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Biomedical subjects

D M Hoenig

Publications and source records attributed to D M Hoenig.

27 records · Page 2Linked to original sources
PubMed1997

Risk of nodal metastases at laparoscopic pelvic lymphadenectomy using PSA, Gleason score, and clinical stage in men with localized prostate cancer.

Laparoscopic pelvic lymph node dissection (LPLND) is a low-morbidity procedure used to stage prostate cancer accurately prior to definitive local therapy. To better select patients for LPLND, we reviewed the clinical features of 120 patients with clinically localized prostate cancer who underwent LPLND to define significant risk factors for nodal metastases. The age ranged from 43 to 79 years (mean 68). Serum prostate specific antigen (PSA) concentration ranged from 1.3 to 329 ng/mL, Gleason score ranged from 2 to 9, and clinical stage ranged from T1b to T3c. Nodal metastases were discovered in 15 patients (13%). Among men with a Gleason score > or = 7, 21% had nodal metastases (P = 0.004). A serum PSA > 20 ng/mL and clinical stage T1b, T2b, or greater also were statistically significant predictors of lymph node metastases (20% and 19%, respectively). In multivariate analysis, Gleason score significantly predicted nodal metastases when controlling for all other clinical measures. Therefore, LPLND is indicated for any patient with a Gleason score > or = 7, PSA > 20 ng/mL, and advanced clinical T stage, independently or in combination.

Age Factors↗
PubMed1997

Laparoscopic ablation of peripelvic renal cysts.

PURPOSE: We describe and define the operative techniques, findings and results of laparoscopic ablation of peripelvic renal cysts. MATERIALS AND METHODS: One male and three female patients, ranging in age from 35 to 59 years, underwent laparoscopic ablation of symptomatic peripelvic cysts. All patients had symptoms of ipsilateral flank pain and obstruction. One patient had an episode of pyelonephritis before detection of the cyst, and 2 patients had concomitant stones within the obstructed system. Cysts ranged in size from 4 to 6 cm. Dissection was uniformly complex because of the depth to which the cyst extended into the renal parenchyma and the overlying renal vessels and collecting system. RESULTS: Operative times ranged from 315 to 390 minutes (mean 338 minutes). The average length of hospital stay was 2.75 days (range 2 to 4 days). Three of 4 patients (75%) had resolution of their symptoms and collecting system obstruction. One patient, the only case of a retroperitoneal approach, had recurrence of her symptoms and cyst 2 months after the operation and required open surgical repair. CONCLUSIONS: Laparoscopic ablation of peripelvic cysts is a challenging yet feasible procedure. Because of the medial location of these cysts, a transperitoneal approach may be preferable to retroperitoneal access alone.

Adult↗
PubMed1996

Laparosonic coagulating shears: alternative method of hemostatic control of unsupported tissue.

Ultrasonic energy is now available as a hemostatic tool to aid dissection during surgery. A new device, the Laparosonic Coagulating Shears (LCS-Ethicon/Ultracision, N. Smithfield, RI), has been developed to allow hemostatic coagulation and division of tissue. We describe the mechanism of action and its effects in the porcine model. In addition, we compare this modality with conventional electrosurgery.

Animals↗
PubMed1996

Contralateral reflux after unilateral ureteral reimplantation.

PURPOSE: We analyzed the incidence and outcome of postoperative contralateral reflux after unilateral ureteral reimplantation by the Cohen and Glenn-Anderson techniques. MATERIALS AND METHODS: We retrospectively reviewed the records of 120 patients 3 months to 21 years old in whom unilateral vesicoureteral reflux was treated by unilateral reimplantation. The incidence of postoperative contralateral reflux was documented by followup voiding cystourethrography. RESULTS: Overall 19% of patients who underwent unilateral reimplantation had contralateral vesicoureteral reflux postoperatively, including 21% after the Cohen and 17% after the Glenn-Anderson procedure. Of the cases 61% spontaneously resolved, 13% were surgically corrected and 26% continue to be followed. CONCLUSIONS: The rates of postoperative contralateral vesicoureteral reflux are not significantly different after Cohen and Glenn-Anderson repair. A majority of cases will resolve spontaneously within 2 years. The likelihood of trigonal distortion as the etiology of contralateral reflux is low given the similar incidence in cross-trigonal and ureteral advancement reimplantation.

Adolescent↗
PubMed1996

Transitional cell carcinoma of the bladder in the pediatric patient.

PURPOSE: We report on 5 boys with transitional cell carcinoma of the bladder, describe the identifying characteristics, review the literature, and define the issues of diagnosis, treatment and followup in this rare disease in pediatric patients. MATERIALS AND METHODS: Five boys 11 to 18 years old were identified with transitional cell carcinoma of the bladder. Preoperative imaging and urinary cytology were correlated with cystoscopic and biopsy findings. RESULTS: In all patients evaluation was prompted by gross hematuria. Low grade lesions, definitive cystoscopic management and a low recurrence rate were uniform findings. Preoperative imaging identified the tumor in all cases and bladder ultrasound was the most sensitive scan with 4 of 4 cases identified. CONCLUSIONS: While rare, transitional cell carcinoma of the bladder in children presents a challenge in diagnosis and followup since cystoscopy typically requires general anesthesia in this age group. Bladder ultrasound was found to be extremely sensitive in identifying lesions, and it may be a valuable and minimally invasive surveillance tool.

Adolescent↗
PubMed1995

Laparoscopic unroofing of symptomatic renal cysts: three distinct surgical approaches.

Although they are rarely associated with complaints, benign renal cysts may be the cause of pain, hypertension, or other problems. Simple aspiration is rarely definitive treatment. We have had good results with three laparoscopic approaches to cyst unroofing: transperitoneal, with reflection of the colon medially or dissection through the mesocolon and direct retroperitoneoscopy. We recommend initial percutaneous aspiration with cytology study both to rule out malignancy and to identify those cysts clearly in need of unroofing.

Adult↗
PubMed1995

Direct retroperitoneoscopic adrenalectomy in the porcine model.

An experimental protocol was developed to determine the safety and feasibility of retroperitoneoscopic adrenalectomy in the porcine model. We describe the technique and our experience with this exciting new endoscopic surgical modality.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

Laparoscopic pyelolithotomy in a pelvic kidney: a case report and review of the literature.

BACKGROUND AND OBJECTIVES: Laparoscopic pyelolithotomy was performed in a pelvic kidney with a large renal pelvis calculus. METHODS AND RESULTS: Laparoscopic pyelolithotomy was successfully performed in a pelvic kidney with an operative time of 310 minutes. The use of intraoperative fluoroscopy and a semi-automatic suturing device greatly facilitated the procedure. The patient's operative pain was managed with 3 doses of ketorolac; she resumed a regular diet the day after surgery, and was discharged on the first postoperative day. CONCLUSIONS: For patients with a large stone in the renal pelvis of an ectopic kidney, laparoscopic pyelolithotomy provides an effective approach.

Female↗