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Biomedical subjects

Chandru P Sundaram

Publications and source records attributed to Chandru P Sundaram.

At least 19 recordsLinked to original sources
PubMed2007

Limitations of laparoscopy for bilateral nephrectomy for autosomal dominant polycystic kidney disease.

PURPOSE: We retrospectively studied outcomes following bilateral hand assisted laparoscopic nephrectomy. MATERIALS AND METHODS: We retrospectively reviewed the charts of 18 patients with symptomatic autosomal dominant polycystic kidney disease who underwent bilateral hand assisted laparoscopic nephrectomy. Preoperative radiographic imaging was reviewed retrospectively to determine kidney size based on an ellipsoid shape. A visual analog pain scale with scores of 0 to 10 to assess pain related to autosomal dominant polycystic kidney disease was measured preoperatively and postoperatively. RESULTS: Average patient age was 48.2 years (range 30 to 64). Of the patients 14 successfully underwent bilateral hand assisted laparoscopic nephrectomy, while 4 required open conversion. A total of 16 patients underwent nephrectomy for pain and 2 underwent surgery for frequent recurrent symptomatic urinary tract infections. All patients except 1 underwent renal transplantation before bilateral nephrectomy. There was a significant difference in the volume of the right and left kidneys between the hand assisted laparoscopic and open groups (mean +/- SD 1,043 +/- 672 and 1,058 +/- 603.8 vs 4,052 +/- 548 and 3,592 +/- 1,752 cm(3), p <0.001 and 0.06 respectively). There were 5 complications, including wound infection and protracted ileus in 2 patients each, and incisional hernia in 1. In addition, the difference in mean preoperative and postoperative visual analog pain scores was statistically significant (6.9, range 3 to 10 and 0.5, range 0 to 2, p <0.05). CONCLUSIONS: Bilateral laparoscopic hand assisted nephrectomy is a safe and reliable option in patients requiring removal of the 2 kidneys in a single setting. Rather than performing staged nephrectomies, hand assisted laparoscopic nephrectomy allows the single administration of general anesthesia and provides effective relief of bothersome symptoms in patients with symptomatic autosomal dominant polycystic kidney disease. This procedure is safe in patients with renal transplants. Patients with massive polycystic kidneys with a kidney volume of greater than 3,500 cc are at increased risk for open conversion and they may have improved outcomes if open nephrectomy is attempted from the outset.

Adult↗
PubMed2006

Laparoscopic partial nephrectomy for renal masses: effect of tumor location.

OBJECTIVES: To report our single institutional experience of laparoscopic partial nephrectomy (LPN) for enhancing renal masses and evaluate outcomes and histopathologic findings with respect to the location of the renal mass. METHODS: A retrospective review of LPN for 123 renal masses completed by 7 urologists was performed. Of these lesions, 49 (40%) were exophytic, 19 (15.5%) endophytic, 47 (38%) mesophytic, and 8 (6.5%) were hilar. We defined exophytic as more than 60%, mesophytic as 40% to 60%, and endophytic as less than 40% of the renal mass protruding off the surface of the kidney on radiologic imaging studies. Hilar lesions were those located within 5 mm of the renal hilar structures, regardless of the surface characteristics. RESULTS: The mean tumor size was 2.6 cm (range 1 to 9). Hilar vessel clamping was performed during 55 procedures (44.7%); the mean warm ischemia time was 27 minutes (range 12 to 52). On final histopathologic examination, 3 patients (2.5%) had positive tumor resection margins. Overall, 26 (20.6%) complications occurred. The complication rate was significantly less for patients who underwent LPN for an exophytic (10%) or a mesophytic (12.8%) mass than for those with an endophytic (47%) or a hilar (50%) mass. Histopathologic examination of the renal masses revealed malignant pathologic features in 86 (69%) and benign findings in 37 (31%). In our series, only 55% of exophytic tumors were malignant and, if malignant, were invariably low grade (96%). CONCLUSIONS: The complications of LPN and the malignancy rate of the renal lesions were related to the tumor location within the kidney.

Adult↗
PubMed2006

Methods of vascular control during laparoscopic donor nephrectomy.

Vascular control during laparoscopic donor nephrectomy (LDN) requires expeditious control of the renal artery and vein while preserving maximum graft vascular length. The vascular stapler with three rows of staples on either side of the division has been widely used, but it loses more vascular length than other methods. In the accompanying video, we illustrate vascular control with the different staplers and locking polymer clips. The techniques include two nonabsorbable polymer ligating clips (10-mm Hem-o-Lok; MLX Weck Closure Systems), the Endo-GIA Universal stapler (35-mm length, 2.5-mm staples; Autosuture), and the Endo-TA 30 stapler (30-mm length, 2.5-mm staples; Autosuture). In an in-vitro study, we previously determined that the Endo-TA 30 stapler and the polymer clips resulted in significantly less compromise of the vessel length compared with the other methods of vascular control. LDN has been recently included by the clip manufacturer as a contraindication for the use of the polymer locking clips. The Endo TA stapler can be used when preservation of maximum graft vascular length is important.

Humans↗
PubMed2006

Randomized trial of laparoscopic donor nephrectomy with and without hand assistance.

PURPOSE: To compare the early results of standard laparoscopic (SL) and hand-assisted laparoscopic (HAL) donor nephrectomy in a randomized study. PATIENTS AND METHODS: Forty donors were randomly assigned in equal numbers to either SL or HAL. Two donors in the SL group and three patients in the HAL group underwent right nephrectomy; the others underwent left nephrectomy. In the SL group, specimen extraction was performed via a Pfannenstiel incision and in HAL group through a periumbilical midline incision. Objective intraoperative, hospital stay, and postoperative data as well as pain analog scores were collected prospectively. Patients completed the quality-of-life (QoL) SF-36 questionnaire preoperatively and at 1 month and 3 months of follow-up. RESULTS: There was a statistically significant difference in the mean operative time in the two groups (200 +/- 20.8 minutes for SL v 219 +/- 28.3 minutes for HAL; P = 0.02). There was no difference in the mean estimated blood loss (141.5 +/- 221.8 mL v 97.4 +/- 73 mL, respectively; P = 0.41), warm ischemia time (157.5 +/- 76.3 seconds v 135.5 +/- 53.7 seconds; P = 0.32), length of postoperative hospital stay (1.9 +/- 0.5 days v 2.1 +/- 0.5 days; P = 0.61), intravenous analgesia (22.1 +/- 14.0 mg v 28.3 +/- 14.8 mg of morphine sulfate equivalent; P = 0.18), or pain score on postoperative day 1 (6.1 +/- 1.0 v 6.2 +/- 1.1) and 2 (3.3 +/- 1.2 and 3.4 +/- 1.3). There were five minor complications in the SL group and three in the HAL group. The mean preoperative (89.7 +/- 4.8 v 89.2 +/- 7.4; P = 0.84), 1-month (63.4 +/- 13.9 v 64.5 +/- 12.6; P = 0.82), and 3-month (82.7 +/- 7.4 v 80.2 +/- 8.4; P = 0.41) postoperative QoL scores did not differ significantly between the groups. None of the recipients required postoperative dialysis, and there was no statistical difference between the two groups in the serum creatinine concentration. CONCLUSION: Laparoscopic and hand-assisted donor nephrectomies have similar outcomes and postoperative pain. Both approaches are well tolerated with minimal complication rates and have similar impact on patients' quality of life.

Female↗
PubMed2005

Evaluation of hydrogel tissue sealant in porcine laparoscopic partial-nephrectomy model.

BACKGROUND AND PURPOSE: Laparoscopic partial nephrectomy (LPN) is technically challenging with a steep learning curve, primarily because techniques used to control bleeding on the cut surface of the kidney can be ineffective, inconsistent, or challenging. Hemostatic techniques can include intracorporeal suturing, vascular coagulation (argon-beam coagulator, bipolar cautery, laser), and application of various tissue sealants. There is no uniformity of opinion regarding which hemostatic technique is optimal for this application. CoSeal, a hydrogel (Baxter Healthcare Corp, Deerfield, IL), has been effective following vascular surgery but has not been applied to a partial-nephrectomy model. We evaluated the effectiveness of this hydrogel in controlling bleeding and sealing the collecting system by comparing it with intracorporeal suturing and fibrin sealant (Tisseel; Baxter) in a porcine laparoscopic partial-nephrectomy model. MATERIALS AND METHODS: Bilateral synchronous upper-pole partial nephrectomies were performed in two groups of 18 farm pigs, and the three hemostatic techniques (suturing, Tisseel, CoSeal) were applied. In the first group, partial nephrectomies were performed and the pigs sacrificed 3 days postoperatively (acute group). In the second group, the pigs were euthanized 6 weeks postoperatively (chronic group). In both groups, weight, blood pressure, estimated blood loss, weight of the partial and completion nephrectomy specimen, presence/ absence of urinary leak on retrograde study, histopathologic findings, and complications were recorded. RESULTS: The mean weight, blood pressure, estimated blood loss, histopathology findings, and weight of the partial and completion nephrectomy specimens were similar in the three groups. CoSeal did not adhere well to the renal parenchyma compared with Tisseel. All three animals in the acute CoSeal group and three of the six pigs in the sutured group had small urinary leaks during retrograde ureteral study, whereas none of the pigs in the fibrin-glue cohort had urinary leaks. There was one complication (urinary leak) in the CoSeal group, necessitating sacrifice of the animal on postoperative day 8 because of sepsis. CONCLUSIONS: CoSeal is not as effective as fibrin glue in adhering to the cut renal surface and sealing the collecting system during laparoscopic partial nephrectomy.

Animals↗
PubMed2005

Impact of a double-pigtail stent on ureteral peristalsis in the porcine model: initial studies using a novel implantable magnetic sensor.

BACKGROUND AND PURPOSE: The effect of stents on ureteral peristalsis in vivo is not entirely clear. We sought to develop a minimally invasive method for its study. MATERIALS AND METHODS: In female domestic pigs, electrical potentials from the ureter were measured by bipolar steel-wire electromyography electrodes delivered laparoscopically. Mechanical movement was measured by giant magneto resistive sensors mounted on custom-made aluminum strips. After baseline values were obtained, the animals were randomized to receive silicone or polyurethane stents, and ureteral peristalsis was measured for 8 hours acutely and for 4 hours 1 week later. RESULTS: Implantation of the devices took an average of 30 minutes. A consistent correlation was found between laparoscopically observed peristaltic waves and the peristalsis detected by the two measuring devices. The devices themselves did not affect peristalsis. Stent insertion increased peristaltic activity initially but later reduced or stopped it. There was no difference in the effects of the two types of stents. CONCLUSIONS: The new technique permits close monitoring of ureteral peristalsis in vivo. Smaller stents appear to have less immediate effect than larger ones, but all type of stents tested eventually caused aperistalsis.

Animals↗
PubMed2005

Optical-access visual obturator trocar entry into desufflated abdomen during laparoscopy: assessment after 96 cases.

BACKGROUND: The introduction of optical-access laparoscopic trocars was met with enthusiasm and the impression that these devices provide safer access with decreased complication rates. However, serious complications have been reported. PATIENTS AND METHODS: We retrospectively reviewed our first 96 consecutive cases (17 radical prostatectomies, 2 sacrocolpopexies, 6 adrenalectomies, and 71 renal procedures), performed between October 2001 and April 2003, of optical-access laparoscopic trocar placement as initial entry into the desufflated abdomen. After creating a 12-mm periumbilical or lateral-rectus incision, the 12-mm Endopath Bladeless visual obturator trocar (Ethicon Endosurgery, Cincinnati, OH) was inserted into the peritoneum while carefully observing the separation of the layers of fascia, muscle, and peritoneum. RESULTS: There were no vascular injuries. However, we observed 2 (2.1%) large-bowel injuries: a seromuscular injury and a through-and-through enterotomy of the mid-descending colon. In both cases, the visual obturator was placed lateral to the left rectus muscle, and the large colon was noted to be adherent to the anterior abdominal wall. The bowel injuries were repaired in two layers (running 3-0 Vicryl for the mucosa and 3-0 silk for the seromuscular layer). The operations were completed without open conversion and with uneventful recovery. CONCLUSIONS: Direct placement of an optical-access visual obturator trocar into the desufflated abdomen carries the potential for significant injury. Our current practice is to place the visual trocar after Veress-needle peritoneal insufflation.

Adrenalectomy↗
PubMed2005

Pulmonary sequestration presenting as retroperitoneal cyst: case report.

A 21-year-old woman presented with flank pain, and an abdominal and pelvic CT scan demonstrated a left 7.4-cm simple cyst superior to the left kidney. She underwent laparoscopic cyst decortication complicated by a diaphragmatic injury and pneumothorax. The final pathology report described a retroperitoneal pulmonary sequestration (RPS). Urologists need to consider RPS in the differential diagnosis of a retroperitoneal cyst because of the associated morbidity of hemorrhage during surgical excision. With the widespread use abdominal imaging techniques, more cases of RPS are likely to be identified and referred for laparoscopic management.

Adult↗
PubMed2005

Instrumentation for laparoscopic renal surgery--Padron Endoscopic Exposing Retractor (PEER) and Endoholder: point of technique.

During laparoscopic surgery, as in open surgery, exposure is critical. However, this can be difficult during laparoscopy due to limited haptic feedback and the loss of 3-dimensional visualization. Excessive force may be inadvertently applied by assistants when anatomic structures are retracted; similarly, the retractors may be unknowingly moved because the limited field of view with the laparoscope precludes constant visualization of the retracting instrument. To overcome these problems, we have been using a 5- or 10-mm PEER retractor in combination with an articulating arm instrument holder (Endoholder) to aid laparoscopic renal surgery. The adjustable spring-loaded articulating instrument holder (Endoholder) consists of 4 components, including table attachment, a base rod, flexible extension arm, and precision clamp. The clamp accommodates variously sized instruments, and the flexible extension arm rotates 360 degrees to aid in positioning. The instrument holder is clamped to the table via the base rod over a sterile drape. A PEER Retractor, Roto-lok ratchet (5- or 10-mm diameter and 32-cm length) is placed intracorporeally to retract and position the kidney for hilar, upper, and lower pole dissection. The PEER retractor's handle is secured in place using the precision clamp of the instrument holder. The articulating instrument holder and PEER retractor are used for our renal, adrenal, and ureteral laparoscopic procedures. Placement of the retractor through a 5- or 10-mm port and deployment can be done quickly. Adequate and stable positioning of the retractor provides excellent and secure visualization of the operative field. These instruments have been used in more than 200 cases without any complication except 1 minor liver laceration. The articulating instrument holder with the PEER retractor is a very useful aid during laparoscopic renal surgery. This instrument reduces the chances of inadvertent injury to viscera by the assistant while maintaining an excellent anatomic view throughout the procedure. This will have a significant impact on the advancement of laparoscopy and its acceptance by every urologist.

Adrenalectomy↗
PubMed2004

Laparoscopic radical prostatectomy: a multi-institutional study of conversion to open surgery.

OBJECTIVES: To perform a multi-institutional review of the incidence and factors contributing to conversion from laparoscopic radical prostatectomy (LRP) to open radical retropubic prostatectomy (RRP) among eight surgeons. METHODS: The medical records from all patients undergoing LRP at seven institutions were reviewed to assess the incidence of open conversion to RRP. The clinical, operative, pathologic, and functional outcomes of patients who required conversion were compiled and analyzed. RESULTS: Of 670 operations, 13 (1.9%) were converted from LRP to RRP. The most common steps at which conversion occurred were the apical dissection (38%) and the posterior seminal vesicle dissection (31%). Failure to progress was the most common cause of conversion, followed by injury to adjacent structures and hypercarbia. Comorbidities associated with conversion were prior pelvic surgery and obesity (body mass index greater than 30). Six of the 13 conversions occurred in the surgeons' first 5 cases. Despite open conversion, patients were continent (no pads) (92%) and potent (44%) with at least 6 months of follow-up. CONCLUSIONS: Open conversion from LRP to RRP is an uncommon event, but is more likely to occur during a surgeon's early experience. Surgeons beginning their experience with LRP are advised to select their patients carefully to minimize the need for conversion to open surgery. Obese patients and those at risk of periprostatic adhesions should initially not be considered for LRP. Despite open conversion, the functional outcomes did not appear to be adversely affected.

Adenocarcinoma↗
PubMed2004

Laparoscopic radical prostatectomy: Washington University initial experience and prospective evaluation of quality of life.

BACKGROUND AND PURPOSE: The laparoscopic approach to radical prostatectomy offers an alternative to the open surgical procedure with less morbidity. We prospectively collected data including a validated quality-of-life questionnaires on our first 38 laparoscopic radical prostatectomies (LRPs). The first 10 patients (group 1), second 10 patients (group II), and the most recent 18 patients (group III) were examined separately to study the learning curve for this procedure. In addition, we determined the pattern of recovery of urinary continence, potency, and quality of life. PATIENTS AND METHODS: Between July 1999 and July 2002, 38 consecutive transperitoneal laparoscopic radical prostatectomies were performed for clinically localized prostate carcinoma. Patients completed quality-of-life questionnaires (Rand 36 Health Survey) before surgery as well as at 1, 3, 6, and 12 months and every 6 months thereafter. The patients were also interviewed by an individual not directly involved in patient care. RESULTS: One patient (the second in our experience) was converted to the open approach because of failure to progress. The average operating time for the whole series was 423 +/- 137.6 minutes (range 215-825 minutes), the last 10 procedures taking 305 +/- 63 minutes (range 215-420 minutes). Complications consisted of one case each of intraoperative bladder injury, transient superficial peroneal nerve palsy, pulmonary embolism, and bladder neck obstruction. The bladder injury was closed laparoscopically without further complication. Bladder neck obstruction was secondary to a bladder wall fold that was treated with transurethral resection 14 months after surgery with good results. Four patients in group 1 had minor anastomotic leaks, while only one patient after that had a leak (group III). Four patients required transfusion, two intraoperatively and two postoperatively. In group III, the urethral catheter remained in place for an average of 8 days (range 6-10 days). With a mean follow-up of 22.8 months (range 9-43 months), 84.8% of the patients had perfect urinary control. Postoperatively, 9 patients (27%) were fully continent on removal of the Foley catheter. At 1, 3, 6, and 9 months postoperatively, diurnal urinary control was reported by 30.3%, 48%, 72.7%, and 84.8% of the patients, respectively. One patient needed an artificial urinary sphincter. Among the incontinent patients, 24.2% had urinary urgency, and one third of these patients reported urge incontinence. CONCLUSIONS: Laparoscopic prostatectomy is a reproducible technique with a steep learning curve. Operating times and the incidence of anastomotic leaks and urinary incontinence decrease significantly after the initial 10 patients.

Erectile Dysfunction↗
PubMed2004

Laparoscopic sacrocolpopexy for the correction of vaginal vault prolapse.

BACKGROUND AND PURPOSE: Laparoscopic sacrocolpopexy offers a minimally invasive approach to correcting vaginal vault prolapse. We describe our operative technique and review our experience. PATIENTS AND METHODS: A retrospective study of 10 patients who underwent laparoscopic sacrocolpopexy between February 2000 and June 2002 for posthysterectomy vaginal vault prolapse was performed. Data collected included operative time, complications, hospital stay, and postoperative morbidity. RESULTS: One patient underwent primary laparoscopic repair of an intraoperative bladder injury. Conversion from a laparoscopic to an open procedure was required in one patient because of dense bowel adhesions in the pelvis. The mean analgesic (morphine sulfate equivalent) requirement was 7.3 mg (range 5-21 mg). With a mean follow-up of 16 months (range 5-32 months), prolapse recurred in one patient. CONCLUSION: In the short term, laparoscopic sacrocolpopexy appears to be an effective approach for the treatment of vaginal vault prolapse with minimal postoperative pain and morbidity.

Adult↗
PubMed2004

Smooth-muscle regeneration after electrosurgical endopyelotomy in a porcine model as confirmed by electron microscopy.

BACKGROUND AND PURPOSE: Endopyelotomy is the preferred treatment for ureteropelvic junction (UPJ) obstruction because of its short operating time, limited morbidity, fast recovery, and reasonable efficacy. We used tissue and immunohistochemistry staining and electron microscopy to look at the muscle regeneration following an endopyelotomy incision in a porcine model. MATERIALS AND METHODS: Bilateral electrosurgical endopyelotomy was performed in six domestic pigs with placement of 7F 20-cm Percuflex double-J stents for up to 4 weeks, and urinary tracts were harvested at 3 or 5 months. Specimen evaluation included tissue staining with hematoxylin-eosin, Masson's trichrome, and Verhoeff's iodine and Van Gieson solution; histochemical staining for smooth-muscle actin, desmin and myosin staining, and electron microscopy. Each specimen was assigned a "healing" score of 0 (normal) 1 (slight changes), 2 (mild changes), or 3 (severe changes). The fibrosis score was based on six factors: muscle layer fibrosis, lamina propria fibrosis, amount of granulation tissue present, new deposits of collagen, fibrosis in the periureteral fat, and presence of myofibroblasts. The muscles were characterized with immunohistochemistry and electron microscopy. RESULTS: At both 3 and 5 months, the urothelium was healed, and the lamina propria was healed with focal loss. By 3 months, smooth-muscle bundles bridged the defect, and by 5 months, the whole defect was covered. Smooth muscle cells were evident by electron microscopy by 3 months, and actin and myosin could be detected by immunohistochemistry. Desmin-positive cells accounted for 50% of the population at 3 months and 40% at 5 months. The regenerated smooth-muscle bundles were oriented in different directions and intermingled with fibrous tissue. They could be distinguished easily from normal ureter under the microscope. CONCLUSION: Verifiable, functional smooth-muscle bundles bridge the endopyelotomy defect by 3 months, as confirmed by immunohistochemistry staining and electron microscopy.

Animals↗
PubMed2004

Prospective comparison of the immunological and stress response following laparoscopic and open surgery for localized renal cell carcinoma.

PURPOSE: We prospectively compared the systemic immune and stress response of patients who underwent laparoscopic total nephrectomy (LRN) (14) and open nephrectomy (ON) (10) for renal cell carcinoma. The ON group comprised open radical (4), open total (2) and open partial (4) nephrectomy cases. MATERIALS AND METHODS: Only patients with no history of cancer or autoimmune disease and American Society of Anesthesiologists score 2 or less who were not using immunosuppressive drugs were selected. Peripheral venous blood was collected preoperatively and intraoperatively, and 24 hours, 2 weeks, 4 weeks and 3 months postoperatively. Blood was analyzed for stress markers (adrenalin, noradrenalin and cortisol), inflammatory response markers (C-reactive protein, white blood count and leukocyte count), lymphocytic response markers (CD3, CD4 and CD8), cytokines interleukin-2 and 4, interferon-alpha and tumor necrosis factor-alpha), HLA-DR expression and the proliferative response to mitogen stimulation using concanavalin A, phytohemagglutinin 10, and pokeweed mitogen. RESULTS: Mean tumor size +/- SD for ON and LRN was 5.6 +/- 2.4 and 4.5 +/- 1.6 cm, respectively (p = 0.21). The trends with time for all measured postoperative parameters were similar in the 2 groups. Inflammatory and stress response markers were statistically similar for in the groups at all time points. A significant difference between the groups was noted for the percentage of CD4+ and CD8+ lymphocytes. However, this difference was present preoperatively and there was no significant absolute change in these 2 parameters. The cytokine response and HLA-DR expression were similar in the 2 groups at all time points. Likewise, the lymphocytic stimulation index for concanavalin A, phytohemagglutinin and pokeweed mitogen were statistically similar for LRN and ON at all time points. CONCLUSIONS: The immunological and stress response after LRN and ON for renal cell carcinoma is similar. The few differences observed in measured parameters likely reflect preoperative differences in baseline and/or the contributory effect of anesthesia.

Carcinoma, Renal Cell↗
PubMed2004

Laparoscopic mid sagittal hemicystectomy and bladder reconstruction with small intestinal submucosa and reimplantation of ureter into small intestinal submucosa: 1-year followup.

PURPOSE: We evaluated the long-term results of laparoscopic hemicystectomy and bladder replacement with small intestinal submucosa (SIS) with ureteral reimplantation into the SIS material. MATERIALS AND METHODS: A total of 12 minipigs underwent laparoscopic hemicystectomy. Six pigs underwent bladder reconstruction with SIS and ipsilateral ureteral reimplantation. The remaining 6 control pigs underwent hemicystectomy and primary bladder closure with ipsilateral nephroureterectomy. Preoperative and followup evaluations included blood chemistry, radiography and urodynamic evaluations. The 6, 3, 6 and 9-week, and 12-month followup evaluations included biopsies. At 1 year the animals were sacrificed. Histopathological and contractility studies, and reverse transcriptase-polymerase chain reaction for growth factors and basement membrane components were performed. RESULTS: Bladder capacity and bladder compliance were similar in the 2 groups at all time points. One pig per group died, that is a control at the 9-month evaluation due to an anesthetic complication and an SIS pig 7 months after bladder reconstruction due to spontaneous bladder rupture at the anastomotic site. In the SIS group 4 of 5 surviving pigs had unobstructed reimplanted ureters without evidence of hydroureteronephrosis, while 1 had high grade obstruction at the reimplantation site. Histopathology study after 1 year revealed muscle at the graft periphery and center but it consisted of small fused bundles with significant fibrosis. Nerves were present at the graft periphery and center but they were decreased in number. CONCLUSIONS: Laparoscopic SIS bladder reconstruction and ureteral reimplantation into the SIS after hemicystectomy are technically feasible. However, compared to primary bladder closure no advantage in bladder capacity or compliance was documented.

Animals↗