Archive for the Video

LESS radical nephrectomy, a new born experience

Mahmoud M. Shalaby, Mohamad A. Zarzour, Amr H. Abofaddan and Fathy G. Elanany
Department of Urology, Assiut University Hospital


This video reports our initial experience with single incision laparoscopic radical nephrectomy.

A 56 y female presented by Rt loin pain and hematuria. CT revealed a multicentric renal tumor (T1 N0 M0).

Laparoscopic radical nephrectomy was done through single site, multiport approach
Operative time was 4 h 30 min. There was no intraoperative complications.
Tube drain was removed on post operative day 3 and patient was discharged 24 h later.
The specimen harbored a grade II clear cell RCC.

Conclusion:
LESS Radical nephrectomy is feasible. The operative time is longer compared to conventional laparoscopy but this is a very early point on the learning curve.

Laparoscopic radical cystectomy, the first report from Upper Egypt

Mahmoud M. Shalaby, Mohamad A. Zarzour, Amr H. Abofaddan and Fathy G. Elanany
Department of Urology, Assiut University Hospital


Radical cystectomy represents a considerable portion of the work load in every center in Egypt, it’s also a surgery with major toll on the patient.

This video describes the technique oflaparoscopic radical cystectomy. At the end of the procedure, the specimen is extracted through a 7cm Pfannenstiel incision, which is also used for creation of urinary diversion.

Operative time ranged from 3h 15min to 4h 30min. there were no intraoperative or postoperative complication.

Two patients completed 6months follow up, both had orthotopicilealneobladders. Both patients are disease free and continent.

Conclusion:
Laparoscopic Radical cystectomy should be considered as a standard procedure in our centers, it should have the same status as laparoscopic radical prostatectomy.

LESS URETEROLITHOTOMY

Ahmed Abdalla , Mahmoud Abdel Hakim, Amr Abdel Hakim.
Urology Department, Cairo University, Cairo, Egypt


INTRODUCTION
AS the laparoendoscopic single site surgery(LESS) using a transumbilical access represents the closest surgical technique to scarless surgery we assess the feasibility of LESS in management of ureteral stones .

PATIENTS AND METHODS
Four cases of LESS ureterolithotomy were performed by a single laparoscopic surgeon. The indications for LESS ureterolithotomy were a stone size of ≥20 mm, an impacted stone or failure of endourological management. All procedures were done using SILS port that was inserted through a 20-30-mm umbilical incision. Patients age range was 36 to 44, BMI was less than 25 kg/m2.Articulating instruments were used.

RESULTS
Mean operative time was 87 minutes. Blood loss was less than 50 cc. The mean stone size was 22.4 mm. The stones were located in the upper ureter in two patients and in the middle ureter in the other 2 patients.Ureteral stent were fixed in all patients after stone remval.Pain score was between 1 to 2 in all patients. Mean hospital stay was 2 days. Uretheral catheter were removed after 5 days. No intra or post operative complications were encountered. No analgesics were required. Ureteral stent were removed after 4 weeks.

CONCLUSION
LESS ureterolithotomy is technically feasible procedure however a large number of cases is needed to establish its efficiency as a line of management.

LESS RADICAL PROSTATECTOMY

Mahmoud Abdel Hakim, Ahmed Abdalla, Amr Abdel Hakim.
Urology Department, Cairo University, Cairo, Egypt.


INTRODUCTION
Our aim is to present our first case of pure laparoendoscopic single site radical prostatectomy

PATIENTS AND METHODS
One patient underwent LESS radical prostatectomy using SILS port that was inserted through a 20-30-mm umbilical incision. PSA was 8.7gm/dl.Gleason score was 3+3. The whole gland size was 57 gm.

RESULTS
Patients age was 63 years old. Operative time was 287 min. Blood loss was 350.Hospital stay was 2 days. Visual analogue pain score was 2/10. No need for analgesic use in the early post operative period. The procedure  was completed successfully without need for additional ports .Articulating instruments were used. Uretheral catheter was removed on tenth day. P.O pathology reveal prostate adenocarcinoma gleason 3+3 with negative surgical margin.P.S.A was 0.04 six weeks after the procedure.

CONCLUSION
LESS radical prostatectomy is a technically challenging procedure whoever a large number of cases is needed to point out its role in management of prostate cancer cases.

LAPAROSCOPIC URETEROLYSIS FOR RETROPERITONEAL FIBROSIS

Mahmoud Abdel Hakim, Ahmed Abdalla, Amr Abdel Hakim.
Cairo University Egypt


INTRODUCTION
Retro-peritoneal fibrosis is caused by the entrapment of one or more commonly both ureters in thick fibro-collagenous material, due to variable aetiologies. This presents by bilateral hydronephrosis, and is treated by freeing the ureter, intraperitonealisation of the ureter and or omental wrapping.

PATIENTS AND METHODS
We performed laparoscopic ureterolysis, and intraperitonealization of the ureter in 6 renal units in 3 patients. Two females and one male, ages were 36, 48 and 49 respectively. The aetiologies were idiopathic in all patients.. We started by insertion of bilateral Double J stents, before the procedure.The technique was done in the left lateral position, and the patients position was changed during the procedure.

RESULTS
Operative time was 6, 4 and 5 hours respectively. No intra operativeor post operative complications or bleeding were encountered . Hospital stay was 48 hours.

CONCLUSION
Laparoscopic ureterolysis, is a safe and effective substitution to open ureterolysis, and saves the patient the morbidity of the large abdominal incision.

Augmentation Vaginoplasty

Tarek Osman, Ahmad Elshahat, Mohammad Abdelghany, Amr Gamal
Department of Urology and Plastic Surgery, Ain Shams University


In this video we present a technique for treatment of extensive  vaginal stenosis following multiple surgeries and/or inflammatory processes involving the lower female genito-urinary tract. The patient has severe stress incontinence as well.  First a posterolateral longitudinal vaginal incision is made and dissection is performed to create a large vaginal wall defect measuring at least 12×7 cm. A rectus fascia sling is carried out and appled as usual through a separate anterior vaginal incision. A suitable full thickness medial thigh flap is harvested and medially rotated and sutured in an inlay fashion to the posterolateral vaginal wall. The resulting vagina is capacious and can admit easily two fingers. Postoperatively,  the patient is satisfied, continent and sexually active.

LAPARO-ENDOSCOPIC SINGLE-SITE SURGERY (LESS) EXTRAVESICAL REPAIR OF VESICOUTERINE FISTULA

Aly Abdel-Karim*, Mostafa Elmissery and Salah Elsalmy,
Urology Department, Alexandria University, Alexandria, Egypt


INTRODUCTION AND OBJECTIVES:
In this video we describe for the first time the technique of laparo-endoscopic single-site surgery (LESS) extravesical repair of vesicouterine fistula.

METHODS:
The case that we present in this video is a 32 years old female that presented with Youssef̕ s syndrome following cesarean section. Computed tomography (CT) of the abdomen and pelvis revealed a localized reaction between the bladder and uterus. Diagnostic cystoscopy revealed a foreign body (gauze) that protruding into the posterior bladder wall and was removed cystoscopically.  However, the patient̓ s symptoms were not resolved. CT cystography and cystoscopy showed a vesicouterine fistula. The fistula was repaired through extravesical LESS using the quadri-port and pre-bent instruments. The fistulas tract was identified and completely excised extravesically using sharp dissection. The edge of the bladder was trimmed at the site of fistulas tract. The uterus was closed by one 3/0 vicryl suture in a figure of 8 fashion, while urinary bladder was closed in 2 layers using 3/0 vicryl suture. An additional 5-mm extraport was added at time of suturing to allow triangulation and hand-free intracoprporeal suturing. An omental flap was interposed between the bladder and uterus. The urinary bladder was drained by an indwelling urethral catheter for 3 weeks.

RESULTS:
The operative time was 150 minutes. Blood loss was 50 c.c. There were no intraoperative or postoperative complications. Postoperative hospital stay was 2 days. There was no postoperative urinary leakage. Follow up of the patient showed complete clinical cure and no recurrence of vesicouterine fistula.

CONCLUSIONS:
LESS extravesical repair of vesicouterine fistula is technically feasible and effective procedure that adheres to the principles of transabdominal open surgical repair. However, the technique requires advanced laparoscopic skills.

LESS nephrectomy for children, an initial experience

Mahmoud M. Shalaby, Amr H. Abofaddan, Mohamad A. Zarzour and Fathy G. Elanany
Department of Urology, Assiut University Hospital


This video demonstrates our technique for LESS nephrectomy, the patient was an 11 y male who had a hydronephrotic non functioning Lt kidney.

A single site, multiport approach was adopted.  Operative time was 3 h 30 min.There were no intraoperative or postoperative complications. Tube drain was removed on post operative day 2 and patient was discharged the next day.

Conclusion:
LESS nephrectomy is a good option for children as for adults; in our experience there were no space limitations or any additional discomfort. More experience is needed to optimize and shorten the procedure.


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