Kallappan Senthil

Laparoscopic Boari Flap Repair: Report of 3 Cases

PURPOSE Boari flap reimplantation is one of the options for ureteric reimplantation when the diseased ureteric segment is long. Open Boari flap reimplantation is well established. In this paper, we describe laparoscopic Boari flap reimplantation in 3 patients. MATERIALS AND METHODS Since May 2004, 3 patients had a successful laparoscopic Boari flap ureteric reimplantation. Preoperative intravenous urogram and retrograde pyelogram confirmed the length and site of the obstruction. The first patient was a 16-year-old boy with primary obstructive megaureter, with the adynamic segment extending from just below the sacro iliac joint. The second was a middle-aged diabetic lady with a long lower ureteric stricture. The third was a ureteric injury that occurred following a laparoscopic ovarian cystectomy. RESULTS The mean operative time was around 320 minutes. There were no intra- or postoperative complications. All the patients recovered well and are being followed up clinically and radiologically. CONCLUSION Laparoscopic Boari flap reimplantation is a challenging procedure. With increasing technical skill and confidence, one can attempt the procedure with the obvious advantage to the patient.

Cost Reductive Laparoendoscopic Single Site Surgery Endotrainer and Animal Lab Training—Our Methodology

Laparoendoscopic single site surgery (LESS) is a new avenue in laparoscopic urology. The main advantage is the enhanced cosmetic benefits of single hidden scar. Lately many papers are being published on various procedures done by LESS. Like conventional laparoscopy, this approach is likely to be used more widely and hence exposure to this field is essential. However, formal training in this technique is not widely available. Expensive ports and nonavailability of endotrainer may be the factors deterring the training. We have modified the standard laparoscopic endotrainer with improvised ports, to make it suitable for single port laparoscopic training. For the animal lab training improvised ports and low cost instruments were used. Thus the overall cost of the training in LESS was reduced, and better confidence levels were achieved prior to human applications.

A Comparison of Continuous and Interrupted Suturing in Laparoscopic Pyeloplasty

Background: Laparoscopic pyeloplasty is one of the most common reconstructive procedures performed by urologists. Both continuous and interrupted sutures are being practiced for ureteropelvic anastomosis. The success rate and the complications associated with the suturing technique needs evaluation. We analyzed the results from of our patients who underwent laparoscopic pyeloplasty using both techniques. Objective: To review the outcome differences among patients undergoing laparoscopic pyeloplasty regarding suturing technique. Materials and Methods: All patients who underwent laparoscopic, transperitoneal dismembered pyeloplasty of the primary pelviureteric obstruction were analyzed. The primary outcome was successful pyeloplasty, as assessed by the resolution of symptoms and T½ <10 minutes. The secondary outcomes were the complication rate and the operative parameters. The difference in the parameters was assessed by Student t test analysis. Results: Of the 107 patients we studied, 65 had interrupted suturing and 42 had continuous suturing. The success rate was not significantly different among the 2 groups. The mean suturing time, postoperative drainage volume, postoperative hospital stay, and total cost of the procedure were significantly less in the continuous suturing group. Conclusion: The continuous suturing technique is preferred over the interrupted suturing technique for laparoscopic pyeloplasty because the success rates are equal and the postoperative stay, suturing time, drain output, and cost of the procedure are better.

Laparoscopy-assisted ileal conduit in sacral agenesis.

Sacral agenesis is a rare congenital anomaly. The neurologic deficits are usually static. However, there are reports of progressive neurologic deterioration. They have neurogenic bladder, which usually present late and managed according to the presenting urodynamic pattern. In this paper, we report the urologic management in a 4-and-half-year-old boy with sacral agenesis. He presented with constant dribbling owing to gross instability with a small-capacity bladder. He also had bilateral ureteric obstruction (i.e., stricture at the level of bilateral ureteric reimplantation, which was done at the age of 1 year for high-grade reflux). He was not compliant with intermittent self-catheterization. Various options were discussed with the parents, but they preferred an ileal conduit (which could take care of the leak and avoid complex reconstructive surgery), with an option of reconstruction later. Laparoscopic ileal conduit was performed, with the uretero ileal anastomosis and restoration of ileal continuity performed extracorporeally. Extracorporeal part of the procedure was done without any additional incision (by bringing the ureters and ileal segment outside through the 12-mm port and then pushing it back inside after the completion of the anastomosis). We present this case report for the less-morbid management of a complicated urologic problem.

Early-Onset Port Site (Drain Site) Hernia in Pediatric Laparoscopy: A Case Series

INTRODUCTION Laparoscopic procedures for children with urological problems are common under the present conditions. Laparoscopic surgery is associated with complications such as port site hernia that are not associated with open surgery. Drain site hernia is one variety of port site hernia. SUBJECTS AND METHODS We did a retrospective analysis for the development of port site hernias among pediatric patients who underwent laparoscopic procedures. We also analyzed the various methods of prevention. RESULTS Among the 148 children who underwent laparoscopic procedures, 5 (3.4%) had a port site hernia in the early postoperative period. All of them were drain site hernias with early presentations, and the content was omentum. Three patients had reduction under sedation. Two patients needed laparoscopy: one for the reduction into the preperitoneal space and the other for the nonreducible hernia due to omental edema. All the patients had an uneventful recovery. CONCLUSIONS Port site hernia is an uncommon complication in children undergoing laparoscopy. The drain site is the predominant location of port site hernia. Sedation during drain removal and judicious use of drain may help to decrease such occurrences.

Laparoscopic Undiversion in a Child with Sacral Agenesis into Augmentation Cystoplasty

Laparoscopic undiversion with ileal augmentation cystoplasty appears to be a feasible and effective procedure in a child with sacral agenesis.

Modified device-free HAL: an innovative cost-reductive approach.

Hand-assisted laparoscopy (HAL) has been in vogue since 1994. The major advantages are tactile sensation, quicker dissection, and easy removal of specimen. These advantages could not be availed in developing countries due to the cost of the available HAL devices. This has initiated the use of HAL without devices in our unit. Instead of a device, a double glove with a sponge between the inner and outer glove at the wrist acted as an obturating cuff. A muscle-splitting incision in the iliac fossa helped in minimizing the air leak. In this article, we report our experience in nephrectomy and nephroureterectomy.

A Novel Technique of Cystolithotripsy for Large Vesical Calculus in Children

Large bladder calculi in children have always been a challenge for the minimally invasive surgeon. We describe a novel technique in which a suprapubic laparoscopic grasper is used to stabilize and remove large fragments of the stone, disintegrated transurethrally. This procedure minimizes injury to the delicate urethra and bladder mucosa.

Laparoscopic Nephrectomy with Adrenalectomy for Synchronous Adrenal Myelolipoma and Renal Cell Carcinoma.

Introduction. Adrenal myelolipomas are uncommon nonfunctioning tumors of the adrenal. Synchronous renal cell carcinomas with adrenal myelolipomas are very rare. We present the case report of adrenal myelolipoma with synchronous RCC managed laparoscopically. Case Report. A 60-year-old old gentleman presented with incidental right upper polar mass with right adrenal mass. Metastatic work-up was negative. Laparoscopic radical nephrectomy with adrenalectomy was done under general anesthesia. The biopsy report was right kidney clear cell adenocarcinoma (T1b) with right adrenal myelolipoma. Conclusion. This is the first case report of laparoscopic adrenalectomy with nephrectomy for ipsilateral synchronous renal cell carcinoma with adrenal myelolipoma.

Laparoscopic Ureterocystoplasty Before Kidney Transplantation

PURPOSE To describe the technique of total laparoscopic ureterocystoplasty. MATERIALS AND METHODS Laparoscopic ureterocystoplasty was performed to optimize the bladder function before kidney transplantation in a 23-year-old man. This patient had undergone bilateral cutaneous ureterostomy with fulguration of a posterior urethral valve at the age of 11 months. He underwent open surgical removal of multiple renal stones at age 10. He progressed to chronic renal failure at the age of 20, at which time hemodialysis was initiated. Because of grade IV vesicoureteral reflux and a poorly compliant bladder, the patient underwent laparoscopic ureterocystoplasty. RESULTS The patients lower urinary tract symptoms improved, and a urodynamic study performed after 6 months revealed a compliant bladder. Subsequently, a right nephrectomy and a live-donor renal transplantation from his mother were performed. At 1-year follow-up, his renal parameters were within normal range, he does not have any significant residual urine or urinary symptoms. CONCLUSION Laparoscopic ureterocystoplasty is an excellent option for a poorly compliant bladder, especially when a patient has had multiple open surgeries and is awaiting renal transplantation.