Creation of ureteropelvic junction obstruction and its correction by chemical glue-assisted laparoscopic dismembered pyeloplasty.

PURPOSE: We established a porcine model of ureteropelvic junction (UPJ) obstruction using a laparoscopic technique and assessed the outcome of standard suture-assisted and chemical glue-assisted laparoscopic pyeloplasty. MATERIALS AND METHODS: Female domestic pigs (N = 20) underwent laparoscopic suture-ligature to create UPJ obstruction. One month later, laparoscopic end-to-end anastomosis was performed to correct the obstruction: with standard suturing techniques in 10 animals and with chemical (cyanoacrylate) glue in the other 10. Postoperative ureteral stents were not used. Four weeks postoperatively, intravenous urography was performed to evaluate the patency of the anastomoses. The UPJ was procured by laparotomy to assess the anastomoses and periureteral fibrosis histologically. RESULTS: The UPJ obstruction was created in an average of 15 +/- 6 minutes. There was no early postoperative mortality. Eighteen pigs survived for at least 1 month, and UPJ obstruction developed in 17 (95%). Microscopically, the lumen of the UPJ was partially occluded, measuring an average of 40% +/- 5% of normal. After laparoscopic correction, a patent UPJ was found in seven of nine animals treated with traditional sutures. Among the eight animals with chemically glued anastomoses, none had a patent UPJ, and severe periureteral adhesions and intraluminal fibrosis were noted at the pyeloplasty site. Marked ureteral tortuosity was present in six of the eight pigs receiving glue-assisted pyeloplasty but in none of the animals having suture-assisted pyeloplasty. CONCLUSIONS: Ureteropelvic junction obstruction was established by laparoscopic suture-ligature in a porcine model with a 95% success rate. Chemical glue-assisted anastomosis was inferior to standard laparoscopic sutures for pyeloplasty to correct the obstruction.

Efficacy of ultrasonic tissue dissector and tissue glue for laparoscopic partial nephrectomy in a porcine model.

The purpose of this study was to evaluate the efficacy and long-term tissue effects of ultrasonic dissector and cyanoacrylate glue during laparoscopic partial nephrectomy in a porcine model. Nine domestic pigs underwent laparoscopic left lower pole partial nephrectomy without vascular control. An ultrasonic tissue dissector was used to assist in the parenchymal incision, and the raw surfaces of the kidneys, including the exposed urinary system, were sealed with cyanoacrylate glue. No internal stents or additional sutures were placed. Intraoperative hemorrhages and urinary extravasation were recorded. The animals were humanely killed 28 days after undergoing the operations. The long-term effects of ultrasonic dissector and cyanoacrylate glue on the healing process of urothelium and renal parenchyma were determined histologically. All pigs survived the laparoscopic partial nephrectomy, and the blood loss ranged from 0 to 120 ml (mean, 60 ml). The average operative time was 89 +/- 10 min. The severity of the bleeding was minimal in six animals and moderate in three animals. No urinary extravasation was found using intravenous urography at the 28th postoperative day. No urinary fistula or renal abscess formation was found histologically. Cyanoacrylate glue infiltrated into the tissue defects and did not dissolve. The glue was encased by fibrotic tissue with minimal foreign body inflammatory reaction. Ultrasonic dissector was effective in achieving hemostasis during laparoscopic partial nephrectomy without the need of vascular control in pigs. Cyanoacrylate glue achieved good long-term adhesive power. The sealing effects provided by cyanoacrylate glue were adequate to prevent urinary extravasation from urothelial defects at least for 1 month.

Comparison study on two different accessing methods for retroperitoneoscopic adrenalectomy.

OBJECTIVES: To compare, in a retrospective nonrandomized study, two retroperitoneal laparoscopic access methods for treatment of adrenal tumors: direct needle insufflation with balloon dissection and finger-assisted dissection without balloon dissection. METHODS: The operative data from 120 consecutive patients undergoing retroperitoneoscopic adrenalectomy (RA) for benign adrenal tumors were reviewed. The operative outcomes of 70 RAs accessed by direct needle insufflation and balloon dissection were compared with another 50 RAs accessed by finger dissection without balloon dissection. The RA surgical parameters for tumors with different laterality, pathologic features, and size were also analyzed. RESULTS: The operative time in the finger dissection group was shorter (118 +/- 11 minutes) compared with that in the balloon dissection group (143 +/- 21 minutes; P = 0.03). The surgical parameters, including incidence of peritoneal perforation, intraoperative blood loss, time to oral intake, analgesic requirement, postoperative hospital stay, and convalescence, did not differ between the groups. For tumors greater than 5 cm, the operative time increased to 220 +/- 30 minutes compared with 132 +/- 31 minutes for tumors 5 cm or less (P = 0.02). The finger and balloon dissection methods had similar operative times for tumors larger than 5 cm (218 +/- 10 versus 224 +/- 15 minutes). No additional morbidity regarding the recovery time was noted in the finger dissection group compared with the balloon dissection group. CONCLUSIONS: Finger dissection appears to be a more efficient and equally effective access method for RA compared with balloon dissection. We suggest that balloon dissection may not be required for RA in patients not excessively obese.