PURPOSE:It is generally accepted that simultaneous occlusion of the renal artery and vein during warm ischemia is more damaging than occlusion of the artery alone. Pneumoperitoneum during laparoscopy may impair venous backflow, negating the benefits of clamping the artery alone. We evaluated the effect of laparoscopic vs open surgery on the recovery of renal function after clamping of the renal artery and vein, and the artery alone in a solitary kidney porcine model. MATERIALS AND METHODS:Right laparoscopic nephrectomy was performed in 36 pigs. After a 12-day recovery period the animals were randomized into 3 groups, including 1) 120-minute warm ischemia with renal artery and vein occlusion, 2) 120-minute warm ischemia with artery alone occlusion and 3) control sham surgery. The groups were further subdivided into an open and a laparoscopic arm. Serum creatinine was assessed preoperatively, and on postoperative days 1, 3, 8 and 15. RESULTS:Artery alone clamping resulted in a significantly lower serum creatinine increase on postoperative days 1 and 3 in the open arm compared to the laparoscopic arm. Compared to open renal artery and vein clamping the increase in serum creatinine for open artery alone clamping was also significantly lower on postoperative days 1 and 3. No significant difference in postoperative serum creatinine was found between the laparoscopic artery alone, and the renal artery and vein arms at any time point. No significant serum creatinine changes were observed in the control sham surgery group compared to preoperative values at all followup time points. CONCLUSIONS:In this porcine model clamping of the artery alone during open surgery better protected the kidney from warm ischemia compared to renal artery and vein occlusion. This benefit was not observed during laparoscopic surgery. We speculated that the presence of pneumoperitoneum causes at least partial occlusion of the renal vein, thus, negating the benefit of renal artery clamping only.

Background and Purpose: Sural nerve grafting for patients undergoing prostatectomy has been previously reported using open and minimally invasive methods. We report our experience with sural nerve grafting during robot-assisted laparoscopic radical prostatectomy (RLRP).Materials and Methods: Patients with preoperative potency and a minimum of 6 months follow-up were included in this prospective review. A total of 333 patients were identified between February 2003 and January 2006 who met these criteria including 22 of the 25 patients who underwent sural nerve grafting. Patients were divided into 5 groups to compare unilateral and bilateral sural nerve cohorts with non-nerve-sparing and unilateral and bilateral nerve-sparing groups. Patients were followed prospectively using health-related quality-of-life questionnaires.Results: Twenty-two patients underwent sural nerve grafting that included three bilateral grafts. Mean follow-up was 14 months. There was no statistical difference in patients' ages, body mass index, preoperative prostate-specific antigen level, blood loss, complications, and positive margin rate. Operative time was statistically longer for both sural graft cohorts when compared with unilateral (without graft) and bilateral nerve-sparing cohorts. No significant differences in subjective or objective sexual function, sexual bother, or urinary function were seen with 6 and 12 months follow-up, possibly related to smaller sural cohorts. Graft-related complications include leg pain in one patient.Conclusion: Sural nerve grafting during RLRP is technically feasible and safe and offers improved dexterity and visualization deep within the pelvis. However, a larger randomized cohort of patients will be required to validate any improved benefits afforded by the robot system.

You have accessJournal of UrologyDiscussed Poster, Tuesday, May 23, 2006, 9:00 am - 12:00 pm1 Apr 20061051: Comparison of Laparoscopic and Open Partial Nephrectomy: The University of Chicago Experience Edward M. Gong, Marcelo A. Orvieto, Frederick P. Mendiola, Benjamin R. Stockton, Gary D. Steinberg, and Arieh L. Shalhav Edward M. GongEdward M. Gong More articles by this author , Marcelo A. OrvietoMarcelo A. Orvieto More articles by this author , Frederick P. MendiolaFrederick P. Mendiola More articles by this author , Benjamin R. StocktonBenjamin R. Stockton More articles by this author , Gary D. SteinbergGary D. Steinberg More articles by this author , and Arieh L. ShalhavArieh L. Shalhav More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33276-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1051: Comparison of Laparoscopic and Open Partial Nephrectomy: The University of Chicago Experience." The Journal of Urology, 175(4S), p. 338 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 338 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Edward M. Gong More articles by this author Marcelo A. Orvieto More articles by this author Frederick P. Mendiola More articles by this author Benjamin R. Stockton More articles by this author Gary D. Steinberg More articles by this author Arieh L. Shalhav More articles by this author Expand All Advertisement PDF DownloadLoading ...

You have accessJournal of UrologyModerated Poster, Monday, May 22, 2006, 1:00 - 3:00 pm1 Apr 2006874: Laparoscopic Partial Nephrectomy in Renal Insufficient Patients Albert A. Mikhail, Marcelo A. Orvieto, Edward M. Gong, Kevin C. Zorn, Frederick P. Mendiola, Alvaro Luciani, and Arieh L. Shalhav Albert A. MikhailAlbert A. Mikhail More articles by this author , Marcelo A. OrvietoMarcelo A. Orvieto More articles by this author , Edward M. GongEdward M. Gong More articles by this author , Kevin C. ZornKevin C. Zorn More articles by this author , Frederick P. MendiolaFrederick P. Mendiola More articles by this author , Alvaro LucianiAlvaro Luciani More articles by this author , and Arieh L. ShalhavArieh L. Shalhav More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33110-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "874: Laparoscopic Partial Nephrectomy in Renal Insufficient Patients." The Journal of Urology, 175(4S), p. 282 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 282 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Albert A. Mikhail More articles by this author Marcelo A. Orvieto More articles by this author Edward M. Gong More articles by this author Kevin C. Zorn More articles by this author Frederick P. Mendiola More articles by this author Alvaro Luciani More articles by this author Arieh L. Shalhav More articles by this author Expand All Advertisement PDF DownloadLoading ...