Adrenal and renal laparoscopic surgery

Vol. 169, No.4, Supplement, Saturday, April 26, 2003 THE JOURNAL OF UROLOGY® 19

72DORSAL ONLAY URETHROPLASTY USING PENILE SKIN: AMULTI-INSTITUTIONAL REVIEW OF LONG TERM RESULTSAndrew C Peterson*, Fernando Delvecchio, Durham, NC; Enzo Palminteri,Massimo Lazzeri, Giorgio Guazzoni. Guido Barbagli, Arezzo, Italy; GeorgeD Webster, Durham, NC

INTRODUCTION AND OBJECTIVE: Recently the repair of long bulbarurethral stricture using a ventral or dorsal onlay of full thickness penile skin hasbeen superceded by the use of buccal mucosa. This has been supported by goodshort-term results in the latter. We review a lO-year combined experience of simpledorsal onlay (no stricture excision) and augmented anastomotic (up to 2 em. ofstricture excised) bulbar urethroplasties using penile skin in an attempt to establishthe durability of this type of graft.

function and response to Sildenafil of patients with known posterior urethralinjuries due to pelvic fractures.

METHODS: All patients referred to our department for posterior urethralreconstruction, for strictures due to pelvic fractures, were prospectively evaluated.Preoperatively patients underwent Nocturnal Penile Tumescence - NPT testing. IfNPT results were abnormal, penile Duplex US with intra cavernous injection andarteriography were performed, when indicated, to diagnose the etiology of ED.Patients were specifically questioned concerning their erectile function every threemonths after surgery and if they complained of ED they were offered Sildenafil100Mg. Patients followed for at least 18 months after surgery are included in thisreport.

RESULTS: 29 consecutive patients were evaluated. 22 (76%) of them had EDpreoperatively by NPT criteria. Follow up of 18 months or longer was available for15 of the patients with ED. 47% of these patients responded favorably to treatmentwith Sildenafil. All but one of the patients that responded to Sildenafil hadneurogenic ED. In 33% of the patients ED resolved within the follow up period. Allpatients with spontaneous resolution of ED previously responded to Sildenafil(71% of Sildenafil responders).

CONCLUSIONS: In patients with ED after an urethral injury associated withpelvic fractures favorable response to Sildenafil may predict spontaneousresumption of normal erectile function.

Source of Funding: None.

71LONG-TERM FOLLOW-UP OF BUCCAL MUCOSAL GRAFTSFOR ANTERIOR URETHRAL RECONSTRUCTION DanielKellner*, John A Fracchia, Noel Armenakas, New York, NY

INTRODUCTION AND OBJECTIVE: During the past 10 years buccalmucosal grafts have secured an important place in our armamentarium ofsubstitution urethroplasty for the treatment of congenital and acquired anteriorurethral disease. We present our long-term experience with buccal mucosal graftsfor the treatment of anterior urethral strictures.

METHODS: Twenty-three patients with anterior urethral strictures underwenturethral reconstruction using buccal mucosa as a ventral onlay graft. Eighteengrafts were placed in the bulbar and five in the penile urethra. All operations wereperformed in one-stage by a single surgeon. Mean graft length was 4.9 ern (range3 to 12 em). IPSS and uroflowmetry were obtained preoperatively, and at 3, 6 and12 months postoperatively, and annually thereafter. Urethral imaging was obtainedpreoperatively, at the time of catheter removal, and at 6 months postoperatively.Disease specific quality of life was assessed with the BPH Impact Index. Failurewas defined as obstructive voiding symptoms with radiographic or endoscopicconfirmation of recurrent stricture.

RESULTS: Patients were followed for a mean of 41 months (range 9 to 82months). Etiology of the strictures was instrumentation (n=9), idiopathic (n=9), priorhypospadias repair (n=2), urethritis (n=2), and trauma (n=I). Twenty-one of the 23patients (91%) were previously treated for their urethral strictures, with a total of 59procedures (mean 2.8 procedures/patient). Success, defined as normal voiding withoutany need for subsequent urethral manipulation, was achieved in 20/23 patients (87%).The remaining three patients developed a distal anastomotic stricture, each managedwith one internal urethrotomy; one of these patients continues to require monthlyself-dilation. There were no graft sacculations or fistulas.

CONCLUSIONS: Our series, with long-term follow-up, confirms thedurability of ventrally placed buccal mucosal grafts for the treatment of anteriorurethral strictures. This proven procedure results in a high success rate with fewcomplications.

Results shown asmean


METHODS: We reviewed the available records and radiographs of all patientsundergoing such bulbar urethroplasties from January 1991 to March 2002. Weanalyzed patient demographics and outcomes, etiology and length of stricture, andprior treatments.

RESULTS: 114 such urethroplasties were performed with a mean follow up of58.8 months. Strictures ranged from 1.5 to 8 (mean 4.1) ern .. There were 53augmented anastomotic repairs and 61 dorsal onlay repairs. Twenty-one of 114(18.4%) urethroplasties failed at an average of 19.5 months. Dorsal onlay repairssuffered the highest failure rate, 14/61 (22.9%) at 18 months, while 7/53 (13.2%)augmented anastomotic repairs failed at 21.5 months. Age, stricture etiology,length, location, and prior treatments did not correlated with failure. All 21 failureswere successfully treated.

CONCLUSIONS: The failure rate for penile skin onlay urethroplasty has beenreported to be < 10% at 23 months. With longer follow up we show an increaseto 18.4% at 58.8 months. This exceeds reports using buccal mucosal graft. Dorsalonlay repairs have a higher rate of failure than augmented anastomotic repairs. Thisdifference may be due to removal of the dominant portion of the stricture in thelatter, and also to the fact that simple onlay repairs tend to be performed on longerstrictures. While seemingly less successful than buccal graft repairs, long termresults of the latter must be awaited and other factors influencing the outcome(stricture excision and ventral vs dorsal onlay) must be considered in the analysis.We still consider the use of penile skin in augmented repairs a viable option inurethroplasty surgery.


Adrenal and Renal Laparoscopic SurgeryVideo Session

Saturday, April 26, 2003 1:00-3:00 PM

V74LAPAROSCOPIC PARTIAL NEPHRECTOMY WITHCONCOMITANT ADRENALECTOMY: THE TECHNIQUEWilson R Molina*, Cleveland, OH

INTRODUCTION AND OBJECTIVE: Small upper pole renal tumors canoccasionally abut the adrenal gland, raising concern for malignant adrenalinvolvement. Laparoscopic partial nephrectomy, an attractive treatment option forselect patients with a small renal tumor, can be performed in the clinical setting ofsuspected concomitant ipsilateral adrenal gland pathology. In this video we presentour technique for laparoscopic partial nephrectomy with concomitant ipsilateraladrenalectomy.

METHODS: A 59-year-old clinically asymptomatic man was diagnosed on CTscan to have an upper pole enhancing cystic renal tumor with calcificationdistorting the ipsilateral adrenal gland, raising suspicion of local adrenal

V73LAPAROSCOPIC BILATERAL PARTIAL ADRENALECTOMYFOR PHEOCHROMOCYTOMA Sidney C Abreu*, Inderbir S Gill,Jihad Kaouk, Surena Matin, Cleveland, OH

INTRODUCTION AND OBJECTIVE: In this video, we describe thetechnique of transperitoneal laparoscopic bilateral synchronous partialadrenalectomy in a patient with bilateral adrenal pheochromocytoma.

METHODS: An Sf-year-old female, ASA 3, who presented with bilateraladrenal masses incidentally diagnosed on a body MRI. The right adrenal tumormeasured 2.5 x 1.8 em and a left adrenal tumor 4 x 2.8 ern. Both glands revealedincreased signal intensity on T2 suggesting pheochromocytoma. With the patient ina 45-degree left flank position, a 3-port transperitoneal approach was employedwith an additional port for liver retraction during right partial adrenalectomy.Laparoscopic flexible ultrasonography was invaluable for localizing the adrenaltumor and for precise planning of the line of tumor excision and preservation of anormal appearing adrenal cortical remnant. The right main adrenal vein waspreserved. Dissection and enucleation of the adrenal tumor and parenchymalhemostasis was achieved effectively using harmonic scalpel (U.S. Surgical,Norwalk, CT).

RESULTS: Total operative time was 2 and 2.5 hours for the left and rightadrenal gland, respectively. No major intraoperative hemodynamic instability wasnoted. Total blood loss was 150cc and hospital stay was 4 days. Pathologyconfirmed bilateral adrenal pheochromocytoma.

CONCLUSIONS: Laparoscopic partial adrenalectomy for pheochromocytomais safe and technically feasible. Laparoscopic intraoperative ultrasonography andharmonic scalpel are helpful tools to precisely localize the tumor and to achieveadequate hemostasis, respectively.


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20 THE JOURNAL OF UROLOGY® Vol. 169, No.4, Supplement, Saturday, April 26, 2003

involvement. Laparoscopic partial nephrectomy with concomitant adrenalectomywas performed by a four port transperitoneal approach: (I) - port placement, (2)mobilization of the liver and right colon, (3) renal hilum dissection, (4) completionof adrenalectomy, (5) upper pole kidney dissection, (6) renal hilum clamping, (7)adrenal gland and upper pole tumor excision en bloc, (8) collecting system repair,(9) parenchymal hemostatic suturing. Herein, we also present data of the 4 patientswho underwent partial nephrectomy and concomitant adrenalectomy at ourinstitution.

RESULTS: Table ICONCLUSIONS: Laparoscopic partial nephrectomy with concomitant

ipsilateral adrenalectomy is feasible, safe and effective for patients with renaltumor and radiologically suspected adrenal gland involvement.

Table 1• Results

V76LAPAROSCOPIC NEPHRON SPARING SURGERY: ASTEPWISE BRAZILIAN WAY OF USING NO DISPOSABLES ATALL YET BEING SAFE AND EFFECTIVE. SPENDING TIMEPRACTICING IS SAVING COSTS! Cassio Andreoni*, AlexandreBomfim, Nelson Gattas, Homero Arruda, Miguel Srougi, Sao Paulo-SP,Brazil

INTRODUCTION AND OBJECTIVE: Laparoscopic nephron-sparing surgery(LNSS)remains challenging because of some technical difficulties due to anincreased probability of conversion to open surgery and postoperativecomplications, as such urinary fistula and bleeding. Several different tools withdifferent techniques have been used in order to improve the outcomes, however,none of them have proven to be safe and effective. The author attempted to performLNSS in the same manner the open cases are performed in our institution using nodisposables at all.

METHODS: From November 2000 to October 2002 LNSS was performed in12 patients. All procedures were performed transperitoneally with four trocars andwith temporary renal arterial occlusion; both the renal artery and the renal veinwere dissected individually; the kidney was dissected and the fat around the tumorwas spared. A laparoscopic bulldog (Aesculap, TuttiingeniGermany) was used toclamp the renal artery after 10 min Manitol was given; the renal pole wastransected using a laparoscopic knife 1 em away from the tumor and closure of the

V75LAPAROSCOPIC PARTIAL NEPHRECTOMY: IMPACT OF 3DCT AND INTRAOPERATIVE ULTRASONOGRAPHY Anup PRomani", Cleveland, OH

INTRODUCTION AND OBJECTIVE: Volume rendered 3D CT in the videoformat provides excellent details of kidney parenchyma, vasculature and collectingsystem. As such 3D CT is routinely used at our institute prior to a laparoscopicpartial nephrectomy. Intraoperative ultrasound is also used routinely to delineateprecisely the extent and depth of parenchymal invasion by the tumor, which guideslaparoscopic resection. Used in tandem, they facilitate the performance oflaparoscopic partial nephrectomy.

METHODS: Volume rendered 3D CT was performed preoperatively in 175patients undergoing laparoscopic partial nephrectomy for renal tumor. Volumerendered 3D reconstruction was recorded in video format. Data obtained includednumber and retationships of arteries and veins, collecting system and soft tissuestructures. Intraoperative ultrasound was performed using a flexible, steerable,color-doppler laparoscopic probe just before resection. Ultrasound demarcated thesize, extent and depth of tumor, which guided resection in partial nephrectomy.

RESULTS: 3D CT 3mm cuts provided vital preoperative data regarding tumorinvasion, vascular anatomy and surrounding structures which helped intraoperativeplanning. Intraoperative ultrasound was used to accurately delineate and score themargins of resection.

CONCLUSIONS: Volume rendered 3D CT and intraoperative ultrasonographyin combination. provide an essential roadmap for the precise planning and reliableperformance of laparoscopic partial nephrectomy. In our hands, these twomodalities are an integral part of laparoscopic partial nephrectomy.


'case shown during video presentation


parenchyma and the collecting system, separetly,was begun with free handintracorporeal suturing using interrupted absorbable stitches; the laparoscopicbulldog was removed after 30 minutes whether or not the suture was completed andManitol was given again. More stitches were applied if necessary and the perirenalfat was sewed over the parenchyma. The specimen was removed intact in anendobag. A drain was left in place.

RESULTS: The procedures were concluded laparoscopicaly and noconversions occurred. The procedures included 10 partial nephrectomies, 1 wedgeresection and 1 enucleation. The mean OR time was 3.3 hours, mean EBL was 300cc.mean hospital stay was 4 days,mean warm ischemia time was 28.9 minutes. Noreoperations were necessary and no fistula occurred. No patient developed renalinsufficiency. Histopathological analysis revealed no positive margins.

CONCLUSIONS: The description of this technique reproduces the opentechnique performed at our institution; it is feasible, safe and does not requireexpensive disposable tools but a permanent laparoscopic bulldog. However,mastering intracorporeal suturing is indispensable. Also, the use of a bulldog clampinstead of a Satinsky clamp allowed for saving one port throughout the procedureand perhaps a better preservation of the parenchyma due to venous reflux.


V77TECHNIQUE OF LAPAROSCOPIC RENAL HYPOTHERMIAFOR PARTIAL NEPHRECTOMY Sidney C Abreu*, Inderbir S cut.Christopher Ng, Desai Mihir, Andrew Steinberg, Anup Ramani, Jihad Kaouk,Cleveland, OH

INTRODUCTION AND OBJECTIVE: We developed a novel technique oflaparoscopic renal hypothermia for partial nephrectomy.

METHODS: Between May and August 2002, 12 patients underwent atransperitoneal laparoscopic partial nephrectomy with intracorporeal renalhypothermia. Initially, the renal artery and vein are circumferentially mobilized enbloc. The kidney is then completely mobilized within Gerota s fascia. Laparoscopicultrasonography is performed to delineate the tumor and to score the proposed lineof resection. The inferior pararectal port is removed, and an Endocatch-II bag isinserted, opened, and carefully positioned around the kidney. The drawstring ispulled thus, detaching the bag from the metallic ring. Further cinching of thedrawstring, and placement of Week clips were necessary to gently snug the mouthof the bag around the intact renal hilum. The pre-positioned Satinsky clamp isclosed around the hilun, thus initiating renal ischemia. The bottom of the engagedbag is grasped and delivered outside the abdomen, for this purpose the inferiorpararectal trocar is removed. The exteriorized bottom of the bag is opened andsecured with hemostats. Using previously loaded 30 cc syringes,ice-slush is rapidlyinserted into the bag thus, completely surrounding the kidney with ice. The cut endof the bag is closed with a tie, and the bag is re-inserted into the abdomen. A IOmmBluntip balloon cannula is secured at this port-site, and pneumoperitoneum isreestablished. After approximately 10 minutes, the bag is incised and the ice-slushis removed from around the tumor site only. The tumor is ressected with anadequate margin of healthy tissue. Any pelvicalicial entry is identified and suturerepaired. Sutures are placed over surgicel bolsters to achieve parenchymalhemostasis, thus completing partial nephrectomy.

RESULTS: Time to deploy the bag around the kidney was 7 minutes (5-20),volume of ice-slush introduced was 600 cc (300-750), and time taken to insertice-slush was 4 minutes (3-10). Total ischemia time was 43.5 minutes (25-55).Nadir core renal temperature range from 5C - 19C, and the drop in systemictemperature was 0.6C (0.3-0.9). Intraoperative complications included partialslippage of the bag (1), and malfunction of Satinsky clamp (1).

CONCLUSIONS: A novel technique of laparoscopic renal hypothermia usingice-slush was developed, replicating open surgery. By achieving cold ischemia, thistechnique has the potential to extend the scope of laparoscopic partial nephrectomyto more deeply infiltrating or complicated renal tumors.


V78NEW TECHNIQUE: HAND-ASSISTED LAPAROSCOPICPARTIAL NEPHRECTOMY WITH HYPOTHERMIA S DukeHerrell", Nashville, TN; D Duane Baldwin, Lorna Linda, CA; Jason KSprunger, Nashville, TN; Peter Langenstroer, Madison, WI; Jake Porter,Kansas City, KS

INTRODUCTION AND OBJECTIVE: Open approaches for complex partialnephrectomy typically utilize temporary vascular occlusion with hypothermia toprotect against ischemic damage while allowing meticulous dissection andreconstruction. Initiallaparoscopic reports in the literature have not recreated theseadvantages.

METHODS: After isolation and temporary occlusion of the renal hilum, thekidney was cooled to appropriate temperatures(-15 degrees C). Complex partialnephrectomy with sutured closure of the collecting system and parenchyma wasperformed in a bloodless field.

4270

150

chronic inftammation,dystrophic calcification

freeofdisease

3260

75

5

renal cell carcinoma

4cmcorticaladenoma

260

75

2

5

adult mesoblasticnephroma

free ofdisease

4

l'300

150

CaseORTime (min)Blood Loss(cc)Hospital Slay(days)Kidney Pa· benignthology cortical cystAdrenal Pa- freeofdis-thology ease

'Presenting author.

Vol. 169, No.4, Supplement, Saturday, April 26, 2003 THE JOURNAL OF UROLOGY® 21

RESULTS: Laparoscopic partial nephrectomy with hypothermia wasperformed in 7 patients (8 renal units). Identification of the hilar vessels followedby clamping and cooling allowed meticulous dissection and removal of the renaltumor in a bloodless field. Suture closure of the collecting system was alsoperformed. Complications consisted of a single post-operative stroke, and onetransient urine leak which sealed spontaneously following stent placement.Surgical margins were negative in each patient.

CONCLUSIONS: This video illustrates a novel surgical technique which allowslaparoscopic partial nephrectomy to be meticulously performed in a bloodless field.Some previously reported techniques for laparoscopic partial nephrectomy do notprovide optimal conditions for resection. Laparoscopic partial nephrectomy ofintraparenchymal lesions without vascular control risks significant bleeding.Hemorrhage may obscure vision of the surgical field compromisingthe margin status.Performing partial nephrectomy with warm ischemia requires significantfacility withintracorporeal suturing, and time pressure constraints may compromise margin statusand risk renal deterioration. Our new technique recreates the advantages of the openprocedure while maintaininga minimally invasive approach.


V79NON-EXOPHYTIC RENAL CELL CANCER; A DIFFICULTCASE FOR RETROPERITONEAL LAPAROSCOPIC PARTIALNEPHRECTOMY -SUCCESSFUL ASSISTANCE WITH POWERDOPPLER ULTRASONOGRAPHY- Hidenori Zakoji", KazuhikoShiiki, Yasuhisa Furuya, Takayuki Tsuchida, Isao Araki, Yoshio Takihana,Nobuaki Tanabe, Masayuki Takeda, Yamanashi, Japan

INTRODUCTION AND OBJECTIVE: Laparoscopic partial nephrectomy fornon-exophytic renal tumor is challenging procedure because of difficulty indetecting tumor. We report a male case of non-exophytic renal cancer for whichidentification with endoscope was difficult, but he successfully underwentretroperitoneal laparoscopic partial nephrectomy assisted by intraoperativeultrasonography.

METHODS: Using retroperitoneal laparoscopic technique, the kidney wasidentified and separated from perirenal fat to explore the tumor. Only slightlyprotrudingarea of renal surface was seen, but could not be comfirmedendoscopically.Sonographical monitoring in IOMHz frequency was performed to evaluate locationand size of the tumor.Power Doppler ultrasoundwas very helpful in recognizingtumorand its blood flow. Laparoscopic partial nephrectomy could be performed usingmicrowave tissue coagulator and argon beam coagulator for hemostasis.

RESULTS: Operative time was 202 minutes. Blood loss was lOamI. Therewere no complications during 9-day-hospital stay. Pathological diagnosis was renalcell carcinoma, and the surgical margin was negative.

CONCLUSIONS: Intraoperative ultrasonography is very helpful forlaparoscopic partial nephrectomy, even in non-exophytic renal tumors.


V80LAPAROSCOPIC RADICAL NEPHRECTOMY FOR CANCERWITH LEVEL I RENAL VEIN THROMBUS Anup P Romani",CLEVELAND, OH

INTRODUCTION AND OBJECTIVE: Renal cell carcinoma(RCC) isassociated with thrombus extending into the venous system in 5-10% cases. Inpatients with organ-confined disease, open radical nephrectomy with concomitantthrombectomy is considered the treatment of choice. Laparoscopic radicalnephrectomy is rapidly becoming a standard of care for a majority of patients withTl-T2 cancers. With growing experience, we have applied laparoscopy to selectpatients with T3b RCC with level I renal vein thrombus.

METHODS: We present a video of a 82 year old patient with a pre-operativediagnosis of renal cancer with renal vein thrombus who underwent laparoscopicradical nephrectomy at our institution. The tumor size was 5 cms. Laparoscopy wascarried out by a 4-port transperitoneal approach. The renal vein was secured withan endo -GIA stapler proximal to the thrombus. To date we have performedlaparoscopic radical nephrectomy in 16 patients having cancer with a renal veinthrombus. These data are also presented.

RESULTS: The total operative time was ISO minutes. The blood loss was150cc. Intra-operative urine output was 775cc. The specimen weight was 867grams. There were no complications. The patient was ambulating and on oralliquids by 24 hours. At 2 month follow up there was no local recurrence ormetastasis. For the 16 cases done to date, the mean blood loss was 363cc, meanoperative time was 3.2 hours, mean follow up was 14.5 months and 3 patients hadrecurrence of tumor.

CONCLUSIONS: Laparoscopic radical nephrectomy is feasible and safe inpatients with renal cell carcinoma with level I thrombus. With growing experience,laparoscopy may potentially be applied to more extensive venous involvement inthe future.


V8lLAPAROSCOPIC RADICAL NEPHRECTOMY WITH VENACAVAL AND RIGHT ATRIAL THROMBECTOMY UTILIZINGDEEP HYPOTHERMIC CIRCULATORY ARREST- THE VIDEOAnoop M Meraney*, Mihir Desai, Gyung Tak Sung, Anup Ramani, Sidney Abbreu,Hiroaki Harasaki, Manabu Sato, Jihad Kaouk, lnderbir Gill, cleveland, OH

INTRODUCTION AND OBJECTIVE: In patients with renal cel1cancer withlevel 3 or 4 tumor thrombi, conventional treatment comprises surgical explorationthrough a median sternotomy and large midline or chevron abdominal incision, forperformance of radical nephrectomy followed by inferior vena cava and right atrialthrombectomy under deep hypothermic circulatory arrest. Recently, advances inminimally invasive surgery have enabled the application of these techniques for theperformance of technically advanced surgical procedures. This video demonstrateslaparoscopic radical nephrectomy and minimally invasive level 4 thrombectomyutilizing deep hypothermic circulatory arrest in the calf model.

METHODS: The procedure was performed in 6 male calves weighing 70-80kg. Initially, the neck vessels were cannulated for subsequent cardiopulmonarybypass. Next, a laparoscopic team performed right radical nephrectomy andexposed the intra abdominal inferior vena cava (IVC). Simultaneously,thoracoscopic access to the right atrium was obtained by a second group oflaparoscopic surgeons. Subsequently, cardio-pulmonary bypass, cardiac arrestunder deep hypothermic conditions, and complete exsanguination were performed.A level 4 coagulum thrombus was created by needle injection. Combinedlaparoscopic and thoracoscopic IVC and right atrial thrombectomy were performedin a bloodless field. An angioscope was employed to visually confirm completethrombus clearance. Laparoscopic and thoracoscopic techniques were then utilizedfor suture repair of the IVC and right atrium. Cardiopulmonary bypass wasre-established, and the animal was gradually re-warmed. Once sinus rhythm wasre-established at normal body temperature, the animal was weaned off the pump.

RESULTS: Average operative time was 494.5 mins (range, 355 to 705 mins),average time to achieve core cooling was 63.5 mins (range, 50 to 120 mins), andaverage time to rewarm the animal was 101.8 mins (range, 70 to 130 mins).Following ciculatory arrest, the average blood volume drained into the bypasspump was 2633.3 cc (range, 1400 to 3200 cc). The average estimated blood losswas 350 cc (range, 200 to 750 cc).

CONCLUSIONS: Laparoscopic radical nephrectomy with IVC and right atrialthrombectomy is feasible in the calf model. The technique can be performedutilizing minimally invasive techniques exclusively.


V82PERCUTANEOUS RENAL CRYOABLATION William BShingleton», Patrick E Sewell, Jackson, MS

INTRODUCTION AND OBJECTIVE: Renal tumor cryoablation can beperformed via a percutaneous approach with minimal morbidity and technicalsuccess. This videotape will demonstrate the technique utilizing magneticresonance image (MRI) guidance.

METHODS: A 75 year old male with a biopsy proven renal cell carcinomameasuring 4.5 ern in diameter underwent percutaneous cryoablation. The imageguidance system was an interventional MRI unit and the cryoablation instrumentwas the Galil Medical Cryohit System.®

RESULTS: This videotape illustrated the complete procedure required forpercutaneous renal cryoablation.

CONCLUSIONS: Renal cryoablation can be successfully performedpercutaneously with MRI guidance. There is minimal morbidity associated withthis procedure. This treatment technique will require continued follow-up to assessthe durability of response.


Adrenal, Kidney, Ureteral Surgery (II)Moderated Poster

Saturday, April 26, 2003 3:30-5:30 PM

84LAPAROSCOPIC AND OPEN PARTIAL NEPHRECTOMY IN 200CASES lnderbir S Gill, Cleveland, OH; Surena F Matin", Houston, TX; MihirM Desai, Andrew Steinberg, Jihad H Kaouk, Edward Mascha, Julie Thorton,Brenda Strzempkawski, Mahmoud Sherief, Andrew C Novick, Cleveland, OH

INTRODUCTION AND OBJECTIVE: We compare the perioperativeoutcomes after laparoscopic and contemporary open nephron sparing surgery(NSS) for patients with a solitary renal tumor -:57 em.

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Adrenal and renal laparoscopic surgery