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Sahadev R, Rodriguez MV, Kawal T, Barashi N, Srinivasan AK, Gundeti M, Shukla AR. Upper or lower tract approach for duplex anomalies? A bi-institutional comparative analysis of robot-assisted approaches. J Robot Surg 2022; 16:1321-1328. [PMID: 35079941 DOI: 10.1007/s11701-022-01372-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
Abstract
Optimal management of duplication anomalies may include an upper or lower tract surgical approach. In the contemporary era, the robot-assisted laparoscopic heminephrectomy (RALHN) and robot-assisted laparoscopic ipsilateral ureteroureterostomy (RALIUU) are viable interventions predicated on clinical, institutional and surgeon preferences. We present a multi-institutional comparative analysis aiming to compare the outcomes of RALHN and RALIUU to see if either of the approaches confers an advantage over the other in treating duplex renal anomalies needing intervention. We completed a retrospective review of consecutive children undergoing RALIUU at Hospital A and RALHN at Hospital B from January 2009 to March 2017. The primary outcome was 'surgical success' defined by the resolution of clinical symptoms, improved radiological parameters, and no unplanned subsequent interventions till the time of study completion. Secondary outcomes included operative parameters, complications, and subsequent urinary infections. There were 39 RALIUU and 28 RALHN. Baseline demographic and clinical parameters across two cohorts were similar. The primary outcome of 'surgical success' was 100% across both cohorts. There were no major surgical complications, and the incidence of postoperative urinary tract infection was minimal and similar for both groups. Operative time favored RALHN; blood loss and analgesic requirements were minimal in both cohorts. Both RALIUU and RALHN are definitive surgical interventions in children with complex duplex moieties, delivering satisfactory surgical outcomes with a low complication profile and marginal differences in the postoperative patient outcomes. This pilot bi-institutional study provides the basis for a larger collaboration to further define optimal techniques, standardize surgical care pathways, and interrogate long-term outcomes.
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Affiliation(s)
- Ravindra Sahadev
- Pediatric Urology, Children's Hospital of Philadelphia, 3401, Civic center Blvd, Philadelphia, PA, 19104, USA.
| | - Maria Veronica Rodriguez
- Pediatric Urology, University of Chicago Medicine Comer Children's Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA
| | - Trudy Kawal
- Pediatric Urology, Children's Hospital of Philadelphia, 3401, Civic center Blvd, Philadelphia, PA, 19104, USA
| | - Nimrod Barashi
- Pediatric Urology, University of Chicago Medicine Comer Children's Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA
| | - Arun K Srinivasan
- Children's Hospital of Philadelphia, 3401, Civic center Blvd, Philadelphia, PA, 19104, USA
| | - Mohan Gundeti
- University of Chicago Medicine Comer Children's Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA
| | - Aseem R Shukla
- Children's Hospital of Philadelphia, 3401, Civic center Blvd, Philadelphia, PA, 19104, USA
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Saoud R, Abou Heidar N, Andolfi C, Gundeti M. Antegrade Colonic Enema Channels in Pediatric Patients Using Appendix or Cecal Flap: A Comparative Robotic versus Open series. J Endourol 2021; 36:462-467. [PMID: 34931548 DOI: 10.1089/end.2021.0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction We present perioperative outcomes of a single center experience with robotic assisted ACE channel creation for the treatment of chronic constipation refractory to medical therapy and compare it to the traditional open surgical approach. We also demonstrate a step-by-step video presentation of the robotic approach for cecal flap ACE performed as part of a dual continence procedure in patients with short length of appendix. Methods A retrospective chart review of pediatric patients who underwent ACE channel creation between 2008-2020 was performed. We compared demographics, intraoperative, and postoperative variables of the open versus robotic approach. Results Among 28 patients, 15 were open and 13 robotic. In order to construct the ACE channel, a cecal flap was utilized in 36%, split appendix in 50%, full length appendix in 11%, and sigmoid colon in 3% of patients. Both approaches showed equivalent estimated blood loss (50 ml [IQR=20-100]), median length of hospital stay (7 vs. 8 days, p=0.7) and median time to return to regular diet (4 vs. 5 days, p=0.5) (table 1). Patients in the open group were more likely to have a history of prior abdominal surgeries than those in the robotic group (80% vs. 38.5%, p=0.02). The risk of Clavien-Dindo grade 3 or more complications (40% vs. 23.1%, p=0.04) and the rate of ACE channel stenosis (46.7% vs. 7.7%, p=0.02) were significantly higher in the open approach. Channel stenosis was significantly higher in patients with an appendix ACE channel (87.5% vs. 12.5%, p<0.05) compared to those with cecal flap ACE. Conclusions Robotic assisted ACE channel creation is a safe and acceptable alternative with a significantly lower rate of channel stenosis and other Clavien grade 3 complications compared to the traditional open approach. Cecal flaps are also at a lower risk of stomal stenosis than appendix.
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Affiliation(s)
- Ragheed Saoud
- University of Chicago, 2462, Surgery, 5840 S MARYLAND AVE, Chicago, Chicago, Illinois, United States, 60637-5418;
| | - Nassib Abou Heidar
- American University of Beirut Medical Center, 66984, Beirut, Lebanon, Lebanon;
| | - Ciro Andolfi
- The University of Chicago Medical Center, 21727, Surgery (Urology), Chicago, Illinois, United States;
| | - Mohan Gundeti
- University of Chicago , Surgery( Urology), 5841, South Maryland Av, chicago, chicago , Illinois, United States, 60637;
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Greenwald DT, Mohanty A, Andolfi C, Gundeti M. Systematic Review and Meta-Analysis of Pediatric Robotic Assisted Laparoscopic Pyeloplasty (RALP). J Endourol 2021; 36:448-461. [PMID: 34806401 DOI: 10.1089/end.2021.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION To perform a systematic review and meta-analysis of outcomes of robotic-assisted laparoscopic pyeloplasty for UPJ obstruction in children. EVIDENCE ACQUISITION A systematic review of the English-language literature on surgical techniques and perioperative outcomes of robotic-assisted laparoscopic pyeloplasty for UPJ obstruction in children was performed without time filters using the MEDLINE (via PubMed), EMBASE, and Cochrane databases in July 2020 according to the PRISMA statement recommendations. EVIDENCE SYNTHESIS Overall, 58 studies were selected for qualitative analysis, 46 of which were included in the meta-analysis. Nearly all studies included were observational and retrospective, either cohort or case-control. The quality of evidence was assessed using Modified Newcastle Ottawa Scoring, with the majority of studies scoring medium or high quality. The mean success rate was 95.4% (CI 91.0-99.3%), over a wide age range. There was a noticeable heterogeneity in reported follow up length and definitions of success rate. The majority of studies reported length of stay of ~1 day. The mean overall complication rate was 12%. For studies that reported complication rate by grade, the mean low Clavien grade (grade 2 or less) complication rate was 9.3% and the mean high Clavien grade (grade 3 or more) complication rate was 6.5%. CONCLUSIONS Robotic assisted surgery is technically feasible and has been shown to achieve very favorable outcomes for pyeloplasty in children. The evidence however is mostly retrospective and from single sites, which introduces potential biases. Further research is needed to further elucidate RALP benefits compared to the open and laparoscopic approach. As a RCT may not be practical in this space, perhaps a prospective multi-institutional design with a uniform reporting system of pediatric RALP is the next step to define its benefits and limits.
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Affiliation(s)
- David Theodore Greenwald
- The University of Chicago Hospital, 21727, 5841 S. Maryland Ave, Chicago, Illinois, United States, 60637-1470;
| | - Amrita Mohanty
- The University of Chicago Hospital, 21727, Chicago, Illinois, United States;
| | - Ciro Andolfi
- The University of Chicago Medical Center, 21727, Surgery (Urology), Chicago, Illinois, United States;
| | - Mohan Gundeti
- University of Chicago , Surgery( Urology), 5841, South Maryland Av, chicago, chicago , Illinois, United States, 60637;
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Mallenahalli S, Fifolt M, Gundeti M, Lakshmanan Y, Gargollo P, Ost MC, Dangle PP. Survey of COVID-19 impact on pediatric urology services. Can J Urol 2021; 28:10834-10840. [PMID: 34657656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION To better understand how the COVID-19 pandemic has forced rapid operational changes in the global healthcare industry, changes implemented on an individual, institutional basis must be considered. There currently is not adequate literature about the overall impact COVID-19 has had on pediatric urology services worldwide. We believe that they have dramatically decreased during the COVID-19 crisis, but have adapted to accommodate changes. We hypothesize that patient care was widely variant due to inadequate standardized recommendations or crisis planning. MATERIALS AND METHODS A web-based survey was deployed to 377 pediatric urologists globally via email to analyze COVID-19's impact on various types of pediatric urology practices. Key categories included impacts on elective services, telemedicine use, finances, and recovery operations. A total of 114 responses were collected between April 29th - May 22nd, 2020. RESULTS The widespread cancellation of elective surgical procedures caused significant disturbances in the field. There was a uniform, significant increase (75%) in telemedicine use across practices. The pandemic has created many changes in care provision for physicians, institutions, and patients themselves. Furthermore, the sudden economic burden on healthcare facilities could lead to cost-cutting measures, creating further strain within institutions. Though telemedicine has its limitations, it is a very viable option when traditional services are unavailable. CONCLUSIONS Immediate steps should be taken to ensure that the recovery phases of pediatric urology practices are as efficient as possible. Institutions should develop task forces to develop critical workflow processes in the event of health crises, while still maintaining patient-centered care. This will be essential in maximizing appropriate care allocation.
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Affiliation(s)
| | - Matthew Fifolt
- University of Alabama at Birmingham School of Public Health, Alabama, USA
| | - Mohan Gundeti
- The University of Chicago Medicine Comer Children's Hospital and Pritzker School of Medicine Chicago, Illinois, USA
| | | | | | - Michael C Ost
- West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Pankaj P Dangle
- Department of Urology, University of Alabama at Birmingham, Alabama, USA
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Adamic B, Kirkire L, Andolfi C, Labbate C, Aizen J, Gundeti M. Robot‐assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in children: Step‐by‐step and modifications to UChicago technique. BJUI Compass 2020; 1:32-40. [PMID: 35474913 PMCID: PMC8988522 DOI: 10.1002/bco2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/12/2020] [Accepted: 01/12/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Brittany Adamic
- Pediatric Urology Section of Urology Department of Surgery Comer Children's Hospital The University of Chicago Pritzker School of Medicine Chicago IL USA
| | - Lakshmi Kirkire
- The University of Chicago Pritzker School of Medicine Chicago IL USA
| | - Ciro Andolfi
- Pediatric Urology Section of Urology Department of Surgery Comer Children's Hospital The University of Chicago Pritzker School of Medicine Chicago IL USA
| | - Craig Labbate
- Pediatric Urology Section of Urology Department of Surgery Comer Children's Hospital The University of Chicago Pritzker School of Medicine Chicago IL USA
| | - Joshua Aizen
- Pediatric Urology Section of Urology Department of Surgery Comer Children's Hospital The University of Chicago Pritzker School of Medicine Chicago IL USA
| | - Mohan Gundeti
- Pediatric Urology Section of Urology Department of Surgery Comer Children's Hospital The University of Chicago Pritzker School of Medicine Chicago IL USA
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Kanabolo D, Rodriguez J, Waggoner D, Tucker S, Deplewski D, Kaumeyer B, Lastra RR, Gundeti M. A Phenotypic Female Adolescent with Primary Amenorrhea and Dysmorphic Features. Pediatr Ann 2019; 48:e495-e500. [PMID: 31830290 DOI: 10.3928/19382359-20191118-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report on a case of a 14-year-old phenotypic female with a microdeletion at 13q31.1-q31.3, dysmorphic facial and limb features, and neurologic symptoms. She presented to her pediatrician with concerns for delayed puberty, and laboratory analysis revealed hypergonadotropic hypogonadism. She was found to have an XY karyotype and streak gonads. Further genetic studies did not reveal another cause for her gonadal dysgenesis and, to our knowledge, an association with her known 13q-microdeletion has not yet been reported. Given the risk of malignancy with XY gonadal dysgenesis, the patient had surgery to remove the gonads and had no postoperative complications after a 6-month follow-up visit. We also discuss the role of the pediatrician in cases of delayed puberty, from initial diagnosis to definitive management. [Pediatr Ann. 2019;48(12):e495-e500.].
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Greeley SAW, Littlejohn E, Husain AN, Waggoner D, Gundeti M, Rosenfield RL. The Effect of the Testis on the Ovary: Structure-Function Relationships in a Neonate with a Unilateral Ovotestis (Ovotesticular Disorder of Sex Development)
. Horm Res Paediatr 2017; 87:205-212. [PMID: 28253506 PMCID: PMC5805385 DOI: 10.1159/000455142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/14/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS To evaluate gonadal function in a newborn with suspected ovotesticular disorder of sex development (DSD). METHODS Gonadal function was evaluated at baseline and after gonadotropin-releasing hormone agonist (GnRHag) stimulation testing. RESULTS A full-term 46,XX neonate with genital ambiguity produced serum testosterone and anti-Müllerian hormone (AMH) levels appropriate for males within days, while serum estradiol remained prepubertal, both spontaneously and in response to GnRHag stimulation testing. Ovotesticular DSD was diagnosed at laparoscopy: the left gonad was an ovotestis and the right gonad an ovary arrested at the primordial follicle stage of development. Mosaicism for an isochromosome of the Y short arm in 6-18% of gonadal cells was demonstrated. After ovotestis removal at 3 weeks of age, serum AMH became low within a month, but the elevated testosterone was slow to resolve, apparently from ovarian androgenic hyperfunction coincident with ovarian estrogenic hyperfunction and an adult degree of ovarian development. Ovarian morphology and function gradually normalized as neonatal minipuberty waned. CONCLUSIONS In a neonate with genital ambiguity due to ovotesticular DSD, testicular AMH and testosterone production respectively appear to account for the initial arrest of ovarian development and subsequent rapid hyperfunction of the contralateral ovary after ovotestis removal.
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Affiliation(s)
- Siri Atma W. Greeley
- Departments of Pediatrics and Medicine (Endocrinology), University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Elizabeth Littlejohn
- Departments of Pediatrics and Medicine (Endocrinology), University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Aliya N. Husain
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Darrel Waggoner
- Department of Human Genetics, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Mohan Gundeti
- Department of Surgery (Pediatric Urology), University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Robert L. Rosenfield
- Departments of Pediatrics and Medicine (Endocrinology), University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Cohen A, Nottingham C, Packiam V, Jaskowiak N, Gundeti M. Attitudes and knowledge of urethral catheters: a targeted educational intervention. BJU Int 2016; 118:654-9. [DOI: 10.1111/bju.13506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew Cohen
- Department of Surgery; University of Chicago Medical Center; Chicago IL USA
| | - Charles Nottingham
- Department of Surgery; University of Chicago Medical Center; Chicago IL USA
| | - Vignesh Packiam
- Department of Surgery; University of Chicago Medical Center; Chicago IL USA
| | - Nora Jaskowiak
- Department of Surgery; University of Chicago Medical Center; Chicago IL USA
| | - Mohan Gundeti
- Department of Surgery; University of Chicago Medical Center; Chicago IL USA
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Boysen W, Belleville L, Ahkavan A, Ellison J, Lendvay TS, Huang J, Kirsch A, Kim C, Baek M, Koh C, Noh P, Schulte M, Shrivastava D, Shukla A, Srinivasan A, Monn F, Whittam B, Palmer B, Gundeti M. MP55-11 MULTI-INSTITUTIONAL REVIEW OF OUTCOMES AND COMPLICATIONS OF ROBOTIC-ASSISTED LAPAROSCOPIC EXTRAVESICAL URETERAL REIMPLANTATION (RALUR-EV) FOR TREATMENT OF PRIMARY VESICOURETERAL REFLUX (VUR) IN CHILDREN. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gundeti M. Editorial comment for Chung et al. J Endourol 2014; 29:275-6. [PMID: 25360849 DOI: 10.1089/end.2014.0723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Mohan Gundeti
- Department of Surgery (Urology), University of Chicago , Chicago, Illinois
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Ledezma R, Malik R, Dangle P, Gundeti M. V3-04 ROBOTIC-ASSISTED LAPAROSCOPIC HEMINEPHRECTOMY: THE RETROGRADE TECHNIQUE. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elassiuty YE, Klarquist J, Speiser J, Yousef RM, El Refaee AA, Hunter NS, Shaker OG, Gundeti M, Nieuweboer-Krobotova L, Le Poole IC. Heme oxygenase-1 expression protects melanocytes from stress-induced cell death: implications for vitiligo. Exp Dermatol 2011; 20:496-501. [PMID: 21426408 DOI: 10.1111/j.1600-0625.2010.01232.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To study protection of melanocytes from stress-induced cell death by heme oxygenases during depigmentation and repigmentation in vitiligo, expression of isoforms 1 and 2 was studied in cultured control and patient melanocytes and normal skin explants exposed to UV or bleaching agent 4-TBP. Similarly, expression of heme oxygenases was followed in skin from vitiligo patients before and after PUVA treatment. Single and double immunostainings were used in combination with light and confocal microscopic analysis and Western blotting. Melanocyte expression of heme oxygenase 1 is upregulated, whereas heme oxygenase 2 is reduced in response to UV and 4-TBP. Upregulation of inducible heme oxygenase 1 was also observed in UV-treated explant cultures, in skin of successfully PUVA-treated patients and in melanocytes cultured from vitiligo non-lesional skin. Heme oxygenase encoding genes were subsequently cloned to study consequences of either gene product on cell viability, demonstrating that HO-1 but not HO-2 overexpression offers protection from stress-induced cell death in MTT assays. HO-1 expression by melanocytes may contribute to beneficial effects of UV treatment for vitiligo patients.
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Affiliation(s)
- Yasser E Elassiuty
- Department of Pathology, Microbiology and Immunology/Oncology Institute, Loyola University Chicago, IL, USA
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Wille M, Acharya S, Gundeti M. V1114 ROBOTIC-ASSISTED LAPAROSCOPIC APPENDICOVESICOSTOMY IN A PATIENT WITH PRUNE-BELLY SYNDROME. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
AIMS To describe a novel modification of the posterior prone retroperitoneoscopic nephrectomy/nephroureterectomy which allows the entire procedure to be performed through a single instrument port. METHODS With the patient in a prone position, a retroperitoneal working space is created with the aid of a homemade balloon. A single instrument port is then placed at the tip of the 11th/12th rib under direct vision. Gerota's fascia is incised, the kidney is reflected anteriorly, and the hilar vessels are identified and divided. The ureter is mobilized as far distally as possible before division. The specimen is removed directly via the camera port or in an endobag. RESULTS We have employed this technique in 26 children with a high success rate. The median operating time was 58 (range 45-90) min. Blood loss was minimal in all cases and there were no complications. There have been no conversions and the cosmetic outcome has been excellent. Most of the children (24 of 26) were discharged home the day after surgery. CONCLUSIONS The single instrument port laparoscopic (SIMPL) nephrectomy is a feasible and safe technique for the experienced paediatric laparoscopic urologist.
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Affiliation(s)
- S Garg
- Department of Urology, Great Ormond Street Hospital for Children and Guy's Hospital, Great Ormond Street, London WC1N 3JH, UK
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Gundeti M, Queteishat A, Desai D, Cuckow P. Use of an inner preputial free graft to extend the indications of Snodgrass hypospadias repair (Snodgraft). J Pediatr Urol 2005; 1:395-6. [PMID: 18947578 DOI: 10.1016/j.jpurol.2005.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Accepted: 03/21/2005] [Indexed: 11/30/2022]
Abstract
Tubularized incised plate (tip) urethroplasty or Snodgrass repair has become the most commonly used procedure for distal hypospadias repair. However, where the urethral plate is narrow or shallow, the good results may be compromised. We present our experience of using a small inner preputial graft to deepen and widen the urethral plate (Snodgraft). This procedure has certainly reduced the number of two-stage hypospadias repairs in patients who lack a urethral groove or have a small glans. The cosmetic and functional results are excellent.
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Affiliation(s)
- M Gundeti
- Great Ormond Street Hospital for Children, and Institute of Urology Middlesex Hospital, University College London, UK.
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Abstract
PURPOSE Maintaining adequate renal function without compromising cure in children with bilateral Wilms' tumor is surgically demanding and challenging. The aim of this study was to assess renal function and outcome in children treated in one institution for bilateral Wilms' disease by renal salvage procedures. METHODS This study is a retrospective review of all patients with histologically proven bilateral nephroblastoma who underwent a renal salvage procedure between November 1973 and June 2002. The median follow-up time was 52 months (range, 8 to 326 months). RESULTS Twenty-three patients were included in the study. The median age at diagnosis was 19 months (range, 5 to 65 months). Patients who presented before 1982 (n = 5) were treated surgically first followed by chemotherapy. The remainder (n = 18) received initial chemotherapy before the operation. Of the 46 kidneys, 18 had a nephrectomy. The remaining 28 underwent a renal salvage procedure. At follow-up, 19 patients had good renal function, 2 had satisfactory function, and 2 had renal failure. Seventeen of the 23 children are alive and tumor free at follow-up (74%). Four children died of distant metastases and 2 of renal failure. Local recurrence in the salvaged kidney was detected in 1 patient 12 years after surgery after the commencement of immunosuppression for renal transplantation. CONCLUSIONS These results confirm that renal salvage procedures, in combination with chemotherapy, are a safe and effective way of treating children with bilateral Wilms' disease. In addition, renal salvage surgery can maintain satisfactory renal function in the majority of these patients without an increased risk of local recurrence. When transplantation is required, the remaining native kidney should be removed to prevent tumor recurrence.
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Affiliation(s)
- Rainer Kubiak
- Department of Urology, Great Ormond Street Hospital for Children and the Institute of Child Health, London, England, UK
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