RESUMO
PURPOSE: To describe the technique of laparoscopy-assisted undiversion of an ileal conduit into a continent orthotopic ileal neobladder performed on a patient with a previous radical cystoprostatectomy and ileal conduit. CASE REPORT: A 57-year-old man presented with a prolapsed stoma and a history of a right radical nephroureterectomy for grade 3 ureteral transitional-cell carcinoma and a radical cystoprostatectomy and ileal conduit urinary diversion for in-situ bladder carcinoma, performed 12 and 8 years ago, respectively. After the ileal stoma was resected, five trocars were placed transperitoneally. Partial resection of the distal ileal conduit was performed, leaving in place the proximal segment with its left ureteroileal anastomosis. Flexible urethroscopy revealed a contracting external sphincter, and random urethral frozen-section biopsies ruled out tumor. A 45-cm segment of ileum was isolated and exteriorized through the stoma site, and an ileal neobladder was created extracorporeally, suturing the proximal ileal-conduit segment, with its ureteroileal anastomosis, to it. The ileal neobladder was reintroduced into the abdomen and anastomosed laparoscopically to the urethral stump with six 2-0 polyglactin sutures. The total operative time was 7 hours with a blood loss of 100 mL. There were no intraoperative complications. The hospital stay was 7 days. At a follow-up of 24 months, the patient had total daytime continence and normal renal function, and intravenous urography revealed an unobstructed urinary tract. CONCLUSION: Laparoscopy-assisted ileal-conduit undiversion into an orthotopic ileal neobladder is technically feasible. It can be considered an alternative to open surgery for patients who have undergone urinary diversion.
Assuntos
Estruturas Criadas Cirurgicamente , Derivação Urinária , Coletores de Urina , Carcinoma de Células de Transição/cirurgia , Cistectomia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Prostatectomia , Estomas Cirúrgicos , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
We report successful laparoscopic repair of a saccular renal-artery aneurysm in a patient with renovascular hypertension. The repair was performed by clamping the renal hilum, excising the aneurysm, and suturing the vascular defect intracorporeally. Postoperative imaging studies confirmed normal arterial flow in the repaired artery.
Assuntos
Aneurisma Intracraniano/cirurgia , Laparoscopia/métodos , Artéria Renal/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Angiografia , Humanos , Hipertensão Renal/diagnóstico por imagem , Hipertensão Renal/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Artéria Renal/diagnóstico por imagem , Circulação RenalRESUMO
PURPOSE: We present our initial experience with the laparoscopic Boari flap for long ureteral strictures. MATERIALS AND METHODS: Nine patients underwent a laparoscopic Boari flap procedure at our institution. Eight patients had 4 to 7 cm distal ureteral strictures on excretory urogram and retrograde pyelogram, and 1 had transitional cell carcinoma in the distal right ureter. We analyzed our intraoperative parameters with regard to operative time and intraoperative complications. The operative results assessed were hospital stay, renal function, symptomatic improvement and radiological studies. The patient with ureteral transitional cell carcinoma was excluded from analysis because ureteral stricture etiology differed from that in the other 8. RESULTS: Mean operative time was 156.6 minutes. Mean estimated blood loss was 124 cc. There were no intraoperative complications. Mean hospital stay was 3 days. At a mean followup of 17.6 months all patients were symptom-free and had an unobstructed ureterovesical anastomosis on followup excretory urogram. One surgical postoperative complication resolved laparoscopically. CONCLUSIONS: The laparoscopic Boari flap is a feasible alternative surgical technique in patients with long distal ureteral strictures. Larger series with longer followup are needed to validate these results vs the standard open technique.