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Laparoscopic Anatrophic Nephrolithotomy: Feasibility Study in a Chronic Porcine Model

2003; Lippincott Williams & Wilkins; Volume: 169; Issue: 2 Linguagem: Inglês

10.1016/s0022-5347(05)63994-8

1527-3792

Jihad Kaouk, Inderbir S. Gill, Mihir Desai, KEVIN L.W. BANKS, Shanker Raja, Marek Skacel, Gyung Tak Sung,

Paleopathology and ancient diseases

No AccessJournal of UrologyINVESTIGATIVE UROLOGY1 Feb 2003Laparoscopic Anatrophic Nephrolithotomy: Feasibility Study in a Chronic Porcine Model JIHAD H. KAOUK, INDERBIR S. GILL, MIHIR M. DESAI, KEVIN L.W. BANKS, SHANKER S. RAJA, MAREK SKACEL, and GYUNG TAK SUNG JIHAD H. KAOUKJIHAD H. KAOUK More articles by this author , INDERBIR S. GILLINDERBIR S. GILL More articles by this author , MIHIR M. DESAIMIHIR M. DESAI More articles by this author , KEVIN L.W. BANKSKEVIN L.W. BANKS More articles by this author , SHANKER S. RAJASHANKER S. RAJA More articles by this author , MAREK SKACELMAREK SKACEL More articles by this author , and GYUNG TAK SUNGGYUNG TAK SUNG More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)63994-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Anatrophic nephrolithotomy performed via open surgery involves incising the renal parenchyma along an avascular plane to remove a large, complex renal stone. We determined the feasibility of performing laparoscopic anatrophic nephrolithotomy in a survival porcine model. Furthermore, we present a novel technique of creating a staghorn calculus in the porcine model. Materials and Methods: After developing the technique in 3 pigs the survival study was performed in 10 consecutive animals. The procedure comprised 2 aspects. 1) We developed an animal model for staghorn calculi by retrograde injection of polyurethane (Fomo Products, Inc., Norton, Ohio) into the renal pelvis through a ureteral catheter. For a 2-week period the staghorn calculus was allowed to create hydronephrosis. 2) Laparoscopic anatrophic nephrolithotomy was done, involving control of the renal artery and vein, in situ renal hypothermia with ice slush in 1 animal, lateral renal parenchymal incision, stone extraction and suture repair of the incised collecting system and renal parenchyma. Results: Synthetic stone formation and laparoscopic anatrophic nephrolithotomy were successful in all 10 animals, including 1 that underwent staged bilateral anatrophic nephrolithotomy. Mean operative time for anatrophic nephrolithotomy was 125 minutes. Mean blood loss was 68 cc and mean warm ischemia time was 30 minutes (range 23 to 39). A residual small pelvicaliceal calculus was noted postoperatively in the initial 3 cases only. Thereafter, routine intraoperative ultrasonography and flexible endoscopy were done for stone localization, resulting in a stone-free rate of 100% in all 7 remaining animals. Diethylenetriamine pentaacetic acid renal scans documented improvement in the glomerular filtration rate from a mean of 26.4 ml. per minute after stone creation and hydronephrosis to 54.8 ml. per minute 4 to 5 weeks after laparoscopic anatrophic nephrolithotomy. Conclusions: Laparoscopic techniques can be applied to complex stone surgery such as anatrophic nephrolithotomy with encouraging surgical and functional outcomes. To our knowledge this report represents the initial study of in situ creation of experimental staghorn calculi and laparoscopic anatrophic nephrolithotomy performed completely intracorporeally in a chronic porcine model. References 1 : Anatrophic nephrotomy and plastic calyrhaphy. J. Urol1968; 99: 521. 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Unpublished data Google Scholar From the Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Departments of Nuclear Medicine and Pathology and Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byBagetti Filho H, Pereira-Sampaio M, Favorito L and Sampaio F (2008) Pig Kidney: Anatomical Relationships Between the Renal Venous Arrangement and the Kidney Collecting SystemJournal of Urology, VOL. 179, NO. 4, (1627-1630), Online publication date: 1-Apr-2008.PREMINGER G, ASSIMOS D, LINGEMAN J, NAKADA S, PEARLE M and WOLF J (2018) CHAPTER 1: AUA GUIDELINE ON MANAGEMENT OF STAGHORN CALCULI: DIAGNOSIS AND TREATMENT RECOMMENDATIONSJournal of Urology, VOL. 173, NO. 6, (1991-2000), Online publication date: 1-Jun-2005.CHERULLO E, GILL I, PONSKY L, BANKS K, DESAI M, KAOUK J, MERANEY A, SKACEL M and SUNG G (2018) Laparoscopic Ureterocalicostomy: A Feasibility StudyJournal of Urology, VOL. 169, NO. 6, (2360-2364), Online publication date: 1-Jun-2003. Volume 169Issue 2February 2003Page: 691-696 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordskidneypolyurethaneskidney calculilaparoscopyswineMetricsAuthor Information JIHAD H. KAOUK More articles by this author INDERBIR S. GILL More articles by this author MIHIR M. DESAI More articles by this author KEVIN L.W. BANKS More articles by this author SHANKER S. RAJA More articles by this author MAREK SKACEL More articles by this author GYUNG TAK SUNG More articles by this author Expand All Advertisement PDF downloadLoading ...