INTRODUCTION:Globally, more than two million babies are stillborn every year. The primary cause of stillbirth is placental dysfunction, which impairs oxygen and nutrient delivery to the fetus. From a physical perspective, the efficiency of this exchange depends on placental blood flow and microvascular villous structure. Doppler ultrasound (US) imaging is used clinically to assess abnormal placental blood flow, but evaluation of placental structure remains largely observational. Texture analysis of B-mode US images offers a quantitative approach to indirectly characterize placental structure through analysis of US image pixels. Therefore, the objective of this study was to investigate whether integrated quantitative biomarkers derived from placental texture, Doppler ultrasound, and standard clinical variables improve the assessment of pregnancies associated with adverse fetal outcomes. METHODS:Patients (N = 129) were recruited, and B-mode US images and Doppler measurements were acquired at visit 1 (28-32 weeks of gestation) and visit 2 (34-38 weeks of gestation). Clinical outcome data were used to define patients as High-Risk based on previously established markers of significant stillbirth risk (e.g., preeclampsia with severe features, severe FGR, perinatal hypoxia). Logistic regression and random forest models were used to evaluate the predictive value of each modality with clinical variables and in combination. RESULTS:Quantitative placental texture features demonstrated predictive performance comparable to Doppler ultrasound measurements, supporting their associations with adverse fetal outcomes. Integrating clinical, Doppler, and texture features further improved model performance compared with models developed from clinical variables alone or paired with either imaging modality individually. These findings demonstrate that quantifying placental US texture provides complementary information to Doppler and clinical variables. While further validation in larger external cohorts is required, this work supports the potential of quantitative multimodal ultrasound biomarkers for assessing pregnancies with adverse fetal outcomes.

The leading cause of perinatal mortality is fetal growth restriction (FGR), defined as in utero fetal growth below the 10th percentile. Insufficient exchange of oxygen and nutrients at the maternal-fetal interface is associated with FGR. This transport occurs through the vasculature of the placenta, particularly in the terminal villi, where the vascular membranes have a large surface area and are the thinnest. Altered structure of the placenta villi is thought to contribute to decreased oxygen exchange efficiency, however, understanding how the three-dimensional microstructure and properties decrease this efficiency remains a challenge. Here, a novel, multiscale workflow is presented to quantify patient-specific biophysical properties, 3D structural features, and blood flow of the villous tissue. Namely, nanoindentation, optical coherence tomography, and ultrasound imaging were employed to measure the time-dependent material properties of placenta tissue, the 3D structure of villous tissue, and blood flow through the villi to characterize the microvasculature of the placenta at increasing length scales. Quantifying the biophysical properties, the 3D architecture, and blood flow in the villous tissue can be used to infer changes in maternal-fetal oxygen transport at the villous membrane. Overall, this multiscale understanding will advance knowledge of how microvascular changes in the placenta ultimately lead to FGR, opening opportunities for diagnosis and intervention.

PURPOSE:AUA stone management guidelines recommend stenting duration following ureteroscopy be minimized to reduce morbidity; stents with extraction strings may be used for this purpose. However, an animal study demonstrated that short dwell time results in suboptimal ureteral dilation, and a pilot clinical study showed this increases postprocedure events. Using real-world practice data we examined stent dwell time after ureteroscopy and its association with postoperative emergency department visits.MATERIALS AND METHODS:We used the Michigan Urological Surgery Improvement Collaborative registry to identify ureteroscopy and stenting procedures (2016-2019). Pre-stented cases were excluded. Stenting cohorts with and without strings were analyzed. Using multivariable logistic regression we evaluated the risk of an emergency department visit occurring on the day of, or day after, stent removal based on dwell time and string status.RESULTS:We identified 4,437 procedures; 1,690 (38%) had a string. Median dwell time was lower in patients with a string (5 vs 9 days). Ureteroscopy in younger patients, smaller stones, or renal stone location had a higher frequency of string use. The predicted probability of an emergency department visit was significantly greater in procedures with string, compared to without string, when dwell times were less than 5 days (P < .01) but were not statistically significant after.CONCLUSIONS:Patients who had ureteroscopy and stenting with a string have short dwell times. Patients are at increased risk of a postoperative emergency department visit around the time of stent removal if dwell time is ≤4 days. We recommended stenting duration of at least 5 days in nonpre-stented patients.

Purpose: Endourologic procedures such as percutaneous nephrolithotomy (PCNL) employ the use of foot pedals in low-light operating room (OR) settings. These pedals can be especially difficult to locate or distinguish when several pedals are present during a single operation. Improper instrument activation in the OR has led to serious complications ranging from unintentional electrocautery to patient burns and even an intraoperative explosion. This study evaluates the impact of color-coded illumination on speed and efficiency of foot pedal activation. Materials and Methods: During a simulated PCNL procedure, the foot pedals for a C-arm, laser, and ultrasonic lithotripter (USL) were placed in random positions. Ten participants performed pedal activation in a randomized sequence. Objective outcomes included time to instrument activation, number of attempted pedal presses, number of incomplete pedal presses, and number of incorrect pedal presses. Subjective preferences for pedal illumination were also determined. Data were analyzed using Mann-Whitney U, Wilcoxon signed-rank, and Chi-square tests with p<0.05 indicating statistical significance. Results: Illuminated foot pedals were associated with decreases in the average activation time for all instruments collectively (3.95 seconds vs 6.49 seconds; p=0.017) and individually (C-arm: 3.07 seconds vs 4.21 seconds; p=0.006; laser: 13.04 seconds vs 15.18 seconds; p<0.001; USL: 3.28 seconds vs 4.91 seconds; p<0.001) compared with nonilluminated pedals. Illuminated pedals were associated with fewer attempted pedal presses (33.5 vs 39.5; p=0.007) and incomplete pedal presses (1.5 vs 8.5; p=0.002). The number of incorrect pedal presses decreased with illumination, but this did not reach statistical significance (0 vs 0.5; p=0.08). Participants reported that illumination simplified pedal activation and recommended its use (p<0.01). Conclusion: Color-coded illumination improved the speed and efficiency of foot pedal activation during simulated PCNL. Participants subjectively preferred using illuminated foot pedals for endourologic procedures and felt that they improved safety and efficiency.

brain malignancies have been demonstrated in physicians routinely exposed to radiation.Lead glasses have been shown to reduce direct radiation exposure up to 98%, but the effect of lead glasses upon scattered radiation to the eyes and brain is poorly characterized.The purpose of this study is to determine if lead glasses reduce the amount of radiation received by the eyes and the brain.METHODS: A PCNL procedure was simulated using a female cadaver (BMI 22.7) in the prone position.The surgeon was simulated using a cadaver head mounted on a torso and covered by a conventional 0.35 mm lead apron.This was placed six inches away from the edge of the operating table to mimic the position of the surgeon during PCNL.The C-arm was set at 3.8 mA and 90 kVp, positioned over the kidney, and activated for a total of 10 minutes per trial.A total of eight dosimeters were used per trial.A dosimeter was placed in front of each cornea and six were placed in the bilateral frontal, temporal, and parietal lobes of the cadaver surgeon head.Ten trials were conducted: 5 with lead glasses on the cadaver surgeon head and 5 without the glasses.Radiation exposures were analyzed using a two-tailed t-test with p<0.05 indicating significance.RESULTS: Lead glasses only reduced the dose of scattered radiation to the corneal dosimeters by 62% on the left (12.2 vs. 4.4 mrem; p<0.0001) and 44% on the right (10.4 vs. 5.8 mrem; p¼0.001).In addition lead glasses did not significantly reduce the radiation dose of the frontal lobes (left: 4.0 vs. 2.6 mrem; p¼0.135; right: 4.6 vs. 2.8 mrem; p¼0.096), temporal lobes (left: 3.2 vs. 1.8 mrem; p¼0.160; right: 4.6 vs. 3.8 mrem; p¼0.064), or parietal lobes (left: 1.4 vs. 1.2 mrem; p¼0.799; right: 3.0 vs. 2.2 mrem; p¼0.136).CONCLUSIONS: Although lead glasses significantly reduced the dose of scattered radiation, the corneas still received up to 56% of the unshielded radiation dose.Lead glasses did not reduce scattered radiation as effectively as they reduce direct radiation exposure and they had no significant effect on brain radiation exposure.Therefore, surgeons should also take other measures to reduce radiation exposure including reducing fluoroscopy time and settings.

You have accessJournal of UrologyProstate and Renal Oncology1 Apr 2017V8-04 PERCUTANEOUS EXTERNALLY ASSEMBLED LAPAROSCOPIC (PEAL) NEPHRECTOMY Jerry Thomas, Mohamed Keheila, Samuel Abourbih, Patrick Yang, Nazih Khater, Jim Shen, Salim Cheriyan, and D. Duane Baldwin Jerry ThomasJerry Thomas More articles by this author , Mohamed KeheilaMohamed Keheila More articles by this author , Samuel AbourbihSamuel Abourbih More articles by this author , Patrick YangPatrick Yang More articles by this author , Nazih KhaterNazih Khater More articles by this author , Jim ShenJim Shen More articles by this author , Salim CheriyanSalim Cheriyan More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2340AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single-site nephrectomy (LESS) provides excellent cosmetic outcomes, but is technically challenging due to loss of triangulation and increased instrument collision. A novel Percutaneous Externally Assembled Laparoscopic (PEAL) surgical paradigm was developed to simplify minimally invasive surgery while providing a nearly scarless outcome. In this video, we will demonstrate how PEAL instruments restore triangulation and simplify LESS nephrectomy. METHODS The PEAL instrument is composed of a reusable handpiece and a disposable 2.96 mm shaft and interchangeable 5 mm instrument tips. These instruments are inserted without a trocar which minimizes their cosmetic impact. This video will demonstrate a PEAL nephrectomy in a 69 year-old female with a nonfunctional duplicated right kidney. Initially a multi-access port was inserted into the umbilicus and used to take down adhesions from a previous surgery. Adhesions to the liver were left intact to provide liver retraction. A 2.96 mm instrument shaft was introduced in the right mid-clavicular line at the level of the umbilicus using a special introducer tip. It was brought out through the multi access port and switched to a 5 mm grasper tip. This PEAL instrument was able to reestablish triangulation and upon its removal required no wound closure. RESULTS The use of the PEAL surgical paradigm restored triangulation and allowed a nearly scarless nephrectomy despite this patient's giant duplicated kidney. This 2.96 mm instrument shaft was inserted through a small puncture and maintains the nearly scarless cosmesis of LESS surgery. The 5 mm grasping tip, which can be changed through any conventional laparoscopic port, was robust and allowed for the effective manipulation of this giant kidney. The estimated blood loss was 100 cc and the operative time was 310 min. The patient tolerated the procedure well without any perioperative complications. The patient was discharged home on POD 1 and required no narcotic pain medications. CONCLUSIONS The addition of the PEAL instrument facilitated the completion of LESS nephrectomy in a patient with complicated anatomy. By using these externally assembled instruments, PEAL provides a functional, robust 5 mm tip and reestablishes instrument triangulation, thereby greatly simplifying LESS surgery. In addition the <3mm shaft maintains a nearly scarless cosmetic outcome. The PEAL instruments can be used to simplify LESS, reduce the invasiveness of conventional laparoscopic surgery or as stand-alone surgical paradigm. For these reasons we feel that the PEAL paradigm is a promising new surgical approach © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e907-e908 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jerry Thomas More articles by this author Mohamed Keheila More articles by this author Samuel Abourbih More articles by this author Patrick Yang More articles by this author Nazih Khater More articles by this author Jim Shen More articles by this author Salim Cheriyan More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2017MP59-17 SUBCLINICAL RHABDOMYOLYSIS: AN UNDER-RECOGNIZED CONTRIBUTOR TO POSTOPERATIVE ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING MINIMALLY INVASIVE UROLOGIC SURGERY Jim Shen, Mohamed Keheila, Samuel Abourbih, Patrick Yang, Ingrid Wahjudi, Liang Ji, Salim Cheriyan, Nazih Khater, and D. Duane Baldwin Jim ShenJim Shen More articles by this author , Mohamed KeheilaMohamed Keheila More articles by this author , Samuel AbourbihSamuel Abourbih More articles by this author , Patrick YangPatrick Yang More articles by this author , Ingrid WahjudiIngrid Wahjudi More articles by this author , Liang JiLiang Ji More articles by this author , Salim CheriyanSalim Cheriyan More articles by this author , Nazih KhaterNazih Khater More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1833AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Rare cases of clinically apparent rhabdomyolysis have been reported in patients undergoing minimally invasive urologic surgery. This study aims to estimate the incidence of subclinical postoperative rhabdomyolysis and determine its effect on renal function. METHODS Daily postoperative serum creatinine kinase level was prospectively collected on 1034 patients who underwent urologic surgery. Rhabdomyolysis was defined as serum creatinine kinase (CK) ≥1000 U/L. Univariate and multivariate analysis was performed in order to identify factors associated with postoperative rhabdomyolysis. Patients were stratified by degree of CK elevation. Kruskal-Wallis tests were performed in order to determine the association between degree of CK elevation and peak postoperative serum creatinine level. p < 0.05 indicated statistical significance. RESULTS Rhabdomyolysis occurred in 13.7% of patients (142/1034), with 97.2% (138/142) being subclinical. On multivariable analysis, sex, BMI, operative time, use of a hand-assisted surgical approach, and flank position were associated with development of rhabdomyolysis. Subclinical rhabdomyolysis was associated with postoperative acute kidney injury in surgeries involving complete loss of renal unit, with higher peak serum CK levels being associated with higher peak serum creatinine levels (Table 1). CONCLUSIONS Rhabdomyolysis is often clinically silent and may represent an under-recognized contributor to postoperative acute kidney injury in patients undergoing minimally invasive urologic surgery. Recognition of risk factors associated with rhabdomyolysis is important in order to maintain an appropriate index of suspicion during the postoperative period. Further study is required to determine if treating subclinical rhabdomyolysis improves outcomes. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e787-e788 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jim Shen More articles by this author Mohamed Keheila More articles by this author Samuel Abourbih More articles by this author Patrick Yang More articles by this author Ingrid Wahjudi More articles by this author Liang Ji More articles by this author Salim Cheriyan More articles by this author Nazih Khater More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To compare the outcomes between laparoendoscopic single-site (LESS) and a novel percutaneous externally assembled laparoscopic (PEAL) nephrectomy in an in vivo porcine model.MATERIALS AND METHODS:Ten female farm pigs were randomized to LESS nephrectomy (5) or PEAL nephrectomy (5). Operative times, estimated blood loss, and intraoperative and postoperative complications were compared. The surgeons used a Likert scale to grade difficulty of peritoneal access, port placement, tool assembly, hilar dissection, closure, and overall difficulty of surgery. Scar assessment was performed by a blinded plastic surgeon using the Vancouver Scar Scale. Descriptive statistics were reported as median and range. The Mann-Whitney U test was used for continuous and ordinal variables. A p value <0.05 was considered significant.RESULTS:Median operative time was significantly shorter in the PEAL group vs the LESS group (85 minutes vs 127 minutes, p = 0.03). Median Likert scores showed overall hilar dissection and nephrectomy to be significantly easier using PEAL compared with LESS (2 vs 9, p < 0.01 for both). The PEAL instruments left no visible scar at 5 feet in any animal, and only 1 out of 10 scars could be identified on physical examination.CONCLUSIONS:The PEAL surgical paradigm demonstrates nearly scarless outcomes while providing shorter operative times and easier performance than LESS nephrectomy in a porcine model.

PURPOSE:To investigate the effect of laser fiber stripping on stone fragmentation and laser fiber power output.MATERIALS AND METHODS:In a benchtop simulation of laser lithotripsy, 20 BegoStone phantoms were positioned within a ureteral model and irradiated for 10 minutes at 8 Hz and 0.8 J. A freshly cleaved 365 μm laser fiber was used for all trials, with half of the fibers also undergoing stripping. Power output was measured at 1-minute intervals, beginning with an initial prelithotripsy recording at 0 minutes. Fiber tips were imaged with scanning electron microscopy. In a single-blinded manner, final masses of residual stone fragments were measured and used to quantify stone breakdown. Independent-sample Mann-Whitney U tests were performed with significance set at p < 0.05, comparing stripped and unstripped fiber tips with respect to power output and fraction of stone fragmentation.RESULTS:Mean power output after 1 minute of lasing was significantly greater in unstripped laser fibers (p = 0.015), while fibers, whether stripped or not, demonstrated no significant output differences prelithotripsy or at any time from 2 to 10 minutes. However, stripped laser fibers achieved significantly increased stone breakdown compared to unstripped fibers (p = 0.004), fragmenting 63 mg (25%) more of the initial stone mass per trial.CONCLUSIONS:Although unstripped laser fibers provided superior power output at 1 minute, output at all other time points was similar between stripped and unstripped fibers. However, despite similar optical output, stripped laser fibers achieved greater stone fragmentation, possibly due to improved contact between stone and fiber tip.

You have accessJournal of UrologyPediatrics1 Apr 2017V7-06 PERCUTANEOUS EXTERNALLY ASSEMBLED LAPAROSCOPIC (PEAL) SURGERY FOR FOWLER-STEPHENS ORCHIOPEXY: A VIDEO PRESENTATION David Ruckle, Samuel Abourbih, Minh-Hang T. Chau, Mohamed Keheila, Jim Shen, Patrick Yang, Salim Cheriyan, Nazih Khater, and D. Duane Baldwin David RuckleDavid Ruckle More articles by this author , Samuel AbourbihSamuel Abourbih More articles by this author , Minh-Hang T. ChauMinh-Hang T. Chau More articles by this author , Mohamed KeheilaMohamed Keheila More articles by this author , Jim ShenJim Shen More articles by this author , Patrick YangPatrick Yang More articles by this author , Salim CheriyanSalim Cheriyan More articles by this author , Nazih KhaterNazih Khater More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1924AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopy is the gold standard for diagnosis and treatment of boys with non-palpable testicles. In an effort to reduce the invasiveness of laparoscopic orchiopexy, various strategies have been employed including use of laparoendoscopic single site surgery (LESS) and needlescopic surgery. Needlescopic instruments have limited functionality due to their small size and are more prone to intrabdominal organ injury. LESS has been criticized when used in children due to the requirement of a much larger 3 cm incision. In this video we will demonstrate the feasibility of a novel percutaneous externally assembled laparoscopic (PEAL) surgery paradigm for orchiopexy which is designed to reduce the invasiveness of the procedure while maintaining instrument triangulation. METHODS The PEAL surgical paradigm is composed of a reusable handpiece and a disposable 2.96 mm instrument shaft and interchangeable disposable 5 mm instrument tips. This video will demonstrate how the PEAL instruments are externally assembled and brought back into the abdomen without a trocar to perform the surgery. Due to their small size and because they are assembled externally, they produce an essentially scarless outcome. This video will demonstrate the PEAL surgical paradigm for the performance of Fowler-Stephens orchiopexy. RESULTS Using this innovative new paradigm, a 9 month-old infant underwent first stage and a 9 year-old child underwent second stage successful bilateral Fowler-Stephens orchiopexies. Operative times were 65 minutes for the first stage and 180 minutes for the second stage. Blood loss was minimal in both cases. Both patients were discharged the day of surgery with no complications. At follow up, the objective cosmetic results were excellent and the second patient′s testis was palpable in the scrotum and well-positioned. CONCLUSIONS Due to its improved cosmesis and ease of performance, the PEAL surgical paradigm shows promise in reducing the invasiveness of pediatric Fowler-Stephens orchiopexy. In addition it shows promise with a wide variety of minimally invasive surgical applications. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e824-e825 Advertisement Copyright & Permissions© 2017MetricsAuthor Information David Ruckle More articles by this author Samuel Abourbih More articles by this author Minh-Hang T. Chau More articles by this author Mohamed Keheila More articles by this author Jim Shen More articles by this author Patrick Yang More articles by this author Salim Cheriyan More articles by this author Nazih Khater More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy II1 Apr 2017PD21-04 COMPARISON OF ULTRASOUND-GUIDED, CONVENTIONAL FLUOROSCOPIC, AND A NOVEL LASER DIRECT ALIGNMENT RADIATION REDUCTION TECHNIQUE FOR PERCUTANEOUS NEPHROLITHOTOMY Samuel Abourbih, Mohamed Keheila, Patrick Yang, Muhannad Alsyouf, Jason Smith, Braden Mattison, Nazih Khater, Jim Shen, Salim Cheriyan, and D. Duane Baldwin Samuel AbourbihSamuel Abourbih More articles by this author , Mohamed KeheilaMohamed Keheila More articles by this author , Patrick YangPatrick Yang More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Jason SmithJason Smith More articles by this author , Braden MattisonBraden Mattison More articles by this author , Nazih KhaterNazih Khater More articles by this author , Jim ShenJim Shen More articles by this author , Salim CheriyanSalim Cheriyan More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1042AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Currently, urologists routinely use either ultrasound or conventional fluoroscopic guidance during percutaneous nephrolithotomy (PCNL). In an attempt to reduce the radiation exposure during PCNL, a novel laser Direct Alignment Radiation Reduction Technique (DARRT) was developed where the renal access is guided by a laser sight placed upon the C-arm. The purpose of this study is to compare the outcomes of these 3 techniques in patients undergoing percutaneous stone surgery. METHODS In this chart review, the first 25 consecutive patients undergoing PCNL using laser DARRT were compared to 25 US-guided and 25 conventional access patients. These 3 cohorts were matched in terms of age, body mass index, stone burden and location. Primary outcomes were total fluoroscopy time and access fluoroscopy time. Secondary outcomes included stone burden, operative time, estimated blood loss, stone free status and major complications (≥Clavien III). Patients with residual fragments ≤4 mm were considered to be stone free. Statistical analysis was done using ANOVA for continuous variables and the chi-square test for categorical variables. A p value <0.05 was considered significant. RESULTS There were no differences between the 3 cohorts in baseline demographics and mean stone burden (Table 1). The stone free rates between the US (68%), conventional PCNL (76%) and laser DARRT (84%) were similar (p=0.27). Major complications and EBL were not significantly different between the groups. Operative time for the laser DARRT was 20 minutes shorter than the conventional PCNL and 24 minutes shorter than the US, however, this difference did not reach significance (p=0.58). Mean access fluoroscopy time was 3, 844 and 8.9 seconds, and total fluoroscopy time was 8.5, 944.6 and 17.4 seconds for US, conventional, and laser DARRT PCNL respectively. Both US and laser DARRT had significantly lower total and access fluoroscopy times than conventional PCNL (p<0.01 for all comparisons). CONCLUSIONS The use of the novel laser DARRT and US-guided technique both resulted in a >98% reduction in the fluoroscopy time compared to the conventional technique. The operative time and stone free rates of the laser DARRT compared favorably with the US-guided and conventional techniques. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e437 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Samuel Abourbih More articles by this author Mohamed Keheila More articles by this author Patrick Yang More articles by this author Muhannad Alsyouf More articles by this author Jason Smith More articles by this author Braden Mattison More articles by this author Nazih Khater More articles by this author Jim Shen More articles by this author Salim Cheriyan More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyPediatrics: Testis, Varicocele & Stones1 Apr 2017MP66-12 PERCUTANEOUS EXTERNALLY ASSEMBLED LAPAROSCOPIC INSTRUMENTS FOR FOWLER-STEPHENS ORCHIOPEXY: THE FEASIBILITY OF A NEW SURGICAL SYSTEM Isaac Kelly, Samuel Abourbih, Minh Chau, Nazih Khater, Mohamed Keheila, Salim Cheriyan, Patrick Yang, Jim Shen, Matthew Pierce, and D. Duane Baldwin Isaac KellyIsaac Kelly More articles by this author , Samuel AbourbihSamuel Abourbih More articles by this author , Minh ChauMinh Chau More articles by this author , Nazih KhaterNazih Khater More articles by this author , Mohamed KeheilaMohamed Keheila More articles by this author , Salim CheriyanSalim Cheriyan More articles by this author , Patrick YangPatrick Yang More articles by this author , Jim ShenJim Shen More articles by this author , Matthew PierceMatthew Pierce More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2027AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conventional laparoscopy is routinely used for the evaluation and management of the non-palpable testis but routinely requires three 5 mm ports that result in 9-10 mm scars. We have developed novel percutaneous externally assembled laparoscopic (PEAL) instruments which allow for nearly scarless laparoscopy. We present here a clinical series of six pediatric patients who underwent a Fowler-Stephens orchiopexy using these instruments. METHODS Using the PEAL instruments, one patient underwent a single stage, four patients underwent a first stage and one patient underwent a second stage Fowler-Stephens orchiopexy. In all cases, a 5 mm port was placed at the umbilicus for the camera. The PEAL instrument, which consists of a reusable handle and a 2.96 mm shaft was then introduced lateral to the rectus sheath at the level of the umbilicus using a special introducer tip under direct visualization. The introducer was then brought out through the camera port and switched to a 5 mm grasper tip. An additional 5 mm port was placed on the right at the same level for insertion of a hook electrode and clip applier. RESULTS The PEAL instruments functioned well for all dissection and grasping tasks, similar to 5 mm conventional instruments. Using these innovative new instruments, all patients underwent successful Fowler-Stephens procedures. Median operative time was 66 minutes (45-180 minutes). Blood loss was less then 5 mL in all cases. All six patients were discharged the day of surgery. The procedures were well tolerated without any perioperative or postoperative complications. At follow up, the average length of the PEAL scars was 3.25 mm, while the 5 mm port scars were 10 mm. CONCLUSIONS We describe a novel instrument paradigm for performing a pediatric laparoscopic Fowler-Stephens orchiopexy. These instruments offer improved cosmesis compared to conventional laparoscopy, and may show promise in other laparoscopic applications. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e866 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Isaac Kelly More articles by this author Samuel Abourbih More articles by this author Minh Chau More articles by this author Nazih Khater More articles by this author Mohamed Keheila More articles by this author Salim Cheriyan More articles by this author Patrick Yang More articles by this author Jim Shen More articles by this author Matthew Pierce More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...