Contents

Preface v

Acknowledgments vii Contributors xxvii

SECTION I: BASIC CONSIDERATIONS

CHAPTER 1: HISTORY OF LAPAROSCOPY: AN ODYSSEY OF INNOVATIONS ■ 3

Sergio G. Moreira, Jr., Raul C. Ordorica, and Sakti Das ■ References 11

CHAPTER 2: LAPAROSCOPIC ANATOMY: UPPER ABDOMEN ■ 13

Dinesh Singh

■ Introduction 13

■ Right Adrenal Gland 15

■ Left Adrenal Gland 16

CHAPTER 3: LAPAROSCOPIC ANATOMY OF THE MALE PELVIS ■ 19

Bertrand Guillonneau, Karim A. Touijer, and Jeffery W. Saranchuk

■ Introduction 19

■ Intra-Abdominal Anatomy of the Pelvis 19

■ The Retropubic Space 22

■ Prostatic Fascia and Prostatic Pedicles 24

■ Sphincteric Complex 26

■ Conclusion 27

■ References 27

CHAPTER 4: PHYSIOLOGIC ASPECTS OF LAPAROSCOPY ■ 29

■ Introduction 29

■ Physiologic Factors 29

■ Physiologic Responses 32

■ Physiologic Complications 35

■ References 41

CHAPTER 5: MODERN ABDOMINAL IMAGING: IMPLICATIONS FOR LAPAROSCOPIC SURGERY ■ 47

Erick M. Remer, Joseph C. Veniero, and Brian R. Herts

■ Introduction 47

■ Computed Tomography 48

■ Computed Tomography Protocol for Laparoscopic Surgical Planning 48

■ Magnetic Resonance Imaging 49

■ Magnetic Resonance Protocol for Laparoscopic Surgical Planning 51

■ Image Interpretation and Three-Dimensional Volume Rendering 52

■ Radiologic Guidance During Laparoscopic Surgery 55

■ Postoperative Imaging 59

■ Conclusion 62

■ References 63

SECTION II: EQUIPMENT

CHAPTER 6: LAPAROSCOPIC INSTRUMENTATION ■ 67

Mihir M. Desai

■ Introduction 67

■ Laparoscopic Instrumentation 67

■ Operating Room Setup 73

■ Conclusion 74

■ References 75

CHAPTER 7: AUDIOVISUAL EQUIPMENT AND THE OPERATING ROOM OF THE FUTURE ■ 77

James O. L'Esperance and Glenn M. Preminger

■ Introduction 77

■ Digital Imaging 77

■ Video Endoscopy (AKA "Chip on A Stick") 79

■ Digital Imaging, Video Documentation, and Editing 80

■ Illumination 81

■ Image Display Systems and High-Definition Video Systems 82

■ Three-Dimensional Video Endoscopic/Laparoscopic Systems 83

■ Virtual Reality Endoscopic/Laparoscopic Simulation 84

■ Internet and Telemedicine 85

■ The Operating Rooms of the Future-Today 86

■ Conclusion 88

■ References 88

CHAPTER 8: BIOADHESIVETECHNOLOGY ■ 91

Andrew B. Joel and Marshall L. Stoller

■ Introduction 91

■ Hemostasis 92

■ Topical Biologic Agents: Pharmacologic 93

■ Topical Biologic Agents: Physical 96

■ Urologic Laparoscopic Applications 97

■ Potential Complications 100

■ Topical Synthetic Agents 101

■ Conclusion 101

■ References 102

CHAPTER 9: SURGICAL ROBOTICS ■ 105

Akshay Bhandari, Lee Richstone, and Ashutosh Tewari

■ Introduction 105

■ History of Robotics 105

■ Robotics in Surgery 106

■ Robotics in Urology 107

■ Telesurgery 111

■ Virtual Reality 112

■ Limitations of Robotic Surgery 113

■ Future Robotic Surgery Systems 113

■ References 114

SECTION III: LAPAROSCOPY: GENERAL TECHNIQUES

CHAPTER 10: BASICS OF RETROPERITONEAL LAPAROSCOPY ■ 119

Monish Aron, Benjamin Chung, and Inderbir S. Gill

■ Introduction 119

■ Indications 119

■ Contraindications 119

■ Preoperative Workup 120

■ Surgical Technique 120

■ Intraoperative Troubleshooting 126

■ Time Management 126

■ Complications 127

■ Conclusion 127

■ References 127

CHAPTER 11: LAPAROSCOPIC SUTURING TECHNIQUES: GENERAL CONSIDERATIONS ■ 129

Louis J. Giorgi, Jr. and Michael E. Moran

■ Introduction 129

■ Laparoscopic Suturing Time Line 130

■ Essentials of Laparoscopic Suturing 131

■ Laparoscopic Extracorporeal Knotting 139

■ Laparoscopic Intracorporeal Suturing and Knotting 142

■ References 153

CHAPTER 12: LAPAROSCOPIC SUTURING: PROCEDURE-SPECIFIC ■ 159

Louis J. Giorgi, Jr. and Michael E. Moran

■ Laparoscopic Urologic Sutured Reconstruction 159

■ Robotic Reconstruction 170

■ Conclusion 175

■ Practical Skills Acquisition Exercises 177

■ References 177

SECTION IV: ADULT LAPAROSCOPY: BENIGN DISEASE

CHAPTER 13: LAPAROSCOPIC ADRENALECTOMY: TECHNIQUE ■ 185

■ Introduction and Background 185

■ Patient Selection: Indications and Contraindications 186

■ Preoperative Preparation 188

■ Technique 189

■ Lateral Transperitoneal Technique 193

■ General Technical Modifications 198

■ Anterior Transperitoneal Technique 199

■ Lateral Retroperitoneal Technique 199

■ Posterior Retroperitoneal Technique 200

■ Other Techniques and Modifications 200

■ Conclusion 202

■ References 203

CHAPTER 14: LAPAROSCOPIC PARTIAL ADRENALECTOMY ■ 207

Günter Janetschek

■ Introduction 207

■ Relevant Anatomic Details 207

■ Indications and Contraindications 208

■ Therapeutic Concepts 208

■ Preoperative Investigation 210

■ Preoperative Optimization 210

■ Pheochromocytoma: Potential Surgical Risks 210

■ Anesthetic Management 211

■ Surgical Technique 211

■ Laparoscopic Partial Adrenalectomy for Recurrent Pheochromocytomas 214

■ References 215

CHAPTER 15: LAPAROSCOPIC SURGICAL MANAGEMENT OF EXTRA-ADRENAL PHEOCHROMOCYTOMA ■ 217

Ashish Behari and McClellan M. Walther

■ Introduction 217

■ Embryology 217

■ Clinical Presentation and Diagnosis 217

■ Surgical Technique 218

■ Discussion 220

■ Conclusion 221

■ References 221

CHAPTER 16: LAPAROSCOPIC ADRENALECTOMY FOR BENIGN DISEASE: CURRENT STATUS ■ 223

David S. Wang and Howard N. Winfield

■ Introduction 223

■ Diagnosis 223

■ Aldosteronomas 225

■ Cushing's Syndrome 225

■ Pheochromocytoma 225

■ Indications for Laparoscopic Adrenalectomy 226

■ Results of Laparoscopic Adrenalectomy for Benign Disease 226

■ References 228

CHAPTER 17: LAPAROSCOPIC SIMPLE NEPHRECTOMY: TECHNIQUE ■ 231

Simon V. Bariol and David A. Tolley

■ Introduction 231

■ Patient Selection 231

■ Preoperative Preparation 231

■ Technique 232

■ Postoperative Care 236

■ Complications 237

■ References 238

■ Bibliography 239

CHAPTER 18: LAPAROSCOPIC SIMPLE NEPHRECTOMY: CURRENT STATUS ■ 241

Moses Kim, Debora K. Moore, and Robert G. Moore

■ Introduction 241

■ Indications 241

■ Special Considerations 242

■ References 244

CHAPTER 19: LAPAROSCOPIC RENAL BIOPSY: TECHNIQUE AND RESULTS ■ 247

Christopher A. Warlick and David Y. Chan

■ Introduction 247

■ Surgical Technique 247

■ Discussion 250

■ References 251

CHAPTER 20: LAPAROSCOPIC NEPHROPEXY ■ 253

Lewis CH. Liew and Adrian D. Joyce

■ Introduction 253

■ Patient Selection and Diagnosis 254

■ Surgical Technique 254

■ References 258

CHAPTER 21: LAPAROSCOPIC RENAL CYST ABLATION: TECHNIQUE AND RESULTS ■ 259

Li-Ming Su

■ Introduction 259

■ Patient Selection 260

■ Preoperative Preparation 263

■ Surgical Technique 265

■ Postoperative Care 273

■ Measures to Avoid Complications 274

■ References 278

CHAPTER 22: LAPAROSCOPIC SURGERY FOR CALCULOUS DISEASE: TECHNIQUE AND RESULTS ■ 279

Ashok K. Hemal

■ Introduction/Background 279

■ Patient Selection: Indications and Contraindications 280

■ Preoperative Preparation and Patient Position 281

■ Technique 281

■ Pyelolithotomy 281

■ Pyelolithotomy with Concomitant Pyeloplasty 283

■ Robot-Assisted Pyelolithotomy and Pyeloplasty 283

■ Anatrophic Nephrolithotomy 283

■ Removal of Urachovesical Calculus 284

■ Ureterolithotomy 284

■ Retroperitoneal vs. Transperitoneal Nephrectomy for Nonfunctioning Kidneys Due to Calculous Disease 286

■ Retroperitoneoscopic Nephrectomy for Hydronephrotic Kidney Due to Ureteropelvic Junction Obstruction with Stones 286

■ Laparoscopic Nephrectomy for Xanthogranulomatous Kidneys 286

■ Laparoscopic Nephrectomy for Patients with History of Previous Stone Surgery or Percutaneous Nephrostomy 286

■ Retroperitoneoscopic Nephroureterectomy for Nonfunctioning Kidneys Due to Calculous Disease 287

■ Partial Nephrectomy 287

■ Bladder Diverticulectomy with Stone Removal 287

■ Complications 289

■ References 291

■ Commentary D. Assimos 292

CHAPTER 23: LAPAROSCOPIC PYELOPLASTY: TECHNIQUE ■ 295

George K. Chow

■ Introduction 295

■ Patient Selection and Diagnosis 296

■ Preoperative Preparation 296

■ Surgical Technique 296

■ Postpyeloplasty Procedure 299

■ Postoperative Management 300

■ Postoperative Complications 300

■ References 301

CHAPTER 24: ROBOTIC-ASSISTED ADULT AND PEDIATRIC PYELOPLASTY ■ 303

Joseph J. Del Pizzo, Michael A. Palese, Ravi Munver, and Dix P. Poppas

■ Introduction 303

■ Patient Selection: Indications and Contraindications 304

■ Preoperative Preparation 305

■ Robotic-Assisted Technique 306

■ Specific Measures to Avoid Complications 311

■ References 311

CHAPTER 25: LAPAROSCOPIC PYELOPLASTY: CURRENT STATUS ■ 313

Ioannis M. Varkarakis and Thomas W. Jarrett

■ Introduction 313

■ Current Management of Ureteropelvic Junction Obstruction and Indications for Laparoscopic Pyeloplasty 313

■ Results: Transperitoneal Laparoscopic Pyeloplasty 314

■ Results: Retroperitoneal Laparoscopic Pyeloplasty 315

■ Laparoscopic Pyeloplasty in Children 316

■ Robot-Assisted Laparoscopic Pyeloplasty 316

■ Laparoscopic Pyeloplasty for Secondary Ureteropelvic Junction Obstruction 317

■ Laparoscopic Pyeloplasty with Concomitant Pyelolithotomy 317

■ Laparoscopic Pyeloplasty in the Presence of Upper Urinary Tract Abnormalities 318

■ Management of Failed Primary Laparoscopic Pyeloplasty 318

■ References 319

■ Commentary Michael C. Ost and Arthur Smith 320

CHAPTER 26: LAPAROSCOPY FOR THE CALYCEAL DIVERTICULUM: TECHNIQUE AND RESULTS ■ S2S

Christopher S. Ng

■ Background 325

■ Indications for Urologic Intervention 326

■ Urologic Treatment Modalities 326

■ Patient and Treatment Selection 327

■ Preoperative Preparation 328

■ Technique: Laparoscopic Calyceal Diverticulectomy 329

■ Postoperative Management 335

■ References 336

CHAPTER 27: LAPAROSCOPIC LIVE DONOR NEPHRECTOMY: TECHNIQUE ■ 337

Joseph J. Del Pizzo

■ Introduction 337

■ Patient Selection 338

■ Preoperative Preparation 339

■ Operative Preparation 339

■ Laparoscopic Donor Nephrectomy: Basic Instrumentation 341

■ Operative Technique 341

■ References 351

CHAPTER 28: LAPAROSCOPIC DONOR NEPHRECTOMY: CURRENT STATUS ■ 353

Michael W. Phelan and Stephen C. Jacobs

■ Initial Experience and Motivation 353

■ Early Controversies 354

■ Unsolved Controversies 357

■ Surgical Technical Issues 358

■ Donor Evaluation 359

■ Expansion of Live Renal Donation 359

■ Current Status of Laparoscopic Approach 361

■ References 362

■ Commentary John M. Barry 366

CHAPTER 29: LAPAROSCOPIC URETERAL SURGERY: NONCALCULOUS APPLICATIONS ■ 369

■ Introduction 369

■ Retrocaval Ureter 369

■ Idiopathic Retroperitoneal Fibrosis 370

■ Transureteroureterostomy 371

■ Cutaneous Ureterostomy 372

■ Ureteroneocystostomy 372

■ References 373

CHAPTER 30: LAPAROSCOPIC MARSUPIALIZATION OF LYMPHOCELE ■ 375

W. Patrick Springhart, Charles D. Scales, Jr., and David M. Albala

■ Introduction 375

■ Patient Selection: Indications and Contraindications 375

■ Preoperative Preparation 376

■ Laparoscopic Technique 376

■ Avoiding Complications 378

■ References 378

CHAPTER 31: LAPAROSCOPIC BLADDER AUGMENTATION: WITH AND WITHOUT URINARY DIVERSION ■ 381

Raymond R. Rackley and Joseph B. Abdelmalak

■ Introduction 381

■ Patient Selection: Indications and Contraindications 381

■ Preoperative Preparation 382

■ Surgical Technical Steps 382

■ References 391

CHAPTER 32: LAPAROSCOPIC BLADDER NECK SUSPENSION: TECHNIQUE AND RESULTS ■ 393

Jim Ross and Mark Preston

■ Introduction 393

■ Selection, Evaluation, and Anatomy 393

■ Set-Up, Instrumentation, and Surgical Procedure 395

■ Entry into the Space of Retzius 397

■ Outcomes, Comparative Studies, Complications, and Costs 398

■ Paravaginal Repair 405

■ References 406

CHAPTER SS: LAPAROSCOPIC MANAGEMENT OF VESICOVAGINAL FISTULA ■ 411

Ali Mahdavi, Farr Nezhat, Bulent Berker, Ceana Nezhat, and Camran Nezhat

■ Introduction 411

■ Diagnosis 412

■ Surgical Technique 412

■ Prevention 414

■ References 414

CHAPTER 34: LAPAROSCOPIC SURGERY OF THE SEMINAL VESICLES ■ 417

Robert B. Nadler and Scott E. Eggener

■ Introduction 417

■ Anatomy, Embryology, and Function 417

■ Indications 417

■ Surgical Technique 419

■ References 421

CHAPTER 35: LAPAROSCOPIC VARICOCELECTOMY ■ 423

James F. Donovan and Marlou B. Heiland

■ Introduction 423

■ Diagnosis 423

■ Indications for Treatment 424

■ Treatment Options 424

■ Contraindications to Laparoscopic Varix Ligation 425

■ Surgical Technique 425

■ References 428

CHAPTER 36: LAPAROSCOPIC PLACEMENT OF PERITONEAL DIALYSIS CATHETER ■ 431

Wisoot Konchareonsombat, Arif Asif, and Raymond J. Leveillee

■ Introduction 431

■ Anatomy of the Abdominal Wall and Peritoneum 432

■ Factors Affecting Peritoneal Dialysis Efficiency 433

■ The Indication for Dialysis 433

■ Peritoneal Access Devices 434

■ Contraindications to Peritoneal Dialysis Catheter Placement 434

■ Surgical Techniques 434

■ Laparoscopic Implantation of Continuous Ambulatory Peritoneal Dialysis Catheter 438

■ Videolaparoscopy-Assisted Implantation of Continuous Ambulatory Peritoneal Dialysis Catheter 439

■ Minilaparoscopic Placement of Peritoneal Dialysis Catheter 439

■ Burying the Peritoneal Dialysis Catheter 440

■ Postoperative Care 441

■ Complications of Laparoscopic Placement of Chronic Peritoneal Dialysis Catheter 441

■ Peritoneal Dialysis Catheter Removal 443

■ References 444

CHAPTER 37: LAPAROSCOPIC SURGERY FOR CHYLURIA ■ 447

■ Introduction 447

■ Etiopathogenesis 447

■ Clinical Presentation and Evaluation 449

■ Conservative Treatment 449

■ Patient Selection for Laparoscopic Lymphatic Disconnection 450

■ Technique of Retroperitoneoscopic Laparoscopic Lymphatic Disconnection 450

■ Technical Tips to Aid Laparoscopic Lymphatic Disconnection 452

■ Postoperative Care and Follow-Up 453

■ Advantages of Laparoscopy 453

■ Retroperitoneal vs. Transperitoneal Lympholysis 454

■ References 454

CHAPTER 38: LAPAROSCOPIC INGUINAL HERNIA SURGERY ■ 455

Bipan Chand and Jeffrey Ponsky

■ Introduction 455

■ Indications and Contraindications 455

■ Surgical Techniques 457

■ Postoperative Care 458

■ Technical Pearls 458

■ References 460

SECTION V: LAPAROSCOPIC UROLOGIC ONCOLOGY

CHAPTER 39: LAPAROSCOPIC ADRENALECTOMY FOR MALIGNANCY ■ 465

Alireza Moinzadeh

■ Introduction 465

■ Adrenalectomy for Solitary Metastasis 465

■ Adrenalectomy for Adrenocortical Carcinoma 466

■ Controversy About the Role of Laparoscopy for Malignancy 467

■ Laparoscopy for Malignant Adrenal Lesions 468

■ General Guidelines for Surgery 469

■ Laparoscopic Adrenalectomy for Malignancy: Caveats 469

■ References 470

CHAPTER 40: LAPAROSCOPIC RADICAL NEPHRECTOMY: TRANSPERITONEAL APPROACH ■ 473

Michael Grasso III

■ Introduction 473

■ Indications for Surgical Intervention Using a Transperitoneal Laparoscopic Approach 473

■ Contraindications to Laparoscopic Radical Nephrectomy 474

■ Preoperative Evaluation 474

■ Surgical Technique 475

■ References 480

CHAPTER 41: LAPAROSCOPIC RADICAL NEPHRECTOMY: RETROPERITONEAL TECHNIQUE ■ 483

Howard Evans and Michael G. Hobart

■ Introduction 483

■ Indications and Contraindications 484

■ Preoperative Preparation 484

■ Procedure 484

■ Specific Measures Taken to Avoid Complications 490

■ References 491

CHAPTER 42: LAPAROSCOPIC RADICAL NEPHRECTOMY: CURRENT STATUS ■ 493

Isaac Yi Kim and Ralph V. Clayman

■ Introduction 493

■ Surgical Approaches 493

■ Intraoperative and Perioperative Results 494

■ Oncologic Outcome 495

■ Complications 496

■ References 497

CHAPTER 43: SMALL RENAL TUMORS: OVERVIEW AND MANAGEMENT BY ACTIVE SURVEILLANCE ■ 501

Alessandro Volpe and Michael A. S. Jewett

■ Natural History of Small Renal Tumors 502

■ Active Surveillance of Small Renal Tumors 503

■ References 505

■ Commentary Morton A. Bosniak 507

CHAPTER 44: LAPAROSCOPIC PARTIAL NEPHRECTOMY: TECHNIQUE ■ 511

Jihad H. Kaouk

■ Introduction 511

■ Indications and Contraindications 511

■ Perioperative Patient Preparation 511

■ Surgical Techniques 512

■ Alternative Techniques 516

■ References 517

CHAPTER 45: LAPAROSCOPIC PARTIAL NEPHRECTOMY: CURRENT STATUS ■ 519

Massimiliano Spaliviero and Inderbir S. Gill

■ Introduction 519

■ Nephron-Sparing Surgery: Current Concepts 519

■ Nephron-Sparing Surgery: Current Indications 521

■ Open Partial Nephrectomy vs. Laparoscopic Radical Nephrectomy 522

■ Laparoscopic Partial Nephrectomy 522

■ Multiple Tumors 524

■ Concomitant Adrenalectomy 526

■ Complications 526

■ Hemostatic Aids and Impact of Floseal 527

■ Impact of Warm Ischemia 530

■ Laparoscopic Renal Hypothermia 530

■ Oncologic Outcomes 531

■ Impact of Pelvicalyceal Suture Repair 532

■ Laparoscopic Heminephrectomy 532

■ Central vs. Peripheral Tumor 533

■ Hilar Clamping vs. Non-Clamping 533

■ Effect of Tumor Size 533

■ Laparoscopic Partial Nephrectomy for Cystic Masses 534

■ Laparoscopic Partial Nephrectomy for Hilar Tumors 534

■ Laparoscopic Partial Nephrectomy in the Solitary Kidney 535

■ Transperitoneal vs. Retroperitoneal Laparoscopic Partial Nephrectomy 535

■ Financial Analysis 536

■ Hand-Assisted Laparoscopic Partial Nephrectomy 536

■ Future Directions: Hydro-Jet Technology 537

■ References 539

CHAPTER 46: RENAL CRYOABLATION: TECHNIQUE AND RESULTS ■ 543

Murali K. Ankem and Stephen Y. Nakada

■ Introduction 543

■ Patient Selection: Indications and Contraindications 544

■ Preoperative Preparation 544

■ Technique 545

■ Instrument List 547

■ References 551

CHAPTER 47: RENAL RADIOFREQUENCY ABLATION: TECHNIQUE AND RESULTS ■ 553

Edward D. Matsumoto and Jeffrey A. Cadeddu

■ Introduction 553

■ Mechanism of Action 553

■ Patient Selection: Indication and Contraindications 554

■ Preoperative Preparation 554

■ Laparoscopic Radiofrequency Ablation Technique 554

■ Percutaneous Radiofrequency Ablation Technique 556

■ Radiofrequency Ablation Follow-Up 557

■ Results: Experimental Studies 558

■ Results: Clinical Studies 559

■ References 561

■ Commentary Harrison K. Rhee and John A. Libertino 562

CHAPTER 48: LAPAROSCOPIC RADICAL NEPHROURETERECTOMY: TECHNIQUES FOR THE MANAGEMENT OF DISTAL URETER AND BLADDER CUFF ■ SGS

Gary W. Chien, Marcelo A. Orvieto, and Arieh L. Shalhav

■ Techniques for Management of Distal Ureter and Bladder Cuff S6S

■ Open Management of the Distal Ureter and Bladder Cuff Following Laparoscopic Radical Nephroureterectomy S69

■ References S71

■ Commentary John M. Fitzpatrick S72

CHAPTER 49: LAPAROSCOPIC RADICAL NEPHROURETERECTOMY: CURRENT STATUS ■ 573

Surena F. Matin

■ Introduction 573

■ Nephrectomy 573

■ The Current Status of Laparoscopic Radical Nephroureterectomy, Distal Ureterectomy, and Bladder Cuff Excision 575

■ Morbidity Associated with Laparoscopic Radical Nephroureterectomy 577

■ Oncologic Efficacy 578

■ Adjunctive Procedures During Laparoscopic Radical Nephroureterectomy: Lymphadenectomy and Adrenalectomy 578

■ Local Recurrences: Port Site and Ureteral Stump 579

■ References 582

■ Commentary J. deKernion 584

CHAPTER 50: KIDNEY CANCER SPECIMEN EXTRACTION: INTRACORPOREAL MORCELLATION ■ 587

Maxwell V. Meng

■ Introduction 587

■ Background 587

■ Description of Method 588

■ Outcomes of Morcellation 591

■ Pathologic Considerations 592

■ References 596

CHAPTER 51: LAPAROSCOPIC RETROPERITONEAL LYMPH NODE DISSECTION TECHNIQUE ■ 599

Nasser Albqami and Günter Janetschek

■ Introduction 599

■ Therapeutic Concepts and Patient Selection 599

■ Contraindications for Laparoscopic Retroperitoneal Lymph Node Dissection 601

■ Preoperative Preparation 601

■ Templates 602

■ Patient Positioning 602

■ Trocar Placement and Pneumoperitoneum 603

■ Procedure 603

■ Extraperitoneal Approach 606

■ References 609

CHAPTER 52: LAPAROSCOPIC RETROPERITONEAL LYMPH NODE DISSECTION FOR CLINICAL STAGE I NONSEMINOMATOUS GERM CELL TESTICULAR CANCER: CURRENT STATUS ■ 611

Sam B. Bhayani and Louis R. Kavoussi

■ Introduction 611

■ Differences in Laparoscopic Retroperitoneal Lymph Node Dissections 611

■ Efficacy of Treatment Options 612

■ Complications of Laparoscopic Retroperitoneal Lymph Node Dissection 614

■ Postchemotherapy Laparoscopic Retroperitoneal Lymph Node Dissection 614

■ References 614

■ Commentary Jerome P. Richie 615

CHAPTER 53: LAPAROSCOPIC PELVIC LYMPHADENECTOMY FOR PROSTATE AND BLADDER CANCER ■ 617

Antonio Finelli

■ Introduction 617

■ Prostate Cancer 617

■ Bladder Cancer 619

■ Port-Site Tumor Seeding and Local Recurrence 621

■ References 621

CHAPTER 54: LAPAROSCOPIC RADICAL CYSTECTOMY (PROSTATE SPARING) ■ 625

Xavier Cathelineau, Carlos Arroyo, François Rozet, Eric Barret, and Guy Vallancien

■ Introduction 625

■ Patient Selection: Indications and Contraindications 625

■ Preoperative Preparation 626

■ Detailed Laparoscopic Technique 626

■ Description of Technical Modifications 628

■ Specific Measures Taken to Avoid Complications 630

■ Postoperative Evaluation 631

■ Discussion 632

■ References 634

CHAPTER 55: LAPAROSCOPIC RADICAL CYSTECTOMY: TECHNIQUE ■ 637

Karim A. Touijer and Stephen J. Savage

■ Introduction 637

■ Patient Selection 637

■ Preoperative Patient Preparation 638

■ Surgical Technique 638

■ Laparoscopic Radical Cystectomy in the Male Patient 638

■ Laparoscopic Radical Cystectomy in the Female Patient 641

■ Robot-Assisted Laparoscopic Radical Cystectomy 642

■ Urinary Diversions 642

■ Conclusion 642

■ References 642

CHAPTER 56: LAPAROSCOPIC BOWEL SURGERY: GENERAL CONSIDERATIONS ■ 643

Anthony J. Senagore

■ Introduction 643

■ Patient Selection: Indications and Contraindications 643

■ Perioperative Care 643

■ Operative Techniques 644

■ References 646

CHAPTER 57: LAPAROSCOPIC URINARY DIVERSION ■ 647

David Canes, Harrison K. Rhee, and Ingolf Tuerk

■ Introduction 647

■ Indications and Contraindications 648

■ A: Noncontinent Urinary Diversions 650

■ Ileal Conduit 650

■ Lap-Assisted Ileal Conduit Urinary Diversion 651

■ Pure Laparoscopic Ileal Conduit Urinary Diversion 653

■ B: Continent Urinary Diversion 655

■ Orthotopic Neobladder 655

■ Lap-Assisted Orthotopic Neobladder 656

■ Pure Laparoscopic Orthotopic Neobladder 658

■ Laparoscopic Mainz II Pouch (Sigma-Rectum Pouch) 660

■ Future Directions 663

■ References 664

■ Commentary JohnP.Stein 665

■ Commentary Urs E. Studer 667

CHAPTER 58: LAPAROSCOPIC SURGERY FOR BLADDER CANCER: CURRENT STATUS ■ 669

Osamu Ukimura and Inderbir S. Gill

■ Introduction 669

■ Histologic and Experimental Background 670

■ Clinical Series 670

■ International Registry and Future Direction 674

■ References 675

CHAPTER 59: TRANSPERITONEAL LAPAROSCOPIC RADICAL PROSTATECTOMY: TECHNICAL VARIATIONS, ONCOLOGIC AND FUNCTIONAL RESULTS,AND TRAINING ■ 677

Jens J. Rassweiler, Tibet Erdogru, Marto Sugiono, Marzel Hrutza and Dogu Teber

■ The History of Laparoscopic Radical Prostatectomy 677

■ Indications of Laparoscopic Radical Prostatectomy 678

■ Specific Contraindications 679

■ Laparoscopic Transperitoneal Ascending Radical Prostatectomy (The Heilbronn Technique) 679

■ Laparoscopic Transperitoneal Descending Radical Prostatectomy (The Montsouris Technique) 685

■ Technical Variations 688

■ References 700

■ Commentary Guy Vallancien 702

CHAPTER 60: LAPAROSCOPIC RADICAL PROSTATECTOMY: EXTRAPERITONEAL TECHNIQUE ■ 705

Clément-Claude Abbou, Andrâs Hoznek, Laurent Salomon, Matthew T. Gettman, and Philippe Sebe

■ Introduction 705

■ Operative Technique 705

■ Discussion 711

■ Conclusion 712

■ References 713

■ Commentary Renaud Bollens and Claude Schulman 714

CHAPTER 61: ROBOTIC RADICAL PROSTATECTOMY: TECHNIQUE AND RESULTS ■ 717

Melissa C. Fischer, James O. Peabody, Mani Menon, and Ashok K. Hemal

■ Introduction and Background 717

■ Patient Selection: Indications and Contraindications 717

■ Preoperative Preparation 718

■ Detailed Robotic Prostatectomy Technique 718

■ Extraperitoneal Approach for Robotic Radical Prostatectomy 724

■ Specific Measures Taken to Avoid Complications 724

■ References 726

■ Commentary Guy Vallancien 727

CHAPTER 62: LAPAROSCOPIC RADICAL PROSTATECTOMY: CURRENT STATUS ■ 729

Karim A. Touijer, Edouard Trabulsi, and Bertrand Guillonneau

■ Introduction 729

■ Technique 730

■ Perioperative Parameters 731

■ Cancer Control 734

■ Functional Results 736

■ New Innovations in Laparoscopic Prostate Surgery 737

■ Personal Experience of the Senior Author (B. G.): The Lessons Learned 737

■ References 739

■ Commentary Robert P. Myers 741

CHAPTER 63: PORT SITE METASTASIS IN UROLOGIC LAPAROSCOPY ■ 745

Steven M. Baughman and Jay T. Bishoff

■ Introduction 745

■ History: Gynecologic and General Surgery Literature 745

■ Urologic Experience 746

■ Basic Science and Predisposing Factors 749

■ Port Site Recurrence Prevention 751

■ Percutaneous Ablation 751

■ References 752

SECTION VI: PEDIATRIC LAPAROSCOPY

CHAPTER 64: LAPAROSCOPY IN THE CHILD: SPECIFIC ISSUES ■ 757

Craig A. Peters

■ Indications 757

■ Patient Preparation 758

■ Port Positioning and Setup 758

■ Hand Instruments 759

■ Manipulation Principles 760

■ Retroperitoneal Access 761

■ Physiology and Anesthetic Considerations 762

■ Complications 762

■ Surgical Complications 763

■ Postoperative Course 763

■ References 764

CHAPTER 65: LAPAROSCOPIC MANAGEMENT OF THE UNDESCENDED NONPALPABLE TESTICLE ■ 767

Gerald H. Jordan and Linda Baker

■ Introduction 767

■ Considerations for Orchidopexy 768

■ Therapeutic Laparoscopy 771

■ References 776

CHAPTER 66: LAPAROSCOPIC URETERAL REIMPLANTATION ■ 779

Jonathan H. Ross and Richard Sutherland

■ Introduction 779

■ Vesicoureteral Reflux: Management 779

■ Transvesical Cross-Trigonal Approach 780

■ Laparoscopic Extravesical Approach 780

■ References 781

SECTION VII: HAND-ASSISTED LAPAROSCOPY

CHAPTER 67: HAND-ASSISTED LAPAROSCOPIC NEPHRECTOMY ■ 785

Steven J. Shichman and Joseph R. Wagner

■ Introduction 785

■ Patient Selection: Indications and Contraindications 786

■ Preoperative Preparation 786

■ Detailed Laparoscopic Technique 787

■ Pros and Cons of Different Techniques 793

■ Specific Measures Taken to Avoid Complications 795

■ References 796

CHAPTER 68: HAND-ASSISTED LAPAROSCOPY: CURRENT STATUS ■ 799

J. Stuart Wolf, Jr. and Stephen Y. Nakada

■ Introduction 799

■ Experience with Hand-Assisted Laparoscopy 800

■ Complications of Hand-Assisted Laparoscopy 803

■ Comparison of Hand-Assisted Laparoscopy to Other Laparoscopic Techniques 804

■ Selection of Patients for Hand-Assisted Laparoscopy 808

■ References 809

CHAPTER 69: GASLESS LAPAROSCOPY ■ 813

Kazuo Suzuki

■ Introduction 813

■ Equipment and Technique 815

■ Gasless vs. Pneumoperitoneum 817

■ References 819

SECTION VIII: LAPAROSCOPY: DEVELOPING TECHNIQUES

CHAPTER 70: THORACOSCOPIC TRANSDIAPHRAGMATIC ADRENALECTOMY ■ 825

Massimiliano Spaliviero and Anoop M. Meraney

■ Introduction 825

■ Current Indications and Contraindications of Laparoscopic Adrenalectomy 825

■ Transthoracic Laparoscopy: Experimental and Clinical Data 826

■ Thoracoscopic Transdiaphragmatic Adrenalectomy: Patient Selection 827

■ Surgical Technique 828

■ Technical Limitations 833

■ References 833

CHAPTER 71: RENAL HYPOTHERMIA ■ 835

Anup P. Ramani

■ Introduction 835

■ Physiology of Renal Hypothermia 835

■ Techniques of Laparoscopic Renal Hypothermia 836

■ Laparoscopic Ice Slush Renal Hypothermia 836

■ Endoscopic Retrograde Cold Saline Infusion 837

■ Transarterial Renal Hypothermia 838

■ The Laparoscopic Cooling Sheath 839

■ Ancillary Techniques for Ischemic Renoprotection 839

■ References 840

CHAPTER 72: LAPAROSCOPIC RENOVASCULAR SURGERY ■ 841

■ Introduction 841

■ Laparoscopic Aortorenal Bypass 841

■ Laparoscopic Renal Autotransplantation 842

■ Laparoscopic Repair of Renal Artery Aneurysm 843

■ References 843

CHAPTER 73: LAPAROSCOPIC SURGERY FOR THE HORSESHOE KIDNEY ■ 845

Hyung L. Kim and Peter Schulam

■ Introduction 845

■ Pyeloplasty 845

■ Heminephrectomy 847

■ References 849

CHAPTER 74: LAPAROSCOPIC BOARI FLAP URETERONEOCYSTOSTOMY AND ILEAL URETER REPLACEMENT ■ 851

Amr F. Fergany

■ Laparoscopic Boari Flap Ureteroneocystostomy 851

■ Laparoscopic Ileal Ureter Replacement 852

■ References 854

CHAPTER 75: TRANSVESICAL LAPAROSCOPIC BLADDER DIVERTICULECTOMY ■ 855

Vito Pansadoro

■ Introduction 855

■ History of Laparoscopic Diverticulectomy 855

■ Indications and Contraindications 855

■ Surgical Technique 856

■ Current Data from the Literature 857

■ Complications 857

■ Advantages and Disadvantages 857

■ References 857

CHAPTER 76: LAPAROSCOPIC SIMPLE PROSTATECTOMY ■ 859

Rene Sotelo Noguera and Alejandro Garcia-Segui

■ Introduction 859

■ Patient Selection 860

■ Preoperative Preparation 860

■ Laparoscopic Technique 861

■ Technical Modifications 862

■ Pros and Cons of Various Techniques 864

■ Specific Measures Taken to Prevent Complications 866

■ References 866

CHAPTER 77: TECHNIQUES FOR URETHROVESICAL ANASTOMOSIS IN LAPAROSCOPIC RADICAL PROSTATECTOMY ■ 869

Roland F. P. van Velthoven

■ Introduction 869

■ Patient Positioning 869

■ Surgeon Positioning 870

■ Preparation of the Urethral Stump 870

■ Preparation of the Bladder Neck 871

■ Urethrovesical Anastomosis in the Montsouris Technique 871

■ Running Suture Technique for Vesicourethral Anastomosis 872

■ Single Knot Method for the Laparoscopic Running Urethrovesical Anastomosis 874

■ Discussion 876

■ References 879

CHAPTER 78: MINILAPAROSCOPIC UROLOGIC SURGERY ■ 883

Anoop M. Meraney

■ Introduction 883

■ Minilaparoscopic Instruments 883

■ Minilaparoscopic Urologic Procedures 884

■ Benefits and Limitations 887

■ Current Status and Future Potential 887

■ References 888

CHAPTER 79: ROBOTIC SURGERY: OTHER APPLICATIONS ■ 889

Amy E. Krambeck and Matthew T. Gettman

■ Introduction 889

■ Upper Urinary Tract 889

■ Lower Urinary Tract 893

■ Conclusion 895

■ References 896

SECTION IX: LAPAROSCOPIC COMPLICATIONS: ETIOLOGY, PREVENTION, MANAGEMENT

CHAPTER 80: VASCULAR COMPLICATIONS DURING UROLOGIC LAPAROSCOPY ■ 901

James R. Porter

■ Introduction 901

■ Frequency of Laparoscopic Vascular Injury 901

■ Access-Related Injury 904

■ References 908

CHAPTER 81: LAPAROSCOPIC COMPLICATIONS: GASTROINTESTINAL ■ 911

Ramakrishna Venkatesh and Jaime Landman

■ Introduction 911

■ Abdominal Access-Related Bowel Injuries 911

■ Non-Access-Related Bowel Injuries 913

■ Electrocautery Bowel Injury 915

■ Mechanical Bowel Injury 917

■ Gastric or Duodenal Injuries 917

■ Hepatobiliary, Splenic, or Pancreatic Injury 917

■ Previous Open Abdominal Surgery and Laparoscopic Surgery 918

■ Hand-Assisted Laparoscopy 918

■ Trocar Site Hernia 919

■ Rectal Injury During Radical Prostatectomy 919

■ Surgeon Experience 920

■ References 921

CHAPTER 82: LAPAROSCOPIC COMPLICATIONS: NEUROMUSCULAR ■ 923

Dan B. French and Robert Marcovich

■ Introduction 923

■ Anatomic Overview 923

■ Risk Factors for Neuromuscular Injury 925

■ Types of Injuries 927

■ References 932

CHAPTER 8S: COMPLICATIONS: THORACIC ■ SSS

Sidney C. Abreu, Joäo Batista G. Cerqueira, and Gilvan Neiva Fonseca

■ Introduction 933

■ Incidence 933

■ Diagnosis and Management 936

■ Prevention 936

■ References 937

CHAPTER 84: GYNECOLOGIC INJURIES INVOLVING THE URINARY SYSTEM ■ 939

John E. Jelovsek, Tommaso Falcone, and Paul K. Tulikangas

■ Introduction 939

■ Gynecologic Disorders That Involve the Lower Urinary Tract 939

■ Preoperative Gynecologic Evaluation 939

■ Uterine Leiomyomata 940

■ Hysterectomy 941

■ Pelvic Adhesions 941

■ Pelvic Inflammatory Disease 943

■ Adnexal Masses 944

■ Ovarian Remnant 945

■ Cervical Cancer 945

■ Endometriosis 946

■ Urinary Tract Injury During Gynecologic Procedures 947

■ Injury to the Urethra 947

■ Injury to the Bladder 947

■ Injuries to the Ureter 948

■ Manipulators 948

■ References 949

SECTION X: LAPAROSCOPY: SELECT ASPECTS

CHAPTER 85: IMMUNOLOGIC ASPECTS OF LAPAROSCOPY ■ 953

Prokar Dasgupta and Ben Challacombe

■ Introduction 953

■ Basic Principles of Immunology 954

■ Laparoscopy and Systemic Immunity 955

■ Laparoscopy and Intraperitoneal Immune Function 959

■ Tumor Growth, Metastasis, and Immune Function 961

■ Laparoscopic Bowel Injury 962

■ Immunologic Aspects of Laparoscopic Urology 962

■ Future Directions 965

■ References 967

CHAPTER 86: LAPAROSCOPIC SURGERY IN THE HIGH RISK PATIENT ■ 971

Assaad El-Hakim and Benjamin R. Lee

■ Previous Abdominal Surgery 971

■ Coagulation Disorders 973

■ Cardiopulmonary Disorders 976

■ Advanced Age 980

■ References 981

CHAPTER 87: LAPAROSCOPIC SURGERY DURING PREGNANCY ■ 983

Michael D. Rollins and Raymond R. Price

■ Introduction 983

■ Anatomic and Physiologic Considerations 984

■ Special Considerations 986

■ Advantages of Laparoscopic Surgery 988

■ Safety of Laparoscopy 988

■ Nongynecologic Laparoscopic Procedures 989

■ Common Gynecologic Laparoscopic Procedures 992

■ Recommendations 992

■ References 993

CHAPTER 88: LAPAROSCOPY AND TRAUMA ■ 997

Abraham A. Nisim and Daniel R. Margulies

■ Introduction and Background 997

■ Penetrating Injuries 998

■ Blunt Trauma 999

■ References 999

CHAPTER 89: LAPAROSCOPIC ULTRASONOGRAPHY ■ 1001

Osamu Ukimura

■ General Principles of Laparoscopic Ultrasound 1001

■ Technique 1001

■ Doppler Ultrasound 1002

■ Urologic Utility of Laparoscopic Ultrasonography 1003

■ Prospects and Limitations for Laparoscopic Ultrasonography and New Technology 1006

■ References 1007

CHAPTER 90: FINANCIAL ASPECTS OF UROLOGIC LAPAROSCOPY ■ 1009

Yair Lotan and Jeffrey A. Cadeddu

■ Introduction 1009

■ The Importance of Perspective 1009

■ Current Financial State of Laparoscopic Procedures 1012

■ Laparoscopic Nephrectomy 1012

■ Laparoscopic Prostatectomy 1013

■ References 1015

CHAPTER 91: LAPAROSCOPIC SURGERY AND THE COMMUNITY UROLOGIST ■ 1017

Scott D. Miller

■ Introduction 1017

■ The Private Practice Model 1017

■ Patient Outcome 1018

■ Building a Laparoscopic Practice 1020

■ References 1022

CHAPTER 92 LAPAROSCOPIC SURGERY: MEDICOLEGAL ASPECTS ■ 1025

Michael Perrotti, Peter J. Millock, and Michael E. Moran

■ Introduction 1025

■ Laparoscopic Complications 1029

■ Informed Consent 1041

■ References 1046

SECTION XI: THE FUTURE

CHAPTER 93: TISSUE ENGINEERING ■ 1053

J. Daniell Rackley and Anthony Atala

■ Introduction 1053

■ Basic Principles of Tissue Engineering 1053

■ Biomaterials for Genitourinary Tissue Engineering 1054

■ References 1058

CHAPTER 94: HYDRO-JET TECHNOLOGY ■ 1061

Bijan Shekarriz

■ Introduction 1061

■ Principles of Dissection 1062

■ Experimental Data in Urology 1063

■ Clinical Applications in Urology 1065

■ Future Perspectives 1065

■ References 1066

CHAPTER 95: TISSUE EXPANSION ■ 1067

Jose R. Colombo, Jr., Osamu Ukimura, and Inderbir S. Gill

■ Pathophysiology 1068

■ Visceral Tissue Expansion in Urinary Tract 1068

■ Desai Study 1069

■ Clinical Study 1075

■ Clinical Implications 1075

■ References 1076

CHAPTER 96: EXTRACORPOREAL TISSUE TRIPSY IN UROLOGY ■ 1079

M. Marberger and Y. K. Fong

■ Introduction 1079

■ Radiosurgery 1079

■ Mechanical Tissue Tripsy 1079

■ Thermal Tissue Ablation 1082

■ References 1088

CHAPTER 97: TELEMENTORING AND TELESURGERY ■ 1091

Mehran Anvari

■ Introduction 1091

■ Telementoring 1092

■ Robot-Assisted Remote Telepresence Surgery 1093

■ References 1096

CHAPTER 98: VIRTUAL REALITY AND SIMULATION IN UROLOGY ■ 1097

Robert M. Sweet and Jeffrey Berkley

■ Introduction 1097

■ Virtual Reality Role in Procedural Training 1100

■ Building a Virtual Reality Simulator 1100

■ Survey of Virtual Reality Urologic Simulators 1116

■ Cognitive Simulation Engines 1117

■ Complete Procedures 1117

■ References 1125

CHAPTER 99: MATHEMATICAL MODELING FOR PREDICTING OUTCOMES IN LAPAROSCOPIC UROLOGY ■ 1129

Sijo Joseph Parekattil

■ Introduction 1129

■ What Is Mathematical Modeling? 1130

■ Application of Modeling in Urology 1131

■ Application of Modeling in Laparoscopy 1131

■ References 1139

CHAPTER 100: NANOTECHNOLOGY AND UROLOGY ■ 1141

Iqbal S. Shergill, Manit Arya, and Hiten Patel

■ Introduction 1141

■ Potential Applications of Nanotechnology in Urology 1141

■ Delivery Systems for Drug and Gene Therapy 1142

■ Imaging and Labeling with Nanostructured Materials 1142

■ Molecular Recognition 1142

■ Nanosurgical Tools 1143

■ Synthetic Therapeutic Devices 1143

■ Nanotechnology and Limitations 1143

■ Nanotechnology and the Future 1143

■ Conclusion 1144

■ References 1144

CHAPTER 101: THE SURGEON OF THE FUTURE ■ 1145

Richard M. Satava

■ Introduction 1145

■ Clinical Practice 1146

■ Emerging Technologies 1147

■ Education and Training 1148

■ Research for Clinical Trials 1149

■ Moral and Ethical Challenges 1149

■ Conclusion 1149

■ References 1150

Index 1151

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