Faculty Bibliography

PURPOSE/OBJECTIVE:The most difficult portion of laparoscopic pyeloplasty is the intracorporeal suturing involved in the anastomosis. We identified whether there is a difference in outcomes between a laparoscopic hand sewn anastomosis and a robotic assisted anastomosis. MATERIALS AND METHODS/METHODS:We studied 29 patients who underwent pyeloplasty in the last 30 months, including a robotic assisted procedure in 15, a laparoscopic procedure in 12 and an aborted procedure in 2. RESULTS:Followup was 10 to 122 weeks (average 41). All surgeries except 1 were deemed successful by resolution of hydronephrosis on ultrasound and symptomatic criteria. Intraoperative time for robotic assisted pyeloplasty was 150 to 290 minutes (average +/- SD 223.1 +/- 46.5). Laparoscopic time was 200 to 285 minutes (average 236.5 +/- 24.1). CONCLUSIONS:Robotic assisted and laparoscopic anastomosis produced similar outcomes in pediatric patients who underwent pyeloplasty. Overall operative times did not vary significantly between the 2 procedures. There appeared to be no quantifiable benefits between the 2 procedures.

The ability to access selectively distal nerve branches at the level of the compound pudendal nerve (PN) would allow control of multiple neural pathways and genitourinary functions at a single location. Nerve cuff electrodes can selectively stimulate individual fascicles; however the PN fascicular anatomy is unknown. The fascicular representation of distal branches was identified and traced proximally to create fascicle maps of 12 compound PNs in seven cadavers. Distal nerves were represented as groups of individual fascicles in the PN. Fascicle maps were consistent between specimens and along the PN within specimens. PN branch free length was 26+/-7.7 mm. PN cross-sections were relatively flat with major and minor diameters of 4.3+/-0.90 and 1.7+/-0.45 mm, respectively. Placing a nerve cuff on the PN is anatomically and surgically feasible. The PN fascicular anatomy, branch free length, and cross-section geometry are conducive to selective stimulation of distal nerves with a single nerve cuff electrode.

PURPOSE OF REVIEW/OBJECTIVE:Energy-based tumor ablative techniques are under development for the minimally invasive treatment of renal cell carcinoma. Radiofrequency ablation has recently entered phase II clinical trials for the treatment of small renal tumors. The authors review the status of these clinical trials. RECENT FINDINGS/RESULTS:Radiofrequency ablation has shown reproducible tumor destruction in both animal models and recent clinical trials. Radiographic follow-up of radiofrequency ablated small renal tumors demonstrates little or no residual contrast enhancement depending on tumor size, location within the kidney, and mode of delivering radiofrequency energy. Pathologic evaluation of ablated tumors shows more variability in outcome, with many tumors demonstrating small areas of viable residual tumor. SUMMARY/CONCLUSIONS:Radiofrequency ablation shows promise for the minimally invasive treatment of small renal tumors but will remain experimental until the resolution of certain technical issues.