Biomedical subjects

Kenneth A Beasley

Publications and source records attributed to Kenneth A Beasley.

3 recordsLinked to original sources

PubMed2004

Laparoscopic versus open partial nephrectomy.

OBJECTIVES: To compare, retrospectively, the results of laparoscopic partial nephrectomy (LPN) to open partial nephrectomy (OPN) using a tumor size-matched cohort of patients. Limited data are available comparing LPN to OPN in the treatment of small renal tumors. METHODS: Between September 2000 and September 2003, 27 LPNs and 22 OPNs were performed to treat renal masses less than 4 cm. Patient demographics and tumor location and size (2.4 +/- 1.0 cm versus 2.9 +/- 0.9 cm, respectively; P = not statistically significant) were similar between the LPN and OPN groups. RESULTS: Although the mean operative time was longer in the LPN than in the OPN group (210 +/- 76 minutes versus 144 +/- 24 minutes; P <0.001), the blood loss was comparable between the two groups (250 +/- 250 mL versus 334 +/- 343 mL; P = not statistically significant). No blood transfusions were performed in either group. The hospital stay was significantly reduced after LPN compared with after OPN (2.9 +/- 1.5 days versus 6.4 +/- 1.8 days; P <0.0002), and the postoperative parenteral narcotic requirements were lower in the LPN group (mean morphine equivalent 43 +/- 62 mg versus 187 +/- 71 mg; P <0.02). Three complications occurred in each group. With LPN, no patient had positive margins or tumor recurrence. Also, direct financial analysis demonstrated lower total hospital costs after LPN (4839 dollars+/- 1551 dollars versus 6297 dollars+/- 2972 dollars; P <0.05). CONCLUSIONS: LPN confers several benefits over OPN concerning patient convalescence and costs, despite prolonged resection times at our current phase of the learning curve. Long-term results on cancer control in patients treated with LPN continue to be assessed.

Adult↗

PubMed2004

Laparoscopic robotic pyeloplasty using the Zeus Telesurgical System.

We present the initial clinical experience using a robot to perform a laparoscopic dismembered pyeloplasty at a Canadian centre. Five patients were confirmed to have ureteropelvic junction obstructions through nuclear renography, cross sectional imaging and intravenous pyelography. After performing a retrograde ureteropyelography and double J stent placement, laparoscopic dismembered pyeloplasty was performed by a single surgeon at a remote workstation using the ZeusTM Telepresence Surgery System (Intuitive Surgicala). The mean total operative time was 225+/-48 minutes, anastomotic time was 71+/-16 minutes, and the mean time required to set-up the robot was 30+/-17 minutes. The estimated blood loss was less than 100 ml in each case. A mean total of 22+/-10 mg of morphine sulfate equivalents were used for analgesia, and the patients were discharged home after a mean of 58+/-10 hrs. There were no robotic failures, and all evaluable patients are free of pain and demonstrable obstruction. One patient developed a delayed urine leak, which resolved with percutaneous drainage. The robot provides the ability to perform complicated operations with precision through elimination of tremor, scaling of motion, and through the use of 'wristed' instruments that enhance the freedom of movement normally limited by straight-shafted laparoscopic needle drivers. The development of robotic telesurgery is still in its infancy, and the significance of its role in urologic surgery continues to be evaluated.

Adult↗

PubMed2003

Upper tract imaging after ureteroscopic holmium:YAG laser lithotripsy: when is it necessary?

INTRODUCTION/OBJECTIVE: Advances in ureteroscope design and refinements of ancillary instrumentation have resulted in an expanded role for ureteroscopy in the management of urinary calculi. Technological enhancements coupled with improved endourologic skills have also been associated with a reduction in procedural-related complications. Historically, postoperative imaging with ultrasound (U/S) or intravenous pyelogram (IVP) had been advocated to rule out persistent obstruction due to retained stone fragments or ureteral stricture. The purposes of this study were to evaluate the incidence of postoperative ureteral obstruction in a contemporary series of patients undergoing ureteroscopic holmium:YAG laser lithotripsy without basket extraction of fragments and to identify patient, stone and operative factors predictive of which patients will benefit from postoperative imaging. MATERIALS AND METHODS: The charts and imaging studies of 89 consecutive patients undergoing a total of 94 holmium:YAG ureteroscopic lithotripsy procedures between December 1998 and December 2000 were retrospectively reviewed. Preoperative, intraoperative and postoperative data were collected and analyzed. The primary outcome measure was the incidence of postoperative ureteral obstruction documented on upper tract imaging. Secondary outcome measures included interventions required for postoperative obstruction and other nonobstructive postoperative complications. RESULTS: Twenty-eight females and 61 males were studied, with a mean patient age of 54 (range 13-80) years. Fifty-five percent of patients underwent related procedures prior to referral to our tertiary endourology centre. Complete clinical and radiological follow-up is available for 68 of 89 (76.4%) patients, with a mean follow-up duration of 24.2 weeks. Overall stone-free rate was 97%. Six patients had evidence of urinary tract obstruction on follow-up radiological assessment, two from residual stone fragments and four from ureteral stricture. Each of these four patients had at least one preoperative risk factor for ureteral stricture. CONCLUSIONS: Routine postoperative upper tract imaging is not necessary in all patients undergoing uncomplicated ureteroscopic holmium:YAG laser lithotripsy. Indications for upper tract imaging include chronic stone impaction, significant ureteral trauma, pre-existing renal function impairment, endoscopic evidence of stricture and postoperative flank pain or fever.

Adolescent↗