Video Library

The Lithocatch (TM) by Boston Scientific: how to use it and how to solve a common problem

Vol. 44 (x): 2018 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0105


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Giuseppe Giusti 1, Marco Lucci Chiarissi 1, Antonello De Lisa 1
1 Department of Urology, University of Cagliari, Cagliari , Italy

ABSTRACT

Introduction: The LithocatchTM basket is a immobilization device commercialized by Boston Scientific. It allows to col­lect multiple stone fragments from the ureter. The ability of the basket to capture a large number of stone fragments, is however responsible for a problem connected to its usage: the entrapment of the basket inside the ureter. In this video we explain how to use it and how to solve this problem.

Material and Methods: After positioning the LithocatchTM over the fragments, the basket is opened and it is rotated through a special handle to collect stones. One frequent problem occurs when too many fragments are collected at once, preventing the extraction of the device. We research our archives to extrapolate the total number of procedures carried out with the LithocatchTM in the last two years and the total number of complications occurred.

Results: We experienced the above mentioned complication in 16 procedures (14% of the total) of 114 surgeries per­formed. The way described to solve this complication was efficient and did not produce any damage to the ureter or to the basket.

Conclusion: The LithocatchTM has an excellent ability to capture small stones so it allows to reduce the length of the pro­cedure. Paying attention to limit the amount of fragments collected, it is possible to avoid the entrapment of the basket. If this complication occurs, the problem can be solved by reducing the size of the stone fragments. The preferable type of energy is the ballistic one.

 

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20180105_Giusti_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

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Robotic excision of complex adrenal mass with retrocaval extension and encasement of renal hilum with renal preservation

Vol. 44 (x): 2018 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0384


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Vishnu Raveendran 1, Ramaprasad Manasseri Koduveli 1, Kishore Thekke Adiyat 1
1 Aster Medcity, Kochi, Kerala, India

ABSTRACT

Objective: The purpose of this video is to present robotic excision of a complex adrenal mass with retrocaval extension and encasement of renal hilum in a 16 year old boy. Biochemical screening was negative for metabolically active compo­nent. Computerized tomographic scan with contrast revealed a homogenous mass of approximately 10.8 cm x 6.2 cm x 4.2 cm in the suprarenal area on right side that was extend-ing behind inferior vena cava and encasing renal hilar vessels. Imaging findings were that of a classical ganglioneuroma.

Material and methods: Robot assisted laparoscopic adrenalectomy with sparing of renal hilar vasculature was performed. With patient in lateral position, five ports were used, including one for liver retraction. Da Vinci® system with four arms was docked from over the right shoulder. The displaced renal hilar structures were identified by opening Gerota’s fascia. Mass was dissected completely and removed through Pfan-nensteil incision.

Results: Duration of procedure was 345 minutes and console time was 290 minutes. Blood loss was 250 mL. Post-opera­tive renal doppler showed normal blood flow. He was discharged on post-operative day three. Histopathologic examina­tion of specimen revealed ganglioneuroma arising from adrenal gland.

Conclusion: Ganglioneuroma is a rare adrenal tumor with good prognosis on surgical removal. The advent of robotic surgery has made complex surgical procedures involving vital structures like inferior vena cava be performed using minimally invasive techniques without compromising oncologic principles.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170384_Raveendran_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

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Robotic adenomectomy using a laparoscopic dissector

Vol. 44 (x): 2018 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0609


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Lessandro Curcio Gonçalves 1, Felipe Monnerat Lott 2, Rafael Rosa 1
1 Serviço de Urologia, Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brasil; 2 Departamento de Urologia, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brasil

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Complete supine percutaneous nephrolithotomy with GoPro®. Ten steps for success

Vol. 44 (x): 2018 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0337


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Fabio Carvalho Vicentini 1, Hugo Daniel Barone dos Santos 1, Carlos Alfredo Batagello 1, Julia Rothe Amundson 2, Evaristo Peixoto Oliveira Neto 1, Giovanni Scala Marchini 1, Miguel Srougi 1, Willian Carlos Nahas 1, Eduardo Mazzucchi 1
1 Divisão de Urologia, Grupo de Endourologia do Hospital das Clínicas, Faculdade de Medicina da Uni­versidade de São Paulo, USP, São Paulo, SP, Brasil; 2 University of Miami, Miller School of Medicine, Miami, EUA

 

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Complete supine percutaneous nephrolithotomy with GoPro®. Ten steps for success

Vol. 44 (x): 2018 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0337


VIDEO SECTION

Fabio Carvalho Vicentini 1, Hugo Daniel Barone dos Santos 1, Carlos Alfredo Batagello 1, Julia Rothe Amundson 2, Evaristo Peixoto Oliveira Neto 1, Giovanni Scala Marchini 1, Miguel Srougi 1, Willian Carlos Nahas 1, Eduardo Mazzucchi 1
1 Divisão de Urologia, Grupo de Endourologia do Hospital das Clínicas, Faculdade de Medicina da Uni­versidade de São Paulo, USP, São Paulo, SP, Brasil; 2 University of Miami, Miller School of Medicine, Miami, EUA

ABSTRACT

 

Objective: To show a video of a complete supine Percutaneous Nephrolithotomy (csPCNL) performed for the treatment of a staghorn calculus, from the surgeon’s point of view. The procedure was recorded with a GoPro® camera, demonstrating the ten essential steps for a successful procedure.

Materials and methods: The patient was a 38 years-old woman with 2.4cm of left kidney lower pole stone burden who presented with 3 months of lumbar pain and recurrent urinary tract infections. She had a previous diagnosis of polycystic kidney disease and chronic renal failure stage 2. CT scan showed two 1.2cm stones in the lower pole (Guy’s Stone Score 2). She had a previous ipsilateral double J insertion due to an obstructive pyelonephritis. The csPCNL was uneventful with a single access in the lower pole. The surgeon had a Full HD GoPro Hero 4 Session® camera mounted on his head, controlled by the surgical team with a remote control. All of the mains steps were recorded. Informed consent was ob­tained prior to the procedure.

Results: The surgical time was 90 minutes. Hemoglobin drop was 0.5g/dL. A post-operative CT scan was stone-free. The patient was discharged 36 hours after surgery. The camera worked properly and didn’t cause pain or muscle discomfort to the surgeon. The quality of the recorded movie was excellent.

Conclusion: GoPro® camera proved to be a very interesting tool to document surgeries without interfering with the pro­cedure and with great educational potential. More studies should be conducted to evaluate the role of this equipment.

ARTICLE INFO
Available at: http://www.intbrazjurol.com.br/video-section/20170337_Vicentini_et_al

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Robotic adenomectomy using a laparoscopic dissector

Vol. 44 (x): 2018 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0609


VIDEO SECTION

Lessandro Curcio Gonçalves 1, Felipe Monnerat Lott 2, Rafael Rosa 1
1 Serviço de Urologia, Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brasil; 2 Departamento de Urologia, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brasil

ABSTRACT

Introduction: Only few reports are known about the use of robotic surgery for prostate benign enlargement. The robotic surgery can be improved by laparoscopic tricks. We show a video of robotic adenomectomy where a laparoscopic dissector is used to help create the plan between prostatic capsule and adenoma.
Materials and methods: A 62 years old male had severe urinary flow outlet obstruction. Medical therapy was not effective.
Ultrasound detected a 92gr enlarged prostate with a large middle lobe. Robotic assisted adenomectomy was scheduled.
The procedure followed this sequence: opening of Retzius space, superficial suture of the Dorsal vein complex, horizontal cistotomy. The plan was created with electrocautery and blunt dissection with the laparoscopic dissector. Haemostatic sutures were placed between prostate fossa and the posterior bladder neck and closure of the cistotomy.
Results: Whole operation time was 160 minutes, with a blood loss of 80cc. There was no perioperative or post-operative complication. Catheter was removed after 4 days. Post-operatory uroflowmetry shows a peak flow of 30ml/sec. Pathological examination is negative for tumor. After 60 days IPSS was 8.
Conclusion: Robotic prostate adenomectomy using the laparoscopic dissector is a safe and effective minimally invasive treatment for benign prostatic enlargement. It is a novel technique to find and dissect the plane between prostatic adenoma
and capsule. This could be one more use of laparoscopic technology to improve surgical outcomes in robotic field.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170609_Goncalves_et_al

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Robot-assisted laparoscopic bladder diverticulectomy and greenlight laser anatomic vaporization of the prostate

Vol. 44 (2): 403-404, March – Abril, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0016


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Luca Cindolo 1, Manuela Ingrosso 1, Michele Marchioni 2, Ambra Rizzoli 2, Francesco Berardinelli 2, Luigi Schips 1
1 Department of Urology, ASL Abruzzo 2, Chieti, Italy; 2 Department of Urology, SS Annunziata Hospital, “G. D’Annunzio” University of Chieti, Chieti, Italy

No Abstract available

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Laparoscopic – assisted percutaneous nephrolithotomy as an alternative in the treatment of complex renal calculi in patients with retrorenal colon

Vol. 44 (2): 405-406, March – Abril, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0043


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Petronio Augusto de Souza Melo 1, Fabio Carvalho Vicentini 1, David Jacques Cohen 1, Marcelo Hisano 1, Claudio Bovolenta Murta 1, Joaquim Francisco de Almeida Claro 1
1 Divisão de Urologia, Centro de Referência da Saúde do Homem, Hospital Brigadeiro, São Paulo, SP, Brasil

No Abstract available

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Step by step male to female transsexual surgery

video section Vol. 44 (2): 407-408, March – Abril, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0044


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Rodrigo Uliano Moser da Silva 1, Fernando Jahn da Silva Abreu 1, Gabriel M. V. Da Silva 1, João Vitor Quadra Vieira dos Santos 1, Nelson Sivonei da Silva Batezini 1, Brasil Silva Neto 1, Tiago Elias Rosito 1
1 Departamento de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil

 

ABSTRACT

Introduction: After the diagnosis of transsexualism is confirmed therapy commences with psychotherapeutic preparation for the conversion, and after conversion, long-term patient rehabilitation is maintained for at least two years. The indication for surgery is chronic discomfort caused by discord with the patient’s natural gender, intense dislike of developing secondary sex characteristics and the onset of puberty. The surgical conversion of transsexuals is the main step in the complex care of these problematic patients (1). This surgery was first described by Benjamin H, using a flap of inverted penile skin (2) and is considered the gold standard since then. Male-to-female transsexual surgical techniques are well defined and give good cosmetic and functional results. Sex reassignment surgery promotes the improvement of psychological aspects and social relationships as shown in the World Health Organization Quality of Life Assessment applied in the patients submitted to this procedure (3). Techniques include the creation of a normal appearing female introitus, a vaginoplasty allowing sexual intercourse and the capability of clitoral orgasm (4). Various methods for neovaginoplasty have been described and can be classified into five categories, i.e. pedicled intestinal transplants, penile skin grafts, penile skin flaps, non-genital skin flaps and non-genital skin grafts (5). In our Hospital, we use penile and scrotal skin flaps.

Until now, 174 procedures have been performed by our team using this technique with high rates of satisfaction (3).

Patients and methods: We present a step-by-step male to female transsexual surgery.

Conclusion: Surgical gender reassignment of male transsexuals resulted in replicas of female genitalia which enabled coitus with orgasm (1). With this video we show step by step that a surgery using penile skin flaps is able to be performed with good cosmetic results.

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An unusual presentation of urethral duplication presenting with chronic bladder retention, left scrotal transposition and left renal agenesis

Vol. 44 (2): 409-410, March – Abril, 2018

doi: 10.1590/S1677-5538.IBJU.2016.0119


VIDEO SECTION

Antonio Macedo Jr. 1, Marcela Leal da Cruz 1, João Luiz Gomes Parizi 1, Gustavo Marconi Caetano Martins 1, Riberto Liguori 1, Sérgio Leite Ottoni 1, Bruno Leslie 1, Gilmar Garrone 1
1 Universidade Federal de São Paulo, São Paulo, Brasil

ABSTRACT

Introduction and objective: Urethral duplication is a rare congenital anomaly, with roughly 200 cases reported in the literature (1). It is more frequent in males, with few cases reported in females. The clinical presentation differs according to the anatomical variant present. The duplication most commonly occurs in the sagittal plane with one urethra located ventrally and the other dorsally (2). Usually the ventral urethra is the more functional of both. Duplications occurring in the coronal plane are quite rare and they are usually associated with bladder duplication (3). The purpose of this paper was to present a video of a boy with an unusual urethral duplication form.

Materials and Methods: Patient was born premature due to oligohydramnios at 7 months-gestational age and he has initial diagnosis of hypospadia. Since then, he presented at least 7 febrile UTI and mother complained of difficult micturition and a presence of a mass at lower abdomen. Patient was referred to our institution and we identified urethral duplication with a glandar and scrotal meatus, palpable bladder and left penile-hemiscrotum transposition. US and CT-scan showed left kidney agenesis and overdistended bladder. VCUG and retrograde urethrography showed duplication, presence of contrast in the seminal vesicles and complete catheterizing of both urethras was not possible.

Results: The topic urethra was dysplastic and not patent to a 4Fr plastic tube so we were unable to access it endoscopically.

We performed initially a Mitrofanoff procedure to allow CIC and treat chronic retention. Six months later, we assessed both urethras surgically and concluded that dorsal urethra was dysplastic after 3cm still in the penile area and scrotal urethra was not possible to be catheterized. We excised the ventral urethra because of dribbling complaints up to bulbar area and reconstructed the scrotal transposition, keeping the topic urethra for cosmetic issues. Patient had excellent outcome, performs CIC every 4 hours and has not presented further UTI episodes.

Discussion and conclusion: The urethral duplication is an anomaly that has multiple anatomical presentations. There are several theories about the etiology, but none can explain all types of presentations. There is also more than one rating available, and the Effmann classification is the most detailed. The case exemplifies this varied spectrum of anatomic urethral duplication. It resembles the urethral duplication type IIa-Y, however, ventral urethra meatus was located in penoscrotal area and both urethras were at least partially hypoplastic/dysplastic associated with obstruction and bladder retention. In determining how to best manage a patient with Y-type urethral duplication, the caliber and quality of the orthotopic urethra must first be assessed. Published reports suggest that best outcomes are those using the ventral duplicated urethra for the reconstruction (4). In this case, none of urethras were functional and a supravesical outlet channel had to be provided. The treatment of this condition requires an individualized planning and a vast technical knowledge of reconstructive surgery.

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