Single-Setting Bilateral Hand-Assisted Laparoscopic Partial Nephrectomy

Abstract Purpose: To assess the feasibility and safety of single-setting bilateral hand-assisted laparoscopic partial nephrectomy. Materials and Methods: Between August 2003 and June 2004, we performed single-setting bilateral laparoscopic partial nephrectomies on three patients. A hand-assisted approach was used, employing the same hand-assistance incision for both sides. Renal hilar clamping was not required, as the depth of penetration of all six tumors was only 0 to 4mm (mean, 1.8mm). The tumor diameters ranged from 1.8 to 3.8cm (mean, 2.4cm). Results: All operations were performed successfully, with no conversion to open surgery. Excision was performed with bipolar forceps, and final hemostasis was obtained with an argon beam coagulator (Valleylab, Boulder, CO) and Floseal (Baxter, Deerfield, IL), without suturing. The mean estimated blood loss was 208mL. The mean operative time was 246 minutes, which included repositioning. There were no intraoperative complications, and the postoperative course was uneventful in all patients except for a hospital stay of 5 days in one patient owing to transient ileus. Pathology revealed a benign lesion on one side and renal cell carcinoma on the other side in two patients, and bilateral leiomyomas in one patient. All margins of resection were negative, and neither of the two patients with cancer has had recurrence at a mean follow-up of 51 months. Among all three patients, the mean preoperative serum creatinine was 0.9mg/dL, and the average level at a mean of 35 months postoperatively was 1.0mg/dL. Conclusion: Single-setting bilateral hand-assisted laparoscopic partial nephrectomies can be safely and effectively performed on patients with bilateral small exophytic kidney tumors. We do not recommend this technique if both kidneys require temporary hilar occlusion, but it can be considered if only one kidney requires hilar occlusion.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78122/1/end.2008.0549.pd

Extraperitoneal v Intraperitoneal Robotic Prostatectomy: Analysis of Operative Outcomes

Background and Purpose: Robotic prostatectomy can be performed either via an extra- or intraperitoneal approach. The extraperitoneal approach has advantages similar to those of an extraperitoneal open radical prostatectomy, but the potential disadvantages of a small working space. We report our experience using both approaches. Methods: From July 2003 to June 2004, 55 patients underwent a robot-assisted laparoscopic prostatectomy. During the first 6 months, 21 prostatectomies were performed using an intraperitoneal approach (group 1); 34 were performed using an extraperitoneal approach (group 2) during the next 6 months. Clinicopathologic parameters and perioperative complications were compared in both groups. All patients were categorized as intent-to-treat analysis. Results: Median surgery time was significantly shorter in the extraperitoneal compared with the intraperitoneal approach (3 hours and 34 minutes v 4 hours and 1 minute, respectively, P = 0.017). This was because of the shorter time interval between the skin incision and incision of the endopelvic fascia in the extraperitoneal v the intraperitoneal approach (55 minutes v 74 minutes, respectively, P < 0.0001). There was no significant difference in terms of patient age, clinical and pathologic stage, length of hospital stay, and perioperative complications between the two approaches. Conclusion: Extraperitoneal robot-assisted laparoscopic prostatectomy offers a similar clinical outcome as the intraperitoneal approach. However, the extraperitoneal approach avoids potential bowel injury or complications related to an intraperitoneal urine leak.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63120/1/end.2007.9872.pd