W. Massoud

Early unclamping technique during robot-assisted laparoscopic partial nephrectomy can minimise warm ischaemia without increasing morbidity.

To compare perioperative outcomes of early unclamping (EUC) vs standard unclamping (SUC) during robot‐assisted partial nephrectomy (RAPN), as early unclamping of the renal pedicle has been reported to decrease warm ischaemia time (WIT) during laparoscopic PN.

Laparoscopy in Ureteral Engineering: A Feasibility Study

OBJECTIVE We recently bioengineered a ureter substitute from a seeded scaffold implanted by open surgery in the omentum. In view of the development of laparoscopy in the treatment of benign conditions of the ureter, obtaining a ureter substitute by minimally invasive techniques would be a desirable objective. However, conflicting results about the biological impact of carbon dioxide insufflation on the microcirculation of intra-abdominal organs prompted us to investigate first whether the results obtained by open surgery, in terms of vascular supply and maturation, could be reproduced laparoscopically. MATERIALS AND METHODS Bladder full-thickness tissue was harvested laparoscopically from three pigs for urothelial and smooth muscle cell primary cultures subsequently used to seed a small intestinal submucosa (SIS) matrix. After 2 wk, the in vitro seeded constructs were shaped around silicone drains and transferred laparoscopically into the abdomen for omental maturation. Three weeks later, the constructs were harvested for histological, immunohistochemical, and electron microscopic analysis. RESULTS The laparoscopic procedures were performed successfully in all animals. After omental maturation, the constructs were vascularized and comprised of a well-differentiated multilayered urothelium with umbrella cells, over connective tissue and smooth muscle cells, with no evidence of fibrosis or inflammation. Electron microscopic analysis showed characteristics of a terminally differentiated urothelium. CONCLUSION As shown by conventional microscopy, immunochemistry, and electron microscopy, carbon dioxide insufflation does not impact cell growth and differentiation. These findings validate the laparoscopic approach for omental maturation of ureter substitutes.

Prolonged Urinary Leakage After Partial Nephrectomy: A Novel Management Pathway

INTRODUCTION To describe an original method for managing prolonged urinary leakage after partial nephrectomy. We placed a Malecot catheter in the ureter to improve the urinary drainage and therefore avoid the renal percutaneous treatment of the fistula or potential open surgery. TECHNICAL CONSIDERATIONS We performed ureteral stenting using a 16 F Malecot catheter in 3 patients who had a prolonged urinary fistula after partial nephrectomy in which the placement of a ureteral stent could not resolve the urine leak. Drainage using 2 ureteral catheters was performed, which proved to be insufficient for the urinary fistula to resolve. We subsequently placed in the dilated ureter a 16 F Malecot catheter into the renal pelvis using a cystoscopic approach and a bladder catheter to complete the drainage. In all cases, the urine leak stopped after stenting with the Malecot catheter. At 1 month after the stenting, computed tomography and magnetic resonance imaging showed complete healing of the fistula. No infection or secondary ureteral stricture was reported. CONCLUSION This technique with a low complication profile can be used as an additional endoscopic step, before more invasive procedures.

Metastatic Breast Carcinoma to the Bladder

Bladder involvement in metastatic breast carcinoma is a rare situation and accounts for about 3% of secondary bladder neoplasms. Most patients are symptomatic, with evidence of disseminated disease at diagnosis.

Feasibility and oncological outcomes of laparoscopic treatment for local relapse of renal cell carcinoma

Local relapse of renal cell carcinoma following radical nephrectomy is rare, and surgical removal provides the only opportunity for cure. Open surgery has been established as the usual approach for these tumours. It is, however, associated with significant morbidity. Our study describes the largest series of laparoscopic treatment of local relapse of renal cell carcinoma with the longest follow‐up. We show that the laparoscopic approach is feasible in expert centres. It provides faster recovery and fewer complications with satisfactory oncological outcomes in selected patients.