Ruben Olivares

Complete excision of urachal cyst by laparoscopic means: A new approach to an uncommon disorder

OBJECTIVE Anomalies of the urachal remnant are rare. Urachal cysts are usually asymptomatic, however, when they become infected, they can mimic a wide variety of intra-abdominal pathologies. We present two patients in which an urachal cyst was found. METHODS Two male patients 25 and 38 years old respectively underwent laparoscopic resection of an urachal remnant. In one of the cases the urachal remnant was complicated by infection. Opportune clinical and radiologic diagnose was made in both cases and complete excision of the urachal remnant was carried out by laparoscopic means. RESULTS The procedures were performed without complications and follow up showed excellent results. Both patients presented very short convalescence with rapid recovery. CONCLUSIONS The treatment of choice for urachal pathology is the complete excision of the complicated lesion. For this matter laparoscopic surgery assures surgical results comparable to conventional surgery adding the advantages of a minimally invasive approach.

Laparoscopic resection of an extra-adrenal pheochromocytoma.

Extra-adrenal pheochromocytomas are of rare occurrence. Since first reported laparoscopic adrenalectomy has become the gold standard in the treatment of adrenal tumors, the feasibility of laparoscopic adrenalectomy in the setting of pheochromocytoma has also been established given a careful preoperative planning. Literature on the laparoscopic treatment of extra-adrenal pheochromocytomas is lacking. We report a hypertensive 54-year-old male patient (body mass index, 26.2) with elevated urinary catecholamines and a 6-cm solid mass under the right renal hilum diagnosed after a magnetic resonance. The patient underwent complete transperitoneal laparoscopic excision of the tumor. Recovery was uneventful and final histopathologic examination showed an extra-adrenal pheochromocytoma. We believe that transperitoneal laparoscopic excision of extra-adrenal pheochromocytoma is a feasible and reproducible technique that allows for complete removal of tumoral tissue with low morbidity, shorter hospital stay, and minimal convalescence.

PD35-11 NEW DIGITAL SINGLE-USE FLEXIBLE URETEROSCOPE (PUSEN TM): FIRST CLINICAL EXPERIENCE

INTRODUCTION AND OBJECTIVES: We report the clinical results of flexible ureteroscopy using the new digital single-use flexible ureteroscope from PUSEN (New South Wales, Australia). This device has an outer diameter of 9 Fr, with a working channel of 3,6 Fr. The deflection system has both options of standart and reverse modes with maximum deflection of 270 in both directions. METHODS: Between August and October 2016 we performed flexibleureteroscopy (FUR)using thenewdevice.Theprimaryoutcomewas stone free rates, secondary outcomeswere total time of the procedure, total time of fluoroscopy and perioperative complications. The tertiary outcome was the behavior of the instrument during and at the end of the procedure RESULTS: A total of eleven FUR were performed. The present study included eight male patients and three female patients, with an average age of 39 years (range 23-65 years). All the patient were treated using a 12 Fr access sheath and holmium laser lithotripsy(260 mm fiber). The average stone size was 6 mm (range 4-10 mm), and stones were located as follow: 3 in proximal ureter, 6 in renal pelvis and 2 in lower calix. Total time taken to complete the surgery was 45 minutes (range 25-85 min). The number of stones treated per patient varied between 1 and 4. Mean fluoroscopy time was 50 seconds. We achieved 100% stone free rate in eight cases and 80% in the remaining three. One patient present an ureteral wall injury, with mucosal erosion at time of ureteral access sheath placement. A double J stent was placed in all patients. The device behaves properly during and at the end of the procedure, there was no loss in image quality or deflection capacity, being able to safely finish all the cases carried out. CONCLUSIONS: With respect to outcomes evaluated in this study with the PUSEN digital single use flexible ureteroscope seems to be similar in comparison to reusable flexible ureteroscope. The clinical results achieved in the present study suggest that this device could be considered a valid method to treat endoscopically renal and proximal ureteral stones reducing maintenance costs.

V5-10 RIGHT RADICAL NEPHRECTOMY WITH DISSECTION OF THROMBUS IN THE INFERIOR VENA CAVA LEVEL III

INTRODUCTION AND OBJECTIVES: The renal cell carcinoma has a known tendency to spread forming tumor thrombus to the renal vein or inferior vena cava (4-10%) The level that reach the tumor, it’s in direct relation with the 5-years survival METHODS: We show a case of a male 58 years old patient with history of diabetes and smoking. The patient complains of hematuria that started ten months ago. In the general lab work, the patient was anemic with a hemoglobin of 8 gr/dL and a serum creatinine of 1.1 mg/mL. The CT-Scan showed an 18 cm right kidney tumor with a thrombus in the inferior vena cava up to the diaphragm (Level III) with no seen metastatic disease or malignant lymphnodes Anterior open nephrectomy was performed, followed by control of inferior vena cava which it’s open entirely to perform the thrombectomy. RESULTS: The estimated operative time was 260 minutes, with a bleeding of 1600ml, requiring 3 units of blood during the surgery. No complications was reported. The post-op management was in the ICU for only 24 hours, with a total of length of stay of 5 days. The patient evolved without any complication, showing in the control lab, a serum creatinine of 1.3 mg/dL. To the date there is no evidence of residual disease, clinical nor in the images. CONCLUSIONS: The radical nephrectomy it’s the standard of care in the, level III inferior vena cava thrombus, in the setting of kidney cancer. It should be done in patients in conditions to have surgery.