ICG-targeted template lymph node dissection in prostate cancer patients

Sentinel lymph node biopsy is successfully used in the treatment of diseases such as breast cancer, penile cancer, and melanoma. For prostate cancer, it is difficult to identify clear single sentinel nodes, but they can be a part of lymph node groups which can be visualized using ICG/NIR technology. The objective of our work is to refine the technique of intraprostatic ICG injection, laparoscopic identification of ICG-positive lymph nodes, and their removal during radical prostatectomy. To achieve ICG/NIR technology, we used Verdye (25mg) Indocyanine green, Diagnostic Green, IMAGE1 S™ 4K Rubina™ KARL STORZ equipment. After the induction of general anesthesia ICG solution, 2.5mg/mL is injected into the area of the MRI-identified tumor and sextant biopsy areas of the prostate (2.5mL per lobe). The positioning of the patient and trocar set-up are standard for a transperitoneal laparoscopic prostatectomy. Using the 25 to 30-degree Trendelenburg position, intestinal loops are moved cranially to expose the field of the common iliac vessels where lymph node luminescence is determined. An incision of the peritoneum along the iliac vessels is performed. Careful ‘en bloc’ excision of fluorescent lymph nodes should be performed. To prevent the further spread of ICG in the lymphatic system, the surgery is started at the cranial boarder of the dissection field and continued caudally. Multiple collateral lymphatic vessels around the node are sealed, using bipolar coagulation or an ultrasonic scalpel. Dissection is then completed, avoiding direct capture of node tissue, as well as its damage. This technique prevents the spread of ICG and chaotic luminescence of the surrounding tissue due to ICG leakage. Conclusion: ICG/NIR laparoscopic visualization is a feasible and effective method to detect lymph node groups draining the prostate, and more specifically prostate cancer. The sentinel nodes are included in the caudal part of these lymph node packages

Hypertensive emergency and type 2 myocardial infarction resulting from pheochromocytoma and concurrent capnocytophaga canimorsus infection

A diagnosis of myocardial infarction is made using a combination of clinical presentation, electrocardiogram and cardiac biomarkers. However, myocardial infarction can be caused by factors other than coronary artery plaque rupture and thrombosis. We describe an interesting case presenting with hypertensive emergency and type 2 myocardial infarction resulting from Pheochromocytoma associated with Capnocytophaga canimorsus infection from a dog bite. We also review current literature on the management of hypertensive emergency and Pheochromocytoma

Laparoscopic pyeloplasty for ureteropelvic junction obstruction of the lower moiety in a completely duplicated collecting system: a case report

<p>Abstract</p> <p>Introduction</p> <p>There are only a few reports on laparoscopic pyeloplasty in kidney abnormalities and only one case for laparoscopic pyeloplasty in a duplicated system. Increasing experience in laparoscopic techniques allows proper treatment of such anomalies. However, its feasibility in difficult cases with altered kidney anatomy such as that of duplicated renal pelvis still needs to be addressed.</p> <p>Case presentation</p> <p>We present a case of a 22-year-old white Caucasian female patient with ureteropelvic junction obstruction of the lower ureter of a completely duplicated system that was managed with laparoscopic pyeloplasty. Crossing vessels were identified and transposed. The procedure was carried out successfully and the patient's symptoms subsided. Follow-up studies demonstrated complete resolution of the obstruction.</p> <p>Conclusion</p> <p>Since laparoscopic pyeloplasty is still an evolving procedure, its feasibility in complex cases of kidney anatomic abnormalities is herein further justified.</p

What is new in surgical treatment of vesicoureteric reflux?

In addition to conventional open surgery and endoscopic techniques, laparoscopic correction of vesicoureteric reflux, sometimes even robot-assisted, is becoming an alternative surgical treatment modality for this condition in a number of centres around the world. At least for a subgroup of patients laparoscopists are trying to develop new techniques in an effort to combine the best of both worlds: the minimal invasiveness of the STING and the same lasting effectiveness as in open surgery. The efficacy and potential advantages or disadvantages of these techniques are still under investigation. The different laparoscopic techniques and available data are presented