Department of Urology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China (all authors).

ABSTRACT

Introduction: The occurrence of pregnancy with Cushing syndrome (CS) is rare but with high risks, posing a great challenge to the clinical diagnosis and treatment of the disease.

Case Description: From Aug 2016 to Aug 2019, we admitted two pregnant women with CS caused by adrenal tumors. After multidisciplinary consultation, they underwent emergency Cesarean section because of heart failure and severe hypoxemia, and finally delivered a living baby after adjuvant therapy. Both patients underwent retroperitoneal laparoscopic adrenectomy (RLA) 2.6 and 1.5 months postpartum to have the adrenal tumors removed successfully. The post- operative pathology confirmed the adrenal tumor as adrenocortical adenoma. Partial hormone replacement therapy was initiated postoperatively and withdrawn uneventfully 1 year after RLA in both patients, and both patients have recovered well.

Conclusion: It is difficult to find CS in early pregnancy, and when it is detected in late pregnancy, it often poses a great risk because it is necessary to consider the safety of both mother and fetus, which requires multidisciplinary coordination and cooperation to positively adjust the cardiopulmonary function and internal environment after Cesarean section, knowing that timely RLA to remove the adrenocortical adenoma can effectively cure CS.

Key Words: Pregnancy, Cushing syndrome, Adrenal tumor, Heart failure, Hypertension.

The post Diagnosis and Treatment of High-risk Pregnant Women With Cushing Syndrome Caused by Adrenal Tumor first appeared on JSLS.

Shanghai JiaoTang University School of Medicine, Ruijin Hospital, Department of Urology, Shanghai, China, 200025.

ABSTRACT

Introduction: Occurrence of synchronous bilateral sporadic renal masses is rare. Retroperitoneoscopical partial nephrectomy of bilateral renal masses in one session can be a technically challenging procedure due to ischemia time, paranchyma preserved and perioperative complications.

Case Description: We present a case where bilateral renal masses were synchronously excised via retroperitoneoscopy in a 53-year-old woman. There were five masses excised in all and pathology revealed chromophobe renal cell carcinoma with histologic concordance. No recurrence or metastasis was detected after 2 years of follow-up and renal function was optimal with glomerular filtration rate (GFR) 76.3 ml/min/1.73 m², compared to the preoperative GFR of 77.5 ml/min/1.73 m².

Conclusion: Retroperitoneoscopical partial nephrectomy is a feasible and effective procedure for bilateral renal masses in one session under experienced hands.

Key Words: Retroperitoneoscopy, Partial nephrectomy, Bilateral renal masses, Synchronous.

The post Retroperitoneoscopical Partial Nephrectomy of Bilateral Renal Masses in One Session first appeared on JSLS.

Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts (Drs. Clark, Feltmate, and Cohen).
Department of Obstetrics and Gynecology, University of Texas Health-McGovern Medical School, Houston, Texas (Dr. Leon).

ABSTRACT

Introduction: Parasitic leiomyoma is a rare condition that may be spontaneous or iatrogenic in origin. Laparoscopic uterine surgery and tissue morcellation are procedures that may lead to the development of parasitic leiomyoma.

Case Description: We report the case of a 36-year-old woman with a history of a laparoscopic myomectomy and uncontained power morcellation who presented to our institution 6 years later with 2 large parasitic fibroids together weighing over 1 kg. We additionally present a review of the literature on development of parasitic leiomyoma after myomectomy, summarizing 35 published cases in addition to our own.

Conclusion: Parasitic leiomyoma is estimated to occur after 0.20 to 1.25% of laparoscopic myomectomies, and is diverse in it’s presenting symptoms and surgical findings. Tissue morcellation is suspected to be a risk factor in the development of this condition.

Key Words: Parasitic leiomyomas, Myomectomy, Uncontained morcellation.

The post Parasitic Leiomyomas Following Laparoscopic Myomectomy first appeared on JSLS.

Department of Urology, Jan Biziel Medical University Hospital, Bydgoszcz, Poland (Drs Jarzemski P, Listopadzki, and Jarzemski M).

Department of Urology, Medical University of Gdańsk, Gdańsk, Poland (Drs Markuszewski and Roslan).

ABSTRACT

Background and Objectives: Minimally invasive techniques have been introduced to decrease the morbidity related to standard laparoscopic procedures. One such approach is transvesical laparoendoscopic single-site surgery (T-LESS). We describe our clinical experience of using this technique for vesicorectal fistula (VRF) repair.

Description: In October 2013, we performed the T-LESS repair of a vesicorectal fistula of 5 mm diameter in a 72-year-old man, in whom conservative treatment with temporary colostomy and Foley catheter placement had failed. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device via a 15 mm incision made 20 mm above the pubic symphysis. Standard 10 mm optic and straight laparoscopic instruments were used. The fistulous tract was dissected and closed in two layers with a running, absorbable, barbed suture. A cystostomy tube was left in place for 22 days, and a Foley catheter for 1 week.

Results: The operation lasted 155 min. Blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a 5-week follow-up, the patient reported no involuntary discharge of urine into the rectum. A voiding cystourethrogram revealed no presence of VRF, and laboratory examination results were all within the normal range. The colostomy was closed after 4 months, and a 12-month follow-up confirmed the integrity of both the urinary and digestive tracts.

Conclusion: Although substantial development of the instruments and skills is needed, the T-LESS VRF repair appears to be feasible and safe. Nevertheless, further experience and observations are necessary.

Key Words: Laparoscopic surgery, Prostate cancer, Vesicorectal fistula.

The post Laparoendoscopic Single-Site Surgery for Vesicorectal Fistula Repair first appeared on JSLS.

Urology Division, Hartford Healthcare Medical Group, Hartford, Connecticut (all authors).

ABSTRACT

Introduction: In an era of ultrasonography and computed tomography (CT), urachal remnants have been detected with increasing frequency. If these remnants become infected, they can mimic a variety of intra-abdominal pathologies. We present the case histories of two patients with an infected urachal cyst that developed after laparoscopic cholecystectomy and necessitated excision.

Case Descriptions: Patient 1: Four years after a laparoscopic cholecystectomy, a 36-year-old man presented with dysuria, abdominal pain, leukocytosis, and fluid leakage from the umbilical port site. CT imaging revealed an infected urachal cyst with an adherent loop of sigmoid colon. Antibiotic treatment preceded laparoscopic excision of the urachal cyst with partial cystectomy and closure of the sigmoid-to-urachus fistula. In a 3-year follow-up, there was no recurrence. Patient 2: A 68-year-old woman presented 11 months after laparoscopic cholecystectomy with abdominal pain, intermittent fever, and leukocytosis. CT imaging revealed an infected urachal cyst with an associated phlegmon in the abdominal wall. Antibiotic treatment preceded two incision-and-drainage procedures. Six weeks later, the patient underwent robotic excision of the urachal cyst and partial cystectomy. A 3-year follow-up showed no recurrence.

Discussion: The urachus can be punctured during laparoscopic periumbilical port placement and convert into a draining sinus or abscess. Subsequent infection can present with umbilical drainage, abdominal pain, urinary symptoms, and systemic infection. Surgical excision is a reasonable option once the acute infection has been treated. Any images that include the urachus should be reviewed before procedures involving an umbilical port, as puncture of urachal cysts may increase the risk of infection.

Key Words: Cholecystectomy, Infection, Laparoscopy, Urachal cyst.

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The post Infected Urachal Cyst Following Laparoscopic Cholecystectomy first appeared on JSLS.

University of Toledo College of Medicine, Toledo, OH, USA (all authors). Department of Urology, University of Toledo Medical Center, Toledo, OH, USA (Dr. Jain).

ABSTRACT

Introduction: Weck Hem-o-Lok (Teleflex Medical, Research Triangle Park, North Carolina) clips are frequently used to achieve hemostasis of the lateral prostatic pedicles during radical prostatectomy. Rarely, these clips can detach and migrate into the bladder wall, leading to postoperative urinary tract complications. Hem-o-Lok clip migration into the bladder is a rare complication of laparoscopic radical prostatectomy that has been reported within 1 year postsurgery.

Case Report: We report the case of a 61-year-old white man who presented with urinary stress incontinence, acute urinary retention, and a history of recurrent urinary tract infections more than 2 years after salvage robot-assisted laparoscopic radical prostatectomy for recurrent prostate cancer that was unsuccessfully treated with brachytherapy. As part of his diagnostic workup, cystoscopy demonstrated an open bladder neck with no evidence of contracture and the presence of a calcification near the vesicourethral anastomosis. Unroofing these calcifications via laser lithotripsy revealed two eroded Hem-o-Lok clips, which were subsequently removed from the bladder wall.

Conclusion: Salvage prostatectomy after radiotherapy as the primary treatment for prostate cancer may increase the window of time in which intravesical clip migration can occur because of delayed wound healing at the vesicourethral anastomosis. Furthermore, clip migration can present with signs of urinary tract dysfunction in the absence of bladder neck contracture and beyond the time frame initially expected.

Key Words: Prostatic neoplasms, Prostatectomy, Laparoscopy, Urinary incontinence, Postoperative complications.

[gview file=”https://crsls.sls.org/wp-content/uploads/2015/08/CRSLS.2014.001683_hi.pdf”]

The post Delayed Hem-o-Lok Clip Erosion Following Salvage Radical Prostatectomy first appeared on JSLS.

Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA (Drs Santomauro, Stroup, Masterson, Auge, Crain, J. L’Esperance, and Ms A. L’Esperance). Division of Urology, University of California, San Diego, CA, USA (Drs Stroup and Derweesh).

ABSTRACT

Background and Objectives: Robotic-assisted laparoscopic retroperitoneal lymph node dissection (RPLND) using a lower abdominal approach for testicular cancer is an advanced and relatively new surgical technique. Herein we describe technical modifications, review benefits, and report our initial series.

Methods: A retrospective review of 16 patients from Jan 1, 2010 to Dec 31, 2012 who underwent robotic RPLND for nonseminomatous germ cell tumors was performed. Patients were positioned in 15° of Trendelenburg and tilted 15° to the right. An infraumbilical midline camera port, 3 robotic ports, and 2 assistant ports were placed in a lower abdominal configuration. Patient demographic and perioperative outcomes were assessed.

Results: Twelve patients underwent staging, prospective nerve-sparing RPLNDs, and 4 underwent postchemotherapy RPLNDs. Mean age was 26.4 years with a mean body mass index of 27.4 kg/m2. The cohort had a mean operative time of 357 minutes, mean estimated blood loss of 205 mL, mean hospital stay of 3.6 days, and mean postoperative morphine equivalent use of 47.1 mg. There were no conversions to open RPLND in this cohort. An average of 26.2 lymph nodes were sampled.

Conclusions: Inferior approach for robotic RPLND enables a thorough dissection of the retroperitoneum, without repositioning, to meet oncologic goals. Further study to evaluate long-term outcomes is warranted.

Key Words: Retroperitoneal lymph node dissection, Robotic surgery, Surgical approaches, Technical modifications, Testicular cancer.

The post Supine Robotic-Assisted Retroperitoneal Lymph Node Dissection for Testicular Cancer first appeared on JSLS.

ABSTRACT

Powered laparoscopic staplers have entered the market in the last few years. We report the first case of a malfunction of a powered laparoscopic stapler during a laparoscopic nephrectomy for a nonfunctioning kidney. The complication was salvaged with further laparoscopic maneuvers by the surgeon without conversion or any further intraoperative complication. Powered laparoscopic staplers, like the nonpowered versions, are equally prone to device malfunction despite manual safety override mechanisms. Laparoscopic surgeons using these devices must be aware of this rare complication and possess the necessary skills to troubleshoot and overcome the problem without endangering the patient.

The post Powered Stapler Malfunction During Laparoscopic Nephrectomy first appeared on JSLS.

Department of Urology, Athens Medical Center, Athens, Greece (Drs. Ac. Ploumidis, An. Ploumidis). Department of Urology, Apollonion Private Hospital, Nicosia, Cyprus (Dr. Philippou). University Department of Urology, Sismanoglio Hospital, Athens, Greece (Drs. Skolarikos, Athanasiadis). Department of Urology, Jaslok Hospital, Mumbai, India (Dr. Raina)

ABSTRACT

Introduction: Robotic-assisted pyelolithotomy (RAPL) has recently immerged as an alternative approach for the management of complex kidney stones. RAPL combines the benefits of minimally invasive surgery with the high stone clearance rates achieved by open lithotomy.

Case Description: We describe the successful combination of RAPL and Holmium laser lithotripsy for the management of a staghorn calculus in a 57-year-old man who had previously undergone a failed percutaneous nephrolithotomy.

Discussion and Conclusion: The 500-m Holmium laser fiber was navigated by the console surgeon, who also controlled the laser foot pedal, thus maximizing surgeon control of the procedure. The combination of robotically assisted laparoscopic surgery and Holmium laser lithotripsy is a feasible and safe management option for achieving clearance of complex renal stones. To the best of our knowledge, this appears to be the first reported case, confirming the safety and efficacy of this combined technique.

Key Words: Robotic pyelolithotomy, Holmium laser, Staghorn calculus

The post Combined Robotic Pyelolithotomy and Laser Lithotripsy for Staghorn Calculi first appeared on JSLS.

Department of Urology, Toyama City Hospital, Toyama, Japan (all authors).

ABSTRACT

Introduction: Retroperitoneoscopic laparoendoscopic single-site surgery for congenital midureteral stricture was performed in a nulliparous girl with contralateral multicystic dysplastic kidney.

Case Description: The patient presented with a 4-year history of intermittent right flank pain and 3 episodes of right acute pyelonephritis. A right-sided retrograde ureteropyelogram showed a short and narrow stricture at the level of L5 with proximal hydroureteronephrosis. Ureterolysis and ureteroplasty were successfully performed via the retroperitoneal route. The total operation time was 200 minutes, and the estimated blood loss was 10 mL. The patient was discharged on postoperative day 5 with no complications. At the 12-month follow-up, the patient reported complete relief from pain and intravenous pyelography showed markedly decreased hydroureteronephrosis.

Discussion: Retroperitoneoscopic laparoendoscopic single-site surgery is an effective treatment option for congenital midureteral stricture with an acceptable esthetic outcome and minimal morbidity.

Key Words: Ureteral obstruction, Midureteral stricture, Laparoendoscopic single-site surgery, Retroperitoneoscopy, Multicystic dysplastic kidney disease.

The post Laparoendoscopic Single-Site Surgery for Congenital Midureteral Stricture first appeared on JSLS.