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K Kerbl

Publications and source records attributed to K Kerbl.

At least 37 records · Page 2Linked to original sources
PubMed1994

Laparoscopic nephrectomy: the Washington University experience.

OBJECTIVE: To report our experience of laparoscopic nephrectomy for benign and malignant disease of the kidney. PATIENTS AND METHODS: Since June 25, 1990, 24 patients have undergone laparoscopic removal of the kidney at the Washington University School of Medicine (Barnes Hospital): 20 patients had benign renal disease and four patients had malignant renal disease. RESULTS: Of the 24 procedures, 23 were completed successfully using laparoscopic procedures; one operation had to be converted to an open surgical nephrectomy. The mean operative time was 340 min (benign disease) and 438 min (malignant disease). Postoperatively the mean hospital stay was 4 days; return to work or usual activities occurred after 3.4 weeks, and full recovery was achieved after 6.6 weeks. CONCLUSION: Laparoscopic nephrectomy, albeit time consuming to perform, results in minimal post-operative discomfort, a brief hospital stay and a rapid convalescence.

Adolescent↗
PubMed1994

Advances in laparoscopic renal and ureteral surgery.

With the introduction of laparoscopy into adult urology, a vast new field has suddenly opened itself up to the urologic surgeon, filled with exciting and promising possibilities of applying the principles of minimally invasive surgery to an ever increasing number of diseases that so far have only been approachable by incisional surgery. While undoubtedly, laparoscopy has been providing unprecedented challenges to the principles of open surgery, it is of paramount importance to critically evaluate each new laparoscopic procedure against its open surgical counterpart. However, despite a widely publicized higher complication rate for laparoscopic procedures, it must not be overlooked that each laparoscopist must go through his/her very own individual learning curve; although a painful process at times, it is not any different than the novice's introduction to open incisional surgery. The problems of the learning curve can be partly alleviated by carefully studying the basic principles of laparoscopy in the animal laboratory, and by subsequent clinical training under the guidance of an experienced laparoscopist. The discoverer's enthusiasm for his or her own newly developed procedure and the instinctive negative reaction of the practicing community to new concepts that threaten to overturn what is perceived as 'tried and true', must both be tempered by the accumulation of clinical data, testing the validity of all procedures, new and old alike. To this end, surgeons have the opportunity to explore a gentler form of surgical practice, one in which the practitioner can heal without the need to harm.

Humans↗
PubMed1994

Clinical experience with the Kaye nephrostomy tamponade catheter.

Herein, we report our clinical experience with achieving intraoperative hemostasis with the Kaye nephrostomy tamponade catheter. Since June 1990 this device has been used 10 times in 7 patients at our institution; in each patient immediate hemostasis of the nephrostomy tract was achieved.

Adult↗
PubMed1993

Laparoscopic nephrectomy.

Since the first clinical operation in June 1990 laparoscopic nephrectomy for benign renal disease has become widely accepted. Although the laparoscopic operation takes much longer than open surgery, there are considerable reductions in the length of postoperative hospital stay and the time taken to return to normal activities and to full recovery. Major complications were relatively common in early operations, but with more experience morbidity has been reduced. Laparoscopic nephrectomy for malignant renal disease is still controversial, largely because of the fear of release of malignant tissue into the abdominal cavity during the morcellation and retrieval of the diseased kidney. To prevent this, the kidney is removed intact through a 5-7 cm incision. Long term follow up is needed, however, before we will know whether the laparoscopic procedure is effective in preventing recurrence of cancer. New developments have improved various technical aspects of the operation, but stringent assessment of new techniques is necessary so that the medical community can decide which procedures should become routine practice.

Humans↗
PubMed1993

Laparoscopic nephrectomy for renal neoplasms.

Laparoscopic nephrectomy has been shown to be an effective minimally invasive technique for treating benign renal disease requiring surgical excision. However, its application to approach renal malignancy has been limited. Herein, we report on 8 patients with renal tumor who underwent a laparoscopic nephrectomy. All kidneys were removed within Gerota's fascia, and in 3 patients with upper pole tumors, the adrenal gland was also removed en bloc. With limited follow-up of seven to thirty-five months (mean 14 months), there has been no clinical or radiographic evidence of tumor recurrence. We believe that laparoscopic radical nephrectomy with strict adherence to oncologic surgical principles is a practical, less invasive alternative in select patients with renal tumors.

Adrenalectomy↗
PubMed1993

Staging pelvic lymphadenectomy for prostate cancer: a comparison of laparoscopic and open techniques.

The operative morbidity and convalescence of our initial 30 patients who underwent laparoscopic pelvic lymph node dissections were compared to those of 16 patients who underwent open surgical pelvic lymph node dissections performed at our institution for staging purposes between 1990 and 1992. The average time for laparoscopic pelvic lymph node dissection (199.4 minutes) was nearly twice that of surgical pelvic lymph node dissection (102.4 minutes). However, the blood loss in the former group was significantly less. Oral intake occurred after a mean of 0.63 days in the laparoscopic pelvic lymph node dissection group compared to 2.87 days in the surgical group. Also, laparoscopic pelvic lymph node dissection was superior to surgical pelvic lymph node dissection in terms of average postoperative analgesic use (1.55 versus 47 mg. morphine sulfate), average hospital stay (1.7 versus 5.37 days), average return to normal daily activities (4.94 versus 42.9 days) and interval to full recovery (10.8 versus 65.5 days). However, the incidence of significant complications in the laparoscopic pelvic lymph node dissection group was 13%, with no complications seen in the surgical group. Interestingly, all significant problems in the bilateral laparoscopic pelvic lymph node dissection patients were confined to our initial 12 patients, indicating the steepness of the laparoscopic learning curve.

Aged↗
PubMed1993

Effect of stent duration on ureteral healing following endoureterotomy in an animal model.

Ureteral strictures were created in 18 minipigs. Six weeks after stricture inducement, endourologic incision with a balloon cutting device was performed and a 7 F internal polyurethane stent was placed. After this step, 14 pigs remained in the study and were randomized into three different groups depending upon the time when the stent was removed: 1, 3 or 6 weeks. Twelve weeks after stricture incision, the pigs were killed, the status of the incised ureteral segment was evaluated histologically, and a healing score was determined. There were no statistically significant overall differences among the mean values of the overall healing score throughout the three different groups. However, when the one-week and the six-week groups (p < .05) were compared with respect to strictures requiring more than one incision due to stricture length greater than 2 centimeters, a more favorable outcome occurred in the 1 week group. Based on these findings it may be reasonable to remove ureteral stents as early as 1 week after endoureterotomy and endopyelotomy.

Animals↗
PubMed1993

Incision of the ureterovesical junction for endoscopic surveillance of transitional cell cancer of the upper urinary tract.

Ureteroscopy for treatment of upper tract transitional cell cancer is complicated by the need for subsequent outpatient, anesthesia-based, surveillance ureteroscopy to detect recurrent tumors. We report on 2 patients with ureteroscopically treated renal pelvic transitional cell carcinoma in whom the ureteral tunnel was incised. By rendering the ureterovesical junction incompetent, we created a widely patent refluxing ureteral orifice. During the last 2 years we have been able to perform repeatedly office-based flexible surveillance ureteroscopy without fluoroscopy and without oral or parenteral analgesics in both patients.

Carcinoma, Transitional Cell↗
PubMed1993

Organ entrapment and renal morcellation: permeability studies.

We collected 24 intact LapSacs* during a laparoscopy course at our institution. Following laparoscopic nephrectomy or nephroureterectomy in a pig using high speed electrical tissue morcellation, the sacks were examined for perforation. When filled with water, 4 of the 24 LapSacs (16%) were found to have small perforations. The 20 remaining sacks were randomly divided into 3 groups of 6 and 2 sacks, although intact, were kept as substitutes to use if a trial with the study sacks could not be completed. Each group of 6 sacks was tested for permeability using 10 mg./ml. bovine serum albumin, 8 mg./ml. indigo carmine or 1 x 10(5)/ml. mouse bladder tumor cells. The results in the 18 tested sacks showed no dialysis of bovine serum albumin in the dialysate at 1, 3 and 18 hours, and no dialysis of indigo carmine at 0, 1, 2 and 3 hours. In 1 of 6 sacks tested with a mouse bladder tumor cell line a single cell was noted on the hemocytometer at 1 and 3 hours. The lack of an increasing concentration of cells at the 3-hour interval likely indicates that this represented contamination of the dialysate rather than ongoing leakage from a perforated sack in this case. We conclude that the LapSac, when properly used, remains impermeable throughout the morcellation process.

Animals↗
PubMed1993

Laparoscopic ureterectomy: initial clinical experience.

With a combination of cystoscopic and laparoscopic techniques, 3 patients underwent total ureterectomy for urothelial cancer without complication. Of the patients 2 underwent concomitant laparoscopic nephrectomy. Mean operating time was 8.2 hours for the laparoscopic surgery and mean hospital stay was 6 days. In 2 patients the ureter was removed intact, while in 1 it was morcellated along with the kidney before removal. In each case the bladder was closed with a 12 mm. GIA laparoscopic stapling device. After 3 to 9 months of followup no patient had recurrent disease or bladder stones on the staple line.

Aged↗
PubMed1993

Laparoscopic stapled bladder closure: laboratory and clinical experience.

We report our experience with closure of the bladder during laparoscopic nephroureterectomy by using a gastrointestinal anastomosis type stapling device designed to deliver 6, 3 cm. rows of 3.5 mm. titanium staples via a 12 mm. trocar. We initially used this stapling device to secure a cuff of bladder in 8 female pigs undergoing laparoscopic nephroureterectomy. Followup in these animals was completed 2 to 6 months postoperatively. Then, 3 patients underwent laparoscopic ureterectomy using the laparoscopic stapler to transect and secure the ureter along with a cuff of bladder. In neither the laboratory nor the clinical situation were any complications encountered due to the transvesical staples (for example extravasation, stone formation, urinary tract infection or abscess formation). Our preliminary results indicate that titanium staples may be an effective method to provide rapid and secure closure of the bladder in patients undergoing either laparoscopic nephroureterectomy or laparoscopic ureterectomy.

Aged↗
PubMed1993

Laparoscopic partial nephrectomy in the pig model.

In an effort to further evaluate the potential application of laparoscopy to urologic surgery, we explored the feasibility of using this minimally invasive approach for performing a partial nephrectomy. Nine female pigs underwent laparoscopic partial nephrectomy (LPN) utilizing a plastic cable tie (15 mm. x 4 mm. x 1 mm.) to achieve renal ischemia and an Argon Beam Coagulator probe (ABC) (Birtcher Medical Systems) to fulgurate the transected surface. Six weeks after LPN, 6 pigs underwent creatinine clearance, renin level, arteriography, BP samples and were then killed. The renal remnants were weighed and sectioned for histological studies. These studies revealed excellent function of the renal remnant, no AV fistula, and no evidence of renovascular hypertension. LPN is a feasible, repeatable procedure in the pig. Control of the renal hilum, transient parenchymal compression with a plastic cable, and use of the argon beam coagulator are key elements in performing this procedure.

Animals↗
PubMed1993

Laparoscopic renal surgery.

Despite all the recent developments in laparoscopic renal surgery, it has to be kept in mind that although only small incisions are made, laparoscopy is still surgery. Therefore, the technical background as well as the surgeons' skills must ensure that any laparoscopic procedure can be quickly converted into an open surgical procedure, if complications (such as bleeding or injury to the viscera) or unexpected difficulties (inability to establish a pneumoperitoneum) should occur. Also, as with any new procedure, the value of each new laparoscopic technique can only be determined by direct and critical comparison to its current open incisional surgical counterpart. In order to progress from a heralded "fad" to a medically accepted "fixture", each laparoscopic innovation must provide the patient with a less morbid, yet equally efficacious alternative to open surgery. Stated more simply, the query remains: "It's new but is it better?"

Humans↗
PubMed1993

Retroperitoneal laparoscopic nephrectomy: laboratory and clinical experience.

Laparoscopic nephrectomy using an entirely retroperitoneal approach was performed in six anesthetized female pigs. In each animal, the kidney was localized using fluoroscopy, following which the retroperitoneum was insufflated with CO2. Subsequently, a retroperitoneal laparoscopic nephrectomy was performed in a 48-year-old man with a chronically obstructed, nonfunctioning kidney. Although the retroperitoneal approach provides excellent exposure for the dissection of the renal hilum, anatomic factors in the human limit port placement and organ entrapment and increase the risk for development of a pneumothorax.

Animals↗
PubMed1993

Laparoscopic nephropexy for symptomatic nephroptosis: initial case report.

Laparoscopic nephropexy was performed in a 25-year-old woman with intractable pain and a palpable pelvic mass associated with right nephroptosis for more than 1 year. Evaluation by a supine and an erect intravenous urogram (IVU) revealed right renal descent of three vertebral bodies with mild hydronephrosis. Laparoscopic transperitoneal nephropexy was performed in a 2 and a half hour procedure. The patient stayed in the hospital 2 days postoperatively and returned to full activities 3 weeks later. At 2 months postoperatively, she is asymptomatic. An upright IVU2 months postoperatively revealed renal descent of only one vertebral body and no hydronephrosis. This is the first report to our knowledge of a successful laparoscopic nephropexy.

Adult↗
PubMed1993

Ligation of the renal pedicle during laparoscopic nephrectomy: a comparison of staples, clips, and sutures.

Evaluation of the role of staples, clips, and sutures for laparoscopic ligation of the renal artery revealed that occluding the renal artery with three, 9 mm titanium clips is as secure as occluding the renal artery with standard 2-0 and 0-silk ligatures. However, a triple staggered line of 2.5 mm staples placed across the renal artery was not as secure as either clips or silk sutures. The authors also studied eight female farm pigs who underwent laparoscopic nephroureterectomy with en masse stapled occlusion of the renal hilum. In one animal, an arteriovenous fistula was documented 6 months postoperatively. Currently, when laparoscopically occluding the renal hilum, the authors recommend a thorough dissection of the renal artery and renal vein; each should then be separately occluded so that three individually placed titanium clips remain on the stump of the renal artery and on the renal vein.

Animals↗
PubMed1993

Laparoscopic nephroureterectomy: evaluation of first clinical series.

Six patients underwent laparoscopic nephroureterectomy as treatment for upper tract transitional cell cancer. Mean operative time was 7.29 h and mean postoperative hospital stay was 4.6 days. In all but 1 case, the cuff of the bladder was obtained using a laparoscopic 12-mm GIA tissue stapler. With follow-up out to 16 months, we have not encountered any complications due to the transvesical staples, such as urine extravasation, stone formation, urinary tract infection or abscess formation. Our initial clinical data indicate that laparoscopic nephroureterectomy, albeit a lengthy procedure, can be performed with minimal morbidity and a short post-operative hospital stay.

Aged↗