Caveat

■ Alternatively, the ureteral catheter and Foley catheter are left to gravity until the day of discharge. This provides an extended period of drainage without the need for a double-pigtail indwelling stent.

TABLE S ■ Specific Technical Alternatives Described in the Literature, Including Type of Laparoscopic Approach, Use of Ureteral Stenting, and Method of Management of the Diverticular Epithelium, Infundibular Neck, and Cavity

Series

Laparoscopic

Diverticular

Epithelial

Infundibular

Indwelling

(patients)

approach

size (mm)

fulguration

management

Cavity filled?

stent?

Gluckman et al.

Transperitoneal

N/A

Argon beam

Argon beam

Omentum

No

(21) (N = 1)

Ruckle et al.

Transperitoneal

S0

Monopolar

Monopolar

No

No

(22) (N = 1)

electrocautery

electrocautery

Harewood et al.

Retroperitoneal

12-S1

Monopolar

Not seen

No (N = 1)

No

(19) (N = S)

electrocautery

Fat tissue (N = 2)

Hoznek et al.

Retroperitoneal

10-12

Monopolar

Monopolar

Tissue sealant

Ureteral

(20) (N = S)

electrocautery

electrocautery

on mesha

catheterb

Curran et al.

Retroperitoneal

50

Monopolar

Not seen

No

No

(2S) (N = 1)

electrocautery

Miller et al.

Retroperitoneal

20-45

Argon beam

Argon beam

Perinephric fat

4-6 weeks

(18) (N = 5)

(N = 3) Suture repair (N = 2)

aGelatin resorcinol formaldehyde glue on surgical mesh.

bUreteral catheter for five to eight days with retrograde pyelogram confirming no leak prior to removal. Abbreviation: N/A, not available.

Operative Equipment Checklist

Instrument Standard laparoscopic renal instrument tray Laparoscopic cyst aspiration needle Laparoscopic needle drivers Laparoscopic vascular clamps Cystoscopy table, ureteral catheter, guidewire

Materials Methylene blue ampule in 200 cc sterile water Radiopaque contrast material, diluted 50%

Tissue sealants (fibrin glue,Tisseel™a) Hemostatic agents (Surgicel™a, Floseal™b) 3-0 or 2-0 polyglactin, RB-1 or CT-2 needle #0 polyglactin, CT-1 needle

Devices Intraoperative ultrasound probe C-arm fluoroscopy Argon beam coagulator aEthicon, Inc., Somerville, NJ.

bBaxter Healthcare Corp., Fremont, CA.

Follow-up intravenous pyelograms or computed tomography urogram is obtained at six weeks after stent removal, then at six months, 12 months, and as needed for symptoms. Subsequent yearly follow-up with ultrasound is sufficient.

Laparoscopic calyceal diverticulectomy replicates the techniques and principles of the open surgical approach. As such, symptom-free, stone-free, and "diverticulum-free" rates in reported series are 100%, 100%, and 93%, respectively, albeit with very short follow-up.

0 0

Post a comment