Kurt Kerbl

Transperitoneal nephrectomy for benign disease of the kidney: a comparison of laparoscopic and open surgical techniques.

OBJECTIVEnThe objective of this study was to compare the results of laparoscopic nephrectomy for benign disease to open surgical nephrectomy for benign disease.nnnMETHODSnTwenty consecutive patients undergoing laparoscopic nephrectomy for benign disease were compared with 23 patients undergoing open surgical nephrectomy for benign disease and with 29 patients undergoing a donor nephrectomy. Data were collected in the following areas: patient age, anesthetic risk, operative time, estimated blood loss, postoperative time to resume oral intake, parenteral analgesics, oral analgesics, hospital stay, complications, and convalescence. Information was obtained through chart review, telephone interviews, and mailed questionnaires.nnnRESULTSnCompared with open surgical nephrectomy, laparoscopic nephrectomy resulted in a statistically significant longer operative time; however, it afforded a statistically significant decrease in postoperative ileus (open group), hospital stay (both groups), oral analgesics (donor group), and convalescence (both groups). The incidence of complications was 15 percent in the laparoscopic group and 0 percent in the two open surgical groups; the majority of complications occurred during the initial seven laparoscopic procedures.nnnCONCLUSIONSnLaparoscopic nephrectomy is a more time-consuming procedure than open surgical nephrectomy. Also, early in ones experience with this technique, the complication rate is higher than with open surgery. However, despite the newness of the technique, it results in significant benefits to the patient: decreased postoperative pain, shorter hospitalization, and more rapid convalescence.

Laparoscopic nephroureterectomy: evaluation of first clinical series.

Six patients underwent laparoscopic nephroureterectomy as treatment for upper tract transitional cell cancer. Mean operative time was 7.29 h and mean postoperative hospital stay was 4.6 days. In all but 1 case, the cuff of the bladder was obtained using a laparoscopic 12-mm GIA tissue stapler. With follow-up out to 16 months, we have not encountered any complications due to the transvesical staples, such as urine extravasation, stone formation, urinary tract infection or abscess formation. Our initial clinical data indicate that laparoscopic nephroureterectomy, albeit a lengthy procedure, can be performed with minimal morbidity and a short post-operative hospital stay.

Laparoscopic ureterectomy: initial clinical experience.

With a combination of cystoscopic and laparoscopic techniques, 3 patients underwent total ureterectomy for urothelial cancer without complication. Of the patients 2 underwent concomitant laparoscopic nephrectomy. Mean operating time was 8.2 hours for the laparoscopic surgery and mean hospital stay was 6 days. In 2 patients the ureter was removed intact, while in 1 it was morcellated along with the kidney before removal. In each case the bladder was closed with a 12 mm. GIA laparoscopic stapling device. After 3 to 9 months of followup no patient had recurrent disease or bladder stones on the staple line.

Advances in laparoscopic renal and ureteral surgery.

With the introduction of laparoscopy into adult urology, a vast new field has suddenly opened itself up to the urologic surgeon, filled with exciting and promising possibilities of applying the principles of minimally invasive surgery to an ever increasing number of diseases that so far have only been approachable by incisional surgery. While undoubtedly, laparoscopy has been providing unprecedented challenges to the principles of open surgery, it is of paramount importance to critically evaluate each new laparoscopic procedure against its open surgical counterpart. However, despite a widely publicized higher complication rate for laparoscopic procedures, it must not be overlooked that each laparoscopist must go through his/her very own individual learning curve; although a painful process at times, it is not any different than the novices introduction to open incisional surgery. The problems of the learning curve can be partly alleviated by carefully studying the basic principles of laparoscopy in the animal laboratory, and by subsequent clinical training under the guidance of an experienced laparoscopist. The discoverers enthusiasm for his or her own newly developed procedure and the instinctive negative reaction of the practicing community to new concepts that threaten to overturn what is perceived as tried and true, must both be tempered by the accumulation of clinical data, testing the validity of all procedures, new and old alike. To this end, surgeons have the opportunity to explore a gentler form of surgical practice, one in which the practitioner can heal without the need to harm.

Clinical experience with the Kaye nephrostomy tamponade catheter.

Herein, we report our clinical experience with achieving intraoperative hemostasis with the Kaye nephrostomy tamponade catheter. Since June 1990 this device has been used 10 times in 7 patients at our institution; in each patient immediate hemostasis of the nephrostomy tract was achieved.