Intestinal Injury by Heat Conduction from Surgical Sealing Devices.

BACKGROUND: There have been no investigations of intestinal injury induced by surgical sealing devices, especially focusing heat conduction from the back of active blades during laparoscopic surgery. OBJECTIVE: This study of damage to the small intestine by heat conduction from the back of active blades both physically and histopathologically was performed to establish safe usage of surgical sealing devices. MATERIALS AND METHOD: We compared seven types of bipolar sealing device and two types of ultrasonic coagulating shear in an animal model simulating laparoscopic surgery. Time-dependent changes in heat conduction from the back of active blades were measured using a direct contact thermometer during intracorporeal activation. Histopathological damage to the small intestine by the back of active blades in laparoscopic surgical application was evaluated. The backs of active blades were activated while attached to the serosa of the small intestine. The depths of histopathological changes were measured to evaluate the thermal effects of surgical sealing devices. RESULTS: Most devices generated temperatures >70°C even on the back of active blades. There were no significant differences in duration for cooling to ≤50°C among these devices. All devices induced histopathological heat damage in the submucosal layer or deeper. CONCLUSIONS: Regardless of type, the backs of active blades of surgical sealing devices conduct high temperatures and can induce heat damage in the small intestine. Surgical sealing devices should not be activated while attached to surrounding tissue or organs in laparoscopic surgery.

[Laparoscopic retroperitoneal lymphnode dissection for testicular cancer: Nagoya experience].

Three patients with stage I disease and 3 patients with stage III disease were treated with laparoscopic retroperitoneal lymphnode dissection. The patient was placed in a semilateral position and 5 trocars were introduced through the lateral abdominal wall. After incising the peritoneum along the Toldt line, the colon was reflected medially and the retroperitoneal structures such as the ureter, aorta, inferior vena cava and both renal arteries and veins were exposed. For right-side disease the paracaval and interaortocaval lymphnodes were dissected, and for left-side disease, the interaortocaval and paraaortic lymphnodes were dissected. The procedure was completed successfully on all 6 patients. The average operative time was 3.4 hours for 3 patients with stage I disease and 4.4 hours for 3 patients with stage III disease treated with prior chemotherapy. All patients started to walk and resumed oral intake from the first post-operative day and the average duration to full convalescence was 21 days. Anteriograde ejaculation and erection were preserved in all six patients. Laparoscopic retroperitoneal lymphnode dissection will be a useful technique for management of testicular cancer.

Long-term results of endopyeloureterotomy using the transpelvic extraureteral approach.

OBJECTIVES: To review our clinical results to confirm the long-term efficacy of the operative technique of endopyeloureterotomy using the transpelvic extraureteral approach that we developed. METHODS: We treated 123 patients with ureteropelvic junction obstruction or upper ureteral stenosis by percutaneous endopyeloureterotomy using the transpelvic extraureteral approach between 1988 and 1999. All were followed up for at least 1 year (mean 58 months). Sixty-eight patients were male and 55 female between the ages of 3 and 78 years (mean 36). We evaluated the efficacy of our procedure preoperatively and then regularly every 6 to 12 months postoperatively using excretory urography and technetium-99m DTPA renography. RESULTS: Our results showed that 115 (90.6%) of 127 procedures relieved the obstruction without any severe complications. In the 107 cases of ureteropelvic junction obstruction, we alleviated the stricture in 96 (90%). In the 20 cases of upper ureteral stenosis, our procedure alleviated the stricture in 19 (95%). In the 47 cases of a stenotic segment of 2 cm or more in length, 43 of our procedures led to a significant improvement (91.5%). Long-term follow-up of the 123 patients revealed late recurrence in 5 patients, despite the initial success. CONCLUSIONS: Percutaneous endopyeloureterotomy using the transpelvic extraureteral approach should be considered the first choice of treatment for ureteropelvic junction obstruction and upper third ureteral stenosis, even if the stenotic segment is 2 or more cm long.