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Zhengqiang W, Yinglei W, Cheng L, Dongbing Z. One-stage laparoscopy combined with resectoscope in the treatment of huge bladder diverticulum, multiple stones in diverticulum, multiple stones in bladder and benign prostatic hyperplasia: A case report. Front Med (Lausanne) 2022; 9:1036222. [DOI: 10.3389/fmed.2022.1036222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBladder diverticulum is due to the abnormal arrangement of congenital bladder wall muscle fibers, weak limitations, combined with lower urinary tract obstruction, increased intravesical pressure, and protruding between the self-separated detrusor muscle bundles of the bladder wall. Giant bladder diverticulum refers to 10*8 cm or diverticulum over 150 ml in volume.Case summaryAn 80-year-old male patient was admitted to our hospital on August 14, 2020, the preoperative diagnosis was: bladder diverticulum, bladder diverticulum calculi, multiple bladder stones and prostatic hyperplasia. On August 18, 2020, one-stage laparoscopic bladder diverticulectomy + diverticulum neck incision for stone removal + cystopuncture fistula + transurethral bladder stone removal + transurethral resection of the prostate (TURP) under general anesthesia. First, the bladder diverticulum was separated under laparoscopy, the diverticulum was incised, the diverticulum calculi were taken out, and then the diverticulum was completely removed, and the neck of the diverticulum was extended by 1.5 cm, and the large calculus of about 2.7*3.6 cm was completely removed, and then cystostomy + transurethral Bladder stone removal + TURP. There was no bleeding from the bladder suture during the operation. 200 ml of urine was drained from the extraperitoneal drainage tube, and 20 ml of urine was drained from the abdominal drainage tube during the operation, the urination is smooth, and the general condition can be discharged. The patient’s general condition is good after follow-up.ConclusionOne-stage laparoscopic treatment of bladder diverticulectomy + diverticulum neck incision for stone extraction + cystopuncture fistula + transurethral bladder stone extraction + TURP surgery. There is no report at home and abroad, which can provide diagnosis and treatment ideas and surgical methods for urological colleagues to deal with such diseases.
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Giannarini G, Rossanese M, Macchione L, Mucciardi G, Crestani A, Ficarra V. Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach. EUR UROL SUPPL 2022; 44:162-168. [PMID: 36110902 PMCID: PMC9468349 DOI: 10.1016/j.euros.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background Objective Design, setting, and participants Surgical procedure Outcome measurements and statistical analysis Results and limitations Conclusions Patient summary
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Affiliation(s)
- Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marta Rossanese
- Urology Section, Gaetano Barresi Department of Human and Paediatric Pathology, University of Messina, Messina, Italy
| | - Luciano Macchione
- Urology Section, Gaetano Barresi Department of Human and Paediatric Pathology, University of Messina, Messina, Italy
| | - Giuseppe Mucciardi
- Urology Section, Gaetano Barresi Department of Human and Paediatric Pathology, University of Messina, Messina, Italy
| | - Alessandro Crestani
- Oncological Urology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vincenzo Ficarra
- Urology Section, Gaetano Barresi Department of Human and Paediatric Pathology, University of Messina, Messina, Italy
- Corresponding author. Urology Section, Gaetano Barresi Department of Human and Paediatric Pathology, University of Messina, Policlinico Universitario G. Martino, Via Consolare Valeria 1, Messina, Italy.
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Ho MC, Hashim H. Surveillance and Management of Bladder Diverticulum in the Setting of Bladder Outlet Obstruction. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Kajaia D, Hager B, Kliebisch S, Weingärtner K, Seggewiss-Bernhardt R, Zugor V. [Robot-assisted laparoscopic bladder diverticulum resection (RABDR)]. Aktuelle Urol 2022; 53:254-261. [PMID: 33975364 DOI: 10.1055/a-1327-5509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS Since October 2018, urinary bladder diverticulum resections at our Department of Urology have been carried out with robot assistance and with minimal invasivion, Paediatrical urological and robot-assisted minimally invasive urological surgery for the Bamberg Social Foundation were performed with the DaVinci robotic systemTM. The aim of the present study was to record the surgical results of our patients and to compare these if necessary with available data on optimal diagnostic and therapy. METHODS In this retrospective analysis, we included all patients who received RAHDR between October 2018 and March 2020. The primary endpoints were postoperative blood loss (postoperative haemoglobin decrease), the operation time (min), complications according to the Clavien-Dindo classification, length of hospital stay (days), postoperative residual urine, postoperative urine extravasation at the anastomosis of the bladder, postoperative quality of life and postoperative satisfaction with micturition. RESULTS We reviewed a total of 11 patients, all of whom were male. Mean age was 64.8 years (52-82). Average BMI was 26.5 (19-37). 3 patients were ranked with ASA score III, 5 with II and 3 with I. The average residual urine value preoperatively was 183 ml (90-240). A cystogram to rule out extravasation was performed on day 6 postoperatively. The mean duration of surgery was 212 min (148-294) and the mean duration of hospitalisation was 7.6 days (6-10). The mean residual urinary value after surgery was 25 ml (10-60). The mean postoperative maximum of flow was measured at 27.7 ml/s (11-55). No contrast agent extravasation in the cystogram was detected in any of the patients. The complications according to Clavien were not measurable. The mean postoperative haemoglobin decrease was 1.61 g/dl (0-3. 2). CONCLUSIONS In most cases, the removal of one or more bladder diverticula is possible using the minimally invasive robotic technique. Various surgeries such as YV-bladder neck plastic, prostate adenoma enucleation, bladder stone restoration, and inguinal herniotomy can be carried out simultaneously. A robot-assisted urinary bladder diverticulum resection is an effective and gentle procedure. However, it must be considered that it brings financial disadvantages due to the lack of adequate representation within the German DRG-system (Diagnosis Related Groups).
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Affiliation(s)
- David Kajaia
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Benjamin Hager
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Stefan Kliebisch
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Karl Weingärtner
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Ruth Seggewiss-Bernhardt
- Sozialstiftung Bamberg, Medizinische Klinik V, Hämatologie und Internistische Onkologie, Bamberg
| | - Vahudin Zugor
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
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Phan YC, Babawale O, Karim O, Wilby D, Ismail M. A single institution experience: Robotic-assisted laparoscopic renal calyceal diverticulectomies, heminephrectomy and bladder diverticulectomies. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211029813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The use of a robotic surgical system has transformed modern urological surgeries. There is little reported, however, on the use of robotic surgical systems in the management of benign urological diseases. We aim to report our experience in robotic-assisted surgery in renal calyceal diverticulectomies, heminephrectomy and bladder diverticulectomies. Methodology: We retrospectively collected the data of patients who had robotic-assisted surgery in our institution from 1 January 2014 to 31 December 2019. Results: Over the last five years, our institution has performed over 1500 robotic-assisted urological surgeries. In this five-year period, four robotic surgeons have performed a total of 25 robotic assisted operations to treat benign urological diseases including three renal calyceal diverticulectomies, one heminephrectomy and two bladder diverticulectomies. All patients were satisfied with the outcomes of their surgery when reviewed at their follow up consultations. Conclusion: We report a very positive experience in using robotic surgical systems in managing our series of benign urological conditions in our hospital. We should not restrict the use of this tool to cancer surgery, but consider the technology in our surgical armamentarium for all aspects of our urological practice.
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Affiliation(s)
| | | | - Omer Karim
- Queen Alexandra Hospital, Portsmouth, UK
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Simultaneous holmium laser enucleation of prostate and laparoscopic bladder diverticulectomy. UROLOGY VIDEO JOURNAL 2020. [DOI: 10.1016/j.urolvj.2020.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Salman MY, Fazlıoğlu A, Kurtuluş FO, Ünlüer SE. Surgical treatment of bladder diverticulum with radical prostatectomy. A case report and literature review. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.455144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cacciamani G, De Luyk N, De Marco V, Sebben M, Bizzotto L, De Marchi D, Cerruto MA, Siracusano S, Benito Porcaro A, Artibani W. Robotic bladder diverticulectomy: step-by-step extravesical posterior approach - technique and outcomes. Scand J Urol 2018; 52:285-290. [PMID: 30339480 DOI: 10.1080/21681805.2018.1492965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility of robotic extravesical posterior surgical bladder diverticulectomy for treatment of symptomatic bladder diverticula (BD). MATERIALS AND METHODS Data from patients with posterior BD who consecutively underwent robotic bladder diverticulectomy (RBD) from 2013 to 2016 in Azienda Ospedaliera Universitaria Integrata, Verona, were retrospectively reviewed. Baseline characteristics, perioperative outcomes including operative time (OT), estimated blood loss (EBL), postoperative transfusion rate and length of hospital stay (LOS), and early (30 days) and late (90 days) postoperative complications were recorded and analysed. RESULTS Six patients underwent RBD. Storage, voiding and postvoiding lower urinary tract symptoms (LUTS) were reported by 33.3%, 100% and 33.3% of patients, respectively. The median [interquartile range (IQR)] BD diameter was 7.1 (5.5-9.5) cm; median (IQR) preoperative postvoiding residual volume (PVR) was 300 (90-395) ml. The median (IQR) OT was 112.5 (83.7-133.7) min and median (IQR) EBL was 25.8 (0-50) ml. The median (IQR) LOS was 7 (4.7-9.0) days. One patient (16.7%) reported early minor postoperative complication. No patient showed early or late major postoperative complications. At 2 month follow-up, all patients underwent a lower abdomen ultrasound and minimal or no postoperative PVR was found. At 6 month follow-up no LUTS were reported. CONCLUSIONS RBD appears to be a safe treatment for posterior BD with excellent perioperative and functional outcomes. The three-dimensional visualization, greater magnification and wristed instrumentation with seven degrees of freedom allow precise dissection of BD and reconstruction of the bladder wall.
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Affiliation(s)
- Giovanni Cacciamani
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Nicolò De Luyk
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Vincenzo De Marco
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Marco Sebben
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Leonardo Bizzotto
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Davide De Marchi
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Maria Angela Cerruto
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Salvatore Siracusano
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Antonio Benito Porcaro
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
| | - Walter Artibani
- a Department of Urology , Azienda Ospedaliera Universitaria Integrata, University of Verona , Verona , Italy
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Single-session Transvesical Laparoendoscopic 1-Port Removal of 2 Bladder Diverticula in a Female Patient. Urology 2018; 120:264-265. [PMID: 29958972 DOI: 10.1016/j.urology.2018.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bladder diverticula are usually encountered in males, and they are a rarity in women, especially in the absence of obstruction. Open surgery, as well as laparoscopic or robotic, or single-port surgery have been applied successfully to remove bladder diverticula.1-3 To the best of our knowledge, no single-port diverticulectomies have been performed in women. OBJECTIVE To present the case of using the transvesical laparoendoscopic single-port surgery (T-LESS) for excision of 2 bladder diverticula in a woman. MATERIALS In August 2016, we carried out the T-LESS access on a 67-year old woman to remove 2 symptomatic bladder diverticula in 1 session. The patient was placed in the lithotomy position and was under general anesthesia. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (Tri-Port+) via a 1.5-cm incision made 3 cm above the pubic symphysis. Standard 10-mm optic and straight laparoscopic instruments were used. The diverticula were dissected and removed from the bladder with a combination of standard laparoscopic and endoscopic instruments introduced through the TriPort+ or the urethra. The bladder wall openings were closed by running absorbable 2/0 polyglactin sutures. An 18F Foley catheter was left in place for 6 days. RESULTS The operation lasted 120 minutes. Blood loss was minimal, and no complications were observed. The postoperative period was uneventful. The patient was discharged within 19 hours of surgery. During a 9-month follow-up, the patient reported the significant improvement in the severity of symptoms. Laboratory examination results were all within the normal range. CONCLUSION The T-LESS procedure can be considered as a valuable option for diverticulectomies in female patients because of its minimal invasiveness, short hospital stay, and fast recovery time.
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Servera A, Benejam J, Pons J, García-Miralles R, Hernández Y. Laparoscopic diverticulectomy: A systemised technique. Actas Urol Esp 2016; 40:650-654. [PMID: 27370011 DOI: 10.1016/j.acuro.2016.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 05/13/2016] [Accepted: 05/14/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To present an original technique for laparoscopic vesical diverticulectomy without the need for dissecting the diverticular wall, thereby making the procedure safe and significantly simpler. MATERIAL AND METHODS Four patients were operated on between September 2014 and April 2016. The diagnosis was made by ultrasonography in all cases, and the study included blood and urine analyses with urine cultures, urine cytology, contrast-enhanced CT scans, prostate symptom questionnaire (International Prostate Symptom Score), flowmetry and cystoscopy. One case required transurethral prostate resection in a first time. RESULTS The mean age of the patients was 64 years (range: 56-71). The mean diverticulum size was 4cm (range: 3-6). The location was retrotrigonal in all cases, on the left side in 2 cases, right retromeatic in 1 case and near the midline in 1 case. The mean surgical time was 146min (range, 120-180), shortening for each new case. There were no significant bleeding, complications or conversion to open surgery in any of the cases. The postoperative period had no incidences. The hospital stay was 3 days in 3 cases and 48h in the other case (mean, 3.5 days). The catheter was withdrawn in the outpatient clinic at 14 days. CONCLUSIONS The initial experience with the technique described above shows it to be safe and reproducible, with results similar to other current laparoscopic techniques. Avoiding the dissection of the diverticular wall significantly reduces the technical difficulty of the procedure.
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Magdy A, Drerup M, Bauer S, Colleselli D, Hruby S, Mitterberger M, Janetschek G. Natural Orifice Transluminal Endoscopic Surgery-Assisted Laparoscopic Transvesical Bladder Diverticulectomy: Feasibility Study, Points of Technique, and Case Series with Medium-Term Follow-Up. J Endourol 2016; 30:526-31. [PMID: 26732642 DOI: 10.1089/end.2015.0693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To demonstrate the feasibility of our novel natural orifice transluminal endoscopic surgery (NOTES)-assisted approach with medium-term follow-up. PATIENTS AND METHODS From March 2012, we included all patients who presented to our clinic with symptomatic or complicated retentive bladder diverticula secondary to long-standing infravesical obstruction. After managing the primary cause, we proceeded in all cases to our novel NOTES-assisted approach. We followed up the patients with abdominal ultrasonography at 6 weeks and 12 months postoperatively. Success was determined as subjective relief of the symptoms and objective disappearance of the diverticula in postoperative retrograde cystogram (RGC). RESULTS Between March 2012 and August 2014, eight diverticula were treated using our new technique. The surgery was uneventful. The mean operative time was 134.25 ± 44.92 minutes. Blood loss was minimal (>50 mL). Retrograde cystography was performed on the 10th postoperative day. The introduction of the needle holder through the urethral natural orifice (NOTES) facilitated a more optimal direction of the needle holder for suturing the bladder wall due to its parallel position in relation to the trigone and posterolateral walls. This renders this step easier compared with suturing the bladder wall through the transvesical laparoscopic ports. One case had a grade IIIa complication according to the Clavien-Dindo classification of surgical complications. The study is limited by the small number of cases. CONCLUSION Laparoscopic transvesical bladder diverticulectomy is a promising and safe procedure with good outcomes. Using the urethra (NOTES assisted) as an extra access to the bladder facilitates diverticular traction and bladder suturing without the need for extra ports. This technique can also be applied together with the novel T-laparoendoscopic single-site surgery approach.
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Affiliation(s)
- Ahmed Magdy
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria .,2 Urology and Andrology Department, Faculty of Medicine, Menoufia University, Egypt
| | - Martin Drerup
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
| | - Sophina Bauer
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
| | - Daniela Colleselli
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
| | - Stephan Hruby
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
| | - Michael Mitterberger
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
| | - Günter Janetschek
- 1 Department of Urology and Andrology, Paracelsus Medical University Salzburg , Salzburg, Austria
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Elands S, Vasdev N, Tay A, Adshead JM. Robot-Assisted Laparoscopic Bladder Diverticulectomy and Ureteral Re-Implantation for a Diverticulum Containing High Grade Transitional Cell Carcinoma. Curr Urol 2015; 8:104-8. [PMID: 26889127 DOI: 10.1159/000365699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/23/2014] [Indexed: 12/30/2022] Open
Abstract
We present a case of an 84-year-old man presenting with painless visible hematuria. Further investigation revealed a primary G3pT1 transitional cell carcinoma confined to a bladder diverticulum. In view of bladder-sparing therapy, he underwent a robot-assisted laparoscopic bladder diverticulectomy with ureteral re-implantation. This report demonstrates a minimally invasive approach offering radical treatment without having to recur to partial or radical cystectomy. We discuss the operative steps, the significance of this case with a review of the literature, and the future potential this may represent for the treatment of tumor-containing bladder diverticula.
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Affiliation(s)
- Sophie Elands
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Nikhil Vasdev
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Andrea Tay
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - James M Adshead
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
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Laparoscopic urinary bladder diverticulectomy combined with photoselective vaporisation of the prostate. Wideochir Inne Tech Maloinwazyjne 2015; 10:62-7. [PMID: 25960795 PMCID: PMC4414110 DOI: 10.5114/wiitm.2015.49671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/05/2014] [Accepted: 01/21/2015] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Pseudodiverticulum of the urinary bladder is mostly a complication of subvesical obstruction (SO). The gold standard of treatment was open diverticulectomy with adenectomy. A more contemporary resolution is endoscopic, in two steps: the first transurethral resection of the prostate (TURP), the second laparoscopic diverticulectomy (LD). AIM To present a one-session procedure - photoselective vaporisation of the prostate (PVP) with LD. MATERIAL AND METHODS From 1/2011 to 6/2014, 14 LDs were performed: 1 LD only, 1 with laparoscopic radical prostatectomy, 12 combined with treatment of benign prostatic hyperplasia (BPH), 4 cases of TURP and LD in the second period. In 8 cases, PVP and LD in one session were combined. These 8 cases are presented. 3D CT cystography was used as a gold standard for assessment of diverticulum. RESULTS The mean age was 66.5 ±5.5 (57.3-75.1) years, the mean size of the diverticulum 61.8 ±22.1 (26-90) mm. The procedure starts in the lithotomy position. It includes PVP and stenting of the ureter(s). Changing of position and laparoscopy follows: four ports, transperitoneal extravesical approach. Photoselective vaporisation of the prostate was performed using the Green Light Laser HPS (1x) or XPS with cooled fibre MoXy (7x). The mean delivered energy in PVP was 205.1 ±106.4 (120-458) kJ. The mean time of operation was 165.0 ±48.5 (90-255) min. No postoperative complications were observed. One patient underwent TUR incision after 1 year for sclerosis of the bladder neck. CONCLUSIONS Pseudodiverticulum of the urinary bladder (with or without SO) is a relatively rare disease. One session of PVP (Green Light Laser XPS, MoXy fibre) and laparoscopic (transperitoneal extravesical) diverticulectomy is the preferred method for treatment of subvesical obstruction due to BPH and bladder diverticulum at our institution.
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Roslan M, Markuszewski M, Kłącz J, Krajka K. Suprapubic transvesical laparoendoscopic single-port bladder diverticulectomy: points of technique with medium-term surgical outcomes. J Endourol 2013; 27:688-92. [PMID: 23514531 DOI: 10.1089/end.2012.0674] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Various minimally invasive techniques have been developed for bladder diverticulectomy. One of the newest is transvesical laparoendoscopic single-site (T-LESS) surgery. In this article, we present points of technique with initial clinical results after a minimum of 7 months of follow-up. The aim of the study was to assess our first series of patients who underwent T-LESS surgery for transvesical excision of symptomatic bladder diverticula. PATIENTS AND METHODS From March 2011 to February 2012, we successfully operated on five men aged 61 to 76 years (mean 66 years) for symptomatic (infections, residual of urine, neoplasm) bladder diverticula, with the use of the T-LESS approach. The procedures were performed using single-port TriPort+, standard laparoscopic instruments, and V-loc suture. All patients underwent follow-up of 6 weeks after surgery and every 3 months thereafter. The follow-up included urine tests, ultrasonography, and cystoscopy when needed. RESULTS The average operative time was 122 minutes (range 80-175 min), and the blood loss was minimal. Patients were discharged on the third (range 2-4 day) postoperative day with no intra- or postoperative complications. The average 14-month follow-up (range 7-19 mos) confirmed good operative results in all cases. An insignificant small recurrent diverticulum was observed in one patient. The patients did not need transurethral resection of the prostate or reoperation. CONCLUSIONS We consider this technique to be a feasible and safe procedure, and a valuable treatment option for bladder diverticulectomy.
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Affiliation(s)
- Marek Roslan
- Department of Urology, Medical University of Gdansk, Gdansk, Poland.
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Thüroff JW, Roos FC, Thomas C, Kamal MM, Hampel C. Robot-assisted laparoscopic bladder diverticulectomy. BJU Int 2012; 110:1820-36. [DOI: 10.1111/j.1464-410x.2012.11576.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joachim W. Thüroff
- Department of Urology; University Medical Center; Johannes Gutenberg University; Mainz; Germany
| | - Frederik C. Roos
- Department of Urology; University Medical Center; Johannes Gutenberg University; Mainz; Germany
| | - Christian Thomas
- Department of Urology; University Medical Center; Johannes Gutenberg University; Mainz; Germany
| | - Mohamed M. Kamal
- Department of Urology; University Medical Center; Johannes Gutenberg University; Mainz; Germany
| | - Christian Hampel
- Department of Urology; University Medical Center; Johannes Gutenberg University; Mainz; Germany
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Eyraud R, Laydner H, Autorino R, Panumatrassamee K, Haber GP, Stein RJ. Robot-Assisted Laparoscopic Bladder Diverticulectomy. Curr Urol Rep 2012. [DOI: 10.1007/s11934-012-0290-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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17
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Christman MS, Casale P. Robot-Assisted Bladder Diverticulectomy in the Pediatric Population. J Endourol 2012; 26:1296-300. [DOI: 10.1089/end.2012.0051] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Pasquale Casale
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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18
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Current trends in minimally invasive reconstructive urology. J Robot Surg 2012; 6:179-87. [PMID: 27638270 DOI: 10.1007/s11701-011-0322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 10/09/2011] [Indexed: 10/15/2022]
Abstract
This paper is a systematic review of the current literature in minimally invasive reconstructive urological surgery. It focuses on the commonest reconstructive procedures in both the upper and lower urinary tracts including laparoscopic and robotic pyeloplasty for ureteropelvic junction obstruction, laparoscopic and robotic bladder diverticulectomy, laparoscopic and robotic partial cystectomy with urinary diversion, laparoscopic and robotic cystoplasty, repair of colovesical fistula, and, in urogynaecology, repair of vesicovaginal fistula. To evaluate the development, current status, feasibility, and safety of minimally invasive surgery (MIS) in reconstructive urology the literature on the topic was collated and reviewed.
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Moore CR, Shirodkar SP, Avallone MA, Castle SM, Gorin MA, Gorbatiy V, Leveillee RJ. Intravesical Methylene Blue Facilitates Precise Identification of the Diverticular Neck During Robot-Assisted Laparoscopic Bladder Diverticulectomy. J Laparoendosc Adv Surg Tech A 2012; 22:492-5. [DOI: 10.1089/lap.2011.0405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Charles R. Moore
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Samir P. Shirodkar
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael A. Avallone
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Scott M. Castle
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael A. Gorin
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Vladislav Gorbatiy
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Raymond J. Leveillee
- Division of Endourology, Laparoscopy, and Minimally Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
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Roslan M, Markuszewski MM, Kłącz J, Krajka K. Laparoendoscopic single-port transvesical diverticulectomy: preliminary clinical experience. J Endourol 2012; 26:975-9. [PMID: 22332668 DOI: 10.1089/end.2011.0550] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE We present our single-center experience with three patients who were undergoing laparoendoscopic single-site (LESS) diverticulectomy through a single-port device introduced directly into the bladder. PATIENTS AND METHODS During March and April 2011, we operated on three men aged 62 to 76 years (mean 67 y) for symptomatic bladder diverticula using a standard lithotomy position and general anesthesia. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (four-channel) via a 1.5-cm incision made 2 cm above the pubic symphysis. Standard 10-mm optic and rigid laparoscopic instruments were used. The defect of the bladder wall was closed with an absorbable 3/0 running V-Loc suture. An 18F Foley catheter was left for 4 to 7 days. RESULTS The average operative time was 128 minutes (range 80-175 min). The blood loss was minimal. Patients were discharged on the third postoperative day with no intra-, nor postoperative complications. The 3-month follow-up confirmed good operative results in all cases. CONCLUSION We consider laparoendoscopic single-port transvesical excision of bladder diverticulum as a feasible and safe procedure and a valuable treatment option for bladder diverticulectomy.
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Affiliation(s)
- Marek Roslan
- Department of Urology, Medical University of Gdańsk, Gdańsk, Poland.
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Altunrende F, Autorino R, Patel NS, White MA, Khanna R, Laydner H, Yang B, Haber GP, Kaouk JH, Stein RJ. Robotic bladder diverticulectomy: technique and surgical outcomes. Int J Urol 2011; 18:265-71. [PMID: 21299640 DOI: 10.1111/j.1442-2042.2010.02716.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Indications for surgical treatment of bladder diverticula include tumor, lower urinary tract symptoms refractory to medical treatment, renal dysfunction or recurrent urinary tract infections. We describe the technique and report the outcomes of robotic bladder diverticulectomy at our institution. METHODS A chart review of patients who underwent robotic bladder diverticulectomy at our institution from 2007 to 2010 was carried out. Indications for the procedure were: lower urinary tract symptoms (LUTS) not responding to medical treatment (2 patients), ureteral obstruction (1 patient), tumor arising in a diverticulum (2 patients) and diverticulum secondary to neurogenic bladder (1 patient). One patient also had renal dysfunction associated with ureteral insertion into the diverticulum and therefore underwent ipsilateral ureteroneocystostomy. Other additional procedures included transurethral resection of the prostate (1 patient) and bilateral pelvic lymph node dissection (1 patient). Perioperative and postoperative outcomes were analyzed. RESULTS Six patients (median age 61.5 years, range 19-75) underwent da Vinci diverticulectomy using a transperitoneal approach without the need for open conversion. Median operative time was 232 min (135-360 min.). Median estimated blood loss was 100 mL (50-150 mL). The Foley catheter was removed after a negative cystogram and median time to catheter removal was 7 days (7-12 days). Median hospital stay was 3 days (2-5 days). The only complication was a urinary tract infection managed with antibiotics. CONCLUSIONS Robotic surgery represents a reasonable minimally invasive treatment option for resection of bladder diverticula when indicated.
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Affiliation(s)
- Fatih Altunrende
- Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Thiel DD, Young PR, Wehle MJ, Broderick GA, Petrou SP, Igel TC. Robotic-assisted bladder diverticulectomy: tips and tricks. Urology 2011; 77:1238-42. [PMID: 21256564 DOI: 10.1016/j.urology.2010.07.542] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 07/23/2010] [Accepted: 07/23/2010] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The da Vinci Surgical System has become extremely popular in the field of urology for procedures requiring complex reconstructive maneuvers, such as radical prostatectomy and pyeloplasty. A natural extension of these procedures is the use of the da Vinci system for complex urinary tract reconstruction deep in the pelvis, such as bladder diverticulectomy. TECHNICAL CONSIDERATIONS In our report and accompanying Video, we have demonstrated some technical tips and tricks with regard to patient selection, preoperative imaging, patient positioning, port placement, intraoperative diverticulum recognition/excision, and cystotomy repair that the surgeon might find beneficial for successful completion of robotic-assisted bladder diverticulectomy. CONCLUSIONS The tips and tricks we have presented might aid in the successful completion of robotic bladder diverticulectomy.
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Affiliation(s)
- David D Thiel
- Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida 32224, USA.
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Stolzenburg JU, Do M, Kallidonis P, Dietel A, Oh MA, Till H, Liatsikos EN. Laparoendoscopic Single-Site Bladder Diverticulectomy: Technique and Initial Experience. J Endourol 2011; 25:85-90. [DOI: 10.1089/end.2010.0109] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Minh Do
- Department of Urology, University of Leipzig, Leipzig, Germany
| | | | - Anja Dietel
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Min-A Oh
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Holger Till
- Department of Paediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Evangelos N. Liatsikos
- Department of Urology, University of Leipzig, Leipzig, Germany
- Department of Urology, University of Patras, Patras, Greece
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Kural AR, Atug F, Akpinar H, Tufek I. Robot-Assisted Laparoscopic Bladder Diverticulectomy Combined with Photoselective Vaporization of Prostate: A Case Report and Review of Literature. J Endourol 2009; 23:1281-5. [DOI: 10.1089/end.2008.0674] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ali Riza Kural
- Department of Urology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Fatih Atug
- Department of Urology, Istanbul Bilim University School of Medicine, Istanbul, Turkey
| | - Haluk Akpinar
- Department of Urology, Istanbul Bilim University School of Medicine, Istanbul, Turkey
| | - Ilter Tufek
- Department of Urology, Istanbul Bilim University School of Medicine, Istanbul, Turkey
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Macejko AM, Viprakasit DP, Nadler RB. Cystoscope- and robot-assisted bladder diverticulectomy. J Endourol 2008; 22:2389-91; discussion 2391-2. [PMID: 18937603 DOI: 10.1089/end.2008.0385] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Minimally invasive approaches to manage bladder diverticula have become increasingly popular; however, intracorporeal identification of bladder diverticula may be challenging. We report a novel technique for diverticular illumination using flexible cystoscopy. PATIENTS AND METHODS After management of bladder neck obstruction, two patients with bladder diverticula and persistent lower urinary tract symptoms underwent robot-assisted bladder diverticulectomy. Cystoscopic illumination was used in both cases to aid diverticular identification and dissection. RESULTS Our technique was simple to perform and facilitated identification and dissection of bladder diverticula. Postoperative cystography revealed no evidence of residual diverticula. CONCLUSIONS Cystoscope-assisted illumination provides a straightforward method of identifying bladder diverticula during robot-assisted laparoscopic diverticulectomy.
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Affiliation(s)
- Amanda M Macejko
- Section of Endourology, Laparoscopy, and Stone Disease, Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA
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26
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Tareen BU, Mufarrij PW, Godoy G, Stifelman MD. Robot-assisted laparoscopic partial cystectomy and diverticulectomy: initial experience of four cases. J Endourol 2008; 22:1497-500. [PMID: 18690815 DOI: 10.1089/end.2007.0297] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We report our initial experience with four cases of robot-assisted laparoscopic partial cystectomy and diverticulectomy performed between June 2005 and August 2007. PATIENTS AND METHODS The series consisted of three male patients and one female with a mean age of 64 years (range 36-77 years). In each case, a transperitoneal laparoscopic approach was used to mobilize the bladder. Next the bladder lesion was scored circumferentially cystoscopically with a Collings knife. The remainder of the excision and bladder reconstruction was performed with the da Vinci robot. RESULTS Mean operative time was 194 minutes with a mean blood loss of 35 mL. The urethral catheter was removed between 5 and 14 days following a normal cystogram. There were no significant complications. Postoperative hospital stay was 2 to 3 days. CONCLUSION Robot-assisted laparoscopic partial cystectomy and diverticulectomy are technically feasible and represent an alternative to open and conventional laparoscopic approaches.
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Affiliation(s)
- Basir U Tareen
- Urologic Oncology Program, Department of Urology, New York University Medical Center, New York, New York 10016, USA
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27
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Mmeje C, Michli E, Parra R. Robotic-assisted laparoscopic bladder diverticulectomy and concomitant ureteral re-implantation: initial clinical experience. J Robot Surg 2008; 2:265-7. [PMID: 27637799 DOI: 10.1007/s11701-008-0110-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Accepted: 08/31/2008] [Indexed: 11/28/2022]
Abstract
We present our initial clinical experience with robotic-assisted laparoscopic bladder diverticulectomy with associated ureteral re-implantation. A 75-year-old man was referred to us for recurrent urinary tract infections and lower urinary tract symptoms. On computed tomography of abdomen and pelvis the patient was found to have a 13 × 14 × 6 cm diverticulum in the left posterior bladder wall. The patient elected to undergo robotic-assisted laparoscopic removal of the diverticulum. The patient's preparation, draping, and trocar placement was performed as per standard fashion of robotic-assisted laparoscopic radical prostatectomy. The bladder was mobilized and diverticulum was identified and removed. The left ureter was transected secondary to its passage through the diverticulum, and required re-implantation. After hemostasis was achieved, the repair was tested and confirmed. The operation was completed in 207 min without any complications. Estimated blood loss was 150 cc. On postoperative day 1, the patient was placed on oral analgesic and discharged home. Our initial report of robotic-assisted laparoscopic bladder diverticulectomy and ureteral re-implantation illustrates that this minimally invasive technique is an effective method of treatment of bladder diverticulum. Proximity of the ureter to the diverticulum should not be a deterrent for this approach of repair.
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Affiliation(s)
- Chinedu Mmeje
- Department of Urology, Cooper University Hospital, Camden, NJ, USA. .,UMDNJ-Robert Wood Johnson Medical School, Education and Research Building, 401 Haddon Avenue, Camden, NJ, 08103, USA.
| | - Eddie Michli
- Department of Urology, Cooper University Hospital, Camden, NJ, USA
| | - Raul Parra
- Department of Urology, Cooper University Hospital, Camden, NJ, USA
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28
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Kim SW, Jung JW, Cho HJ, Kim JC, Hwang TK, Park YH, Hong SH. Laparoscopic Excision of a Giant Bladder Diverticulum. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.4.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sun Wook Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Woo Jung
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Jin Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Chul Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Kon Hwang
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Hyun Park
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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29
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Robotic assisted laparoscopic bladder diverticulectomy. J Urol 2007; 178:2406-10; discussion 2410. [PMID: 17937944 DOI: 10.1016/j.juro.2007.08.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Indexed: 12/19/2022]
Abstract
PURPOSE Surgical management for bladder diverticuli includes open, endoscopic and standard laparoscopic techniques. To our knowledge we report the first series of robotic assisted laparoscopic bladder diverticulectomies. MATERIALS AND METHODS Five patients underwent robotic assisted laparoscopic bladder diverticulectomy between December 2004 and December 2006, as performed by a single surgeon using the da Vinci robotic system for symptomatic diverticuli. The records were reviewed, the surgical technique is described and a review of the literature was performed. RESULTS All patients underwent cystoscopy, ureteral stent placement and placement of an angiographic catheter to distend the diverticulum. The diverticulum was approached transperitoneally, mobilized and transected at its neck, and the bladder was closed in 2 layers. One patient underwent ureteral reimplantation for a Hutch diverticulum. Median total operative time was 178 minutes (range 163 to 235) and robotic operative time was 83 minutes (range 63 to 143). Length of stay was 3 days (range 1 to 6). Two patients who underwent transurethral prostate resection before diverticulum resection did well. Two patients in whom medical management failed ultimately underwent transurethral prostate resection and 1 patient continued on medical therapy with regular followup. CONCLUSIONS Robotic assisted laparoscopic bladder diverticulectomy is safe and effective for patients with a large bladder diverticulum and small prostate. Perioperative surgical outcomes rival those of previously reported open, endoscopic and laparoscopic diverticulectomies.
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Flasko T, Toth G, Benyo M, Farkas A, Berczi C. A New Technical Approach for Extraperitoneal Laparoscopic Bladder Diverticulectomy. J Laparoendosc Adv Surg Tech A 2007; 17:659-61. [PMID: 17907983 DOI: 10.1089/lap.2006.0235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this paper, the authors report on a new, modified laparoscopic technique to remove a large bladder diverticulum. A 26-year-old male with a urinary problem underwent an ultrasound, as well as intravenous urography and cystoscopy examinations, which showed a large bladder diverticulum. The diverticulum was operated upon laparoscopically. The extraperitoneal laparoscopic intervention was facilitated by balloon placed into the diverticulum. The new technique for the laparoscopic diverticulumectomy procedure was successful and the operating time was 140 minutes. There were no perioperative complications. In conclusion, the laparoscopic removal of the bladder diverticulum is a safe and minimally invasive intervention. The introduction of a balloon into the diverticulum makes the operation easier.
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Affiliation(s)
- Tibor Flasko
- Department of Urology, University of Debrecen, Debrecen, Hungary
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31
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Wang CK, Chueh SC. Case Report: Laparoscopic Partial Cystectomy with Endo-GIA Stapling Device in Bladder Diverticular Carcinoma. J Endourol 2007; 21:772-5. [PMID: 17705769 DOI: 10.1089/end.2006.0348] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The incidence of bladder diverticular carcinoma is low, ranging from 0.8% to 10%. Traditionally, treatment consisted of open surgical excision or transurethral resection. More recently, laparoscopic surgery has become widely accepted. We report here a case of bladder diverticular carcinoma treated with laparoscopic partial cystectomy. CASE REPORT A 56-year-old man presented with gross hematuria and was found to have transitional-cell carcinoma in a bladder diverticulum. We performed transurethral resection of the tumors and laparoscopic partial cystectomy. A 45-mm Endo-GIA stapler (U.S. Surgical Corp., Norwalk, CT) was used for direct resection of the diverticular tissue, and the specimen was removed en bloc. Suture of the seromuscular layer was performed with the intracorporeal knotting technique. Lymph-node dissection also was performed. At 3-month follow-up, it was noted that there was tumor recurrence that was not at the original diverticular site, and transurethral resection was carried out. After 1 year, cystoscopy and CT scans showed neither recurrence nor metastasis. No encrustation or erosion was induced by the staples. CONCLUSION Laparoscopic partial cystectomy can be an alternative treatment for bladder diverticular carcinoma.
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Affiliation(s)
- Chun-Kai Wang
- Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Rao R, Nayyar R, Panda S, Hemal AK. Surgical techniques: robotic bladder diverticulectomy with the da Vinci-S surgical system. J Robot Surg 2007; 1:217-20. [PMID: 25484966 PMCID: PMC4247439 DOI: 10.1007/s11701-007-0030-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 06/04/2007] [Indexed: 11/27/2022]
Abstract
Bladder diverticulectomy is a surgical operation for symptomatic or large bladder diverticula. Typically, bladder diverticula are because of infravesical obstruction, although congenital diverticula can occur that may be large and symptomatic. The ability to excise the diverticulum completely, avoid important adjacent structures, and close the bladder defect in a watertight fashion are key fundamentals to this operation. Traditionally done via an open extravesical, intravesical, or combined approach, bladder diverticulectomy can now be done in a minimally invasive fashion. Both laparoscopic and robot-assisted methods have clear advantages over open surgery, including smaller incision, reduced pain, improved cosmesis, and reduced blood loss, with an equivalent functional result. Large bladder diverticula, particularly those involving the ureteric orifice which required ureteric reimplantation, were often considered beyond the scope of conventional laparoscopy. Recently, use of robotic technology as a means of facilitating laparoscopic excision of bladder diverticula has provided the ability to treat large and more complex diverticula. Advantages of the robotic approach are the finer precision and dexterity of the instruments coupled with three-dimensional imaging. Although there are several case reports describing pure laparoscopic diverticulectomy, as far as we are aware there are no published reports of robotic bladder diverticulectomy. This paper will outline a safe and reproducible surgical technique for performing robotic bladder diverticulectomy using the da Vinci-S surgical system.
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Affiliation(s)
- Ranjit Rao
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - S Panda
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ashok K Hemal
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India
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Abstract
PURPOSE We report our initial experience with 13 cases of laparoscopic vesical diverticulectomy done via an extravesical approach between November 2002 and October 2004. PATIENTS AND METHODS All patients were male, with a mean age of 53 years and a mean body mass index of 26.2 kg/m2. A transperitoneal approach was preferred. The diverticulum was of the primary type in three patients and of the secondary type resulting from benign prostatic hyperplasia in seven patients and a longstanding urethral stricture in three patients. RESULTS The mean operative time was 265 minutes with a mean blood loss of <100 mL and a mean postoperative hemoglobin decline of 1.1 g/dL. The urethral catheter was removed on day 7 postoperatively in the patients with a primary diverticulum, whereas it was left for 11 to 14 days in patients with secondary bladder diverticula. Postoperative complications occurred in only one patient with a primary diverticulum, taking the form of extravasation from the suture line in the control gravity-fill cystogram that was done routinely prior to urethral-catheter removal. Leakage resolved with urethral catheterization for 2 more weeks. The postoperative stay was 3 to 4 days. CONCLUSION Laparoscopic diverticulectomy is technically feasible and safe and may represent an alternative to the standard open procedure.
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Shah HN, Shah H, Shah RH, Shah R, Hegde SS, Hegde S, Shah JN, Shah J, Bansal MB, Bansal M. Sequential Holmium Laser Enucleation of the Prostate and Laparoscopic Extraperitoneal Bladder Diverticulectomy: Initial Experience and Review of Literature. J Endourol 2006; 20:346-50. [PMID: 16724908 DOI: 10.1089/end.2006.20.346] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Urologic applications of laparoscopy and the holmium laser have increased exponentially in the past few years. We present our experience with sequential holmium laser enucleation of the prostate (HoLEP) and extraperitoneal laparoscopic diverticulectomy for a large symptomatic bladder diverticulum and associated bladder outlet obstruction. PATIENTS AND METHOD From June 2004 to June 2005, three patients with benign prostatic hyperplasia (BPH) and a large secondary bladder diverticulum were offered sequential HoLEP and laparoscopic extraperitoneal bladder diverticulectomy. Demographic data and perioperative outcomes were recorded. A review of the literature was performed to determine the present role of laparoscopic diverticulectomy. RESULTS All patients underwent the planned procedure successfully. The mean operating time was 63.33 minutes for HoLEP and 246.6 minutes for diverticulectomy. Oral intake was resumed after a mean of 8.6 hours. The mean postoperative analgesia required was 146 mg of parecoxib sodium, and the mean drop in hemoglobin was 1.13 g/dL. Patients were discharged after an average of 66.6 hours. At 1-month follow-up, the average American Urological Association Score had improved from 13 to 6, the post-void [corrected] residual urine volume had decreased from 997 mL to 164 mL, and the peak uroflow rate had improved from 4.9 mL/sec to 10.4 mL/sec. These measures showed further improvement on later follow-up. A total of 30 cases of laparoscopic diverticulectomy have been reported in literature [corrected] of which only two were done extraperitoneally. CONCLUSION Simultaneous HoLEP and laparoscopic extraperitoneal diverticulectomy is an effective strategy for the treatment of BPH with associated large bladder diverticulum.
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Affiliation(s)
- Hemendra N Shah
- Department of Urology, R.G. Stone Urological Research Institute, Mumbai, India.
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35
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Abstract
A 38-year-old female with a history of psychiatric illness presents with irritative urological symptoms and is diagnosed as having a large congenital vesical diverticulum (Hutch diverticulum). An overview of the aetiology, classification and complications of diverticula together with indications for and management of bladder diverticula is discussed. This is the first documented case of a very large symptomatic congenital diverticulum in a female presenting in the third decade of life and emphasizes the importance of ultrasound in irritative urological symptoms resistant to medication.
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Affiliation(s)
- Alistair M Pace
- Department of Surgery, Royal Berkshire Hospital, Craven Road, Reading, RG1 5AN, UK.
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36
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Porpiglia F, Terrone C, Cossu M, Renard J, Grande S, Scarpa RM. Real time ultrasound in laparoscopic bladder diverticulectomy. Int J Urol 2005; 12:933-5. [PMID: 16323993 DOI: 10.1111/j.1442-2042.2005.01180.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe our technique of laparoscopic diverticulectomy under ultrasound (US) guidance after a transurethral resection of prostate (TURP) in the treatment of patients with benign prostatic hyperplasia and bladder diverticulum. A standard TURP is performed with an Iglesias resectoscope. A 12-Fr Foley catheter is positioned in the diverticulum and the catheter balloon is then inflated with 30 mL of water; then a Tiemann catheter is placed through the urethra into the bladder. A US probe is inserted through the 12 mm port placed in the right side by the surgeon, then laparoscopic transperitoneal bladder diverticulectomy is performed under US guidance. In our experience, the use of endolaparoscopic US makes identification and dissection of the diverticulum easy, safe and effective, even when the procedure has to be performed in disadvantageous anatomic conditions such as lateral-posterior diverticulum or post-TURP imbibition of pelvic tissue.
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Affiliation(s)
- Francesco Porpiglia
- Divisione Universitaria di Urologia, Dipartimento di Scienze Cliniche e Biologiche, Azienda Ospedaliera S. Luigi, Orbassano Torino, Italy.
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Juan YS, Li CC, Shen JT, Jang MY, Wu WJ, Wang CJ, Huang CH. Laparoscopic Bladder Diverticulectomy for Large Bladder Diverticulum: A Case Report. Kaohsiung J Med Sci 2004; 20:563-6. [PMID: 15620121 DOI: 10.1016/s1607-551x(09)70259-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Bladder diverticula are herniations of the bladder mucosa through the bladder wall musculature. Acquired bladder diverticula are the result of outlet obstruction, mostly benign prostate enlargement, infections, or urethral stricture. Traditionally, bladder diverticulum was excised by the open method. However, the laparoscopic technique has been widely used to treat many urologic diseases, including bladder diverticulum. Laparoscopic diverticulectomy can be performed transperitoneally or extraperitoneally. We report our initial experience with laparoscopic transperitoneal diverticulectomy for a large bladder diverticulum caused by bladder outlet obstruction. The patient had satisfactory micturition and was discharged on the eighth postoperative day.
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Affiliation(s)
- Yung-Shun Juan
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan.
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Porpiglia F, Tarabuzzi R, Cossu M, Vacca F, Terrone C, Fiori C, Scarpa RM. Is laparoscopic bladder diverticulectomy after transurethral resection of the prostate safe and effective? Comparison with open surgery. J Endourol 2004; 18:73-6. [PMID: 15006059 DOI: 10.1089/089277904322836721] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE In a retrospective nonrandomized study, we compared our experience with transurethral resection of the prostate (TURP) plus sequential laparoscopic bladder diverticulectomy with a series of combined open bladder diverticulectomies with transvesical prostatectomy. PATIENTS AND METHODS We considered 12 consecutive patients (group A) having 16 diverticula who underwent sequential TURP and transperitoneal laparoscopic bladder diverticulectomy and 13 consecutive patients (group B) having 13 diverticula who underwent open bladder diverticulectomy and transvesical prostatectomy. We evaluated the size and position of the diverticulum, adenoma volume, operative time, postoperative hemoglobin variations, analgesia requirement, complications, postoperative hospital stay, and uroflowmetry results. RESULTS No statistically significant differences existed between the groups in adenoma volume or diverticulum size or position. However, a significantly longer operative time was recorded in group A. The endolaparoscopic approach proved to be statistically superior to open surgery regarding blood loss, postoperative analgesia requirement, and hospital stay. No intraoperative complications were recorded. In addition, no statistically significant difference was found in uroflowmetry results. CONCLUSIONS In our experience, the endolaparoscopic approach has proved to be safe, effective, and minimally invasive and therefore superior to transvesical prostatectomy and open bladder diverticulectomy. Its only disadvantage is the longer operative time.
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Affiliation(s)
- F Porpiglia
- Divisione Universitaria di Urologia, Dipartimento di Scienze Cliniche e Biologiche, Azienda Ospedaliera S Luigi, Orbassano, Torino, Italy.
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Abstract
Vesical diverticula refer to hernias of the vesical mucous membrane in the detrusor. The diverticulum wall is therefore constituted by the chorion urothelium. The muscular dehiscence that is at the origin of the diverticulum may be either congenital or degenerative. Two important complications of the diverticulum-that are sometimes interwoven-may occur: a draining defect (responsible for infections, lithiasis, and functional signs of the lower urinary tract), and the development of an urothelial tumour in the diverticulum cavity. For such complicated diverticula, surgery is indicated, by endoscopic or retropubic approach. Results may be excellent, provided the surgical intervention focuses at the same time on the management of the associated sub-vesical obstacle in case of acquired diverticulum.
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Affiliation(s)
- C Linke
- Service d'urologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
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Khonsari S, Lee DI, Basillote JB, McDougall EM, Clayman RV. Intraoperative Catheter Management During Laparoscopic Excision of a Giant Bladder Diverticulum. J Laparoendosc Adv Surg Tech A 2004; 14:47-50. [PMID: 15035845 DOI: 10.1089/109264204322862360] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Massive bladder diverticula present a technical challenge to the laparoscopic surgeon. We describe a laparoscopic approach to transperitoneal diverticulectomy, using a specific catheter arrangement to allow excellent control of the various portions of the procedure. METHODS A 49-year-old male with longstanding frequency was diagnosed with a 1000 cc bladder diverticulum and bladder neck outlet obstruction. Laparoscopic transperitoneal diverticulectomy was performed using a triple catheter arrangement: endoscopic placement of a Councill catheter in the diverticulum, fluoroscopic positioning of an occlusion balloon catheter in the renal pelvis, and placement of a Cope loop suprapubic tube. Additionally, a transurethral incision of the prostate was performed. RESULTS The procedure was completed laparoscopically using a four port transperitoneal approach. During the procedure, the diverticulum could be filled and emptied as needed; the catheter across the diverticular neck facilitated subsequent closure of the bladder wall defect. The diverticulum was completely excised. The remaining defect in the bladder was then closed in 2 layers. The patient was discharged on postoperative day 3. CONCLUSION Careful planning and arrangement of catheters in the bladder, ureter, and diverticulum facilitates laparoscopic transperitoneal diverticulectomy of even a very large volume diverticulum.
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Affiliation(s)
- Sepehr Khonsari
- Department of Urology, University of California, Irvine College of Medicine, Irvine, California, USA
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Faramarzi-Roques R, Calvet C, Gateau T, Ballanger PH. Surgical Treatment of Bladder Diverticula: Laparoscopic Approach. J Endourol 2004; 18:69-72. [PMID: 15006058 DOI: 10.1089/089277904322836712] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Bladder diverticulectomy is classically performed by open surgery (extravesical, intravesical, or combined) or, less frequently, by an endoscopic approach for small diverticula. We used a celioscopic approach to diverticulectomy in order to assess its feasibility and the operative and postoperative complications. PATIENTS AND METHODS Five patients aged 55 to 76 years (mean 64.2 years) were treated by celioscopy between October 1999 and October 2001. All the diverticula had occurred as a result of infravesical obstruction by benign prostatic hyperplasia, which was treated at the same time by endoscopic resection of the prostate. An ipsilateral ureteral catheter was inserted during endoscopy. After creation of an umbilical minilaparotomy with the patient in the dorsal decubitus position, a 10-mm optical trocar was inserted, then two 5-mm trocars into the right and left iliac fossae, and a 10-mm subpubic trocar. Diverticular dissection was performed with a peritoneal approach in order to free the diverticular neck. After resection, the neck was closed in two planes by interrupted absorbable sutures, and a tightness test was performed. RESULTS The average operating time was 160 minutes (range 120-230 minutes), and the average blood loss was 150 mL (range 80-200 mL). There was no conversion to open surgery. The probe was removed on day 5 (range 3-7 days). No complication occurred, and the mean hospital stay was 5 days (range 4-6 days) with resumption of satisfactory micturation. CONCLUSION This technique is a promising alternative to classical surgery, as it is less aggressive and uses a smaller incision. Operative bleeding is minimal, and the technique is reproducible in experienced hands. However, the indications are limited with regard to the associated pathologies (size of the prostate in the present cases), the morphology, the site of the diverticulum, and the surgical history of the patient.
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Porpiglia F, Tarabuzzi R, Cossu M, Vacca F, Destefanis P, Fiori C, Scarpa RM. Sequential transurethral resection of the prostate and laparoscopic bladder diverticulectomy: comparison with open surgery. Urology 2002; 60:1045-9. [PMID: 12475667 DOI: 10.1016/s0090-4295(02)01985-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To compare our experience with transurethral resection of the prostate and sequential laparoscopic bladder diverticulectomy with a previous series of combined open bladder diverticulectomy and transvesical prostatectomy. METHODS We compared the data of 10 consecutive patients (group 1) who underwent sequential transurethral resection of the prostate and transperitoneal laparoscopic bladder diverticulectomy and 13 consecutive patients (group 2) who underwent traditional combined open bladder diverticulectomy and transvesical prostatectomy. The following parameters were considered: size and position of the diverticulum, transrectal ultrasound adenoma volume, operative time, postoperative hemoglobin variations, analgesic requirement, complications, postoperative hospital stay, and urinary flowmetry. RESULTS No statistically significant differences existed between the two groups either for diverticulum size (6.8 versus 7.2 cm) or diverticula position. A significant difference was observed in the operative time (247 minutes for group 1 versus 136 minutes for group 2, P <0.0001), mean postoperative hemoglobin decrease (2.6 g/dL for group 1 and 3.9 g/dL for group 2, P = 0.001), analgesic requirement (1.3 ampoules of buprenorphine cloritrate for group 1 versus 1.8 ampoules for group 2, P = 0.45), and postoperative hospital stay (3 days for group 1 versus 9.6 days for group 2, P <0.0001). No statistically significant difference was recorded for control flowmetry. No intraoperative complications were recorded for the two groups. CONCLUSIONS In our series, sequential transurethral resection of the prostate and transperitoneal laparoscopic diverticulectomy for large diverticula proved to be a safe, effective, and minimally invasive procedure, despite the longer operative times compared with transvesical prostatectomy and open bladder diverticulectomy.
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Affiliation(s)
- F Porpiglia
- Divisione Universitaria di Urologia, Dipartimento di Scienze Cliniche e Biologiche, Azienda Ospedaliera S. Luigi, Orbassano, Torino, Italy
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Vogt DM, Curet MJ, Zucker KA. Laparoscopic management of gastric diverticula. J Laparoendosc Adv Surg Tech A 1999; 9:405-10. [PMID: 10522535 DOI: 10.1089/lap.1999.9.405] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Gastric diverticular are rare and usually are diagnosed incidentally on radiographic examination. Surgical treatment, consisting of simple excision or inversion of the diverticulum, has been reserved for patients with proven symptoms or complications. These procedures have typically required laparotomy, but with the development of advanced endoscopic techniques, a minimally invasive approach may be appropriate. The authors report two cases of gastric diverticula managed laparoscopically and review the literature related to this entity. Between 1993 and 1996, two patients were evaluated for dyspepsia-like gastrointestinal complaints. Both patients were found to have a gastric diverticulum on a contrast study, and one diverticulum was also seen on upper endoscopy. Laparoscopic resection was undertaken in both cases. Flexible gastroscopy was performed intraoperatively to help localize the diverticulum, which was resected with an endoscopic stapling device. Nissen fundoplication was performed in conjunction with the diverticulectomy in the second patient for gastroesophageal reflux. Both procedures were completed laparoscopically without complications. The postoperative course was uneventful in both patients. At long-term follow-up, the patients are asymptomatic. This experience indicates that laparoscopic resection of symptomatic gastric diverticula is a feasible alternative to laparotomy. A prospective analysis to verify the safety and efficacy of this procedure should be done.
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Affiliation(s)
- D M Vogt
- Department of Surgery, University of New Mexico, Albuquerque 87131-5341, USA
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Okamura K, Watanabe H, Iwasaki A, Tsuji Y, Ohshima S. Closure of mouth of bladder diverticulum via endoscopic transvesico-transurethral approach. J Endourol 1999; 13:123-6. [PMID: 10213107 DOI: 10.1089/end.1999.13.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We successfully treated bladder diverticula in two patients using the endoscopic transvesico-transurethral approach. The mouth of the diverticulum was closed in two layers under pneumobladder, using two percutaneous ports placed into the bladder as well as the urethral route. This operation was performed 2 to 3 months after the bladder outlet obstruction was relieved by transurethral resection or incision of the prostate. The patients were able to void with a minimum of residual urine. The endoscopic transvesico-transurethral approach provided satisfactory vision.
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Affiliation(s)
- K Okamura
- Department of Urology, Nagoya University School of Medicine and Atsumi Hospital, Japan
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Grønlund A, Lendorf A, Lauritzen AF, Kvist E. Bladder diverticulectomy: operative technique. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1998; 32:98-101. [PMID: 9606779 DOI: 10.1080/003655998750014440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We present a simple technique of bladder diverticulectomy. Etiology, pathogenesis, diagnosis, and treatment of bladder diverticula are discussed. We recommend this technique for common use, since it is safe and time-saving.
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Affiliation(s)
- A Grønlund
- Department of Surgery, Hillerød Hospital, Denmark
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Iselin CE, Winfield HN, Rohner S, Graber P. Sequential laparoscopic bladder diverticulectomy and transurethral resection of the prostate. J Endourol 1996; 10:545-9. [PMID: 8972790 DOI: 10.1089/end.1996.10.545] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The surgical treatment of prostatic obstruction associated with a clinically significant bladder diverticulum has classically combined open diverticulectomy with relief of the bladder outlet obstruction. This report demonstrates that this result may be efficiently achieved by performing transurethral surgery followed immediately by laparoscopic excision of the diverticulum. As assessed by a retrospective comparison with four open bladder diverticulectomies combined with transurethral resection of the prostate, laparoscopic diverticulectomy markedly reduces the postoperative and convalescence period. The overall financial saving that ensues may benefit both the patient and the healthcare system. Sequential laparoscopic bladder diverticulectomy and transurethral resection of the prostate illustrates the increasing possibilities of minimally invasive surgery.
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Affiliation(s)
- C E Iselin
- Clinique d'Urologie, Département de Chirurgie, Hôpital Cantonal Universitaire, Geneva, Switzerland
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Gong M, Issa MM. A unique perineal herniation of large bladder diverticulum: successful surgical repair through posterior sagittal approach. Urology 1996; 47:569-72. [PMID: 8638371 DOI: 10.1016/s0090-4295(99)80498-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We report a case of symptomatic perineal herniation of a massive posterior bladder diverticulum following abdominoperineal resection in a 75-year-old man with Crohn's disease and renal failure. Presentation, evaluation, and management issues are discussed.
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Affiliation(s)
- M Gong
- Veterans Affairs Medical Center, Palo Alto, California, USA
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Matsuda T, Terachi T, Yoshida O. Laparoscopy in urology: present status, controversies, and future directions. Int J Urol 1996; 3:83-97. [PMID: 8689517 DOI: 10.1111/j.1442-2042.1996.tb00489.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- T Matsuda
- Department of Urology, Kansai Medical University, Moriguchi, Japan
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49
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Abstract
Recent utilization of laparoscopy in urology has led to the performance of several pelvic procedures. The successful performance of laparoscopic diverticulectomies and cystectomies for benign pathology has led to speculation about, and utilization of, the laparoscopic approach in the treatment of bladder cancer. Herein, we relay our experience with the laparoscopic approach for bladder surgery and discuss the pros and cons of its current status in the treatment of bladder cancer.
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Affiliation(s)
- R O Parra
- Division of Urology, St. Louis University School of Medicine, Missouri 36110, USA
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