Biomedical subjects

T O Henkel

Publications and source records attributed to T O Henkel.

At least 19 recordsLinked to original sources

PubMed2000

Permanent brachytherapy: prostate seed implants as an out-patient treatment.

Upto April 1999 interstitial seed implants were being performed throughout Europe only as an in-patient treatment. Consequently, we questioned whether this same method could be performed as an out-patient treatment without forfeiting the required quality and safety normally observed with in-patients. Since April 1999 we have treated 73 patients with iodine 125 seed implants (RAPID strand). The average patient age was 65 yrs, the average PSA was 11.5 ng/ml, tumor stage was either T1 or T2. All treatments were carried out in general anesthesia under ultrasound and flouroscopy monitoring. Pre- and post implant dosimetry was planned using the Variplan 6.7 computer program (former MMS). All patients tolerated the out-patient treatment very well. The average duration for anesthesia was 76 minutes, total time per patient spent in the center on implant day was 250 minutes. 54 patients were treated with a monotherapy 145 Gy, while 19 patients received external beam radiotherapy (45 Gy) plus the iodine seed boost (100 Gy). Almost 75% of the patients experienced some form of voiding discomfort during the 4-10th post implant week. In the CT post plan dosimetry performed 4 weeks after the implant, 95% of the patients obtained a good coverage of the prostate with the planned prescription dose. Iodine seed implants can be considered a safe out-patient form of treatment with a low complication and morbidity rate and a high standard of quality. The technical improvements in computer dosimetry software, modified application methods, constantly updated equipment and critical quality assessment has lead to improved overall long term results.

Aged↗

PubMed1999

Interstitial laser coagulation in benign prostatic hyperplasia: A critical evaluation after 2 years of follow-Up.

Since 1993 we have prospectively followed a cumulative cohort of males with benign prostatic hyperplasia and symptomatic bladder outlet obstruction who underwent interstitial laser coagulation (ILC) of the prostate. We evaluated the safety and efficacy of ILC with respect to relief of symptoms and bladder outlet obstruction. In addition to the critical evaluation of our clinical results, the perineal and transurethral approaches were investigated as they may make a substantial impact on the overall success rate, including prostate size, number of sticks per prostate volume and type of application. A total of 59 patients were treated with the Nd-YAG laser (mediLas fibertom) between April 1993 and December 1996. At the time of reevaluation, 47 patients had completed a follow-up of up to 24 months. A perineal approach was used in 34%, transurethral in 23%, and a combined approach in 43% of the patients, depending on the preoperative volume of the prostate. 75% were high-risk patients in accordance with the ASA score (ASA III). The efficacy of treatment was assessed 6, 12, 24 and 52 weeks postoperatively in accordance with the International Prostate Symptom Score (IPS/quality of life), cystomanometric studies, peak urinary flow rate, residual volume and volume reduction of the prostate. Reduction of prostatic volume and sticks used per prostate volume were correlated to the overall success rate. A significant improvement in all voiding parameters (flow rate, residual volume), including the symptom score, was observed. P(det) decreased from an average of 90 cm H(2)O preoperatively to 42 cm H(2)O postoperatively after 24 weeks and the mean reduction in prostate volume was 14 cm(3). Interestingly, it was noted that the overall success rate was not size-related. A distinct positive correlation was found in the number of sticks performed and the improvement in objective and subjective parameters. In view of the low morbidity outcome, especially in high-risk patients, we proclaim Nd-YAG interstitial laser coagulation of the prostate to be an effective and safe alternative method of treatment for symptomatic benign prostatic hyperplasia.

Aged↗

PubMed1998

Retroperitoneoscopy: experience with 200 cases.

PURPOSE: A retroperitoneal access is commonly used for open urological procedures. Since the introduction of the balloon dissecting technique by Gaur this anatomical route has also been used for laparoscopic surgery. We present our experience with retroperitoneoscopy in 200 cases. MATERIALS AND METHODS: From December 1992 to October 1997 a total of 200 retroperitoneoscopic procedures were performed in 197 patients 4 to 82 years old, comprising 78 nephrectomies, 50 renal cyst resections, 14 nephropexies, 11 ureterolyses, 8 retroperitoneal lymph node dissections, 8 renal biopsies, 6 adrenalectomies, 6 heminephrectomies, 6 pyeloplasties, 5 ureterolithotomies, 6 ureterocutaneostomies and 2 others. Of the patients 38 (19%) and 22 (11%) had undergone previous abdominal surgery, and kidney and ureter operations, respectively. Dissection of the retroperitoneal space was enabled by the use of a balloon catheter in 14, balloon trocar system in 93 and finger dissection technique in 93 cases. RESULTS: We classified 76 procedures (38%) as simple (renal biopsy, renal cyst resections, ureterocutaneostomy), 102 (51%) as difficult (adrenalectomy, nephrectomy, nephropexy) and 22 (11%) as very difficult (pyeloplasty, heminephrectomy, lymphadenectomy). There was a significant learning curve during the first 50 cases reflected by longer operating time, and higher complication, conversion to open surgery and open reintervention rates (14, 10 and 6%, respectively). In addition to the learning curve, mean operating time depended on the difficulty of the procedure, averaging 45 to 100 minutes for a simple, 95 to 185 for a difficult and 185 to 240 for a very difficult retroperitoneoscopy. In the last 50 cases the complication, conversion and reintervention rates (2, 4 and 2%, respectively) were acceptable for routine clinical application. CONCLUSIONS: After experience with more than 200 cases of retroperitoneoscopy the access technique has been significantly simplified. The procedure is standardized, safe and reproducible.

Adolescent↗

PubMed1998

Nephrectomy: A comparative study between the transperitoneal and retroperitoneal laparoscopic versus the open approach.

OBJECTIVES: Different techniques have been introduced to perform laparoscopic nephrectomy using either the transperitoneal or the retroperitoneal route. However, to date only few data exist comparing the results and morbidity of these procedures as well as with the standard technique of open nephrectomy. MATERIAL AND METHODS: This paper compares the clinical results of 18 transperitoneal laparoscopic nephrectomies (TLN) for benign renal disease with 17 retroperitoneal laparoscopic nephrectomies (RLN) and 19 consecutive open nephrectomies (Nx). All groups were comparable in terms of indication. The analysis of clinical data included operative time, morbidity, length of analgesic use and postoperative hospital stay. RESULTS: The mean operative time for benign disease was 206.5 for TLN, 211.2 for RLN and 117 min for open nephrectomy. Analgesic medication requirement per patient was 2 days for TLN, 1 day for RLN and 4 days for Nx while the postoperative hospital stay averaged 7 days for TLN, 6 days for RLN and 10 days for Nx. The time of convalescence was 21 days after RLN, 24 days after TLN versus 40 days after open nephrectomy. CONCLUSIONS: Our results demonstrate an overall clear advantage of a laparoscopic approach when compared to open surgery and also reveals distinct benefits of a retroperitoneal approach.

Adolescent↗

PubMed1996

Laparoscopic retroperitoneal lymph node dissection for nonseminomatous germ cell tumors: indications and limitations.

PURPOSE: We describe our experience with laparoscopic retroperitoneal lymph node dissection in 26 patients with nonseminomatous germ cell tumors: 17 had stage I disease with no clinical (computerized tomography, ultrasound or tumor markers) evidence of metastases and 9 (2 with stage IIb and 7 with stage IIc disease) had residual tumor after chemotherapy but with negative tumor markers. Laparoscopic dissection was performed to assess more fully pathological status of the relevant retroperitoneal lymph nodes in both groups. MATERIALS AND METHODS: The patient was positioned and trocars were introduced at sites similar to that used for transperitoneal laparoscopic nephrectomy (flank position with 3, 10 mm. and 2, 5 mm. ports). After the white line of Toldt was incised and the colon was reflected anteromedially, the retroperitoneal space was exposed. The landmarks of lymph node dissection were then isolated, including the ureter, aorta, inferior vena cava and both renal veins. Lymph node dissection was performed identical to that for open surgery, with a modified template including the paracaval, interaortocaval, upper preaortic and right common iliac nodes for right tumors, and para-aortic and upper preaortic nodes for left tumors. Lymph node chains were retrieved with a small organ bag. RESULTS: The procedure was completed successfully in 16 of 17 patients with stage I disease (mean duration 268 minutes for the left and 312 minutes for the right sides). No intraoperative complications were encountered. One patient had delayed ureteral stenosis requiring operative repair, 1 had a pulmonary embolism with an uneventful outcome and 1 who underwent laparoscopic retroperitoneal lymph node dissection on the right side later had retrograde ejaculation. Embryonal carcinoma was found in 1 of the 17 patients. Average postoperative hospital stay was 4.5 days for patients without complications or conversion to an open procedure. After a median followup of 27 months no patient had regional relapse but 2 had pulmonary metastases that were treated successfully with 3 cycles of platinum based chemotherapy. Laparoscopic dissection was significantly more difficult in patients with stage II tumors after chemotherapy. Only in 2 patients with stage IIb disease was laparoscopic lymphadenectomy successful. In 5 of the 7 patients with stage IIc cancer portions of the dissection had to be done after conversion to an open (conventional) operation via a small incision (suprainguinal or pararectal). In 1 patient the laparoscopic approach was completely abandoned and converted to an open operation via a standard midline incision. In all 9 cases histopathological examination revealed complete necrosis. No patient has evidence of disease. CONCLUSIONS: Our preliminary experience suggests that a modified laparoscopic retroperitoneal lymph node dissection is feasible for stage I tumors. However, it cannot be recommended after previous chemotherapy (stages IIb and IIc disease).

Follow-Up Studies↗

PubMed1996

Retroperitoneal laparoscopic lymph node dissection for staging non-seminomatous germ cell tumors before and after chemotherapy.

We describe our experience with laparoscopic retroperitoneal lymph node dissection in 19 patients with non-seminomatous germ cell tumors. Twelve patients had stage I disease with no clinical evidence (CT-scan, ultrasound, tumor markers) of metastases; 7 patients (stage IIb=2, stage IIc=5) had residual tumor after chemotherapy but with negative tumor markers. A laparoscopic dissection was used to asses more fully the pathologic status of the relevant retroperitoneal lymph nodes of both groups. The patient was positioned and trocars introduced at sites similar to that used for transperitoneal laparoscopic nephrectomy (flank position, five ports - 3 x 10 mm; 2 x 5 mm). After reflecting the colon anteromedially, the landmarks of the lymph node dissection were isolated-namely the ureter, aorta, inferior vena cava, and both renal veins. The lymph node dissection included the paracaval, interaorto-caval, upper preaortic, and right common iliac zonal nodes for right-sided tumors, and paraaortic, upper preaortic zones for left-sided tumors. Retrieval of the lymph nodal chains was accomplished using a small organ bag. The mean duration of the procedure was 298 (range 150-405) minutes. In only one patient was a lymph node positive for tumor (stage I). Otherwise nodes showed extensive necrosis (after chemotherapy). No intraoperative complications were encountered but three patients developed a delayed complication (ureteral stenosis, pulmonary embolism, and retrograde ejaculation, respectively). Whereas we completed the dissection in each patient with stage I tumors, the laparoscopic procedure was more difficult in patients with stage II tumors after chemotherapy. In two patients with stage IIb disease laparoscopic lymphadenectomy was successful. In four other patients parts of the dissection had to be done after conversion to an open (conventional) operation using a small incision (suprainguinal or pararectal); in one patient the laparoscopic approach was abandoned and converted to an open operation. In the post-chemotherapy group the outcome depended primarily on the tumor bulk prior to drug treatment. In two patients in whom all residual necrotic tissue was removed laparoscopically they had "minor" disease (stage IIb); the others had stage IIc tumors. Our preliminary experience suggests that a modified laparoscopic lymph node dissection is feasible for stage I tumors and in selected patients with marker negative residual tumor after chemotherapy (stage IIb).

Feasibility Studies↗

PubMed1995

Ureteral laparoscopic surgery.

During the past years, laparoscopy has grown in popularity and become an alternative technique for the treatment of certain pathologies in urological practice. Retroperitoneal laparoscopic procedures for ureteral surgery were first attempted by Wickham in 1979: in this case a patient with a ureteral calculus underwent a successful ureterolithotomy; More recently, the introduction of the Gaur balloon has permitted quick dilatation and easier access to the retroperitoneum. However, in comparison, the transperitoneal method offers more space and better vision for identification of anatomical landmarks. In our clinic, we have performed laparoscopic ureteral surgery using the transperitoneal as well as the retroperitoneal approach. For situations requiring reconstructive surgery, we preferred the transperitoneal approach in 3 cases of ureterolysis; 2 diagnostical and 1 therapeutical. On the other hand, the retroperitoneal approach was employed for carrying out 2 pyeloplasty, 1 ureterocutaneostomy and 1 ureterolithotomy. Furthermore, we performed in similar fashion 3 nephroureterectomy and 1 heminephrectomy combined with partial ureterectomy. In 3 cases, transperitoneal nephroureterectomy with transurethral orifice circumcision was carried out. In all patients, laparoscopy revealed low morbidity with low grade postoperative pain and shorter hospital stay. Our experience shows that the progressive use of retroperitoneoscopic surgery can maintain minimal invasiveness and permit good access to various procedures without complications connected to use of the Veress needle or the presence of abdominal adhesions. In addition to our own laparoscopic experience, we have reviewed the literature and report on the most frequent ureteral surgery performed laparoscopically.

Humans↗

PubMed1995

The clinical introduction of a third generation lithotriptor: Modulith SL 20.

The Modulith SL 20* was designed as a third generation lithotriptor with outstanding disintegrative efficacy in vitro, and equipped with a combined fluoroscopic and ultrasound localization system integrated in a multifunctional table. Its introduction to clinical extracorporeal shock wave lithotripsy took place in 3 phases. In phase 1 (49 patients) only in line ultrasound localization was possible. The many caliceal stones were adequately disintegrated with restricted generator voltage. In phase 2 (81 patients) fluoroscopic localization with the virtual focus of an adapted x-ray C-arm unit enabled in situ lithotripsy of ureteral stones in 33% of all patients. Phase 3 (549 patients) was characterized by additionally increasing the generator voltage to 20 kv. This development of the lithotriptor by improving the localization system and shock wave energy resulted in the possibility for successful disintegration of stones in the entire upper urinary tract (including the complete ureter), decreased treatment time (52 to 39 minutes) and an improved efficiency quotient (0.45 to 0.67). During phase 3 auxiliary measures were performed before lithotripsy in 24% of the cases. After 1.8% of the treatments minor or moderate perirenal fluid collection or bleeding was detected by routine followup sonography. A 91% stone-free rate was achieved with only 9.3% curative auxiliary measures after extracorporeal shock wave lithotripsy, including a 23% retreatment rate. Thus, the Modulith device had a high efficacy quotient compared with other lithotriptors.

Adult↗

PubMed1994

Spiral-reinforced ureteral stent: an alternative for internal urinary diversion.

Internal urinary diversion of chronic ureteral obstruction is not sufficient in as many as 60% of patients because of tumor compression, catheter kinking, or a small stent lumen. To prevent such problems, we developed a new ureteral stent that is stable in form in spite of a large lumen. This catheter is a thin polyurethane tube supported by a built-in metal spiral wire. We have attempted to use this stent in 16 cases of chronic ureteral obstruction. Stent placement was successful in 14. Other than urinary tract infection in two patients, bladder urgency in one, and stent dislocation in another, there were no complications. Hydronephrosis disappeared soon after stent application in 12 of the 14 patients, and in the remaining two, hydronephrosis was decreased but not totally eliminated. Catheters were left in place for an average of 6.5 weeks (range 2.5-8.5 weeks). A change of catheter because of blockage was necessary in only one patient. This spiral-reinforced stent enables better internal urinary drainage, especially in cases of malignant ureteral obstruction.

Equipment Design↗

PubMed1994

Antegrade-retrograde urethrotomy for treatment of severe strictures of the urethra: experience and literature review.

In cases of urethral stricture that are nonpassable when using conventional internal urethrotomy, open urethroplasty can be avoided by performing combined antegrade-retrograde urethrotomy (ARUT). A rigid cystoscope is guided through a dilated suprapubic cystostomy channel toward the stricture in the membranous or bulbar urethra. A urethrotome is inserted in retrograde fashion, and the "cut to the light" procedure is performed. Using the ARUT method, realignment was achieved in nine patients; four of whom had strictures induced by trauma or urethritis and five of which were the result of previous transurethral management. Recurrent stricture in four of seven cases necessitated further urethrotomy. There was no recurrence in five of seven patients for at least 5 months subsequent to the last treatment. All patients were spared open surgery. The antegrade-retrograde technique was described in 1978, but to date, only 70 cases have been reported in the literature. The primary success rate is 25%. Successful retreatment following recurrence was observed in 65%. We recommend ARUT as a first-choice treatment for severe strictures of the bulbar and membranous urethra.

Adult↗

PubMed1994

Experimental studies for clinical standardization of transabdominal laparoscopic nephrectomy.

In keeping with the maxim that minimal invasiveness is the present working trend in most areas of surgery, we investigated the possibility of laparoscopically removing a diseased human kidney. Before any actual clinical attempt could be made in this direction, an experimental study was set up in order to determine the most beneficial methods and techniques which would guide us through our first clinical cases. This step-by-step training program consists of: (1) initial familiarization with different laparoscopic instruments, bimanual dissection, ligation and coagulation techniques, camera handling and trocar placement as well as organ retrieval systems using the lap simulator; (2) laparoscopic removal of the kidney and ureter of the pig either as short- or long-term study, and (3) laparoscopic simulation with the lap tent during open surgery.

Animals↗

PubMed1994

Retroperitoneal laparoscopic nephrectomy and other procedures in the upper retroperitoneum using a balloon dissection technique.

This article describes a hydraulic balloon dissection technique. The retroperitoneum is developed via a small lumbodorsal incision between the edges of the musculus latissimus dorsi and musculus obliquus externus and then after visualization of its correct position the balloon catheter is filled with 500-1,200 ml of warm normal saline (according to patient size). The device consists of the finger of a surgeon's glove ligated around the end of a rigid bladder catheter. The balloon insufflation is maintained for 5 min to guarantee adequate hemostasis. Recently, we have replaced the balloon catheter by a balloon trocar sheath allowing direct endoscopic control of the hydraulic dissection. After retrieval of the balloon the CO2 insufflator is connected to the first trocar. All secondary trocars are placed under endoscopic control. The hydraulic dissection techniques also enable optimal creation of an effective pneumoperitoneum in children. Until now, we have used this technique for twelve procedures in the upper retroperitoneum including five nephrectomies, two nephroureterectomies, one tumor nephrectomy, one nephropexy, one renal cyst marsupialization and two renal biopsies. Up to now we have encountered no major complications. Three of the nephrectomized patients had undergone multiple previous abdominal surgical interventions. The retroperitoneal approach allows the surgeon to apply similar dissecting techniques as used in respective open procedures. It has become the routine approach for laparoscopic procedures in benign renal disease. This procedure can be performed even in cases with previous abdominal surgery.

Adult↗

PubMed1994

Ureteral stone. Treatment using the Modulith SL 20 and Lithostar plus.

The treatment of ureteric calculi by extra-corporeal shock waves was found to have an 80% success rate by Mannheim authors, regardless of the site of the calculus. The authors compared two 3rd generation apparatuses: 1--the Siemens Lithostar Plus, in which waves are produced by a electromagnetic cylinder and focussed by a parabolic electromagnetic cylinder and focussed by a parabolic reflector: 2--the Storz Medical Modulith SL 10, in which waves produced by an electromagnetic coil are focussed by acoustic lenses. Both apparatuses are based upon image-intensification and ultrasonography concepts. No difference in efficacy was found between the two apparatuses. A second shock wave session was necessary in 16% of cases and some other type of additional treatment in 7% of cases.

Acoustics↗

PubMed1993

Transperitoneal laparoscopic nephrectomy: training, technique, and results.

Transperitoneal laparoscopic nephrectomy was integrated into our daily routine within a 6-month period by means of a step-by-step training program progressing from a pelvic trainer to animal studies (N = 15) to laptent-assisted surgery. The pneumoperitoneum is created with the patient in the flank position, enabling insertion of three trocars: 10-mm periumbilical (Port I), 5/12-mm subcostal (Port II), and 12/5-mm above the iliac spine (Port III). After medial mobilization of the colon, two additional 5-mm trocars (Ports IV and V) are inserted into the lateral abdominal wall parallel to Ports II and III. Once clipping and dissection of the ovarian (spermatic) vein has been carried out, the ureter is identified and dissected. Retraction of the proximal ureter exposes the renal hilum, allowing dissection of the renal vessels. The renal vein is dissected using an endoscopic stapling device, while accessory veins and the renal artery are clipped. Organ retrieval is achieved with a specially designed tissue pouch (Lapsac) and digital fragmentation of the kidney within the organ bag. Using this technique, we have treated 24 patients with benign (N = 20) and malignant (N = 4, including adrenalectomy) renal disease. The mean operative time was 239 (115-300) minutes. In four cases, open surgery was required because of bleeding (N = 2), severe perinephric inflammation (N = 1), or bowel injury (N = 1). For relief of wound pain, an average of 1.15 vials of analgesic (morphine derivatives)/patient were administered for 2.4 days. The postoperative hospital stay averaged 6.2 (4-10) days.

Animals↗

PubMed1993

The technique of transperitoneal laparoscopic nephrectomy, adrenalectomy and nephroureterectomy.

In the traditional kidney position three trocars are inserted after creation of a pneumoperitoneum: 10 mm periumbilical (port I), 10/12 mm subcostal (port II) and 12/10 mm above the iliac spine (port III) in the mamillary line. After laterocolic incision the colon is dissected away from the lateral wall. Thereafter two 5-mm trocars (ports IV, V) are inserted into the lateral abdominal wall parallel to parts II and III. Following clipping and dissection of the ovarian (spermatic) vein, the ureter is isolated and incised. Then the cranial part of the ureter is used as a retractor exposing the renal hilum for dissection of the renal vessels. The main renal artery and vein are dissected separately by use of an endoscopic stapling device (Endo-GIA, white magazine). Finally, the kidney including Gerota's fascia is isolated from the adrenal and the upper peritoneum. Entrapment of the organ is performed with a specially designed bag (Lap-sac). The neck of the bag is brought out onto the surface of the abdomen (via port II/III) allowing digital morcellation with index finger inside the bag and removal of the organ in several pieces. We have applied this technique for 17 procedures in the upper retroperitoneum: 9 transperitoneal laparoscopic nephrectomies (TLN) for benign disease (5 hydronephrosis, 3 renovascular disease, 1 chronic pyelonephritis), 3 radical TLN including adrenalectomy for renal cell carcinoma (T2G2), 1 adrenalectomy for a cortical adrenaloma, 1 nephroureterectomy, 1 diagnostic ureterolysis and 2 modified retroperitoneal lymphadenectomies for stage I testicular cancer. The mean operation time was 4 h (2-5), the mean postoperative hospital stay 6 days (4-12).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenalectomy↗

PubMed1993

[Laparoscopic training in urology. An essential principle of laparoscopic interventions in the retroperitoneum].

The main problem with clinical introduction of laparoscopic techniques in urology is that despite experience with endoscopy no significant endoscopic training is given. Laparoscopic nephrectomy, in particular, is a rather complicated procedure and needs an adequate training concept: The beginner should have the possibility of practising in vitro in a closed "pelvi-trainer" to learn video-optical coordination and orientation; then it is necessary to get used to handling the instruments and practise the different steps of the procedure (i.e. clipping of vessels, sacking of the kidney) either in phantom models or in explanted animal organs. On this basis, we performed laparoscopic nephrectomy in an animal model (n = 18 porcine kidneys). We were able to standardize the technique of creating a pneumoperitoneum, the positioning of the animal, the site and size of the trocars, and preparation and clipping techniques (i.e. Endo-GIA) and entrapment of the kidney (testing different organ bags). A step-by-step approach was used for the introduction to clinical application. For simulation and training of video-assisted preparation techniques in patients and step-wise introduction to laparoscopy (instruments, endocoagulation, trocars), we created a "lap-tent", which was placed over the wound after exposition of Gerota's fascia. Further preparation was performed under laparoscopic conditions (without pneumoperitoneum) with a limited time allowed (1 h). Thereafter, we started with time-limited laparoscopy and laparoscopic lymphadenectomy prior to pelvic surgery (prostatectomy, cystectomy) to introduce the staff to the technique of pneumoperitoneum and placement of the trocars and to the use of the instruments in general. Based on this step-by-step training concept, after a 6-months period we were successful in introducing transperitoneal laparoscopic nephrectomy (TLN) to our clinical routine. So far, we have performed 20 laparoscopic nephrectomies, 1 nephro-ureterectomy, 4 tumour nephrectomies (inducing adrenalectomy), 2 adrenalectomies, and 6 modified retroperitoneal lymphadenectomies. In the lesser pelvis we have experience with 20 laparoscopic varicocelectomies, 23 pelvic lymphadenectomies, and 5 diagnostic laparoscopies for cryptorchidism (February 1993).

Adrenalectomy↗

PubMed1992

Extracorporeal shock wave lithotripsy of ureteric stones with the Modulith SL 20.

A series of 138 patients with ureteric calculi was treated by in situ extracorporeal shock wave lithotripsy (ESWL) during the clinical introduction of the Modulith SL 20. This machine represents a newly developed lithotriptor with an electromagnetic cylinder as shock wave source and a dual localisation system consisting of in-line ultrasound and an integrated fluoroscope C-arm. During the first 2 months, 12 patients (phase 1) were treated under ultrasound localisation alone; during the next 5 months, 37 patients (phase 2) were treated using dual imaging modalities with reduced peak pressure (max. 18 kV = 800 bar); during the final 7 months, 89 patients (phase 3) were treated under ultrasonic and fluoroscopic localisation combined with an increased maximal shock wave pressure (20 kV = 1024 bar). The introduction of fluoroscopic targeting (phases 2 and 3) resulted in satisfactory localisation of calculi in the mid-ureter, previously limited by use of only coaxial ultrasound. The extension of stone localisation to the whole length of the ureter was associated with a marked decrease in treatment time, reflecting the easy handling of the dual localisation system. The rise in generator voltage (phase 3) improved the disintegration rate from 81% (phase 2) to 85%, whereas the number of impulses remained unchanged. However, the rate of auxiliary procedures following ESWL (adjuvant and curative) was reduced from 33% (phase 2) to 24.5%. Thus the Modulith SL 20 in its final design enables in situ ESWL to be the treatment of choice for all ureteric calculi, rendering special positioning techniques or multiple treatment unnecessary.

Humans↗

PubMed1991

Extracorporeal shock-wave lithotripsy and endoscopy: combined therapy for problematic bile duct stones.

Endoscopic treatment of bile duct stones is currently successful in 86% of patients. We prospectively studied the efficacy and complication rate of extracorporeal shock-wave lithotripsy (ESWL) of problematic bile duct stones combined with endoscopy. When stone removal was not possible, patients were subjected to ESWL. Fragmented stones were removed endoscopically. During 1 year, 220 patients presenting with choledocholithiasis were diagnosed and 188 were successfully treated endoscopically. In all, 3 subjects received alternative treatment and the remaining 29 (13%) constituted our study group; 19 (65%) were women and the mean age was 76.7 years. Overall, 22 (76%) were high-risk patients; 23 (79%) were jaundiced and 9 (31%) had cholangitis at admission. The most frequent indication for ESWL was stone size. Stone fragmentation was achieved in 80% of cases. Complications were mild and were managed conservatively. No patient died. Complete stone clearance was possible in 23 (80%) cases. The association of ESWL and endoscopy enhanced the success rate of endoscopic stone clearance from 86% to 96%. During the same period, open surgery was performed in 4 cases for residual common bile duct (CBD) stones and in 32 cases in association with simultaneous cholecystectomy.

Aged↗