Subject Index

Note: The letters ‘f’ and ‘t’ following locators refer to figures and tables respectively.

AAblative renal procedures, complications of

abdominal wall/skin complicationsangiographic embolization, renal bleeding, 273damage to intercostal arteries, prevention, 273electrical skin burns following RFA, prevention, 273inadvertent nerve damage, prevention, 273intercostal vessel injury by RFA, 273fpain/paresthesia, 272

complications unrelated to ablative technique, 274damage to surrounding structures

calyceal obstruction, permanent urothelial damage, 271fcolon injury, 271damage to genitofemoral nerve, effects, 271“finder needle” insertion, percutaneous access, 270injury to pleural cavity, 271lateral tumors/tumors near surrounding organs, imaging

techniques, 270perirenal urinoma formation, 271prevention, pre-operative imaging, 270supine spiral CT scan of patients for ablation process,

270urinary tract in ablation zone, indications, 271

general surgical considerationsknowledge of patient medical/surgical history, 270laparoscopic surgery, contradictions to, 270patients treated under sedation, 270percutaneous ablation, choice of anesthesia in, 270

indications and anatomic considerationspatients eligible for ablation, 268percutaneous/laparoscopic approach based on tumor

location, 268infectious complications

patients at risk, 273–274intraoperative/postoperative hemorrhage

bleeding during laparoscopic ablation, management, 272perirenal hematoma formation by RFA, 272fprimary risk factor, 272selective angioembolization, postoperative management,

272renal treatment

RFA/cryotherapy, 267safety/complications

avoidance maneuvers and management of complications,269t

cryoablation/RFA, study, 269laparoscopic ablation, higher rate of complications, 269

technique for laparoscopic ablation, 268technique for percutaneous ablation, 268

ACC, see American College of Cardiology (ACC)Accessory neural pathways (ANP), 219, 221fAccess techniques to peritoneal cavity

direct trocar entry, 75Hasson technique, 74STEP procedure, 74–75Veress needle approach, 74

Acute-phase proteins, 23–24Acute postoperative hemorrhage, 205ADH, see Antidiuretic hormone (ADH)Adrenal vascular injury, 120AHA, see American Heart Association (AHA)“Air lock,” 5Alternative laparoscopic surgical techniques, comparing

hand-assisted laparoscopic nephrectomy, 131–132laparoendoscopic single-port surgery for donor

nephrectomy, 132retroperitoneoscopic donor nephrectomy, 132robotic-assisted laparoscopic donor nephrectomy, 132

American College of Cardiology (ACC), 9American Heart Association (AHA), 9American Society of Anesthesiologists’ (ASA), 7Anastomotic leaks, 59, 67–70, 199, 241–242Anatomic restoration technique (ART), 216–218

in robotic radical prostatectomyanatomic restoration of vesicourethral junction, 218fbiomechanical forces acting on vesicourethral

anastomosis, 217fsites of postulated biomechanical instability, 216, 217f

Anesthesia and management of anesthetic complicationsmaintenance of cardiovascular function

end of surgery and postanesthesia, 15induction, 14intra-peritoneal insufflation, 14–15positioning, 15See also Cardiovascular function, maintenance

management of oxygenation and ventilationarterial oxygen tension in head-up patients, 16FRC, oxygen reservoir, 16head-down positioning, study, 16optimal inspired oxygen fraction, 16oxygen storage during apnea, 16PEEP, 17pressure/volume-controlled ventilations, 16

307R. Ghavamian (ed.), Complications of Laparoscopic and Robotic Urologic Surgery,DOI 10.1007/978-1-60761-676-4, C© Springer Science+Business Media, LLC 2010

308 Subject Index

Anesthesia and management (cont.)preoperative evaluation and preparation

ASA physical status classification, see ASA physicalstatus classification system

Angiographic embolization, 53, 273ANP, see Accessory neural pathways (ANP)Antidiuretic hormone (ADH), 22Arrhythmias, 4, 9, 15, 208, 281ART, see Anatomic restoration technique (ART)Arterial injury, 154Arteriovenous fistula (AVF), 52–53, 54f, 149–150, 154, 240ASA, see American Society of Anesthesiologists’ (ASA)ASA Difficult Airway Algorithm, 12ASA physical status classification system

ACC/AHA, algorithm/type of surgery planned, 9–10anesthesiologists, role in patient evaluation, 8category E, 8category I, 7–8category II, 7–8category III, 7–8category IV, 7–8category V, 7–8category VI, 8invasive laparoscopic urological surgery, schema, 9laboratory testing, criteria, 8OSA, obesity issue

diagnosis of, polysomnography, 11Pickwickian Syndrome, 11

patient’s airway anatomy examination, 11–12anesthetic induction method, 13ASA Difficult Airway Algorithm, principles of, 12–13LMA ventilation, 12Mallampati airway classification, 12patient’s empty/full stomach literature/study, guidelines,

13–14pulmonary aspiration, risk factors, 13

pulmonary disease identification by history (Roizen)asthmatic patients, treatment, 11auscultation of lungs with stethoscope, 10chest x-ray, 10lung function improvement, preoperative measures, 11PFT, 10risk assessment/reduction of PPCs, guidelines, 11

AVF, see Arteriovenous fistula (AVF)

BBiocompatible liquid polymers, 79Bladder injuries, 59, 67, 74, 137, 248, 249t, 250, 255, 255t, 257,

287–288, 302Bladder neck intussusception (BNI), 215Bladder perforation, 137, 281f, 288, 302Bleeding/vascular injury, RPLND complications

intraoperative bleeding, control, 173–174IVC/aortic injuries, 174laceration of the aorta, control, 174vascular clamping and intracorporeal suturing, 174

BNI, see Bladder neck intussusception (BNI)Bowel complications, 83t–84t

associated with access, 74–75laparoscopic and robot-assisted adrenalectomy, 82

laparoscopic and robot-assisted laparoscopic pyeloplasty,85–86

laparoscopic and robot-assisted LNU, 85laparoscopic and robot-assisted LPN, 85laparoscopic and robot-assisted LRPLND, 86laparoscopic and robot-assisted nephrectomy, 82–85laparoscopic and robotic-assisted laparoscopic radical

prostatectomy, 87f, 88laparoscopic and robotic radical cystectomy, 86–87

Bowel injuries, 47, 73–75, 75t, 77, 78f, 79, 79t, 83t–84t, 88,95, 108–109, 118–119, 123–124, 132–133, 164–165,167–168, 174, 177–178, 193, 201t, 202–203,206–208, 249t, 250, 255, 255t, 257, 263t, 265,286–287, 299, 300–301

Bowel/visceral injury during LRNareas of injury risk, 123perforated viscus

Bishoff’s reports, 123bowel injury by port placement/closure, 123mechanical/antibiotic bowel preparation, 123post-operative bowel obstruction by ischemic colonic

stenosis, 123post-operative melena, 123–124

Brachial plexus injuries, 37, 39Bradycardia, 4, 14–15, 191, 191t, 201–202Breakage, 92t, 96Burch coloposuspension, laparoscopic

complications, see Complications of laparoscopic Burchcoloposuspension

extraperitoneal/intraperitoneal approach, 248laparoscopic approach, advantages, 248port placement, 248surgical principles, 247–248suture/mesh placement, comparitive study, 248

CCardiac arrhythmias, 15, 208, 281Cardiac Risk Index (Goldman), 8Cardiovascular consequences of laparoscopic surgery

cardiac function and venous return, outcomes, 22CO2 absorption and hypercarbia, effect of, 22pneumoperitoneum, mechanical effects of

cardiac output in hypovolemic dogs, study, 21high-/low-pressure pneumoperitoneum, randomized

study/results, 21–22increased IAP, effects in human/dogs, 21

renal perfusion and function, effectseffect of pneumoperitoneum on renal function, clinical

trials, 23intra-abdominal pressure effects in human, study, 22–23intra-abdominal pressure effects in pigs, study, 22oliguria, 22

Cardiovascular function, maintenanceend of surgery and postanesthesia

pulmonary edema, causes, 15induction

control of high blood pressure by vasopressors, 14intravenous fluid administration to reduce heart rate, 14

intra-peritoneal insufflationcardiac arrhythmias, treatment, 15

Subject Index 309

CO2 embolization, signs/treatment, 14increased abdominal pressure, effects, 14–15

positioning, 15Carter-Thomason device, 48Cavernosal nerves (CN), 219Cerebral blood flow, 4Chimney effect, 125Chylous ascites

diagnosis, 175imaging of abdomen/lymphatic system, 175lymphangiography/lymphoscintigraphy, 175

lymphocele formation, management, 175–176milky drainage presentation, 175symptoms, 175treatment

octreotide, use of, 175peritoneovenous shunting, 175refractory ascites, placement of surgical clip/suture, 175,

176fsalt restriction and diuretics, 175

Classic “mill wheel” murmur, 5Class II major histocompatibility (MHC-II) molecule, 26CN, see Cavernosal nerves (CN)CO2 embolus, 5, 47, 129, 286CO2 gas physiology

bone, largest potential reservoir, 20CO2 pneumoperitoneum, 20maximum storage capacity, 20transportation in blood, forms, 20

CO2 insufflationpulmonary/cardiovascular/hemodynamic effects

arrhythmias, 4bradycardia, 4pressure effects of 10 and 20 mmHg

pneumoperitoneum, 4trenin–angiotensin–aldosterone stimulation, 4

Compartment syndrome, 35, 37–38, 86, 115t, 118, 165, 168,181t

See also Well leg compartment syndrome (WLCS)Complications of ablative renal procedures

abdominal wall/skin complicationsangiographic embolization, renal bleeding, 273damage to intercostal arteries, prevention, 273electrical skin burns following RFA, prevention, 273inadvertent nerve damage, prevention, 273intercostal vessel injury by RFA, 273fpain/paresthesia, 272

complications unrelated to ablative technique, 274damage to surrounding structures

calyceal obstruction, permanent urothelial damage, 271fcolon injury, 271damage to genitofemoral nerve, effects, 271“finder needle” insertion, percutaneous access, 270injury to pleural cavity, 271lateral tumors/tumors near surrounding organs, imaging

techniques, 270perirenal urinoma formation, 271prevention, pre-operative imaging, 270supine spiral CT scan of patients for ablation

process, 270urinary tract in ablation zone, indications, 271

general surgical considerationsknowledge of patient medical/surgical history, 270laparoscopic surgery, contradictions to, 270patients treated under sedation, 270percutaneous ablation, choice of anesthesia in, 270

indications and anatomic considerationspatients eligible for ablation, 268percutaneous/laparoscopic approach based on tumor

location, 268infectious complications

patients at risk, 273–274intraoperative/postoperative hemorrhage

bleeding during laparoscopic ablation,management, 272

perirenal hematoma formation by RFA, 272fprimary risk factor, 272selective angioembolization, postoperative management,

272renal treatment

RFA/cryotherapy, 267safety/complications

avoidance maneuvers and management ofcomplications, 269t

cryoablation/RFA, study, 269laparoscopic ablation, higher rate of complications, 269

technique for laparoscopic ablation, 268technique for percutaneous ablation, 268

Complications of laparoscopic and robotic adrenal surgeryaccess-related complications

causes, 106open access technique, safer method, 106

bowel injuries, 108–109complications of retroperitoneal laparoscopic

adrenalectomy, 111complications of robotic-assisted adrenalectomy, 111diaphragmatic/pleural injuries, 110indications and techniques

categories, 103laparoscopic adrenalectomy, contradictions, 104large/small adrenal lesions, indications, 104left retroperitoneal laparoscopic adrenalectomy, 106left transperitoneal laparoscopic/robotic

adrenalectomy, 105operative approaches, 104retroperitoneal approach, 105–106right retroperitoneal laparoscopic adrenalectomy, 106right transperitoneal laparoscopic/robotic adrenalectomy,

104–105liver, pancreas, and splenic injury, 109–110postoperative hormonal complications, 110vascular complications

adrenal vein ligation, 107bipolar vessel-sealing devices, 107hemorrhage, prevention, 107injury to IVC at junction of right adrenal vein by

adrenalectomy, 107, 108fintraoperative bleeding, management, 107–108

Complications of laparoscopic and robotic pyeloplastydiagnosis of complications

CT, study of choice, 183CT urogram demonstrating small leak, 183, 184f

310 Subject Index

Complications of laparoscopic (cont.)KUB demonstrating left ureteral stent out of position

following robotic pyeloplasty, 183, 184fretroperitoneal bleeding, diagnosis, 183

literatureconversion of LP to OP, study, 179intraoperative complication rates, study, 178–179minimally invasive pyeloplasty in upper urinary tract

anamolies, 179postoperative complication rates, LP/RALP study, 179,

180t–181ttypes of laparoscopic reconstruction, 178urinary leak, risk factors, 181

operative planningbowel preparation prior to surgery, 181diuretic renal scans, 181preoperative planning, steps, 181secondary repair considerations, 181surgeon’s preference/experience of minimally

invasive/RALP surgery, 181–182transperitoneal/retroperitoneal approach, selection

of, 182prevention of complications

aberrant vessels, detection, 183anastomotic suturing by robotic assistance, 182fibrosis prevention around ureter, 182Laparoscopic Doppler probe, identification of crossing

vessels, 183, 183flaparoscopic suturing, 182peri-operative care, 182spatulation of ureter with Potts scissors, 182furine leak management, 183urinoma formation, reduced risk of, 183

procedureanastomosis by robotic techniques, 178, 178fpatient positioning, 177prophylactic antibiotics administration, 177renal pelvis and ureter dissection, 177, 178fstone removal after UPJ obstruction, 177–178trocar placement, 177ureteral stent, postoperative removal, 178

RALP/LP, benefits over laparoscopy, 177treatment of complications

early restricturing, treatment, 185hematoma management, 184repeat stenting/nephrostomy tube placement for acute

obstruction, 185stent obstruction/migration, 184urinary leakage, management, 184

Complications of laparoscopic and robotic ureteral surgerydiagnosis of complications

bleeding signs, 193–194renal ultrasound, obstruction/clot evaluation, 194urinoma differentiated from urine leak by CT scan, 193,

194fliterature

complications of ureteral reimplantation, 190–191complications of ureteroureterostomy and other ureteral

surgery, 191–192management of complications

bleeding, 194

recurrence of primary ureteral stricture, 195stent migration, 195tension at anastomosis, 194–195urinary extravasation, 194

operative techniquesinfrequently performed ureteral procedures, 189–190ureteral reimplantation, 189ureteroureterostomy, 187–188

prevention and managementlaparoscopic/robotic urologic reconstructive

procedures, 193preoperative preparation and planning, 192–193

UPJO, treatment options, 187vesicoureteral reflux disease/ureteral strictures,

treatment, 187Complications of laparoscopic Burch coloposuspension,

247–248intraoperative/perioperative complications

excessive blood loss, 250–251perioperative morbidities, 251small bowel obstruction, 251transient urinary retention, management of, 251unrecognized bowel injury, 250vaginal injury, 250wound infection, 251

long-term complicationspelvic organ prolapse, 252urinary retention, 251–252urinary urgency, 251

lower urinary tract injuryfluoroscopic cystogram/CT, diagnostic study, 250intraoperative complications, 249tintraoperative detection, 250post-operative bladder injury, symptoms, 250post-operative presentation of sutures, 250tack erosion into bladder, cases, 250

Complications of laparoscopic donor nephrectomycase description, 128–129comparing alternative laparoscopic surgical techniques

hand-assisted laparoscopic nephrectomy, 131–132laparoendoscopic single-port surgery for donor

nephrectomy, 132retroperitoneoscopic donor nephrectomy, 132robotic-assisted laparoscopic donor nephrectomy, 132

donor complications, see Donor medical complications;Donor surgical complications

injuries during graft extractionbladder perforation, 137graft injury, 137–138

overall complication ratesBMI above 30 kg/m2, higher complication rate, 129donor characteristics, 130tgraft/recipient complications, 131intraoperative/postoperative complications, 131Kocak classification scheme, 131largest study in Maryland, reports, 129, 130tmodification of Clavien classification system

(Kocak), 129operative outcomes, 130t

recipient complicationseffects of pneumoperitoneum on the graft, 138–139

Subject Index 311

ureteral strictures and complications, 139WIT, 138

renal mobilizationgeneral anatomic considerations, 134

vascular dissection and hilar controldissection and ligation of tributary vessels, 135lymphatic injury and chylous ascites, 136renal artery and vein division, 135–136secondary sensory complications, 136–137

Complications of laparoscopic RPLNDbleeding and vascular injury

intraoperative bleeding, control, 173–174IVC/aortic injuries, 174laceration of the aorta, control, 174vascular clamping and intracorporeal suturing, 174

chylous ascites, 175–176ejaculatory dysfunction, 175intraoperative/early postoperative/delayed

postoperative, 173laparoscopic RPLND, procedure

port placement, 171, 172fposterior peritoneum incision, 172postoperative management, 173precaval residual mass dissection following

chemotherapy, 173fretrocaval dissection by “split-and-roll” technique,

172–173, 173fspermatic cord dissection, 172, 172f

organ injurybowel injury, 174cholecystectomy for gallbladder injury, 174clinical diagnosis, 174intestinal abrasions, use of silk suture, 174mesenteric artery injury, 175pancreatic injury, 174renal vascular injury, 175splenic/liver injury, treatment,

174–175unrecognized ureteral injuries, symptoms, 174ureter injury, prevention, 174

RPLND, treatment of NSGCTindications in low-stage NSCGT, 171postchemotherapy laparoscopic RPLND, 171

small bowel obstruction, 176Complications of laparoscopic pelvic organ prolapse

intraoperative/perioperative complications, 249tbowel injury, 255infection, 256lower urinary tract injury, 254–255, 255tvaginal injury, 255–256

long-term complicationsdyspareunia and bowel dysfunction, 257mesh erosion or extrusion, 256–257recurrence of pelvic organ prolapse,

257–258voiding dysfunction, 257

Complications of LPNarterial injury, 154hemorrhage

intraoperative bleeding, 147–148postoperative bleeding, 149–150

hemorrhagic congestion, 155infection, 154–155in the largest series, 149tLPN for solid renal masses, indications, 143LPN, goal, 143NSS, cancer control, 143PSMs

management, 152prevention, 152

RAP, 154risk factors, 155surgical technique

control of the vessels, 144follow-up, 146reconstruction, 144–146tumor excision, 144See also Surgical technique, LPN

urinary leakagemanagement, 151prevention, 151

urinary obstruction, 154WIT

management, 153prevention, 153–154

Complications of pediatric urologic surgeryaccess

bowel perforation, 284fentry-related complications, 283–284epigastric vessel injury at trocar insertion site, 284fiatrogenic iliac vessel injury, 285fimproper port closure, complications, 286insufflatant migration, complications, 286location of port placement, variations, 285port placement and operative strategy, 283fvascular/visceral injury by aggressive needle placement,

284, 284fVeress needle technique, peritoneal approach, 283f

anesthesiacardiac arrhythmias, 281CO2 insufflation due to increased IAP, 280oxygen impairment, 281

complication rates for laparoscopic renal procedures inpediatric population, 281t

complication rates for laparoscopic surgery in pediatricpopulation, 280t

during endoscopic surgery, 281fintraoperative

vascular injury, 286–287viscous injury, see Viscous injury

positioningadequate padding of pressure points, reduced risk of

injury, 282preoperative undocking of robot, 282proper fixation of patient to the bed, 282rate of neuromuscular injuries, 282shear size of the da Vinci R© robot wrt patient, critical

factor, 282, 282fpostoperative

anticipation of risks by surgeons, 289growing level of surgeon experience, benefits, 289infection and herniation, 289

312 Subject Index

Complications of pediatric urologic surgery (cont.)large vessel bleeds, 288spontaneous ventilation impairment, 288Veress needle technique, caution, 289

Complications of RARCaccording to Dindo–Clavien classification system, 238t–239tcystectomy-related complications

bowel leak/enterocutaneous fistula, 242bowel obstruction, 241–242hemorrhage, 237–240prolonged postoperative ileus, 240–241rectal injury, 240venous thromboembolism, 242–243wound infection/fascial dehiscence, 243

diversion-related complicationsureteroenteric anastomotic stricture, 243urine leak, 243

Complications of robotic-assisted laparoscopic surgeryClavien classification of surgical complications, 91tdoulogenic complications

breakage, 96burns, 97ECM or PSM malfunction, 96electrical events, 96–97survey of AEs reported to the FDA MAUDE, 95, 96t

‘FDA approval,’ 93iatrogenic complications

hemorrhage, 93MAUDE, application/limitations, 94non-injurious complications, 95port site hematoma, 93in robotic environment, 93survey of AEs by FDA MAUDE, 95

robotic accidents, 97–98robotic surgery, advantages/disadvantages, 93technical terms used

associated with da Vinci Surgical SystemTM, 92tdoulogenic complications, 92ECM, 92executor/effector unit, 92iatrogenic complications, 92marginal manipulator, 92PSM, 92“robotic,” 91–92

types of complications in RALP, 93, 94tComplications of robotic partial nephrectomy

diagnosis of complicationsbowel injury, 164–165hemorrhage, 164renal insufficiency, 166rhabdomyolysis, 165urine leak, 163–164See also Diagnosis of RALPN complications

intra-operative complications, 162literature

contemporary RALPN series, 162ttypes of complications of RALPN, 162t

partial nephrectomyLPN, 159RALPN, 159treatment of renal tumors, 159

post-operative complications, 162pre-operative technique

bowel preparation, 159identification of renal veins, 160instruments used, 160landmarks identified, 160laparoscopic ultrasound probe, tumor exposure, 160patient positioning, 159positioning of robotic ports, 159, 160frobotic vs. laparoscopic partial nephrectomy, 161

treatment/prevention of complicationsbowel injury, 167–168hemorrhage, 167renal insufficiency, 168rhabdomyolysis, 168urine leak, 166–167See also Treatment/prevention of RALPN complications

Complications of robotic prostatectomyanesthesia-related complications (<0.1%)

corneal abrasions, 202fluid management, 201increased intraabdominal pressure, effects, 201infiltration of intravenous fluids, prevention, 201–202sinus bradycardia, 201

bowel complications (0.2%), 206–207delayed complications

continence, 208potency, 208

lymphocele (0.2%), 207medical complications (0.5%)

low incidence of, factors, 207–208non-vascular access-related complications (0.1%)

open/closed technique, study, 202–203subcutaneous emphysema and air embolism (0%), 202visceral injury (0.1%), 202–203

postoperative anemia and blood transfusionacute postoperative hemorrhage (1.9%), 205meticulous hemostasis, 205patients with chronic anticoagulation, 205

postoperative ileus (0.7%), 206rectal injury (0.3%)

in patients with clinical T3/Gleason 8 or 9 disease, 204posterolateral effects, 204post-operative, repair of, 204recto-vesical fistula, 204

retropubic radical prostatectomy, complication rates, 197technique of VIP

apical dissection and urethral transection, 199bladder neck transection and posterior dissection, 198developing extraperitoneal space, 198lymph node dissection, 198nerve sparing, 198–199patient positioning and port placement, 198patient selection, 198postoperative care, 200–201specimen retrieval, 200suprapubic catheter placement, 200urethrovesical anastomosis, 199–200

treatment of prostate cancer (US), 197ureteral injury (<0.1)

during extended pelvic lymphadenectomy, 204

Subject Index 313

ureteral orifice obstruction during urethrovesicalanastomosis, 204

urinary ascites (0.7%)chemical peritonitis/ileus, 205early continence prevention by two-layer anastomosis,

206patients with unexplained postoperative pain after 48h,

management, 206furinary retention (1.5%), 207vascular complications (<0.1%)

access related, 203access unrelated, 203–204

Complications of single port laparoscopic/robotic surgerysingle port surgery

flexible tip laparoscopes/coaxial flexible operatinginstruments, 261

intraoperative image of multichannel port, 262fLESS surgery, 262natural orifice translumenal endoscopic surgery, 262pain control and cosmesis, benefits, 262selected single port urologic surgery series, 263t

single port surgical complicationsbowel/ureteral injuries, 263Clavien Classification system of long/short-term

complications, 264conversions from single port to standard laparoscopic

procedures, complications, 264–265German study of complication rates, 263–264patient selection, 265reconstructive procedures, complications, 265R-Port device, use of, 264scar image after single port laparoscopic donor

nephrectomy, 266fsingle port laparoscopic surgery in urology (Kaouk and

colleagues), 264single port urologic surgery (Rane and colleagues), 264vascular/infectious complications, 263

Continence, 208Corneal abrasions, 202CPK, see Creatinine phosphokinase (CPK)C-reactive proteins, 24–25Creatinine phosphokinase (CPK), 133, 165, 168Crushing and trapping accidents, 97Cryotherapy, 212, 264, 267, 269, 272Cytokines, 23–28, 36

DDeep venous thrombosis (DVT), 5, 51, 54–56, 82, 93, 115t,

118, 127, 133, 207–208, 241, 243, 264, 298–299Delay under anesthesia (DUA), 95–96Denonvilliers’ fascia, 198–199, 199f, 208, 214, 215f, 220,227Desmopressin, 62Devascularization injury, 63Diagnosis of RALPN complications

bowel injuryrecognized/unrecognized, evaluation of, 164–165

hemorrhagehematuria, delayed hemorrhage, 164immediate post-operative bleeding, effects/prevention,

164

intra-operative hemorrhage, prevention, 164mild gross hematuria, detection, 164post-operative hemorrhage, 164

renal insufficiencyrenal ischemia, 166renal ultrasound, 166renal vascular occlusion, 166WIT, study reports, 166

rhabdomyolysisfasciotomy for compartment syndrome, 165operative intervention for gluteal compartment

syndrome, 165risk factors, 165

urine leakCT urogram study, 164f, 165maximal drainage of urinary tract, methods, 164methylene blue injection into renal pelvis, 163ureteral catheter placement, 163

Diaphragmatic/pleural injuries, 110, 111fDirect nerve injuries, 36, 38Distal ureteral tumors, 116Diuresis, 5, 37, 133, 154, 168Donor medical complications

long-term complications of renal loss and donor safety,139–140

Donor surgical complicationspositioning and surgical entry

DVT, 133pulmonary edema, 133rhabdomyolysis, 133trocar injuries, 133

Doulogenic complications, 92breakage, 96burns, 97ECM or PSM malfunction, 96electrical events, 96–97survey of AEs reported to the FDA MAUDE,

95, 96tDUA, see Delay under anesthesia (DUA)Duodenal artery bleeding, 124Duodenal injury

dissection-related, treatment of, 124duodenal artery bleeding, 124

DVT, see Deep venous thrombosis (DVT)

EECM, see Endoscopic camera manipulator (ECM)ECM/PSM malfunction, 96Ejaculatory dysfunction, 175Electrical events in doulogenic complications,

94t, 96–97Endopyelotomy, 62Endoscopic camera manipulator (ECM), 92, 92tEnergy devices, 5Epigastric vessel injury, repair methods, 48

Carter-Thomason device, 48continuous venous oozing, 48ffascial closures devices, 48Foley catheter, use of, 48open suture ligation via cut-down technique, 48

314 Subject Index

Erectogenic nerve preservation, anatomyfascial planes surrounding prostate capsule

capsular incision, 222LPF, 221prostatic fascia/levator fascia, 221

NVB/CNcross section of adult prostate with NVB situated

posterolaterally, 220fIHP, role in erection/ejaculation/urinary continence, 219

the tri-zonal conceptanatomic findings from cadaveric dissections, 221NVBs in prostatic fossa after removal of prostate gland,

222fperiprostatic nerves, surgical zones, 220, 222f

variations of course of neurovascular bundles, 219ESS, see European scoring system (ESS)European scoring system (ESS), 118

FFascial closures devices, 48FH, see Fractionated heparin (FH)Fiber-optic laryngoscopy, 12Fibrin glue, 61, 144–145, 150, 174Flank position for urologic procedures

advantages, 36neuromuscular complications

brachial plexus injury, 37peroneal nerve injury, 36sciatic nerve injury, 36shoulder pain, 36

FloSeal, 109–110, 134, 150, 166–167,223, 272

Foley catheter, 48, 61–62, 66–67, 69–70, 69f, 129, 137,163, 166–167, 173, 178, 180t, 183–184, 187, 189,193–194, 198–200, 199f, 203, 205, 207, 215f, 248,250, 255, 284, 287–288

Fractionated heparin (FH), 56, 298FRC, see Functional residual capacity (FRC)Functional residual capacity (FRC),

14, 16, 281Furosemide, 37, 154, 168

GGastrointestinal/solid organ injuries

location of injury/treatment and outcome, 76tpancreatic injury, 79recognized bowel injury

large thermal injury and bowel resection,77–79, 78f

small thermal injury and repair, 77, 77fsplenic injury, control of, 79ten patients with laparoscopic bowel injury,

summary of, 75tunrecognized bowel injury, signs/symbols, 79, 79t

GCS, see Graduated compression stockings (GCS)German Urologic Association (GUA), 119Gibson incision, 116, 119Graduated compression stockings (GCS), 56, 243Graft extraction, injuries during

bladder perforation, 137graft injury, 137–138

Graft injury, 137–138GUA, see German Urologic Association (GUA)Gynecologic laparoscopy, 46, 63, 295, 297

HHALNU, see Hand-assisted laparoscopic nephroureterectomy

(HALNU)HALRN, see Hand-assisted laparoscopic renal surgery

(HALRN)Hand-assisted laparoscopic nephrectomy, 131–132Hand-assisted laparoscopic nephroureterectomy (HALNU), 85Hand-assisted laparoscopic renal surgery (HALRN), 82Harmonic scalpel (Ethicon), 49, 108f, 128, 134, 145Hasson technique, 74, 128, 133, 283, 300Hematopoiesis, 23Hematuria, 53, 64, 117, 124, 154, 164, 167, 180t, 181t, 203,

250–251, 255, 271, 287–288Hemorrhage, LPN complications

intraoperative bleedingcase study, 148during parenchymal resection, 147–148upon renal revascularization, 148

postoperative bleedingacute, 149delayed, 149management, 149prevention, 150

Hemorrhagic congestion, 155HLA-DR, see Human leukocyte antigen DR (HLA-DR)Hormonal complications, postoperative, 110

hypotension, cause/treatment, 110inadequate steroid replacement, effects, 110serum/urine hormone levels, preoperative evaluation, 110

Human leukocyte antigen DR (HLA-DR), 26

IIatrogenic complications, 92

hemorrhage, 93MAUDE, application/limitations, 94non-injurious complications, 95port site hematoma, 93in robotic environment, 93survey of AEs by FDA MAUDE, 95

ICIQ-SF, see International Consultation on IncontinenceQuestionnaire-Short Form (ICIQ-SF)

ICP, see Intracranial pressure (ICP)IHP, see Inferior hypogastric plexus (IHP)Impact or collision accidents, 97Inferior hypogastric plexus (IHP), 212, 216, 219, 222Informed consent, definition, 296Injury to blood vessels

bleeding in dorsal venous complexpostoperative duplex scanning, 51prevention, robotic techniques, 50, 50f4th arm/dissecting robotic arms, use in suture prepared,

50, 51fvessel repair under optimal control, 50, 51f

Subject Index 315

collateral circulation, outcomes, 49dissection/trocar or Veress needle insertion, cause, 48increase of intraabdominal pressure to 25 mmHg, 50laparoscopic suction devices with laparotomy pads, 48–49,

49frenal artery injury

monopolar electrocautery/surgical clips for hemostasis,49

tools used for repair, 49Interleukin-1 (IL-1), 24, 26Intermittent pneumatic compression (IPC), 56, 243, 298International Consultation on Incontinence Questionnaire-Short

Form (ICIQ-SF), 213Intracranial pressure (ICP), 4Intra-operative complications of LRN/LNU, 115t

bowel and visceral injury, see Bowel/visceral injury duringLRN

injury to adjacent structuresduodenal injury, treatment, 124liver injury by port placement, 124pancreatic injury, 124splenic injury, 124

port site injuries, placement/closure, 118–119prolonged operative time, 118vascular injury, see Vascular complications

Intraoperative vascular complicationsvascular injury during abdominal access

aortic/vena caval bifurcation at umbilicus, cause of, 47correct placement of Veress needle, 47inadequate reporting of major injuries, consequences, 47injury to epigastric vessels, repair methods, 48mortality rates, access-related vascular injuries, 46safer laparoscopic techniques/devices, 47surgeon experience, critical factor, 47–48trocar-related injuries, 46

Intra-peritoneal insufflation, 14–15IPC, see Intermittent pneumatic compression (IPC)Ischemic colonic stenosis, 123

JJackson–Pratt drainage time, 61

LLaparoendoscopic single-port surgery for donor nephrectomy,

132Laparoendoscopic single-site (LESS) surgery, 262Laparoscopic and robotic adrenal surgery, complications of

access-related complicationscauses, 106open access technique, safer method, 106

bowel injuries, 108–109complications of retroperitoneal laparoscopic

adrenalectomy, 111complications of robotic-assisted adrenalectomy, 111diaphragmatic/pleural injuries, 110indications and techniques

categories, 103laparoscopic adrenalectomy, contradictions, 104large/small adrenal lesions, indications, 104

left retroperitoneal laparoscopic adrenalectomy, 106left transperitoneal laparoscopic/robotic adrenalectomy,

105operative approaches, 104retroperitoneal approach, 105–106right retroperitoneal laparoscopic adrenalectomy, 106right transperitoneal laparoscopic/robotic adrenalectomy,

104–105liver, pancreas, and splenic injury, 109–110postoperative hormonal complications, 110vascular complications

adrenal vein ligation, 107bipolar vessel-sealing devices, 107hemorrhage, prevention, 107injury to IVC at junction of right adrenal vein by

adrenalectomy, 107, 108fintraoperative bleeding, management, 107–108

Laparoscopic and robotic pyeloplasty, complications ofdiagnosis of complications

CT, study of choice, 183CT urogram demonstrating small leak, 183, 184fKUB demonstrating left ureteral stent out of position

following robotic pyeloplasty, 183, 184fretroperitoneal bleeding, diagnosis, 183

literatureconversion of LP to OP, study, 179intraoperative complication rates, study, 178–179minimally invasive pyeloplasty in upper urinary tract

anamolies, 179postoperative complication rates, LP/RALP study, 179,

180t–181ttypes of laparoscopic reconstruction, 178urinary leak, risk factors, 181

operative planningbowel preparation prior to surgery, 181diuretic renal scans, 181preoperative planning, steps, 181secondary repair considerations, 181surgeon’s preference/experience of minimally

invasive/RALP surgery, 181–182transperitoneal/retroperitoneal approach, selection of,

182prevention of complications

aberrant vessels, detection, 183anastomotic suturing by robotic assistance, 182fibrosis prevention around ureter, 182Laparoscopic Doppler probe, identification of crossing

vessels, 183, 183flaparoscopic suturing, 182peri-operative care, 182spatulation of ureter with Potts scissors, 182furine leak management, 183urinoma formation, reduced risk of, 183

procedureanastomosis by robotic techniques, 178, 178fpatient positioning, 177prophylactic antibiotics administration, 177renal pelvis and ureter dissection, 177, 178fstone removal after UPJ obstruction, 177–178trocar placement, 177ureteral stent, postoperative removal, 178

316 Subject Index

Laparoscopic and robotic pyeloplasty (cont.)RALP/LP, benefits over laparoscopy, 177treatment of complications

early restricturing, treatment, 185hematoma management, 184repeat stenting/nephrostomy tube placement for acute

obstruction, 185stent obstruction/migration, 184urinary leakage, management, 184

Laparoscopic and robotic ureteral surgery, complications ofdiagnosis of complications

bleeding signs, 193–194renal ultrasound, obstruction/clot evaluation, 194urinoma differentiated from urine leak by CT scan, 193,

194fliterature

complications of ureteral reimplantation, 190–191complications of ureteroureterostomy and other ureteral

surgery, 191–192management of complications

bleeding, 194recurrence of primary ureteral stricture, 195stent migration, 195tension at anastomosis, 194–195urinary extravasation, 194

operative techniquesinfrequently performed ureteral procedures, 189–190ureteral reimplantation, 189ureteroureterostomy, 187–188

prevention and managementlaparoscopic/robotic urologic reconstructive procedures,

193preoperative preparation and planning, 192–193

UPJO, treatment options, 187vesicoureteral reflux disease/ureteral strictures, treatment,

187Laparoscopic apical prolapse repair

laparoscopic uterosacral fixation, 253sacrocolpopexy

hysterectomy, higher incidence of mesh erosion, 254port placement, 254fsurgical principles of open abdominal sacrocolpopexy,

253–254Laparoscopic Burch coloposuspension, complications of,

247–248intraoperative/perioperative complications

excessive blood loss, 250–251perioperative morbidities, 251small bowel obstruction, 251transient urinary retention, management of, 251unrecognized bowel injury, 250vaginal injury, 250wound infection, 251

long-term complicationspelvic organ prolapse, 252urinary retention, 251–252urinary urgency, 251

lower urinary tract injuryfluoroscopic cystogram/CT, diagnostic study, 250intraoperative complications, 249tintraoperative detection, 250

post-operative bladder injury, symptoms, 250post-operative presentation of sutures, 250tack erosion into bladder, cases, 250

Laparoscopic cholecystectomy, 23–26, 93, 261, 295, 302Laparoscopic cystocele repair

Behnia-Willison reports on, 253pubocervical fascia, identification, 253transvaginal colporrhaphy with/without biograft, 252–253

Laparoscopic donor nephrectomy, 5, 73, 121–122, 127–140,266f, 300

Laparoscopic donor nephrectomy, complications ofcase description, 128–129comparing alternative laparoscopic surgical techniques

hand-assisted laparoscopic nephrectomy, 131–132laparoendoscopic single-port surgery for donor

nephrectomy, 132retroperitoneoscopic donor nephrectomy, 132robotic-assisted laparoscopic donor nephrectomy, 132

donor complications, see Donor medical complications;Donor surgical complications

injuries during graft extractionbladder perforation, 137graft injury, 137–138

overall complication ratesBMI above 30 kg/m2, higher complication rate, 129donor characteristics, 130tgraft/recipient complications, 131intraoperative/postoperative complications, 131Kocak classification scheme, 131largest study in Maryland, reports, 129, 130tmodification of Clavien classification system (Kocak),

129operative outcomes, 130t

recipient complicationseffects of pneumoperitoneum on the graft, 138–139ureteral strictures and complications, 139WIT, 138

renal mobilizationgeneral anatomic considerations, 134

vascular dissection and hilar controldissection and ligation of tributary vessels, 135lymphatic injury and chylous ascites, 136renal artery and vein division, 135–136secondary sensory complications, 136–137

Laparoscopic Doppler probe, 160, 164, 183, 183fLaparoscopic gas insufflation physiology

CO2, role, 20‘ideal’ insufflation gas, 19nitrous oxide as an insufflant, 20pneumoperitoneum effects, 19

Laparoscopic nephroureterectomy (LNU), 28, 85, 113–125,116, 143

Laparoscopic orchiopexy, 278, 302Laparoscopic partial nephrectomy (LPN), 29–30, 59, 60f, 62,

64f, 85, 93, 143–155, 159, 161–162, 166, 267–268,302

Laparoscopic pelvic organ prolapsecomplications, see Complications of laparoscopic pelvic

organ prolapseprocedures for management

laparoscopic apical prolapse repair, 253–254

Subject Index 317

laparoscopic cystocele repair, 252–253laparoscopic rectocele repair, 253

treatment oflaparoscopic/robotic-assisted procedures, long-term

efficacy, 252laparoscopic sacrocolpopexy, 252pelvic compartments, defects in, 252

Laparoscopic pyeloplasty (LP), 62, 85–86, 177, 180t, 181t, 187,192–193, 282f, 302

Laparoscopic pyeloplasty, urinary complicationsclot formation due to postoperative bleeding, 62diagnosis/management, 62Foley catheter drainage/JJ stents for maximum drainage, 62robotic-assisted LP/conventional LP, meta-analysis, 63urinary extravasation, improper management

scarring, 62ureterocalicostomy for repeat pyeloplasty, 62

Laparoscopic radical nephrectomy (LRN), 28–29, 49, 55f, 81f,82, 113–125, 143–144, 268, 301

Laparoscopic radical prostatectomy (LRP), 55, 67, 87f, 88, 93,214, 223, 225

Laparoscopic reconstruction, typesAnderson–Hynes dismembered pyeloplasty, 178Y–V plasty, 178

Laparoscopic rectocele repairkey steps, 253transvaginal approach, 253

Laparoscopic retroperitoneal lymph node dissection (LRPLND),45, 86, 171–176

Laparoscopic/robotic reconstructive procedureslaparoscopic Burch colposuspension, 247–248

complications of, 248–252See also Burch coloposuspension, laparoscopic

pelvic floor disordersadvantages of laparoscopic approach, 247

pelvic organ prolapsecomplications of, 254–258laparoscopic procedures for management, 252–254laparoscopic treatment of, 252See also Laparoscopic pelvic organ prolapse

SUIlaparoscopic treatment for, 247other laparoscopic procedure for, 248See also Stress urinary incontinence (SUI)

Laparoscopic/robotic urologic reconstructive procedures,complications

bleeding, 193recurrence of primary pathology, 193stent migration (proximal or distal), 193tension at anastomosis, 193urinary extravasation, 193

Laparoscopic RPLND, complications ofbleeding and vascular injury

intraoperative bleeding, control, 173–174IVC/aortic injuries, 174laceration of the aorta, control, 174vascular clamping and intracorporeal suturing, 174

chylous ascites, 175–176ejaculatory dysfunction, 175intraoperative/early postoperative/delayed postoperative,

173

laparoscopic RPLND, procedureport placement, 171, 172fposterior peritoneum incision, 172postoperative management, 173precaval residual mass dissection following

chemotherapy, 173fretrocaval dissection by “split-and-roll” technique,

172–173, 173fspermatic cord dissection, 172, 172f

organ injurybowel injury, 174cholecystectomy for gallbladder injury, 174clinical diagnosis, 174intestinal abrasions, use of silk suture, 174mesenteric artery injury, 175pancreatic injury, 174renal vascular injury, 175splenic/liver injury, treatment, 174–175unrecognized ureteral injuries, symptoms, 174ureter injury, prevention, 174

RPLND, treatment of NSGCTindications in low-stage NSCGT, 171postchemotherapy laparoscopic RPLND, 171

small bowel obstruction, 176Laparoscopic surgery and systemic immune response

cell-mediated immunity and response to surgical trauma, 25cytokine/acute-phase proteins response to injury

C-reactive proteins, 24hematopoiesis/leukopoiesis, regulation of, 23IL-6 levels, prolonged tissue injury, 24sources of cytokines, 23TNF-α and IL-1, response to injury, 24

cytokine/acute-phase response on pneumoperitoneumblood analysis, immune/stress response, 25CRP levels, laparoscopic/open cholecystectomy study,

24IL-6 levels, laparoscopic/mini-cholecystectomy groups,

25IL-6 levels, open/laparoscopic nephrectomy in porcine

model, 24effects on cell-mediated inflammatory response

HLA-DR expression, 26neutrophil function, post laparotomy/laparoscopy,

25–26PHA skin testing, 26

effects on peritoneal immunityinsufflation of CO2, effects, 27laparoscopy/laparotomy effects on peritoneal host

defenses in pigs, 27L. monocytogenes administration in mice, study, 27

peritoneal immunity and immune response to surgerycellular response to intraperitoneal inflammation, phases,

26peritoneal macrophages, role, 26TNF and IL-6 levels, cytokine response, 26

Laparoscopic suturing, complications, 182Laparoscopic ultrasound probe, 160Laparoscopy and tumor immunity

port-site metastases, 28–29Lapra-Ty clips, 108, 109f, 144–145, 160, 167, 182Laparoscopic ablation technique, 268

318 Subject Index

Laparoscopic effects on urine outputadequate fluid maintenance, 5diuresis, laparoscopic donor nephrectomy, 5oliguria, 5

Laparoscopic pelvic organ prolapse, complications ofintraoperative/perioperative complications, 249t

bowel injury, 255infection, 256lower urinary tract injury, 254–255, 255tvaginal injury, 255–256

long-term complicationsdyspareunia and bowel dysfunction, 257mesh erosion or extrusion, 256–257recurrence of pelvic organ prolapse, 257–258voiding dysfunction, 257

Laryngeal mask airway (LMA), 12Lateral pelvic fascia (LPF), 219–220, 220f, 221f, 222–225, 226fLateral prostatic fascia nerve-sparing technique, 197LDUH, see Low-dose unfractionated heparin (LDUH)Left retroperitoneal laparoscopic adrenalectomy, 106Left transperitoneal laparoscopic/robotic adrenalectomy

extensive splenic mobilization, 105left adrenal vein identification/dissection, 105trocar positioning, 105

LESS surgery, see Laparoendoscopic single-site (LESS) surgeryLeukopoiesis, 23Ligasure (Valley Lab), 49LigaSure vessel-sealing device, 120Listeria monocytogenes, 27Liver, pancreas, and splenic injury, 109–110LMA, see Laryngeal mask airway (LMA)LMWH, see Low molecular weight heparin (LMWH)LNU, see Laparoscopic nephroureterectomy (LNU);

Laparoscopic nephroureterectomy (LNU)Long/short urine leaks, management, 61Low-dose unfractionated heparin (LDUH), 56Lower tract urinary complications

anastomotic leaks after robotic/laparoscopic prostatectomybladder neck contractures, risk, 67LRP, anastomotic leakage after, 67–68RALP, study results (450 patients review), 67scarring, 67

bladder injuries, 67presentations of anastomotic leaks, 68–70, 68f–69f

follow-up CT cystogram with no leak, 70fLow molecular weight heparin (LMWH), 56LP, see Laparoscopic pyeloplasty (LP)LPF, see Lateral pelvic fascia (LPF)LPN, see Laparoscopic partial nephrectomy (LPN)LPN, urinary leakage after

diagnosis, 60–61kidney obstruction, importance, 60urethral catheter, use of, 60urinary extravasation after LPN, 60f

future direction, 62leak-specific complication rate, 60management of urine leaks

concomitant retrograde pyelogram, 61Jackson–Pratt drain as siphon to keep leak open, 61flong/short urine leaks, 61placement of ureteral stents, 61

prolonged leakage prevention, 61–62urostomy collection appliance, 61

overall urologic complication rate, 60urologic complication rate, LPN/OPN groups, 60

LRN, see Laparoscopic radical nephrectomy (LRN)LRN/LNU, complications, 114t

complications affecting oncologic outcometumor seeding prevention, 125TUR site recurrence, factors, 125urologic literature of port site recurrence, cases, 125

ESS classification of laparoscopic procedures, 118intra-operative complications, 115t

bowel and visceral injury, see Bowel/visceral injuryduring LRN

injury to adjacent structures, 124port site injuries: placement and closure, 118–119prolonged operative time, 118vascular injury, see Vascular injury during LNU

laparoscopic learning curve of complication rates, 118tpost-operative complications, 115t, 124surgical approach

management of the distal ureter for nephroureterectomy,116–117

retroperitoneal, 116transperitoneal, 113–115

LRP, see Laparoscopic radical prostatectomy (LRP)LRPLND, see Laparoscopic retroperitoneal lymph node

dissection (LRPLND)Lymphangiography, 175Lymphatic injury and chylous ascites, 136Lymphoceles, 173, 175, 207–208Lymphoscintigraphy, 175

MMAG3, see Tc-99m mercaptotriacetylglycine (MAG3)Male continence mechanism, anatomy of

dual basis for continence control, 212male urethral sphincter complex, components, 212, 213furethral rhabdosphincter, 212

Male cystoprostatectomy, operative stepsanterior exposure and apical dissection, 235–236control of vascular pedicles and mobilization of NVB, 235crossing of the ureter, 236development of anterior rectal space, 234–235, 235fdevelopment of lateral pelvic space, 234, 235fdevelopment of periureteral space, 234

anatomical landmarks for the technique of spaces, 234fsurgical development of avascular spaces, 233–234

Malpractice and minimally invasive urologic surgeryanesthetic considerations

increased intraabdominal pressure, effects, 298for patients with COPD, 298physiologic changes to be monitored by anesthesiologist,

298bowel injury, 300–301conversion to open

simple/donor nephrectomy, conversion rates, 301DVT

non-randomized study, 298patients at high risk, heparin treatment, 298

Subject Index 319

pneumatic compression devices, use of, 298risk factors, 298–299

fundamental principles, minimally invasive techniques, 295informed consent

Australian Law Reform Commission document,disclosure of risks, 296

Bolitho case, 296case of Canterbury v. Spence (1972), 296case of Natanson v. Kline (1960), 296critical elements of, 296tdegree of disclosure, 296electronic consent form system, emergence of, 297English tort law, 296factors to be considered, 296, 297tpre-operative documentation in medical records, 297Schloendorff v. Society of New York Hospitals (1914),

view of ‘informed consent,’ 296laparoscopic access

10-step guidelines for closed lapproscopic access, 299tstudy of bowel or retroperitoneal vascular injuries, 299study of trocar injuries, 299trocar entry technique, advantages over Veress needle

technique, 299patient positioning

rhabdomyolysis, increased risk of renal failure, 298ulnar neuropathy, 298

pediatric population, unique aspectsbladder injuries during laparoscopic orchiopexy, 302non-access related complications, 301–302

specific considerations in urologydecision of laparoscopic/robotic approach, criteria,

297–298laparoscopic operations, morbidity/mortality rates, 297risks factors for increased complications, 297

vascular injuryhemostasis, importance, 300injury to epigastric vessels, 300intra-operative management, 300self-locking clip, warning against use, 300

wound closure, 301Mannitol, 22, 37, 138, 144, 154, 160–161, 168Manufacturer and User Facility Device Experience (MAUDE),

94MAUDE, see Manufacturer and User Facility Device

Experience (MAUDE)MAUDE database, 94MDCTA, see Multidetector CT angiogram (MDCTA)Mechanical part accidents, 97–98Metabolic changes and procedure duration

patients with COPD, postoperative care, 5retroperitoneoscopic approach, 5venous stasis, obese patients, 5

Metabolic/renal complications and immunologic implicationscardiovascular consequences of laparoscopic surgery

CO2 absorption and hypercarbia, effect of, 22pneumoperitoneum, mechanical effects of, 21–22renal perfusion and function, effects, 22–23

CO2 gas physiology, 20laparoscopic gas insufflation physiology, 19–20laparoscopic surgery and systemic immune response

cell-mediated immunity and response to surgical trauma,25

cytokine and acute-phase proteins response to injury,23–24

effects of pneumoperitoneum on acute-phase responseand cytokines, 24–25

effects on cell-mediated inflammatory response, 25–26effects on peritoneal immunity, 27–28peritoneal immunity and immune response to surgery,

26–27laparoscopy and tumor immunity

open/laparoscopic radical nephrectomy, comparitivestudy, 28

port-site metastases, 28–29role of laparoscopy on tumor growth, experimental

study, 28renal function complications following laparoscopy

laparoscopic partial nephrectomy, 29–30WIT, impact on renal function, 30

MHC-II molecule, see Class II major histocompatibility(MHC-II) molecule

Minimally invasive urologic surgery, medicolegal aspectsdefinitions

elements of negligence, 294factors determining whether a duty of care exists, 294oncology and endourology, clinical areas in suts, 294Tort law, 293

future considerationsexpert testimony, 303innovations in minimally invasive surgery, 302tort reform, 303training and credentialing, 302–303

and malpracticeanesthetic considerations, 298bowel injury, 300–301conversion to open, 301DVT, 298–299fundamental principles, analysis from minimally

invasive techniques, 295informed consent, 296–297laparoscopic access, 299–300patient positioning, 298pediatric population, unique aspects, 301–302specific considerations in urology, 297–298vascular injury, 300wound closure, 301See also Malpractice and minimally invasive urologic

surgeryoverview of the problem

patients affected by medical errors, reports, 293Montsouris technique, 197Multidetector CT angiogram (MDCTA), 120, 128

NNatural orifice translumenal endoscopic surgery (NOTES), 262Nephron-sparing surgery (NSS), 143, 151, 267Nerve preservation and cancer control

Cornell risk-stratified approachathermal robotic nerve-sparing technique, modifications,

227

320 Subject Index

Nerve preservation and cancer control (cont.)Grade 1 approach, 227Grade 2 approach, 227Grade 3 approach, 227Grade 4 approach, 227planes of dissection for differing grades (I–IV) of nerve

sparing, 227frisk-stratified algorithm, 226f

Neuromuscular complicationsin obese patients, 37overstretching of brachial plexus, 37peroneal nerve injury, 36sciatic nerve injury, 36shoulder pain, 36

Neuropathic pain mechanisms, 36Neurovascular bundles (NVB), 198, 205, 212, 216, 219–223,

222f, 235Non-absorbable polymer ligating (NPL) locking clips, 121Nonseminomatous germ cell tumors (NSGCT), 171NOTES, see Natural orifice translumenal endoscopic surgery

(NOTES)NSGCT, see Nonseminomatous germ cell tumors (NSGCT)NSS, see Nephron-sparing surgery (NSS)NVB, see Neurovascular bundles (NVB)

OOAB, see Overactive bladder (OAB)Obesity hypoventilation syndrome, 11Obstructive sleep apnea (OSA), 11Oliguria, 5

ADH, role in, 22ONUs, see Open nephroureterectomies (ONUs)Open duodenojejunostomy, 124Open Hassan technique, 46Open nephroureterectomies (ONUs), 117Open suture ligation via cut-down technique, 48Operative approaches, adrenal surgery

laparoscopic approach, 104lateral transperitoneal technique, 104

robotic approachthree- or four arm robot, use of, 104

Operative strategies for preservation of sexual functionalternatives to electrocautery

control of lateral prostatic pedicles using atraumaticbulldog clamps, 223f

intraoperative use of KTP laser to mobilize NVB, 224fmaneuvers in radical retropubic prostatectomy, 222nerve reconstruction, 224periprostatic planes of fascial dissection, 224–225

Operative techniques, laparoscopic/robotic ureteral surgeryinfrequently performed ureteral procedures

retrocaval ureter, management, 190RPF, open surgical management, 189–190

ureteral reimplantationanti-reflux procedure, selective cases, 189port placement, 189, 189f

ureteroureterostomyanastomosis of ureter, sutures used, 188complications, 191–1925-Fr open-ended catheter, placement of, 188

port placement, 188, 188frobotic-assisted vs. laparoscopic ureteroureterostomy,

188under undue tension, procedures, 188, 189f

Opsins, 26Organ injury, RPLND complications

bowel injury, 174cholecystectomy for gallbladder injury, 174clinical diagnosis, 174intestinal abrasions, use of silk suture, 174mesenteric artery injury, 175pancreatic injury, 174renal vascular injury, 175splenic/liver injury, treatment, 174–175unrecognized ureteral injuries, symptoms, 174ureter injury, prevention, 174

OSA, see Obstructive sleep apnea (OSA)Overactive bladder (OAB), 251

PPancreatic injury, 79, 82, 110, 124, 174Patient positioning

energy devices, use of, 5lateral decubitus positioning, 5reverse Trendelenburg (head-up) position, 4–5Trendelenburg (head-down tilt) position, 4

Patient side manipulators (PSM), 92Pediatric urologic surgery

complicationsaccess, 283–286anesthesia, 280–282intraoperative, 286–288positioning, 282postoperative, 288–289See also Complications of pediatric urologic surgery

contraindicationsbowel obstruction, 279peritonitis, 279pregnancy, 279role of endoscopic surgery, pediatric urology, 279uncorrectable coagulopathy, 279

laparoscopy versus robotic surgerycost aspects, 280robot disadvantage, immensity of equipment for infant

use, 280robotic interface, advantages to surgeon, 280

patient selectionage/size of patient population, challenges, 279fetal laparoscopic/robotic procedures in animal models,

attempts, 279procedures

endoscopic, in pediatric urologic population, 278fextirpative surgery, 278laparoscopic orchiopexy, 278for neurogenic patients, 279non-palpable testes, diagnosis of, 278reconstructive surgery, 278robotic surgery, 279

Pediatric urologic surgery, complications ofaccess

Subject Index 321

bowel perforation, 284fentry-related complications, 283–284epigastric vessel injury at trocar insertion site, 284fiatrogenic iliac vessel injury, 285fimproper port closure, complications, 286insufflatant migration, complications, 286location of port placement, variations, 285port placement and operative strategy, 283fvascular/visceral injury by aggressive needle placement,

284, 284fVeress needle technique, peritoneal approach, 283f

anesthesiacardiac arrhythmias, 281CO2 insufflation due to increased IAP, 280oxygen impairment, 281

complication rates for laparoscopic renal procedures inpediatric population, 281t

complication rates for laparoscopic surgery in pediatricpopulation, 280t

during endoscopic surgery, 281fintraoperative

vascular injury, 286–287viscous injury, see Viscous injury

positioningadequate padding of pressure points, reduced risk of

injury, 282preoperative undocking of robot, 282proper fixation of patient to the bed, 282rate of neuromuscular injuries, 282shear size of the da Vinci R© robot wrt patient, critical

factor, 282, 282fpostoperative

anticipation of risks by surgeons, 289growing level of surgeon experience, benefits, 289infection and herniation, 289large vessel bleeds, 288spontaneous ventilation impairment, 288Veress needle technique, caution, 289

PEEP, see Positive end-expiratory pressure (PEEP)Pelvic floor disorders, 247Pelvic floor muscle therapy, 214Penile erection, 219Perioperative pulmonary complications (PPCs), 10Peroneal nerve injury, 36PFT, see Pulmonary function testing (PFT)PHA, see Phytohemagglutinin (PHA)Physiological changes with immune function, 5–6Physiology of laparoscopy and pneumoperitoneum

background, 3cerebral blood flow

rise in ICP, causes, 4CO2 embolus

“air lock” in atrium, 5effects on urine output

adequate fluid maintenance, 5diuresis, laparoscopic donor nephrectomy, 5oliguria, 5

metabolic changes and procedure durationpatients with COPD, postoperative care, 5retroperitoneoscopic approach, 5venous stasis, obese patients, 5

patient positionenergy devices, use of, 5lateral decubitus positioning, 5reverse Trendelenburg (head-up) position, 4–5Trendelenburg (head-down tilt) position, 4

pediatricslow pulmonary reserve in children/neonates, 4

physiological changes with immune function, 5–6pulmonary/cardiovascular/hemodynamic effects by CO2

insufflationarrhythmias, 4bradycardia, 4pressure effects of 10 and 20 mmHg pneumoperitoneum,

4trenin–angiotensin–aldosterone stimulation, 4

Phytohemagglutinin (PHA), 26Pickwickian Syndrome, see Obesity hypoventilation syndromePluck technique, 116PNB, see Predominant neurovascular bundle (PNB)Pneumothorax/hemothorax, 271Pneumovax vaccine, 124PNP, see Proximal neurovascular plate (PNP)Polysomnography, 11Port placement injury

bowel injury, 118–119trocar site hernias, 119vascular injury, 118–119

Port site injuries, 118–119Port-site metastases

abdominal wall metastases, cases, 29incidence of metastases, 28–29localization of tumor metastases, factors, 29tumor seeding, experimental/clinical studies, 29

Positional/neuromuscular complications, 36tcompartment syndrome

signs/risk factors, 38WLCS, cause/treatment, 38

direct nerve injuries, 38neuromuscular injury-associated pain, mechanisms

peripheral/central pathway, 36neuromuscular injury associated with robotic surgery

patient position for renal/adrenal laparoscopic surgery,36

patient position for robotic radical prostatectomy, 36patient positions, commonly used, 36

patient positioning considerationsin obese patients, 37pelvic surgery, Trendelenburg in conjunction with

lithotomy position, 37pressure evaluation in skin-to-table surface interfaces, 37radical prostate surgery, exaggerated lithotomy position,

37urologic procedures, flank position, see Flank position

for urologic proceduresprevention

careful patient positioning, 39design of laparoscopic instruments, improvements in, 40gel padding and egg crate for patient positioning, 39lithotomy positioning, WLCS, 40novel/ergonomic position, laparoscopic kidney surgery,

39

322 Subject Index

Positional/neuromuscular complications (cont.)partial flank positioning, 39rhabdomyolysis prevention, 40

rhabdomyolysis, 37–38surgeon’s neuromuscular complications

robotic-assisted laparoscopic surgery vs. standardlaparoscopic surgery, 39

Positive end-expiratory pressure (PEEP), 17Positive surgical margins (PSMs)

clamped/unclamped LPN, study, 152cohort study of 56, 152

overall and cancer specific survival rates, 152management, 152prevention

three-dimensional preoperative imaging/intraoperativeultrasound, 152

tumor resection in bloodless field, 152study of 511 LPN cases, results, 151survey results (Breda), 151

Posterior reconstruction of Denonvilliers’ musculofascial plate(PRDMP), 214, 215f

Postoperative anemia/blood transfusion, robotic prostatectomyacute postoperative hemorrhage (1.9%)

management of postoperative hypotension, algorithm,205f

meticulous hemostasis, 205patients with chronic anticoagulation, 205

Postoperative vascular complicationsdelayed presentation of injuries, reasons/symptoms, 52–53hemorrhagic complications, 52

CT after laparoscopic partial nephrectomy, 52, 53f, 55frenal angiography of patient, 53, 54frenal artery pseudoaneurysm/AVF, 52selective angiographic embolization, treatment, 53

patients at riskdevelopment of DVT, risk factors, 56FH/SCD for venous thrombosis prophylaxis, study, 56pulmonary embolism, common cause of death, 55thromboembolism risk, grouping factors, 56thromboprophylaxis, therapies used, 56

venous thromboembolismDVT/PE, study in prostate cancer patients, 55DVT, risk of, 54prevention, recommendations, 56

Postprostatectomy erectile dysfunction, risk factorspenile erection/tumescence, 219

cholinergic/non-adrenergic non-cholinergic mechanisms,219

sexual dysfunction, 219Postprostatectomy incontinence (PPI), 212

assessmentICIQ-SF/standardized 1-h pad test, 213–214initial evaluation factors of PPI, 213pelvic floor muscle therapy, 214urodynamic studies and urethrocystoscopy, 214

risk factors, 212Potency, 208Pouch of Douglas, 234PPCs, see Perioperative pulmonary complications (PPCs)PPI, see Postprostatectomy incontinence (PPI)

PRDMP, see Posterior reconstruction of Denonvilliers’musculofascial plate (PRDMP)

Predominant neurovascular bundle (PNB), 220Preoperative preparation/planning, laparoscopic/ robotic

ureteral surgeryCT/MR urography, ureteral stricture assessment, 192CT scan, hydronephrosis assessment, 192robotic techniques, advantages, 192transperitoneal/extraperitoneal approach, selection criteria,

193ureteral reconstructive surgical techniques, 192t

Proximal neurovascular plate (PNP), 220PSM, see Patient side manipulators (PSM)PSMs, see Positive surgical margins (PSMs)Pulmonary edema, causes, 15, 131, 133, 139Pulmonary function testing (PFT)

arterial blood gas measurement, 10spirometry, 10

Pulmonary thromboembolization, 14

RRadiofrequency ablation (RFA), 267RALP, see Robotic-assisted laparoscopic prostatectomy

(RALP); Robotic-assisted laparoscopic pyeloplasty(RALP)

RAP, see Renal artery pseudoaneursym (RAP)RARC, see Robot-assisted radical cystectomy (RARC)RARC, technique of

complications, see Complications of RARClymph node dissection, 236–237operative steps for male cystoprostatectomy, 233–236

RCC, see Renal cell cancer (RCC); Renal cell carcinoma (RCC)Recipient complications

effects of pneumoperitoneum on the graft, 138–139ureteral strictures and complications, 139WIT, 138

Release and roll technique, RARC, 236–237Renal artery and vein division, 135–136Renal artery pseudoaneursym (RAP), 52, 154Renal cell cancer (RCC), 267Renal cell carcinoma (RCC), 125Renal function complications following laparoscopic renal

surgery, 29–30Renal hilar vascular anatomy, 120–121Renal hilum, methods of hemostasis, 121–122Renal insufficiency, 29Renal mobilization

anatomic considerationsunique to left kidney, 134unique to right kidney, 134

Retrocaval ureter, 190Retrograde ureteropyelography, 64Retroperitoneal fibrosis (RPF), 189Retroperitoneal laparoscopic adrenalectomy, complications of,

111Retroperitoneoscopic donor nephrectomy, 132Retropubic radical prostatectomy, 197Reverse nephropexy, 188, 189fRFA, see Radiofrequency ablation (RFA)Rhabdomyolysis

Subject Index 323

clinical post-operative symptoms, 37ischemia/death of muscle cells, 37patient positioning, 37prevention, 40risk factors, laparoscopic surgery, 38tissue injury, degree of, 37treatment, 37

Right retroperitoneal laparoscopic adrenalectomy, 106Right transperitoneal laparoscopic/robotic adrenalectomy

liver mobilization, 104right adrenal vein identification/dissection, 104–105trocar positioning, 104

Robot-assisted radical cystectomy (RARC), 233–244Robotic accidents

crushing and trapping accidents, 97impact or collision accidents, 97mechanical part accidents, 97–98

Robotic-assisted adrenalectomy, complications of, 111Robotic-assisted laparoscopic donor nephrectomy, 132Robotic-assisted laparoscopic prostatectomy (RALP), 67Robotic-assisted laparoscopic pyeloplasty (RALP), 177Robotic-assisted laparoscopic surgery, complications of

Clavien classification of surgical complications, 91tdoulogenic complications

breakage, 96burns, 97ECM or PSM malfunction, 96electrical events, 96–97survey of AEs reported to the FDA MAUDE, 95, 96t

‘FDA approval,’ 93iatrogenic complications

hemorrhage, 93MAUDE, application/limitations, 94non-injurious complications, 95port site hematoma, 93in robotic environment, 93survey of AEs by FDA MAUDE, 95

robotic accidents, 97–98robotic surgery, advantages/disadvantages, 93technical terms used

associated with da Vinci Surgical SystemTM, 92tdoulogenic complications, 92ECM, 92executor/effector unit, 92iatrogenic complications, 92marginal manipulator, 92PSM, 92“robotic,” 91–92

types of complications in RALP, 93, 94tRobotic-assisted vs. laparoscopic ureteroureterostomy, 188Robotic partial nephrectomy, complications of

diagnosis of complicationsbowel injury, 164–165hemorrhage, 164renal insufficiency, 166rhabdomyolysis, 165urine leak, 163–164See also Diagnosis of RALPN complications

intra-operative complications, 162literature

contemporary RALPN series, 162t

types of complications of RALPN, 162tpartial nephrectomy

LPN, 159RALPN, 159treatment of renal tumors, 159

post-operative complications, 162pre-operative technique

bowel preparation, 159identification of renal veins, 160instruments used, 160landmarks identified, 160laparoscopic ultrasound probe, tumor exposure, 160patient positioning, 159positioning of robotic ports, 159, 160frobotic vs. laparoscopic partial nephrectomy, 161

treatment/prevention of complicationsbowel injury, 167–168hemorrhage, 167renal insufficiency, 168rhabdomyolysis, 168urine leak, 166–167See also Treatment/prevention of RALPN complications

Robotic prostatectomy, complications ofanesthesia-related complications (<0.1%)

corneal abrasions, 202fluid management, 201increased intraabdominal pressure, effects, 201infiltration of intravenous fluids, prevention, 201–202sinus bradycardia, 201

bowel complications (0.2%), 206–207delayed complications

continence, 208potency, 208

lymphocele (0.2%), 207medical complications (0.5%)

low incidence of, factors, 207–208non-vascular access-related complications (0.1%)

open/closed technique, study, 202–203subcutaneous emphysema and air embolism (0%), 202visceral injury (0.1%), 202–203

postoperative anemia and blood transfusionacute postoperative hemorrhage (1.9%), 205meticulous hemostasis, 205patients with chronic anticoagulation, 205

postoperative ileus (0.7%), 206rectal injury (0.3%)

in patients with clinical T3/Gleason 8 or 9 disease, 204posterolateral effects, 204post-operative, repair of, 204recto-vesical fistula, 204

retropubic radical prostatectomy, complication rates, 197technique of VIP

apical dissection and urethral transection, 199bladder neck transection and posterior dissection, 198developing extraperitoneal space, 198lymph node dissection, 198nerve sparing, 198–199patient positioning and port placement, 198patient selection, 198postoperative care, 200–201specimen retrieval, 200

324 Subject Index

Robotic prostatectomy (cont.)suprapubic catheter placement, 200urethrovesical anastomosis, 199–200

treatment of prostate cancer (US), 197ureteral injury (<0.1)

during extended pelvic lymphadenectomy, 204ureteral orifice obstruction during urethrovesical

anastomosis, 204urinary ascites (0.7%)

chemical peritonitis/ileus, 205early continence prevention by two-layer anastomosis,

206patients with unexplained postoperative pain after 48h,

management, 206furinary retention (1.5%), 207vascular complications (<0.1%)

access related, 203access unrelated, 203–204

Robotic radical prostatectomy, 36Robotic radical prostatectomy, methods/maneuvers of

improvementnerve preservation and cancer control, 225–226optimizing continence recovery

anatomy of male continence mechanism, 213ART, 216–218PPI assessment, 213–214PPI, risk factors, 212surgical maneuvers, see Surgical maneuvers for

optimizing continence outcomesurinary incontinence, effects/treatment, 212

optimizing sexual outcomesbalancing nerve preservation with cancer control, see

Nerve preservation and cancer controlerectogenic nerve preservation, anatomy, 219–221postprostatectomy erectile dysfunction, risk factors,

218–219preservation of sexual function, operative strategies,

see Operative strategies for preservation of sexualfunction

Robotic vs. laparoscopic partial nephrectomy, 161RPF, see Retroperitoneal fibrosis (RPF)R-Port device, use in single port surgery, 264

SSacrocolpopexy, 252–258, 254f, 255tSantorini plexus, 199, 213fScarring treatment, 62SCD, see Sequential compression devices (SCD)Sciatic nerve injury, 36Secondary sensory complications, vascular dissection, 136–137Sequential compression devices (SCD), 5, 50, 56, 159,

177, 200Sexual health inventory for men (SHIM), 208SHIM, see Sexual health inventory for men (SHIM)Single port laparoscopic/robotic surgery, complications of

single port surgeryflexible tip laparoscopes/coaxial flexible operating

instruments, 261intraoperative image of multichannel port, 262fLESS surgery, 262

natural orifice translumenal endoscopic surgery, 262pain control and cosmesis, benefits, 262selected single port urologic surgery series, 263t

single port surgical complicationsbowel/ureteral injuries, 263Clavien Classification system of long/short-term

complications, 264conversions from single port to standard laparoscopic

procedures, complications, 264–265German study of complication rates, 263–264patient selection, 265reconstructive procedures, complications, 265R-Port device, use of, 264scar image after single port laparoscopic donor

nephrectomy, 266fsingle port laparoscopic surgery in urology (Kaouk and

colleagues), 264single port urologic surgery (Rane and colleagues), 264vascular/infectious complications, 263

SMA injury, see Superior mesenteric artery (SMA) injurySmall bowel obstruction, 176Soluble tumor necrosis factor receptors (sTNFR), 24Spermatic cord, 172, 172fSpirometry, 10–11Splenectomy, 79, 124, 134, 269tSplenic injury after LRN/LNU

Pneumovax vaccine, post-splenectomy patients, 124treatment, 124

Splenic injury controlbiocompatible liquid polymers, 79splenectomy, 79

Stapler malfunction, 51–52Stent migration (proximal or distal), 193STEP procedure, 74–75sTNFR, see Soluble tumor necrosis factor receptors (sTNFR)Stress urinary incontinence (SUI)

laparoscopic Burch coloposuspension, see Burchcoloposuspension, laparoscopic

laparoscopic treatment, 247other laparoscopic procedures

laparoscopic-assisted suburethral sling placement, 248use of robotic system, 248

Subcutaneous emphysema, 202SUI, see Stress urinary incontinence (SUI)Superior mesenteric artery (SMA) injury, 120Surgical approach for LRN/LNU

management of distal ureter for nephroureterectomydirect cystoscopic visualization technique/modifications,

116–117LNUs/ONUs, comparitive study, 117mitomycin C induction, 116pluck technique, 116renal dissection in case of tumors, 116

retroperitonealaccess to renal hilum, 116Gaur’s technique, 116initial incision at 12th rib, 116port-site incision, 116

transperitonealdissection of kidney/Gerota’s fascia, 114trocar positioning, 113–114

Subject Index 325

Surgical maneuvers for optimizing continence outcomesbladder neck mucosal eversion, 215BNI, 215optimizing preservation of urethral rhabdosphincter length,

214PRDMP, 214, 215fpreservation of bladder neck and internal sphincter, 214–215preservation of neurovascular bundles and continence

nerves, 216preservation of puboprostatic ligaments and arcus tendineus,

216Surgical technique, LPN

control of vesselsapplication of tourniquet around renal artery, 145fapplication of tourniquet around renal vein, 146fself-made Rummel tourniquet for temporary occlusion,

144ffollow-up

CT or MRI scanning, 146renal function evaluation with 99mTc-MAG3, 146

reconstructionapproximation of interstitial tissue (medulla), 145, 148ffibrin injection, 145oxidized regenerated cellulose placement under suture,

145, 148frenal parenchymal repair by Vicryl suture, 144–145,

148frenal perfusion, 145tightened suture secured by non-resorbable clips, 145,

148ftumor excision

in a bloodless field, 144, 147finduction of ischemia using the Rummel tourniquet, 144,

147fuse of cold Endo-Scissors, aim, 144

Surgicel, 134, 150, 160, 167, 174, 272

TTA stapler, see Thoracoabdominal (TA) staplerTCC, see Transitional cell carcinoma (TCC)Tc-99m mercaptotriacetylglycine (MAG3), 64Thermal ureteral injury, 174Thoracoabdominal (TA) stapler, 121TissueLink R© device, 160, 167Tort law, 293Tort reform, 303Total peripheral nutrition (TPN), 271TPN, see Total peripheral nutrition (TPN)Transitional cell carcinoma (TCC), 85–86, 125Transurethral resection (TUR), 125, 240, 294, 297Treatment of rhabdomyolysis, 37Treatment/prevention of RALPN complications

bowel injuryintra-operative consultation, 168laparotomy, unrecognized bowel injuries, 168

hemorrhagearterial bleeding, control of, 167hemostatic agents, use of, 167immediate/delayed, treatment strategies, 167

renal angiogram of kidney before/after superselectivearterial embolization, 165f, 167

TissueLink R©device, prevention of bleeding off-clamp,167

renal insufficiencyadministration of furosemide, effects, 168administration of mannitol, effects, 168clamping of renal artery, control of bleeding, 168minimizing ischemia, techniques, 168

rhabdomyolysisCK for clinical analysis, 168compartment syndrome, treatment, 168urine alkalinization management, 168

urine leakcombination of sutured surgical bolster and Floseal R©,

166JP drain fluid creatinine, assessment, 166multiple synthetic compounds, use of, 166serial imaging, improvement of urinoma,

166–167Trocar site hernias, 79–82, 80f

closure of fascial defects, benefits, 81formation, influencing host factors, 81higher incidence in closed laparoscopy, 81incidence in gynecologic literature, 81incisional/extraction site hernias, risk factors,

81–82, 81fhand-assisted laparoscopic radical nephrectomy, 82

from 8 mm robotic trocar, 81fparaumbilical region, development site, 81

Tumor necrosis factor (TNF-α), 24TUR, see Transurethral resection (TUR)

UUPJ, see Ureteropelvic junction (UPJ)UPJO, see Ureteropelvic junction obstruction (UPJO)Upper tract urinary complications, 59

ureterolysis, 59urinary complications after laparoscopic pyeloplasty, see

Laparoscopic pyeloplasty, urinary complicationsurinary complications after LPN, see LPN, urinary leakage

afterUreteral injuries

gynecologic laparoscopy, risk factors, 63intra-operative management

laparoscopic uretero-ureterostomy for ureter injured withsuture, 63

tension-free anastomosis, ureter repair, 64, 64fureteral identification, 63

mechanisms ofdivision, ligation, and cauterization, 63

postoperative managementcolorenal fistulas due to prolonged urinoma, 65, 66fCT scans, location/extent of leak determination, 64, 65fproximal ureteral injury, repair techniques, 65retrograde ureteropyelography, 64ultrasound and MAG3 renal scans, 64ureteral stricture formation, complication, 65–66ureterovaginal fistula, diagnosis, 66urinoma treatment, 64, 65f

326 Subject Index

Ureteral reimplantation, 189complications

complication rates, study, 190laparoscopic and robotic-assisted complications, 191tpatient study with laparoscopic ureteroneocystostomy,

190–191postoperative complications, 190urine leak/urinoma, 190

Ureterocalicostomy, 62, 180t, 185Ureterolysis, 59, 188, 192, 250Ureteropelvic junction obstruction (UPJO), 86, 187Ureteropelvic junction (UPJ), 154, 179Ureteroureterostomy, 187–188

anastomosis of ureter, sutures used, 1885-Fr open-ended catheter, placement of, 188port placement, 188, 188frobotic-assisted vs. laparoscopic ureteroureterostomy, 188under undue tension, procedures, 188, 189f

Ureterovaginal fistula, diagnosis, 66“pad test,” 66

Urethral rhabdosphincter, 212, 213f, 214, 215f, 216,217f, 218f

Urinary and urologic complicationslower tract urinary complications

anastomotic leaks after robotic or laparoscopicprostatectomy, 67–68

bladder injuries, 67presentations of anastomotic leaks, 68–70

upper tract urinary complications, 59urinary complications after laparoscopic pyeloplasty,

62–63urinary leakage after LPN, 60–62

ureteral injuriesintra-operative management, 63–64postoperative management, 64–66

Urinary extravasation, 60f, 62, 181–182, 193–194Urinary leakage, LPN complications

frequency of occurrence, 150management, 151

intra-/post-operative, 151overall incidence rates, 150prevention

hemostatic agents/sealants, use of, 151ureteral stent placement for methylene blue injection,

151urinary fistula, suture repair, 150

Urinary obstruction, 154Urinary peritonitis, 205–206Urostomy collection appliance, 61

VVascular complications

incidenceconversion to open surgery, 46dissection injuries, urologic procedure, 45stapler malfunction/accidental dislodgement of vascular

clip, 46trocar-related injuries, nonurologic procedure, 45urologic malignancy, complication, 45

injury to major blood vessels, 48–51

intraoperative, see Intraoperative vascular complicationskey to management, 45postoperative complications, see Postoperative vascular

complicationsstapler malfunction, 51–52

Vascular dissection and hilar controldissection and ligation of tributary vessels, 135lymphatic injury and chylous ascites, 136renal artery and vein division, 135–136secondary sensory complications, 136–137

Vascular injury during LNUadrenal vascular injury

adrenal hemorrhage, 120bleeding, source of, 119–120

control by LigaSure vessel-sealing device, 120renal hilum, methods of hemostasis

failure of hemostatic devices, 121failure of NPL locking clips, 121, 122non-locking titanium clip devices, problems, 122renal artery stump with non-locking metal clip distal to

locking clips, 122frenal artery with two locking/non-locking metal clips

placed distally, 122fstapled and transected renal vein, 123funbladed Endo-GIA stapler, 123fvenous/arterial, endovascular stapler/clip complications,

121–122SMA injury, 120variability in renal hilar vascular anatomy

bleeding from vena cava at hilum, 121Japanese cadaver study, 120LRN/LNU cases of conversion to open surgery,

120–121MDCTA, 120renal vein hemorrhage, 121

Vasoactive substances, 26Vattikuti Institute Prostatectomy (VIP), 197Veil of Aphrodite, see Lateral prostatic fascia nerve-sparing

techniqueVenous thromboembolism, 19, 54–56, 242–243, 298

See also Deep venous thrombosis (DVT)Veress needle approach, 74Vesicovaginal fistula, 66

“double dye pad test,” 66VIP, see Vattikuti Institute Prostatectomy (VIP)VIP technique, robotic prostatectomy

apical dissection and urethral transection, 199bladder neck transection/posterior dissection, 198developing extraperitoneal space, 198lymph node dissection, 198nerve sparing

minimal bipolar coagulation, 198“Veil of Aphrodite” (high anterior release/curtain

dissection), 198patient positioning and port placement, 198patient selection, 198postoperative care

complications in 4,000 patients undergoing VIT, 201tdata collection, 201early ambulation, 200heparin, thromboembolic prophylaxis, 200

Subject Index 327

ketorolac/oral acetaminophen with codeine, pain control,200

liquid diet, recommended, 200–201specimen retrieval, 200suprapubic catheter placement, 200, 200furethrovesical anastomosis

causative factors, 199randomized control study, 199sutures run from 4 o’clock to 11 o’clock position, 200suturing of puboprostatic ligament, 199f, 2003-zero double-armed monofilament sutures to form

posterior plate, 1993-zero double-armed monofilament sutures, use of, 199

Visceral and gastrointestinal complicationsanesthesia, 73bowel complications associated with access

access techniques to peritoneum/retroperitoneum, 74major/minor complications, 74

bowel complications in specific procedures, 83t–84tlaparoscopic and robot-assisted adrenalectomy, 82laparoscopic and robot-assisted laparoscopic pyeloplasty,

85–86laparoscopic and robot-assisted LNU, 85laparoscopic and robot-assisted LPN, 85laparoscopic and robot-assisted LRPLND, 86laparoscopic and robot-assisted nephrectomy, 82–85laparoscopic and robotic-assisted laparoscopic radical

prostatectomy, 88laparoscopic and robotic radical cystectomy, 86–87

gastrointestinal/solid organ injuries, 75–79patient selection, 73trocar site and incisional hernias, 79–82

See also Trocar site herniasViscous injury

hollow viscous injury, 287–288solid organ injury, 288

WWarm ischemia time (WIT)

functional recovery/safety limits, 152management

WIT in open surgery, classification, 153prevention

ischemia, protective mechanisms, 154perfusion reinstitution after suture, 153replacement of knotting by clips, 153retroperitoneal approach, 153techniques of regional hypothermia (WIT>30 min),

153–154transperitoneal approach, 153

study of LPN patients with WIT>30 min, 152–153Well leg compartment syndrome (WLCS)

cause, 38risk factors, 38treatment, 38

WIT, see Warm ischemia time (WIT)WLCS, see Well leg compartment syndrome (WLCS)