Piotr Jarzemski

Laparoscopic removal of a congenital seminal vesicle cyst in Zinner's syndrome.

Introduction: Seminal vesicle cysts are rarely diagnosed, but symptomatic congenital seminal vesicle cysts are reported in the literature describing Zinner syndrome. Case Description: We present the case of a 26-year-old patient admitted to the urology department because of abdominal pain. A left seminal vesicle cyst and left kidney agenesis were found on examination, and the patient qualified for laparoscopic removal of the left seminal vesicle cyst. The procedure was performed with transperitoneal access using 5 trocars. The peritoneum was incised between the bladder and the rectum to reveal the left seminal vesicle, which was resected from the surrounding tissue. A TachoSil (Takeda Pharmaceuticals, Zurich, Switzerland) hemostatic sponge was placed in the ledge after cutting the base of the seminal vesicle. Discussion: The aim of this study was to evaluate usefulness of the laparoscopic technique to remove a cystic seminal vesicle. The procedure lasted 180 minutes, and the estimated blood loss was 50 mL. We did not record any intra- or postoperative complications. The patient was discharged from the hospital on the third postoperative day and remains symptom-free after 12 months. Histopathologic examination confirmed the presence of a seminal vesicle cyst, and renal agenesis and stenosis of the vas deferens suggests Zinner syndrome. Symptomatic seminal vesicle cysts are a good indication for the application of a laparoscopic technique and, in our opinion, this is better than the open technique because of the view into the surgical area. Therefore, it should be used as the method of choice in treating seminal vesicle defects.

Laparoendoscopic Single-Site Surgery for Vesicorectal Fistula Repair

Background and Objectives: Minimally invasive techniques have been introduced to decrease the morbidity related to standard laparoscopic procedures. One such approach is transvesical laparoendoscopic single-site surgery (T-LESS). We describe our clinical experience of using this technique for vesicorectal fistula (VRF) repair. Description: In October 2013, we performed the T-LESS repair of a vesicorectal fistula of 5 mm diameter in a 72-year-old man, in whom conservative treatment with temporary colostomy and Foley catheter placement had failed. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device via a 15 mm incision made 20 mm above the pubic symphysis. Standard 10 mm optic and straight laparoscopic instruments were used. The fistulous tract was dissected and closed in two layers with a running, absorbable, barbed suture. A cystostomy tube was left in place for 22 days, and a Foley catheter for 1 week. Results: The operation lasted 155 min. Blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a 5-week follow-up, the patient reported no involuntary discharge of urine into the rectum. A voiding cystourethrogram revealed no presence of VRF, and laboratory examination results were all within the normal range. The colostomy was closed after 4 months, and a 12-month follow-up confirmed the integrity of both the urinary and digestive tracts. Conclusion: Although substantial development of the instruments and skills is needed, the T-LESS VRF repair appears to be feasible and safe. Nevertheless, further experience and observations are necessary.

Mini-laparascopic dismembered pyeloplasty using only 3 mm instruments (3 mmML).

The first laparoscopic (LA) dismembered pyeloplasty presented in 1993 years, William Schuessler and Louis Kavoussi. Since then surgery has evolved over the years. Currently, most treatments are performed by transperitoneal access using the Anderson–Hynes technique. In 1997, a minilaparoscopy (ML) with 3- and 2-mm instruments was introduced having good cosmetic and post-operative pain results and maintaning the same functional results as LA. In 2012, the results of pyeloplasty with the novel retroperitoneal mini-laparoscopic approach: the small-incision access retroperitoneoscopic technique (SMART) was published. Since 1998 in our institution we have been performing laparoscopic (LA) dismembered pyeloplastyand in 2011 we implemented for the first time a pyeloplasty procedure with ML and V-lock stiches. In our video we are shown performing laparoscopic dismembered pyeloplasty in own modification using the V-Loc stitch and only the mini-laparoscopic 3 mm instruments, including 3 mm optic.

Laparoscopic horseshoe kidney isthmusectomy: four case reports

Horseshoe kidney is a congenital defect of the urinary tract that occurs in 0.25% of the general population. The indications for division of the isthmus of horseshoe kidney are controversial, and if done, it is during the concomitant removal of additional defects accompanying horseshoe kidney. The aim of this study was to evaluate the results of isthmusectomy of horseshoe kidney using laparoscopy. This paper presents cases of 4 patients who underwent isthmusectomy, dismembered pyeloplasty, and stone removal using laparoscopy. All patients were operated on by a transperitoneal approach using 4 trocars. In 3 patients, we cut the renal isthmus by means of bipolar scissors and then we closed the renal parenchyma using two continuous hemostatic Vicryl 1-0 stitches. In 1 patient, an endostapler was used for isthmusectomy. The total operative time ranged from 4.5 h to 5.5 h including simultaneous dismembered pyeloplasty in 3 patients. Blood loss ranged from 40 ml to 300 ml. Use of the endostapler greatly facilitated the procedure. There were no complications either during or after the procedure. In all patients, mobilization and oral nutrition were included on the first or second day. On the third day, all patients were ready to be discharged from the hospital. Long-term follow-up after treatment showed good results in all patients. Laparoscopy is an alternative to open surgery, particularly in the correction of congenital defects of the urinary tract. Although the indications for division of the isthmus of horseshoe kidney are controversial, laparoscopic technique in isthmusectomy is safe for patients, as shown by our results.