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Jihad H Kaouk - One of the best experts on this subject based on the ideXlab platform.
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transperineal approach for intracorporeal Ileal Conduit urinary diversion using a purpose built single port robotic system step by step
Urology, 2018Co-Authors: Juan Garisto, Riccardo Bertolo, Jihad H KaoukAbstract:ABSTRACT Introduction To describe a step-by-step technique for single-port transperineal intracorporeal Ileal Conduit urinary diversion using a purpose-built robotic platform. Technical Considerations In one male cadaver, the da Vinci SP1098 surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used to perform intracorporeal Ileal Conduit urinary diversion by a transperineal approach after radical cystoprostatectomy and bilateral pelvic lymph node dissection. The surgery was completed through a 2.5-cm perineal incision through which a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) and a dedicated 25-mm multichannel port accommodating a 12-mm × 10-mm oval articulating robotic camera, three 6-mm double-jointed articulating robotic instruments, and a 6-mm accessory laparoscopic instrument were placed. Moreover, at the planned level of the cutaneostomy, a 12-mm port to accommodate the Endo-GIA was placed. The primary outcomes were the technical feasibility, the operative time, and the record of eventual procedural complications. The intervention was successfully completed without any conversion or need for additional ports. The total operative time was 200 minutes. Operative time for urinary diversion was 90 minutes. Conclusion We demonstrated the feasibility of single-port transperineal intracorporeal Ileal Conduit urinary diversion using the SP1098 purpose-built robotic platform. Limitations include the preclinical setting. The applicability in the clinical model is awaited to be tested after the platform will be commercially available.
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robotic assisted radical cystoprostatectomy and intracorporeal Ileal Conduit urinary diversion for a kidney transplant recipient
International Braz J Urol, 2017Co-Authors: Peter A Caputo, Daniel Ramirez, Matthew J Maurice, Ryan J Nelson, Onder Kara, Ercan Malkoc, David A Goldfarb, Jihad H KaoukAbstract:Introduction and objectives Robotic assisted radical cystectomy (RARC) is an alternative to open radical cystectomy. As experience is gained with the RARC approach the technique is being applied to more complex surgical cases. We describe here our technique for RARC with intracorporeal Ileal Conduit urinary diversion for a renal transplant recipient. Materials and methods The patient is a 60-year old man with high-grade muscle invasive bladder cancer. He has a history of renal failure due to polycystic kidney disease and received a deceased donor renal transplant in 2008. His hospital course at time of transplant was complicated by low-level BK virus viremia. Interestingly his trans-urethral bladder tumor resection specimen at time of bladder cancer diagnosis stained positive for SV40. His native kidneys were anuric so bilateral laparoscopic nephrectomy was performed in a staged fashion 2 weeks prior to RARC. Our surgical technique utilizes 6 trocars, of note a 12-mm assistant trocar is placed 1 cm superior to the pubic symphysis, and this trocar is solely used to pass a laparoscopic stapler to facilitate the excision of the Ileal segment and the stapled enteric anastomosis. Surgical steps include: identification of native ureters bilaterally (removed en bloc with the bladder specimen); identification of the transplanted ureter at the right bladder dome; posterior bladder and prostate dissection along Denonvilliers' fascia; development of the space of Retzius; ligation and transection of the bladder and prostate vascular bundles; apical prostate dissection and transection of urethra; left pelvic lymphadenectomy; ilium resection for creation of the Ileal Conduit; stapled enteric anastomosis; ureteroIleal anastomosis; maturation of the Ileal Conduit stoma. Results The surgery had no intraoperative complications. Operative time was 443 minutes (7.4 hours). Estimated blood loss was 250 cc. Length of hospital stay was 5 days. The patient did not experience any postoperative complications. The patient maintained good renal graft function with no decline in eGFR to date. Conclusions As surgeon comfort and experience with robotic assisted surgery grows, robotic surgery can successfully be applied to less frequently performed procedures. Here we successfully performed a robotic assisted radical cystoprostatectomy with intracorporeal Ileal Conduit urinary diversion for a renal transplant recipient.
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laparoscopic intracorporeally constructed Ileal Conduit after porcine cystoprostatectomy
The Journal of Urology, 2001Co-Authors: Amr Fergany, Inderbir S Gill, Jihad H Kaouk, Anoop M Meraney, Khaled S Hafez, Gyung Tak SungAbstract:Purpose: We present our technique of laparoscopic Ileal Conduit creation after cystoprostatectomy in a porcine model performed in a completely intracorporeal manner.Methods and Methods: After developing the technique in 5 acute animals laparoscopic cystoprostatectomy with intracorporeally performed Ileal Conduit urinary diversion was performed in 10 surviving male pigs. A 5-port transperitoneal technique was used. All steps of the technique applied during open surgery were duplicated intracorporeally. Specifically cystectomy, isolation of an Ileal Conduit, restoration of bowel continuity and mucosa-to-mucosa stented bilateral ileoureteral anastomosis formation were performed by exclusively intracorporeal laparoscopic techniques.Results: Surgery was successful in all 10 study animals without intraoperative or immediate postoperative complications. Blood loss was minimal and average operative time was 200 minutes. Stenosis of the end Ileal stoma specifically at the skin level was noted in 6 animals. Three d...
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laparoscopic radical cystoprostatectomy with Ileal Conduit performed completely intracorporeally the initial 2 cases
Urology, 2000Co-Authors: Inderbir S Gill, Amr Fergany, Jihad H Kaouk, Anoop M Meraney, Gyung Tak Sung, Eric A Klein, Stephen J Savage, James Ulchaker, Andrew C NovickAbstract:Abstract Objectives. To present the initial 2 patients who underwent laparoscopic radical cystoprostatectomy, bilateral pelvic lymphadenectomy, and Ileal Conduit urinary diversion, with the entire procedure performed exclusively by intracorporeal laparoscopic techniques. Methods. Two male patients, 78 and 70 years old, with muscle-invasive, organ-confined, transitional cell carcinoma of the urinary bladder underwent the procedure. The entire procedure, including radical cystoprostatectomy, pelvic node dissection, isolation of the Ileal loop, restoration of bowel continuity with stapled side-to-side ileoIleal anastomosis, retroperitoneal transfer of the left ureter to the right side, and bilateral stented ileoureteral anastomoses were all performed exclusively by intracorporeal laparoscopic techniques. Free-hand laparoscopic suturing and in situ knot-tying techniques were used exclusively. Results. The surgical time was 11.5 hours in the first patient and 10 hours in the second. The respective blood loss was 1200 mL and 1000 mL. In both patients, ambulation resumed on postoperative day 2, bowel sounds on day 3, and oral intake on day 4; the hospital stay was 6 days. Narcotic analgesia comprised 108.3 mg and 16.5 mg of morphine sulfate equivalent, respectively. Pathologic examination revealed pT4N0M0 (prostate) and pT2bN0M0 transitional cell carcinoma of the bladder with the surgical margins negative for cancer in both patients. No intraoperative or postoperative complications occurred in either patient. Conclusions. To our knowledge, this is the initial report of laparoscopic radical cystoprostatectomy with intracorporeal Ileal Conduit urinary diversion. We believe that with further experience and refinement in the operative technique, laparoscopic radical cystoprostatectomy with Ileal Conduit urinary diversion may become an attractive treatment option for selected candidates with localized muscle-invasive bladder cancer.
Joseph A Smith - One of the best experts on this subject based on the ideXlab platform.
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health related quality of life assessment after radical cystectomy comparison of Ileal Conduit with continent orthotopic neobladder
The Journal of Urology, 2002Co-Authors: Sajal C Dutta, Joseph A Smith, Sam S Chang, Christopher S Coffey, Gregory S Jack, Michael S CooksonAbstract:Purpose: Health related quality of life after urinary diversion has been increasingly recognized as an important outcome measure. However, few studies have directly compared patients with an Ileal Conduit with those with a continent orthotopic neobladder and even fewer have used validated quality of life instruments. Therefore, we compared health related quality of life in patients who underwent neobladder versus Ileal Conduit creation using validated questionnaires.Materials and Methods: We mailed 2 validated questionnaires that are measures of health related quality of life, namely the RAND 36-Item Health Survey (SF-36) and Functional Assessment of Cancer Therapy-General (FACT-G), to patients who underwent radical cystectomy for urothelial carcinoma between January 1995 and December 1999. Statistical analysis was performed, including univariate and multivariate analysis.Results: A total of 112 patients were available for assessment. A total of 72 (64%) questionnaires were returned, including 23 (32%) an...
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continent urinary reconstruction versus Ileal Conduit a contemporary single institution comparison of perioperative morbidity and mortality
Urology, 2000Co-Authors: Dipen J Parekh, Michael O Koch, Barritt W Gilbert, Joseph A SmithAbstract:Abstract Objectives. To compare postoperative morbidity and mortality in a concurrent and contemporary series of patients who underwent radical cystectomy with Ileal Conduit versus orthotopic neobladder. Methods. The data of 198 patients were reviewed, 117 with orthotopic reconstruction and 81 with Ileal Conduit during a 5-year time frame. Thirty-day morbidity, mortality, reoperative rates, and parameters associated with the surgical procedures were obtained from chart review. Results. No perioperative or postoperative deaths occurred in either group. The median operative time for the Ileal Conduit was 201 minutes (range 140 to 373), and for the orthotopic neobladder, it was 270 minutes (range 230 to 425). The median blood loss was 389 and 474 mL, respectively. The median length of hospitalization was 8 days for the Ileal Conduit group and 7 days for the orthotopic neobladder group. Diversion-related complications recognized within 30 days that ultimately required a return to the operating room occurred in 3.4% of those with a neobladder and 1.2% of those with an Ileal Conduit. Conclusions. The orthotopic neobladder is a longer and technically more complex procedure than the Ileal Conduit procedure. However, no demonstrable difference in morbidity or perioperative complications were found between the two procedures in our review.
A Stenzl - One of the best experts on this subject based on the ideXlab platform.
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life after cystectomy and orthotopic neobladder versus Ileal Conduit urinary diversion
Seminars in Urologic Oncology, 2001Co-Authors: Alfred Hobisch, Georg Bartsch, Kadir Tosun, Johann F Kinzl, Georg Kemmler, Lorenz Holtl, A StenzlAbstract:Patients frequently complain about changes in their everyday life after radical cystectomy and urinary diversion. The aim of this study was to compare subjective morbidity of Ileal neobladder to the urethra versus Ileal Conduit urinary diversion and to elucidate its influence on quality of life. A total of 102 patients who underwent radical cystectomy due to a bladder malignancy were included in the study: 69 patients (67.6%) with an orthotopic neobladder and 33 patients (32.4%) with an Ileal Conduit. The compliance was 99% and mean follow-up was 37 months. All patients completed two retrospective quality-of-life questionnaires, namely the QLQ-C30 and a questionnaire developed at our institution to elucidate specific items regarding urinary diversion. The questioning was performed by a nonurologist. The results obtained from the validated (QLQ-C30) and our self-designed questionnaire clearly demonstrate that patients with an orthotopic neobladder better adapt to the new situation than patients with an Ileal Conduit. In addition, neobladder to the urethra improves quality of life due to a better self-confidence, better rehabilitation as well as restoration of leisure, professional, traveling, and social activities, and reduced risk of inadvertent loss of urine. For example, 74.6% of neobladder patients felt absolutely safe with the urinary diversion in contrast to 33.3% in the Ileal Conduit group. Only 1.5% of neobladder patients had wet clothes caused by urine leakage during day versus 48.5% of Ileal Conduit patients; 92.8% of neobladder patients felt not handicapped at all; and 87% felt not sickly or ill in contrast to 51.5% and 66.7% of Ileal Conduit patients, respectively. Moreover, 97% of our neobladder patients would recommend the same urinary diversion to a friend suffering from the same disease in contrast to only 36% of Ileal Conduit patients. The results obtained by this study demonstrate that quality of life is preserved in a higher degree after orthotopic neobladder than after Ileal Conduit urinary diversion.
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quality of life after cystectomy and orthotopic neobladder versus Ileal Conduit urinary diversion
World Journal of Urology, 2000Co-Authors: Alfred Hobisch, Georg Bartsch, Kadir Tosun, Johann F Kinzl, Georg Kemmler, Lorenz Holtl, A StenzlAbstract:The impact of bladder removal and urinary diversion for patients' everyday life is largely unknown. The aims of this study were to compare subjective morbidity of Ileal neobladder to the urethra versus Ileal Conduit urinary diversion and to elucidate its influence on quality of life. A total of 102 patients who underwent cystectomy due to a bladder malignancy were included in the study. In 69 patients (67.6%) an orthotopic neobladder and in 33 patients (32.4%) an Ileal Conduit was performed as urinary diversion. The compliance was 99% and mean follow-up was 37 months. All patients completed two retrospective quality of life questionnaires, namely the QLQ-C30 and a questionnaire developed at our institution to ask for urinary diversion specific items. The questioning and assessment was performed by non-urologists. The results obtained from the validated (QLQ-C30) and our own specially compiled questionnaire clearly demonstrate that patients with an orthotopic neobladder are more able to adapt to the new situation than patients with an Ileal Conduit. In addition, neobladder to the urethra improves the quality of life because it improves self-confidence, causes better rehabilitation as well as the restoration of leisure, professional, travelling, and social activities, and reduced risk of inadvertent loss of urine. For example, 92.8% of neobladder patients did not feel handicapped at all, and 87% did not feel sick or ill, in contrast to 51.5% and 66.7% of Ileal Conduit patients, respectively. Of the neobladder patients, 74.6% felt absolutely safe with the urinary diversion in contrast to 33.3% in the Ileal Conduit group. Only 1.5% of neobladder patients had wet clothes caused by urine leakage during the day, versus 48.5% of Ileal Conduit patients. Moreover, 97% of our neobladder patients would recommend the same urinary diversion to a friend suffering from the same disease, but only 36% of Ileal Conduit patients would do so. These results demonstrate that the quality of life is preserved to a higher degree after orthotopic neobladder than after Ileal Conduit urinary diversion.
Michael O Koch - One of the best experts on this subject based on the ideXlab platform.
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incidence and risk factors of parastomal hernia in patients undergoing radical cystectomy and Ileal Conduit diversion
The Journal of Urology, 2014Co-Authors: Nick W Liu, Jeromy T Hackney, Paul Gellhaus, Francesca M Monn, Timothy A Masterson, Richard Bihrle, Thomas A Gardner, Michael G House, Michael O KochAbstract:Purpose: We evaluate the incidence and risk factors of parastomal hernia formation in patients undergoing radical cystectomy and Ileal Conduit urinary diversion.Materials and Methods: We retrospectively reviewed the Indiana University cystectomy database between 2001 and 2011, and identified 516 patients who underwent radical cystectomy and Ileal Conduit diversion. Overall 199 patients had a clinical followup of at least 12 months and all underwent postoperative staging computerized tomography to confirm the presence of parastomal hernia. The incidence of parastomal hernia is reported with correlations made to demographic, patient level and perioperative risk factors.Results: A parastomal hernia developed in 58 patients (29%) at a median followup of 27 months (range 12 to 125). Of these patients 26 (45%) underwent surgical repair due to abdominal discomfort (58%), acute strangulation or obstruction of the small bowel (15%), partial small bowel obstructions (15%) and elective repair for other intra-abdomin...
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continent urinary reconstruction versus Ileal Conduit a contemporary single institution comparison of perioperative morbidity and mortality
Urology, 2000Co-Authors: Dipen J Parekh, Michael O Koch, Barritt W Gilbert, Joseph A SmithAbstract:Abstract Objectives. To compare postoperative morbidity and mortality in a concurrent and contemporary series of patients who underwent radical cystectomy with Ileal Conduit versus orthotopic neobladder. Methods. The data of 198 patients were reviewed, 117 with orthotopic reconstruction and 81 with Ileal Conduit during a 5-year time frame. Thirty-day morbidity, mortality, reoperative rates, and parameters associated with the surgical procedures were obtained from chart review. Results. No perioperative or postoperative deaths occurred in either group. The median operative time for the Ileal Conduit was 201 minutes (range 140 to 373), and for the orthotopic neobladder, it was 270 minutes (range 230 to 425). The median blood loss was 389 and 474 mL, respectively. The median length of hospitalization was 8 days for the Ileal Conduit group and 7 days for the orthotopic neobladder group. Diversion-related complications recognized within 30 days that ultimately required a return to the operating room occurred in 3.4% of those with a neobladder and 1.2% of those with an Ileal Conduit. Conclusions. The orthotopic neobladder is a longer and technically more complex procedure than the Ileal Conduit procedure. However, no demonstrable difference in morbidity or perioperative complications were found between the two procedures in our review.
Ahmed A Hussein - One of the best experts on this subject based on the ideXlab platform.
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natural history and predictors of parastomal hernia after robot assisted radical cystectomy and Ileal Conduit urinary diversion
The Journal of Urology, 2017Co-Authors: Ahmed A Hussein, Youssef Ahmed, Paul May, Taimoor Ali, Basim Ahmad, Sana Raheem, Kevin Stone, Adam Hasasnah, Omer RanaAbstract:Purpose: We investigated the prevalence of and variables associated with parastomal hernia and its outcomes after robot-assisted radical cystectomy and Ileal Conduit creation for bladder cancer.Materials and Methods: We retrospectively reviewed the records of patients who underwent robot-assisted radical cystectomy at our institution. Parastomal hernia was defined as the protrusion of abdominal contents through the stomal defect in the abdominal wall on cross-sectional imaging. Parastomal hernia was further described in terms of patient and hernia characteristics, symptoms, management and outcomes. The Kaplan-Meier method was used to determine time to parastomal hernia and time to surgery. Multivariate stepwise logistic regression was done to evaluate variables associated with parastomal hernia.Results: A total of 383 patients underwent robot-assisted radical cystectomy and Ileal Conduit creation. Of the patients 75 (20%) had parastomal hernia, which was symptomatic in 23 (31%), and 11 (15%) underwent tre...
