial anastomosis with the external iliac artery. Cold and rewarm ischemia times were 100 and 36 min, respectively. The intra and postoperative courses for both donor and recipient were uneventful. Renal function remained stable in both, with no complications, throughout the follow-up of 20 months.</div></div><div><h3>Conclusions</h3><div>This innovative technique of using internal iliac artery autograft offers reduced rewarm ischemia in robot-assisted kidney transplant, the same as that of a single vessel, and eliminates the need for more than one intracorporeal arterial anastomosis. Incidental or asymptomatic small benign renal masses in donor kidneys can be considered for transplantation after being thoroughly evaluated for their suitability, rather than rejected outright.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100309"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted donor nephrectomy in horseshoe kidney: Possible with indocyanine green and firefly","authors":"Swapnil Singh Kushwaha,&nbsp;Amit Aggarwal,&nbsp;Karandeep Guleria,&nbsp;Samit Chaturvedi,&nbsp;Anant Kumar","doi":"10.1016/j.urolvj.2024.100310","DOIUrl":"10.1016/j.urolvj.2024.100310","url":null,"abstract":"<div><h3>Introduction</h3><div>Horseshoe kidney (HSK), a congenital anomaly, presents unique challenges for transplant surgeons due to its complex vascular and collecting system anatomy. The use of HSK as a donor remains controversial, although cases have been performed most frequently in deceased donor transplants, and some have even tried open and laparoscopic approaches in living donors. Typically, in these cases, the isthmus was thin, fibrous and lacked a separate blood supply. In this video, we demonstrate our technique and share the outcome of the world's first robot-assisted donor nephrectomy in HSK for parenchymatous isthmus with multiple vessels.</div></div><div><h3>Materials and methods</h3><div>A 49-year-old female, voluntary kidney donor for her husband, was found to have HSK. The renal scan indicated equal function of both moieties. The right moiety was supplied by a main renal artery and branches of a common lower polar artery. The left moiety was supplied by a main renal artery and two accessory lower polar arteries. One common lower polar renal artery was seen arising from the anterior aspect of the aorta supplying bilateral lower poles and isthmus. She was planned for robot-assisted donor nephrectomy of the right moiety in HSK, as there were no alternate donors.</div></div><div><h3>Results</h3><div>The main right renal artery, along with the accessory arteries to the isthmus, were dissected out. The level of demarcation over the parenchymatous isthmus was noted in firefly mode after injecting intravenous indocyanine green (ICG) dye. Pantaloon anastomosis for both accessory arteries, along with renorrhaphy of the isthmus, was done on bench. The recipient underwent an open kidney transplant; the main right renal artery was anastomosed with the right common iliac artery, and the pantaloon created was anastomosed to the right external iliac artery. The intra and postoperative courses for both donor and recipient were uneventful. Renal function remained stable in both, with no complications, throughout the follow-up of 20 months.</div></div><div><h3>Conclusions</h3><div>Retrieving a living-donor HSK presents significant technical challenges in removing a moiety without compromising the function of the other. Given the global shortage of donor kidneys, utilizing a donor with HSK could be a viable and safe option in experienced hands. We utilized the robotic platform, enhanced with ICG and firefly mode, to successfully complete this challenging procedure.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100310"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence guidance for 3D augmented reality robotic surgery: When the machine falls the human assistance is still alive","authors":"P. Piazzolla ,&nbsp;G. Volpi ,&nbsp;A. Piana ,&nbsp;E. Checcucci ,&nbsp;D. Amparore ,&nbsp;F. Piramide ,&nbsp;S. De Cillis ,&nbsp;P. Verri ,&nbsp;G. Mesterca ,&nbsp;A. Bellin ,&nbsp;C. Fiori ,&nbsp;F. Porpiglia","doi":"10.1016/j.urolvj.2024.100307","DOIUrl":"10.1016/j.urolvj.2024.100307","url":null,"abstract":"<div><div>In the “Precision Surgery Era”, new technologies are being developed in order to guide the surgeon in the execution of “tailored” surgical procedures. Among them, the use of 3-dimensional (3D) virtual models of the organs have already demonstrated an outstanding potential in urology. Moreover, the use of colors in the operative room provides the surgeon an intuitive and precise guidance during the crucial steps of the surgery. In this scenario, Artificial Intelligence is considered a very promising and fascinating tool able to harmonize and maximize the performances of these technologies, obtaining an automatic surgical guidance both for prostate and renal surgery.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100307"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}