Video-Assisted Telescope Operating Monitor 3D System in Microsurgical Varicocelectomy: A Preliminary Report.

INTRODUCTION: Video-assisted telescope operating monitor (VITOM®) with 3D Visualization technology was developed and has been used with favorable results by several surgical specialties. Our study aims to be a preliminary report for initial experience using the VITOM® 3D system for microsurgical varicocelectomy on varicocele patients. METHODS: We performed 35 microsurgical varicocelectomy procedures using the VITOM® 3D system on varying types and grades of varicoceles. The surgeon had the option of using either a 2.5 or 3.5 magnifying loupe in addition to the exoscope for each operation evaluated. The exoscope is a standalone camera head with an integrated 3D telescope and remote control with zoom and focus functions. It is connected to the 3D monitor via a mechanical holding arm. During the procedure, surgeons, assistants, and observers were able to view the 3D high-definition stream displayed on a 26-inch 3D monitor at a convenient viewing angle and distance. The varicocele ligation was performed using a Carl Zeiss Meditec AG microscope. RESULTS: There were 35 patients with varicocele aged 31.51 years old on average, which were included in this report. Most patients had grade 3 bilateral varicocele (n = 13, 37.1%). All procedures were performed without any intraoperative complications. After the procedures, only a few patients suffered from postoperative complications. Three patients suffered scrotal edema (8.6%), while another had hydrocele (2.9%). The postoperative pain results were also very minimal from .89 1 day after the operation to .26 3 days after the operation. CONCLUSION: The VITOM® 3D system showed promise in microsurgical varicocelectomy.

Non-operative management for high-grade isolated renal trauma in pediatric patients: a case series.

The kidney is the most commonly injured urinary tract organ in pediatric trauma with blunt mechanisms, causing around 80% of cases. Non-operative management (NOM) remained the first choice for minor blunt renal trauma; however, its value for major trauma is still under debate. We present three children with high-grade isolated renal trauma diagnosed using computed tomography scans and treated using NOM as the main strategy of treatment. The first patient (12-year-old) fully recovered without needing an auxiliary procedure. The second patient (6-year-old) developed urinoma and underwent percutaneous drainage of urinoma and double J stent (DJ) with an uneventful result. The third patient (14-year-old) developed urinoma and underwent percutaneous drainage and DJ stent. However, he experienced continuous hematuria that was treated via super-selective embolization. In conclusion, NOM for isolated high-grade renal trauma is feasible with good outcomes. If complications were developed during follow-up, minimally invasive procedures, such as super-selective angioembolization in continuing hemorrhage and initial drainage in urinoma, offered a comparable outcome without needing open surgery.