Steven M. Baughman

Multiple intravesical linear staples identified during surveillance cystoscopy after laparoscopic nephroureterectomy

Laparoscopic nephroureterectomy has faced technical criticism secondary to the unknown effects of urine-exposed intravesical or intraureteral staples. Although not reported, staples exposed to urine theoretically create a nidus for encrustation and stone formation. We present a case of a 66-year-old man after left laparoscopic ureterectomy for ureteral malignancy. Surveillance cystoscopy at 6 months revealed a nearly complete intravesical titanium staple line without encrustation. Successful transurethral removal of all staples with standard cystoscopic graspers revealed no immediate, or delayed, sequelae.

Case report: serial percutaneous cholangioscopy with laser ablation for the management of locally recurrent biliary intraductal papillary mucinous tumor.

Wepresent a case of serial cholangioscopic laser fulguration of a biliary recurrence of pancreatic intraductal papillary mucinous tumor in a 76-year-old man. Through established percutaneous biliary drain tracts, the aseptic use of a standard 6.9 F ureteroscope and holmium laser fiber facilitated visual ablation within the biliary tree. Quarterly cholangioscopic laser ablation provided safe and effective local control without biliary infectious complications. This case appears to be the first treatment of recurrent intrabiliary intraductal papillary mucinous tumor by serial antegrade choledocoscopy and laser photocoagulation. Effective local control appears possible with minimal morbidity. Standard ureteroscopic equipment facilitates safe and efficient percutaneous antegrade choledocoscopy.

Laparoscopic and Minimally Invasive Renal Tumor Ablation

Early radiographic identification of small renal masses has led to a lower stage at the time of initial diagnosis (1). This stage migration, coupled with the advancement of nephron-sparing surgical techniques, has focused attention toward the development of minimally invasive technologies for the treatment of small renal tumors. Open nephronsparing surgery (NSS) has proven efficacy among patients with tumors less than 4 cm in diameter, despite normal contralateral kidneys (2,3). Additionally, with the low (3.7%) chance of multicentricity of small renal cell cancers and evidence of increasing rates of renal insufficiency with radical nephrectomy, the argument in favor of NSS is strengthened (4,5). The progressive development of minimally invasive techniques for urologic malignancies has revealed two systems with unique mechanisms and utility cryotherapy and radiofrequency ablation (RFA). Cryotherapy and RFA produce their respective tissue destruction via cellular freezing or molecular agitation leading to heat production with overall molecular and cellular destruction.