Laparoscopic reconstruction for dual extrinsic pathologies compressing the upper ureter: The nutcracker ureteric compression.
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ABSTRACT:
SUBMITTER: Abraham GP
PROVIDER: S-EPMC3263234 | biostudies-literature | 2011 Oct
REPOSITORIES: biostudies-literature
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Laparoscopic reconstruction for dual extrinsic pathologies compressing the upper ureter: The nutcracker ureteric compression.
Abraham George P GP Das Krishanu K Ramaswami Krishnamohan K George P Datson PD Abraham Jisha J JJ Thachil Thomas T Thampan Oppukeril S OS
Indian journal of urology : IJU : journal of the Urological Society of India 20111001 4
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Project description:BackgroundThe ideal treatment for upper ureteric calculi is still debatable, particularly for patients with large, impacted ureteric calculi. Retroperitoneal laparoscopic ureterolithotomy (RLU) may be a worthwhile alternative to open surgery. In this study, we retrospectively evaluated our clinical experience associated with RLU performed for impacted upper ureteric calculi (>1.5 cm) help urologists in clinical practice and provide a reference for clinical work.MethodsA total of 64 cases (38 males; 26 females) with impacted upper ureteric calculi between April 2018 and January 2020 were analyzed retrospectively. The basic information of the included research subjects are as follows: The mean age was 50.8±25.4 years. The largest stone diameter was 1.8±0.3 cm. The mean stone retention time was 42±11 days. The mean degree of hydronephrosis was 2.8±1.2 cm.ResultsThe mean operative time was 85.4±18.3 minutes. The mean hospital duration was 7.5±1.8 days. The stone-free rate was 98.4%. Two patients required additional intervention. Post-operative fever developed in 3 patients. The decrease in hemoglobin levels was 7.8±3.6 g/L. The increase in procalcitonin (PCT) level was 3.7±1.8 ng/mL. No major complications, for example, sepsis, bleeding, bowel injury, or cardiopulmonary morbidities, were reported.ConclusionsRLU should be regarded as an excellent first line treatment modality for impacted upper ureteric calculi (>1.5 cm) owing to the high success rate, low complication rate, and the short length of operative time and hospital duration.
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Project description:A 20-year-old man complained of debilitating left flank pain for 6 months with an episode of gross hematuria. Computed tomography showed compression of the left renal vein between the aorta and superior mesenteric artery with an aortomesenteric angle of 25 degrees. Venography showed a gradient of 3 mm Hg across the compression and 94.4% luminal compression of the left renal vein. After discussion of all surgical and endovascular options, robot-assisted laparoscopic placement of an extravascular cuff around the left renal vein was performed using the da Vinci X Surgical System (Intuitive Surgical, Sunnyvale, Calif). The patient did well with full resolution of the left flank pain.
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Project description:ObjectivesUreter injury is a serious complication of laparoscopic surgery. Current strategies to identify the ureters, such as placement of a ureteral stent, carry additional risks for patients. We hypothesize that the systemically injected near-infrared (NIR) dye IRDye800CW-CA can be used to visualize ureters intraoperatively.MethodsAdult female mixed-breed pigs weighing 24 to 41 kg (n = 2 per dose) were given a 30, 60, or 120 μg/kg systemic injection of IRDye800CW-CA. Using the Food and Drug Administration-cleared Pinpoint laparoscopic NIR system, images of the ureter and bladder were captured every 10 minutes for 60 minutes after injection. To determine the biodistribution of the dye, tissues were collected for ex vivo analysis with the Pearl Impulse system. ImageJ software was used to quantify fluorescence signal and signal-to-background ratio (SBR) for the intraoperative images.ResultsThe ureter was identified in all pigs at each dose, with peak intensity reached by 30 minutes and remaining elevated throughout the duration of imaging (60 minutes). The 60 μg/kg dose was determined to be optimal for differentiating ureters according to absolute fluorescence (>60 counts/pixel) and SBR (3.1). Urine fluorescence was inversely related to plasma fluorescence (R(2) = -0.82). Ex vivo imaging of kidney, ureter, bladder, and abdominal wall tissues revealed low fluorescence.ConclusionSystemic administration of IRDye800CW-CA shows promise in providing ureteral identification with high specificity during laparoscopic surgery. The low dose required, rapid time to visualization, and absence of invasive ureteral instrumentation inherent to this technique may reduce complications related to pelvic surgery.
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Project description:The performance of ECG signals compression is influenced by many things. However, there is not a single study primarily focused on the possible effects of ECG pathologies on the performance of compression algorithms. This study evaluates whether the pathologies present in ECG signals affect the efficiency and quality of compression. Single-cycle fractal-based compression algorithm and compression algorithm based on combination of wavelet transform and set partitioning in hierarchical trees are used to compress 125 15-leads ECG signals from CSE database. Rhythm and morphology of these signals are newly annotated as physiological or pathological. The compression performance results are statistically evaluated. Using both compression algorithms, physiological signals are compressed with better quality than pathological signals according to 8 and 9 out of 12 quality metrics, respectively. Moreover, it was statistically proven that pathological signals were compressed with lower efficiency than physiological signals. Signals with physiological rhythm and physiological morphology were compressed with the best quality. The worst results reported the group of signals with pathological rhythm and pathological morphology. This study is the first one which deals with effects of ECG pathologies on the performance of compression algorithms. Signal-by-signal rhythm and morphology annotations (physiological/pathological) for the CSE database are newly published.
| S-EPMC8131635 | biostudies-literature
Project description:BackgroundPediatric hydronephrosis induced by pelvic-ureteric junction obstruction (PUJO) is treated by dismembered pyeloplasty (DP) via open and laparoscopic surgery. The etiology of PUJO involves both intrinsic stenosis and extrinsic compression of crossing vessels (CVs). PUJO owing to CVs is also treated by DP, as there is no consensus concerning this vascular condition. We encountered a 2-year-old infant with pure extrinsic PUJO combined with horseshoe kidney who successfully underwent laparoscopic transposition for CVs (vascular hitch).Case presentationA 2-year-old boy was prenatally diagnosed with left multicystic dysplastic kidney (MDCK) and right hydronephrosis and received a definitive diagnosis after birth. At 6 months old, renal scintigraphy revealed a non-functioning pattern in the left kidney and an obstructive pattern in the right, showing no response to furosemide loading. The patient also had recurrent urinary tract infection, and his right hydronephrosis gradually worsened. We decided to perform surgery for the right PUJO. Preoperative enhanced computed tomography detected three right renal vessels independently branching from the abdominal aorta. The middle renal vessels were located at the ventral side of the pelvis and coincident with the site of PUJO. These vessels were suspected of being CVs. The patient underwent laparoscopic surgery electively. A 5-mm trocar was inserted at the umbilicus for a 5-mm, 30° rigid scope. Two additional ports were then inserted under laparoscope inspection. The dilated right pelvis and CVs were detected after ascending colon mobilization. To confirm the pathogenesis of PUJO, the CVs were dissected and taped. After taping the CVs, an intraoperative diuretic test was performed using furosemide loading. Peristalsis of the right ureter was recognized, and the extrinsic PUJO owing to the CVs was definitively confirmed. We therefore performed transposition for the CVs (vascular hitch procedure). The CVs were mobilized in the cranial direction and those were wrapped by dilated pelvis. The post-operative course was uneventful. The renal scintigraphy findings improved and showed a favorable response of furosemide loading.ConclusionsThe laparoscopic vascular hitch procedure is minimally invasive and effective for extrinsic PUJO due to CVs. Anastomotic stricture after Anderson and Hynes DP can be prevented by appropriate patient selection.
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Project description:ObjectiveTo report our initial experience in the application of laparoscopy in the management of children with unilateral vesico-ureteric reflux (VUR) using the laparoscopic extravesical transperitoneal approach following the Lich-Gregoir technique, and to evaluate the results and benefits of this technique for such patients.Patients and methodsBetween February 2013 and August 2014, 17 children [13 girls and four boys, with a median (range) age of 60 (24-120) months] presented with recurrent febrile urinary tract infections and were diagnosed with unilateral VUR. They underwent transperitoneal extravesical laparoscopic ureteric re-implantation following the Lich-Gregoir technique. Postoperatively abdomino-pelvic ultrasonography was done at 1 month after surgery and voiding cystourethrography (VCUG) at 3 months after surgery, and in cases with persistent VUR or de novo contralateral VUR another VCUG was done at 6 months after surgery.ResultsThe median (range) operative time was 90 (80-120) min and the postoperative hospital stay was 2 (2-5) days. Intraoperative and postoperative complications were minimal. Patients were followed-up for a median (range) of 6 (3-21) months. All the children had complete resolution symptomatically and on VCUG, without further intervention.ConclusionsThe laparoscopic extravesical transperitoneal approach for ureteric re-implantation, following the Lich-Gregoir technique, is feasible and very effective in the management of VUR. Prospective randomised studies are eagerly awaited to define the benefits of this technique to patients, as well as to determine the cost-effectiveness of this approach.
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