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Objective To explore the causes,management and prevention of major blood vessel injury during urological laparoscopic surgery.Methods Six cases of major blood vessel injuries happened in 1700 laparoscopic surgeries from January 2007 to July 2011.All of the cases were males.Patient age was (53 ± 14) years.There were 4 extraperitoneal and 2 transperitoneal procedures including 3 adrenalectomies,1 radical cystectomy,1 radical prostatectomy and 1 radical nephrectomy.There were lacerations in 3 cases of vena cava,2 cases of external iliac vein and one case of renal vein.The length of laceration was (0.68 ±0.29) cm and blood lost was (114 ++ 79) ml.Results Five of the patients were managed with laparoscopic techniques by suction compressing bleeding sites,dissecting related vessels,adding extra trocar and repairing laceration by suturing in four cases and clipping bleeding site in one case.The bleeding control management lasted (21.0 ± 5.6) min.One laparoscopic adrenalectomty for the treatment of pheochromocytoma converted to open surgery because of increasing blood pressure.All the patients were followed up for (4 ± 2) months.No more related complication occurred.Conclusions Lymph node dissection,local adhesion and energy source are the main causes for blood vascular injuries.This kind of injuries may occur at any stages during a laparoscopic surgery and laparoscopic repairing is safe and feasible.
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Objective To discuss the surgical treatment of contracted bladder caused by ketamine abuse. Methods Twenty-five ketamine male abusers were included in this study.The ages were from 19 to 28 years old and mean age was 24 years old.AIl of them had abused ketamine history for 0.7 tO 4.0 years,and presented with severe lower urinary tract symptoms.including severe frequency,urgency,urge incontinence,and painful haematuria.Urine cultures were negative.Hepatic function and renal function were normal.B ultrasound examination of 23 cases demonstrated the presence of bilateral hydronephrosis,the separation of renal pelvic was(1.8±0.7)cm.B ultrasound examination of 22 cases demonstrated residual urine was 45-1 50 ml,mean 80 m1.Twenty-three IVU investigations demonstrated the presence of bilateral hydronephrosis with calyces renales minores cycloidal expansion and bladder contraction.All the patients took the urodynamies with bladder capacity was (89±34)ml,end filling detrusor pressure was(48±26)cm H2O,Qmax was(7.8±2.3)ml/s,residual urine volume was(82±47)m1.All patients had cystoscopies and random biopsies performed showed ulcerative cystitis only.All patients were required to withdraw the narcotics and the experimental medicines were given without symptoms alleviated.Sigmoid cystoplasty was performed in all the 25 patients. Results The mean follow up was 18 months(rang 6 to 36).Compared with that before operation, bladder capacity increased to (375 ±53)ml, end filling detrusor pressure reduced to( 13 ±9)cm H2O, Qmax increased to(17.6±5.8)ml/s, residual urine volume reduced to(20±10)ml.Compared with the preoperative, there were statistically significant differences.There was no complained of urinary incontinence, enuresis, frequency, urgency.Urine routine examination was normal.IVU showed the vesicoureteral reflux disappeared in all patients, and calyces renales no expansion or calyces renales minores light degree expansion.B ultrasound examination that the separation of renal collecting was(1.0 ±0.5)cm. Conclusions Sigmoidcystoplasty could increase bladder capacity and compliance, lower the intravesieal pressure.It could improve the patients' quality of life.
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Objective To explore the surgical skills and clinical value of transperitoneal laparoscopic radical nephrectomy.Methods Laparoscopic radical nephrectomy was performed on 70 patients with renal cancers through the transperitoneal approach. After the lateral peritoneum was dissected, the vessels in the renal pedicle was controlled and the nephrectomy was carried out. Results The transperitoneal laparoscopic radical nephrectomy was completed in all the 70 patients without conversion to open surgery. The operation time was 90-230 min with a mean of 130 min. No patient received blood transfusion intra- and postoperation. No severe complications occurred in this series. The hospital stay was 4-8 d with a mean of 6.2 d. The patients were followed up for 2-78 months (mean, 47); no recurrence of renal tumor was found during this period. Conclusions Transperitoneal laparoscopic radical nephrectomy shows high clinical value owing to its advantages in minimal injury, safety, feasibility, and quick postoperative recovery.
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Objective To investigate the clinical application of robot-assisted laparosocopic ureterolithotomy.Methods The clinical data of 28 cases(15 males and 13 females),aged 42(18～72),of laparosocopic ureterolithotomy with AESOP system(computer Motion,USA) was analyzed.Of the 28 cases,18 patients had upper ureter stones and 10 had middle ureter stones.Results All procedures were completely performed by robot assisted laparosocopic ureterolithotomy.The operative time was ranged from 35 to 150 min(averaged 50 min) and the intraoperative blood loss was ranged from 20 to 50 ml(averaged 30ml).The postoperative hospital time was 3 to 5 days and no ureter stricture or recurrent calculus was found during the follow-up period(2～13 months).Conclusion The ZEUS AESOP system has the characteristics of high intelligence and humanization.The robot-assisted laparoscopic ureterolithotomy is effective,safe and precise.