Lessons learned from a case of calf compartment syndrome after robot-assisted laparoscopic prostatectomy.

Robot-assisted laparoscopic prostatectomy is rapidly gaining favor as a minimally invasive method to surgically address prostate cancer. The sophisticated equipment and unique positioning requirements of this technology require exceptional preparation and attention to detail to minimize the chance of surgical complications. We present the case of a 57-year-old man who developed left calf compartment syndrome after (robot-assisted laparoscopic prostatectomy) requiring fasciotomies. We use this example to highlight specific areas of risk unique to the da Vinci Surgical System® using intraoperative photos to show danger areas as well as review basic positioning requirements common to all prolonged pelvic surgeries performed in Trendelenburg position.

Complications of laparoscopic renal surgery.

PURPOSE: Laparoscopic renal surgery has become a standard of care over the past decade worldwide. Although more complex laparoscopic renal procedures are being routinely performed worldwide today, complications can occur with any laparoscopic operation. Intraoperative and postoperative complications may occur in patients undergoing laparoscopic renal procedures by urologic surgeons with all degrees of laparoscopic experience. We reviewed the complication rate in patients undergoing laparoscopic renal procedures at a single institution by an experienced laparoscopic surgeon. MATERIALS AND METHODS: We retrospectively reviewed the electronic medical records of patients who underwent laparoscopic renal surgery at the University of Iowa from August 2001 to November 2008. RESULTS: Four hundred twenty-one consecutive laparoscopic renal operations were performed by a single surgeon, consisting of 168 radical nephrectomies, 99 donor nephrectomies, 52 simple nephrectomies, 66 partial nephrectomies, and 36 nephroureterectomies, with a total of 52 complications (12.3%): 20 (11.9%) for radical nephrectomy, 9 (9%) for donor nephrectomy, 3 (5.8%) for simple nephrectomy, 12 (18.2%) for partial nephrectomy, and 8 (22.2%) for nephroureterectomy. The vast majority of complications were minor and resulted in no residual disability. CONCLUSIONS: Despite its advantages, laparoscopic renal surgery is not without its inherent risk of complications for the patient, and a thorough informed consent is crucial to maintain realistic patient expectations. Our results reveal complication rates comparable to those of published series in the literature.

Laparoscopic management of caliceal diverticulum.

INTRODUCTION: Minimally invasive approaches for the treatment of symptomatic caliceal diverticula have become the standard of care. Laparoscopy has been embraced by many urologists and now accounts for many commonly performed approaches to urologic surgery. The laparoscopic approach to treating symptomatic caliceal diverticula adds yet another tool in the urologist's armamentarium for this pathologic entity. MATERIAL AND METHODS: Laparoscopy for symptomatic caliceal diverticula can be performed on both anteriorly and posteriorly located lesions using either an intraperitoneal or extraperitoneal approach. The goals of the laparoscopic approach are similar to that of percutaneous surgery; the overlying capsule and parenchyma are excised, stones, if present are removed, and the cavity marsupialized. RESULTS: The success rate for laparoscopically treated symptomatic caliceal diverticula is good with greater than 90 percent rates of cavity obliteration and stone removal and an approximately 75 percent rate of symptom resolution. CONCLUSIONS: Minimally invasive approaches to urologic disease continue to advance. The laparoscopic approach to treating symptomatic caliceal diverticula provides yet another reliable method for treating this problem and should be considered by urologists versed in laparoscopic technique.