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Urology

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Right laparoscopic ureteroureteroplasty
Lower ureteral strictures are commonly managed with ureteral reimplant surgeries. However, some patients still have a good distal ureteral stump, which can be used in the repair of these pathologies. In those cases, reimplant ureteral surgeries and their surgical maneuvers, e.g. psoas hitch, Boari flap, are not the best management options.
This video shows a ureteroureteroplasty in a 37-year-old female patient with ureteral stricture at the level of the crossing iliac vessels due to several previous endoscopic manipulations for the treatment of ureteral/kidney stones.
The ureteroureteroplasty technique was chosen since the proximal and distal parts of the ureter near the stenosed area were healthy.
At the end of the video, preoperative MRI and 1-year follow-up CT urogram 3D reconstructions are placed side by side, demonstrating the resolution of hydronephrosis.
B Lopes-Cançado Machado, V Chamum Costa
Surgical intervention
10 months ago
1715 views
3 likes
0 comments
08:39
Right laparoscopic ureteroureteroplasty
Lower ureteral strictures are commonly managed with ureteral reimplant surgeries. However, some patients still have a good distal ureteral stump, which can be used in the repair of these pathologies. In those cases, reimplant ureteral surgeries and their surgical maneuvers, e.g. psoas hitch, Boari flap, are not the best management options.
This video shows a ureteroureteroplasty in a 37-year-old female patient with ureteral stricture at the level of the crossing iliac vessels due to several previous endoscopic manipulations for the treatment of ureteral/kidney stones.
The ureteroureteroplasty technique was chosen since the proximal and distal parts of the ureter near the stenosed area were healthy.
At the end of the video, preoperative MRI and 1-year follow-up CT urogram 3D reconstructions are placed side by side, demonstrating the resolution of hydronephrosis.
Laparoscopic peritoneal dialysis catheter placement: step by step approach
This is the case of an 87-year-old man with a history of chronic kidney disease stage 5 proposed for dialysis.
The patient had a medical history of diabetes mellitus type 2 over 10 years, hypertension, anemia treated with erythropoietin. The patient was a former smoker.
After explaining to the patient and his family the option between hemodialysis and peritoneal dialysis, the patient opted for the peritoneal one.
He was admitted electively and submitted to 3D laparoscopic peritoneal dialysis catheter placement. The surgery and post-operative period were uneventful. The patient was discharged on postoperative day 2.
F Cabral, J Grenho, R Roque, R Maio
Surgical intervention
1 year ago
2228 views
155 likes
0 comments
06:36
Laparoscopic peritoneal dialysis catheter placement: step by step approach
This is the case of an 87-year-old man with a history of chronic kidney disease stage 5 proposed for dialysis.
The patient had a medical history of diabetes mellitus type 2 over 10 years, hypertension, anemia treated with erythropoietin. The patient was a former smoker.
After explaining to the patient and his family the option between hemodialysis and peritoneal dialysis, the patient opted for the peritoneal one.
He was admitted electively and submitted to 3D laparoscopic peritoneal dialysis catheter placement. The surgery and post-operative period were uneventful. The patient was discharged on postoperative day 2.
Hand-assisted laparoscopic live donor nephrectomy
Introduction and purpose: The shortage of cadaver donor organs and the progressive acceptation of laparoscopic procedures have significantly increased the number of living donor transplants. Laparoscopic nephrectomy has been rapidly and progressively incorporated as a therapeutic option in most hospitals. We describe the current surgical technique for living donor nephrectomy in our hospital.
Materials and methods: A 42-year-old woman with a medical history of hypertension and end-stage renal disease by IgA glomerulonephritis in predialysis program underwent a living donor transplantation. The donor was her sister, a woman aged 51, with no medical past history. We performed a left laparoscopic nephrectomy, and removal of the graft was performed using a hand-assisted device fixed in a supraumbilical 5cm laparotomy.
Results: Hospital stay was 3 days for the donor and 4 days for the receptor. The receptor had a postoperative creatinine of 1.76 mg/dL. In the third year of follow-up creatinine was 1.46 mg/dL.
Conclusions: Laparoscopic donor nephrectomy has proven to be a safe, less invasive, and effective technique for the renal graft. It has encouraged donation from living donors, given its esthetic results and comfort for the donor.
S Valverde-Martinez , A Martin-Parada, A Palacios-Hernandez, O Heredero-Zorzo, P Eguiluz-Lumbreras, J Garcia-Garcia, R Gomez-Zancajo, F Gomez-Veiga
Surgical intervention
2 years ago
1645 views
149 likes
0 comments
08:47
Hand-assisted laparoscopic live donor nephrectomy
Introduction and purpose: The shortage of cadaver donor organs and the progressive acceptation of laparoscopic procedures have significantly increased the number of living donor transplants. Laparoscopic nephrectomy has been rapidly and progressively incorporated as a therapeutic option in most hospitals. We describe the current surgical technique for living donor nephrectomy in our hospital.
Materials and methods: A 42-year-old woman with a medical history of hypertension and end-stage renal disease by IgA glomerulonephritis in predialysis program underwent a living donor transplantation. The donor was her sister, a woman aged 51, with no medical past history. We performed a left laparoscopic nephrectomy, and removal of the graft was performed using a hand-assisted device fixed in a supraumbilical 5cm laparotomy.
Results: Hospital stay was 3 days for the donor and 4 days for the receptor. The receptor had a postoperative creatinine of 1.76 mg/dL. In the third year of follow-up creatinine was 1.46 mg/dL.
Conclusions: Laparoscopic donor nephrectomy has proven to be a safe, less invasive, and effective technique for the renal graft. It has encouraged donation from living donors, given its esthetic results and comfort for the donor.
Robotic single site left dismembered pyeloplasty for ureteropelvic junction obstruction
This video demonstrates the surgical steps for a left ureteropelvic junction (UPJ) reconstruction performed by means of the new da Vinci® robotic single site platform.
This surgery can be achieved by a 2cm single incision made in the umbilicus.
The system provides 2 robotic instruments crossing into the trocar in order to have an adequate triangulation. In this set-up, the left robotic instrument is placed into the surgical field on the right side while the right robotic instrument is on the left side of the surgical field. The software of the da Vinci™ system allows for the control of the right robotic arm to the left master into the robotic console in order to have the instrument placed in the right part of the surgical field controlled by the right master. This allows for a direct and natural control of the instruments, hence solving the problem of the crossing of the instruments.
This is a great advantage when compared to standard laparoscopic single site surgery.
F Annino, T Verdacchi, M de Angelis
Surgical intervention
5 years ago
2150 views
49 likes
1 comment
05:40
Robotic single site left dismembered pyeloplasty for ureteropelvic junction obstruction
This video demonstrates the surgical steps for a left ureteropelvic junction (UPJ) reconstruction performed by means of the new da Vinci® robotic single site platform.
This surgery can be achieved by a 2cm single incision made in the umbilicus.
The system provides 2 robotic instruments crossing into the trocar in order to have an adequate triangulation. In this set-up, the left robotic instrument is placed into the surgical field on the right side while the right robotic instrument is on the left side of the surgical field. The software of the da Vinci™ system allows for the control of the right robotic arm to the left master into the robotic console in order to have the instrument placed in the right part of the surgical field controlled by the right master. This allows for a direct and natural control of the instruments, hence solving the problem of the crossing of the instruments.
This is a great advantage when compared to standard laparoscopic single site surgery.
Simultaneous robotic right partial nephrectomy and right adrenalectomy
Robot-assisted partial nephrectomy has become a safe procedure if standardized surgical steps are followed [1]. The same goes for robot-assisted adrenalectomy, with the robot offering the possibility to manage complex cases that are considered technically challenging for traditional laparoscopy [2].
A combined laparoscopic partial nephrectomy and an ipsilateral adrenalectomy have been described for upper pole renal tumors contiguously involving the adrenal gland [3].
In this video, we describe the surgical steps for a simultaneous robotic right partial nephrectomy and right adrenalectomy for two distinct renal and adrenal tumors.
References:
[1] Kaouk JH, Khalifeh A, Hillyer S, Haber GP, Stein RJ, Autorino R. Robot-assisted laparoscopic partial nephrectomy: step-by-step contemporary technique and surgical outcomes at a single high-volume institution. Eur Urol 2012;62:553-61.
[2] D’Annibale A, Lucandri G, Monsellato I, De Angelis M, Pernazza G, Alfano G, Mazzocchi P, Pende V. Robotic adrenalectomy: technical aspects, early results and learning curve. Int J Med Robot 2012;8:483-90.
[3] Ramani AP, Abreu SC, Desai MM, Steinberg AP, Ng C, Lin CH, Kaouk JH, Gill IS. Laparoscopic upper pole partial nephrectomy with concomitant en bloc adrenalectomy. Urology 2003;62:223-6.
D Rey, E El Helou, M Oderda, T Piéchaud
Surgical intervention
6 years ago
5355 views
85 likes
0 comments
13:06
Simultaneous robotic right partial nephrectomy and right adrenalectomy
Robot-assisted partial nephrectomy has become a safe procedure if standardized surgical steps are followed [1]. The same goes for robot-assisted adrenalectomy, with the robot offering the possibility to manage complex cases that are considered technically challenging for traditional laparoscopy [2].
A combined laparoscopic partial nephrectomy and an ipsilateral adrenalectomy have been described for upper pole renal tumors contiguously involving the adrenal gland [3].
In this video, we describe the surgical steps for a simultaneous robotic right partial nephrectomy and right adrenalectomy for two distinct renal and adrenal tumors.
References:
[1] Kaouk JH, Khalifeh A, Hillyer S, Haber GP, Stein RJ, Autorino R. Robot-assisted laparoscopic partial nephrectomy: step-by-step contemporary technique and surgical outcomes at a single high-volume institution. Eur Urol 2012;62:553-61.
[2] D’Annibale A, Lucandri G, Monsellato I, De Angelis M, Pernazza G, Alfano G, Mazzocchi P, Pende V. Robotic adrenalectomy: technical aspects, early results and learning curve. Int J Med Robot 2012;8:483-90.
[3] Ramani AP, Abreu SC, Desai MM, Steinberg AP, Ng C, Lin CH, Kaouk JH, Gill IS. Laparoscopic upper pole partial nephrectomy with concomitant en bloc adrenalectomy. Urology 2003;62:223-6.
Single incision right nephrectomy for severe hydrophrenosis in a transplanted patient
Laparoscopy is becoming the "gold standard" approach for nephrectomy when treating different benign and malignant diseases as well as for living donor transplantation.
During the last few months in both experimental and clinical settings, new techniques such as Natural Orifice Transluminal Endoscopic Surgery (NOTES™) and Single Incision Laparoscopic Surgery (SILS) or Single Port Laparoscopic Surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to perform the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision right nephrectomy for severe hydronephrosis in a patient who has undergone a kidney transplant a few years earlier.
A 62-year-old patient underwent a kidney transplant 5 years earlier due to a renal failure caused by a glomerular nephritis. The native kidneys were left in place.
Several admissions of patients presenting with recurrent sepsis were reported to the infectious disease department.
Recurrent sepsis was likely to be caused by the hydronephrosis induced by a large stone located in the middle part of the ureter.
The abdominal MRI showed the severe hydronephrosis of the native right kidney as well as a large stone.
A single incision nephrectomy was performed with no complications and the patient’s postoperative course was uneventful.
L Boni, G Dionigi, E Cassinotti, M Di Giuseppe, E Colombo, L Giavarini, SM Tenconi, F Cantore, M Tozzi, R Dionigi
Surgical intervention
8 years ago
3847 views
34 likes
0 comments
10:10
Single incision right nephrectomy for severe hydrophrenosis in a transplanted patient
Laparoscopy is becoming the "gold standard" approach for nephrectomy when treating different benign and malignant diseases as well as for living donor transplantation.
During the last few months in both experimental and clinical settings, new techniques such as Natural Orifice Transluminal Endoscopic Surgery (NOTES™) and Single Incision Laparoscopic Surgery (SILS) or Single Port Laparoscopic Surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to perform the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision right nephrectomy for severe hydronephrosis in a patient who has undergone a kidney transplant a few years earlier.
A 62-year-old patient underwent a kidney transplant 5 years earlier due to a renal failure caused by a glomerular nephritis. The native kidneys were left in place.
Several admissions of patients presenting with recurrent sepsis were reported to the infectious disease department.
Recurrent sepsis was likely to be caused by the hydronephrosis induced by a large stone located in the middle part of the ureter.
The abdominal MRI showed the severe hydronephrosis of the native right kidney as well as a large stone.
A single incision nephrectomy was performed with no complications and the patient’s postoperative course was uneventful.
Laparoscopic right nephrectomy for renal cell carcinoma
This video demonstrates a laparoscopic radical nephrectomy for renal cell cancer. The surgeon starts his dissection superiorly medially. After identifying the vena cava the renal vein is identified but not clipped. The renal artery is next identified behind the vein and clipped and then the renal vein is transected using a linear stapler. The additional lumbar vessels are then taken down to free the medial aspect of the kidney. The adrenal pedicles are then divided and the kidney and the adrenal gland are mobilized en masse from the psoas and completely freed. Minimal mobilization of the duodenum and hepatic flexure of the colon is required.
The specimen is put into a bag and retrieved through an enlarged trocar incision.
R Gaston
Surgical intervention
14 years ago
8651 views
111 likes
0 comments
20:59
Laparoscopic right nephrectomy for renal cell carcinoma
This video demonstrates a laparoscopic radical nephrectomy for renal cell cancer. The surgeon starts his dissection superiorly medially. After identifying the vena cava the renal vein is identified but not clipped. The renal artery is next identified behind the vein and clipped and then the renal vein is transected using a linear stapler. The additional lumbar vessels are then taken down to free the medial aspect of the kidney. The adrenal pedicles are then divided and the kidney and the adrenal gland are mobilized en masse from the psoas and completely freed. Minimal mobilization of the duodenum and hepatic flexure of the colon is required.
The specimen is put into a bag and retrieved through an enlarged trocar incision.
Laparoscopic living donor nephrectomy for kidney transplantation
The description of the laparoscopic living donor nephrectomy for kidney transplantation covers all aspects of the surgical procedure used for the management of kidney transplantation.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: left nephrectomy, opening of space, left vascular approach, right nephrectomy, right vascular approach, preparation of the ureter, perirenal freeing, preparation/extraction, division/extraction.
Consequently, this operating technique is well standardized for the management of this condition.
V Bettschart, F Mosimann
Operative technique
17 years ago
3854 views
112 likes
1 comment
Laparoscopic living donor nephrectomy for kidney transplantation
The description of the laparoscopic living donor nephrectomy for kidney transplantation covers all aspects of the surgical procedure used for the management of kidney transplantation.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: left nephrectomy, opening of space, left vascular approach, right nephrectomy, right vascular approach, preparation of the ureter, perirenal freeing, preparation/extraction, division/extraction.
Consequently, this operating technique is well standardized for the management of this condition.