SubjectIndex - Springer978-1-60761-676-4/1.pdf · SubjectIndex...
Transcript of SubjectIndex - Springer978-1-60761-676-4/1.pdf · SubjectIndex...
Subject Index
Note: The letters ‘f’ and ‘t’ following locators refer to figures and tables respectively.
AAblative renal procedures, complications of
abdominal wall/skin complicationsangiographic embolization, renal bleeding, 273damage to intercostal arteries, prevention, 273electrical skin burns following RFA, prevention, 273inadvertent nerve damage, prevention, 273intercostal vessel injury by RFA, 273fpain/paresthesia, 272
complications unrelated to ablative technique, 274damage to surrounding structures
calyceal obstruction, permanent urothelial damage, 271fcolon injury, 271damage to genitofemoral nerve, effects, 271“finder needle” insertion, percutaneous access, 270injury to pleural cavity, 271lateral tumors/tumors near surrounding organs, imaging
techniques, 270perirenal urinoma formation, 271prevention, pre-operative imaging, 270supine spiral CT scan of patients for ablation process,
270urinary tract in ablation zone, indications, 271
general surgical considerationsknowledge of patient medical/surgical history, 270laparoscopic surgery, contradictions to, 270patients treated under sedation, 270percutaneous ablation, choice of anesthesia in, 270
indications and anatomic considerationspatients eligible for ablation, 268percutaneous/laparoscopic approach based on tumor
location, 268infectious complications
patients at risk, 273–274intraoperative/postoperative hemorrhage
bleeding during laparoscopic ablation, management, 272perirenal hematoma formation by RFA, 272fprimary risk factor, 272selective angioembolization, postoperative management,
272renal treatment
RFA/cryotherapy, 267safety/complications
avoidance maneuvers and management of complications,269t
cryoablation/RFA, study, 269laparoscopic ablation, higher rate of complications, 269
technique for laparoscopic ablation, 268technique for percutaneous ablation, 268
ACC, see American College of Cardiology (ACC)Accessory neural pathways (ANP), 219, 221fAccess techniques to peritoneal cavity
direct trocar entry, 75Hasson technique, 74STEP procedure, 74–75Veress needle approach, 74
Acute-phase proteins, 23–24Acute postoperative hemorrhage, 205ADH, see Antidiuretic hormone (ADH)Adrenal vascular injury, 120AHA, see American Heart Association (AHA)“Air lock,” 5Alternative laparoscopic surgical techniques, comparing
hand-assisted laparoscopic nephrectomy, 131–132laparoendoscopic single-port surgery for donor
nephrectomy, 132retroperitoneoscopic donor nephrectomy, 132robotic-assisted laparoscopic donor nephrectomy, 132
American College of Cardiology (ACC), 9American Heart Association (AHA), 9American Society of Anesthesiologists’ (ASA), 7Anastomotic leaks, 59, 67–70, 199, 241–242Anatomic restoration technique (ART), 216–218
in robotic radical prostatectomyanatomic restoration of vesicourethral junction, 218fbiomechanical forces acting on vesicourethral
anastomosis, 217fsites of postulated biomechanical instability, 216, 217f
Anesthesia and management of anesthetic complicationsmaintenance of cardiovascular function
end of surgery and postanesthesia, 15induction, 14intra-peritoneal insufflation, 14–15positioning, 15See also Cardiovascular function, maintenance
management of oxygenation and ventilationarterial oxygen tension in head-up patients, 16FRC, oxygen reservoir, 16head-down positioning, study, 16optimal inspired oxygen fraction, 16oxygen storage during apnea, 16PEEP, 17pressure/volume-controlled ventilations, 16
307R. Ghavamian (ed.), Complications of Laparoscopic and Robotic Urologic Surgery,DOI 10.1007/978-1-60761-676-4, C© Springer Science+Business Media, LLC 2010
308 Subject Index
Anesthesia and management (cont.)preoperative evaluation and preparation
ASA physical status classification, see ASA physicalstatus classification system
Angiographic embolization, 53, 273ANP, see Accessory neural pathways (ANP)Antidiuretic hormone (ADH), 22Arrhythmias, 4, 9, 15, 208, 281ART, see Anatomic restoration technique (ART)Arterial injury, 154Arteriovenous fistula (AVF), 52–53, 54f, 149–150, 154, 240ASA, see American Society of Anesthesiologists’ (ASA)ASA Difficult Airway Algorithm, 12ASA physical status classification system
ACC/AHA, algorithm/type of surgery planned, 9–10anesthesiologists, role in patient evaluation, 8category E, 8category I, 7–8category II, 7–8category III, 7–8category IV, 7–8category V, 7–8category VI, 8invasive laparoscopic urological surgery, schema, 9laboratory testing, criteria, 8OSA, obesity issue
diagnosis of, polysomnography, 11Pickwickian Syndrome, 11
patient’s airway anatomy examination, 11–12anesthetic induction method, 13ASA Difficult Airway Algorithm, principles of, 12–13LMA ventilation, 12Mallampati airway classification, 12patient’s empty/full stomach literature/study, guidelines,
13–14pulmonary aspiration, risk factors, 13
pulmonary disease identification by history (Roizen)asthmatic patients, treatment, 11auscultation of lungs with stethoscope, 10chest x-ray, 10lung function improvement, preoperative measures, 11PFT, 10risk assessment/reduction of PPCs, guidelines, 11
AVF, see Arteriovenous fistula (AVF)
BBiocompatible liquid polymers, 79Bladder injuries, 59, 67, 74, 137, 248, 249t, 250, 255, 255t, 257,
287–288, 302Bladder neck intussusception (BNI), 215Bladder perforation, 137, 281f, 288, 302Bleeding/vascular injury, RPLND complications
intraoperative bleeding, control, 173–174IVC/aortic injuries, 174laceration of the aorta, control, 174vascular clamping and intracorporeal suturing, 174
BNI, see Bladder neck intussusception (BNI)Bowel complications, 83t–84t
associated with access, 74–75laparoscopic and robot-assisted adrenalectomy, 82
laparoscopic and robot-assisted laparoscopic pyeloplasty,85–86
laparoscopic and robot-assisted LNU, 85laparoscopic and robot-assisted LPN, 85laparoscopic and robot-assisted LRPLND, 86laparoscopic and robot-assisted nephrectomy, 82–85laparoscopic and robotic-assisted laparoscopic radical
prostatectomy, 87f, 88laparoscopic and robotic radical cystectomy, 86–87
Bowel injuries, 47, 73–75, 75t, 77, 78f, 79, 79t, 83t–84t, 88,95, 108–109, 118–119, 123–124, 132–133, 164–165,167–168, 174, 177–178, 193, 201t, 202–203,206–208, 249t, 250, 255, 255t, 257, 263t, 265,286–287, 299, 300–301
Bowel/visceral injury during LRNareas of injury risk, 123perforated viscus
Bishoff’s reports, 123bowel injury by port placement/closure, 123mechanical/antibiotic bowel preparation, 123post-operative bowel obstruction by ischemic colonic
stenosis, 123post-operative melena, 123–124
Brachial plexus injuries, 37, 39Bradycardia, 4, 14–15, 191, 191t, 201–202Breakage, 92t, 96Burch coloposuspension, laparoscopic
complications, see Complications of laparoscopic Burchcoloposuspension
extraperitoneal/intraperitoneal approach, 248laparoscopic approach, advantages, 248port placement, 248surgical principles, 247–248suture/mesh placement, comparitive study, 248
CCardiac arrhythmias, 15, 208, 281Cardiac Risk Index (Goldman), 8Cardiovascular consequences of laparoscopic surgery
cardiac function and venous return, outcomes, 22CO2 absorption and hypercarbia, effect of, 22pneumoperitoneum, mechanical effects of
cardiac output in hypovolemic dogs, study, 21high-/low-pressure pneumoperitoneum, randomized
study/results, 21–22increased IAP, effects in human/dogs, 21
renal perfusion and function, effectseffect of pneumoperitoneum on renal function, clinical
trials, 23intra-abdominal pressure effects in human, study, 22–23intra-abdominal pressure effects in pigs, study, 22oliguria, 22
Cardiovascular function, maintenanceend of surgery and postanesthesia
pulmonary edema, causes, 15induction
control of high blood pressure by vasopressors, 14intravenous fluid administration to reduce heart rate, 14
intra-peritoneal insufflationcardiac arrhythmias, treatment, 15
Subject Index 309
CO2 embolization, signs/treatment, 14increased abdominal pressure, effects, 14–15
positioning, 15Carter-Thomason device, 48Cavernosal nerves (CN), 219Cerebral blood flow, 4Chimney effect, 125Chylous ascites
diagnosis, 175imaging of abdomen/lymphatic system, 175lymphangiography/lymphoscintigraphy, 175
lymphocele formation, management, 175–176milky drainage presentation, 175symptoms, 175treatment
octreotide, use of, 175peritoneovenous shunting, 175refractory ascites, placement of surgical clip/suture, 175,
176fsalt restriction and diuretics, 175
Classic “mill wheel” murmur, 5Class II major histocompatibility (MHC-II) molecule, 26CN, see Cavernosal nerves (CN)CO2 embolus, 5, 47, 129, 286CO2 gas physiology
bone, largest potential reservoir, 20CO2 pneumoperitoneum, 20maximum storage capacity, 20transportation in blood, forms, 20
CO2 insufflationpulmonary/cardiovascular/hemodynamic effects
arrhythmias, 4bradycardia, 4pressure effects of 10 and 20 mmHg
pneumoperitoneum, 4trenin–angiotensin–aldosterone stimulation, 4
Compartment syndrome, 35, 37–38, 86, 115t, 118, 165, 168,181t
See also Well leg compartment syndrome (WLCS)Complications of ablative renal procedures
abdominal wall/skin complicationsangiographic embolization, renal bleeding, 273damage to intercostal arteries, prevention, 273electrical skin burns following RFA, prevention, 273inadvertent nerve damage, prevention, 273intercostal vessel injury by RFA, 273fpain/paresthesia, 272
complications unrelated to ablative technique, 274damage to surrounding structures
calyceal obstruction, permanent urothelial damage, 271fcolon injury, 271damage to genitofemoral nerve, effects, 271“finder needle” insertion, percutaneous access, 270injury to pleural cavity, 271lateral tumors/tumors near surrounding organs, imaging
techniques, 270perirenal urinoma formation, 271prevention, pre-operative imaging, 270supine spiral CT scan of patients for ablation
process, 270urinary tract in ablation zone, indications, 271
general surgical considerationsknowledge of patient medical/surgical history, 270laparoscopic surgery, contradictions to, 270patients treated under sedation, 270percutaneous ablation, choice of anesthesia in, 270
indications and anatomic considerationspatients eligible for ablation, 268percutaneous/laparoscopic approach based on tumor
location, 268infectious complications
patients at risk, 273–274intraoperative/postoperative hemorrhage
bleeding during laparoscopic ablation,management, 272
perirenal hematoma formation by RFA, 272fprimary risk factor, 272selective angioembolization, postoperative management,
272renal treatment
RFA/cryotherapy, 267safety/complications
avoidance maneuvers and management ofcomplications, 269t
cryoablation/RFA, study, 269laparoscopic ablation, higher rate of complications, 269
technique for laparoscopic ablation, 268technique for percutaneous ablation, 268
Complications of laparoscopic and robotic adrenal surgeryaccess-related complications
causes, 106open access technique, safer method, 106
bowel injuries, 108–109complications of retroperitoneal laparoscopic
adrenalectomy, 111complications of robotic-assisted adrenalectomy, 111diaphragmatic/pleural injuries, 110indications and techniques
categories, 103laparoscopic adrenalectomy, contradictions, 104large/small adrenal lesions, indications, 104left retroperitoneal laparoscopic adrenalectomy, 106left transperitoneal laparoscopic/robotic
adrenalectomy, 105operative approaches, 104retroperitoneal approach, 105–106right retroperitoneal laparoscopic adrenalectomy, 106right transperitoneal laparoscopic/robotic adrenalectomy,
104–105liver, pancreas, and splenic injury, 109–110postoperative hormonal complications, 110vascular complications
adrenal vein ligation, 107bipolar vessel-sealing devices, 107hemorrhage, prevention, 107injury to IVC at junction of right adrenal vein by
adrenalectomy, 107, 108fintraoperative bleeding, management, 107–108
Complications of laparoscopic and robotic pyeloplastydiagnosis of complications
CT, study of choice, 183CT urogram demonstrating small leak, 183, 184f
310 Subject Index
Complications of laparoscopic (cont.)KUB demonstrating left ureteral stent out of position
following robotic pyeloplasty, 183, 184fretroperitoneal bleeding, diagnosis, 183
literatureconversion of LP to OP, study, 179intraoperative complication rates, study, 178–179minimally invasive pyeloplasty in upper urinary tract
anamolies, 179postoperative complication rates, LP/RALP study, 179,
180t–181ttypes of laparoscopic reconstruction, 178urinary leak, risk factors, 181
operative planningbowel preparation prior to surgery, 181diuretic renal scans, 181preoperative planning, steps, 181secondary repair considerations, 181surgeon’s preference/experience of minimally
invasive/RALP surgery, 181–182transperitoneal/retroperitoneal approach, selection
of, 182prevention of complications
aberrant vessels, detection, 183anastomotic suturing by robotic assistance, 182fibrosis prevention around ureter, 182Laparoscopic Doppler probe, identification of crossing
vessels, 183, 183flaparoscopic suturing, 182peri-operative care, 182spatulation of ureter with Potts scissors, 182furine leak management, 183urinoma formation, reduced risk of, 183
procedureanastomosis by robotic techniques, 178, 178fpatient positioning, 177prophylactic antibiotics administration, 177renal pelvis and ureter dissection, 177, 178fstone removal after UPJ obstruction, 177–178trocar placement, 177ureteral stent, postoperative removal, 178
RALP/LP, benefits over laparoscopy, 177treatment of complications
early restricturing, treatment, 185hematoma management, 184repeat stenting/nephrostomy tube placement for acute
obstruction, 185stent obstruction/migration, 184urinary leakage, management, 184
Complications of laparoscopic and robotic ureteral surgerydiagnosis of complications
bleeding signs, 193–194renal ultrasound, obstruction/clot evaluation, 194urinoma differentiated from urine leak by CT scan, 193,
194fliterature
complications of ureteral reimplantation, 190–191complications of ureteroureterostomy and other ureteral
surgery, 191–192management of complications
bleeding, 194
recurrence of primary ureteral stricture, 195stent migration, 195tension at anastomosis, 194–195urinary extravasation, 194
operative techniquesinfrequently performed ureteral procedures, 189–190ureteral reimplantation, 189ureteroureterostomy, 187–188
prevention and managementlaparoscopic/robotic urologic reconstructive
procedures, 193preoperative preparation and planning, 192–193
UPJO, treatment options, 187vesicoureteral reflux disease/ureteral strictures,
treatment, 187Complications of laparoscopic Burch coloposuspension,
247–248intraoperative/perioperative complications
excessive blood loss, 250–251perioperative morbidities, 251small bowel obstruction, 251transient urinary retention, management of, 251unrecognized bowel injury, 250vaginal injury, 250wound infection, 251
long-term complicationspelvic organ prolapse, 252urinary retention, 251–252urinary urgency, 251
lower urinary tract injuryfluoroscopic cystogram/CT, diagnostic study, 250intraoperative complications, 249tintraoperative detection, 250post-operative bladder injury, symptoms, 250post-operative presentation of sutures, 250tack erosion into bladder, cases, 250
Complications of laparoscopic donor nephrectomycase description, 128–129comparing alternative laparoscopic surgical techniques
hand-assisted laparoscopic nephrectomy, 131–132laparoendoscopic single-port surgery for donor
nephrectomy, 132retroperitoneoscopic donor nephrectomy, 132robotic-assisted laparoscopic donor nephrectomy, 132
donor complications, see Donor medical complications;Donor surgical complications
injuries during graft extractionbladder perforation, 137graft injury, 137–138
overall complication ratesBMI above 30 kg/m2, higher complication rate, 129donor characteristics, 130tgraft/recipient complications, 131intraoperative/postoperative complications, 131Kocak classification scheme, 131largest study in Maryland, reports, 129, 130tmodification of Clavien classification system
(Kocak), 129operative outcomes, 130t
recipient complicationseffects of pneumoperitoneum on the graft, 138–139
Subject Index 311
ureteral strictures and complications, 139WIT, 138
renal mobilizationgeneral anatomic considerations, 134
vascular dissection and hilar controldissection and ligation of tributary vessels, 135lymphatic injury and chylous ascites, 136renal artery and vein division, 135–136secondary sensory complications, 136–137
Complications of laparoscopic RPLNDbleeding and vascular injury
intraoperative bleeding, control, 173–174IVC/aortic injuries, 174laceration of the aorta, control, 174vascular clamping and intracorporeal suturing, 174
chylous ascites, 175–176ejaculatory dysfunction, 175intraoperative/early postoperative/delayed
postoperative, 173laparoscopic RPLND, procedure
port placement, 171, 172fposterior peritoneum incision, 172postoperative management, 173precaval residual mass dissection following
chemotherapy, 173fretrocaval dissection by “split-and-roll” technique,
172–173, 173fspermatic cord dissection, 172, 172f
organ injurybowel injury, 174cholecystectomy for gallbladder injury, 174clinical diagnosis, 174intestinal abrasions, use of silk suture, 174mesenteric artery injury, 175pancreatic injury, 174renal vascular injury, 175splenic/liver injury, treatment,
174–175unrecognized ureteral injuries, symptoms, 174ureter injury, prevention, 174
RPLND, treatment of NSGCTindications in low-stage NSCGT, 171postchemotherapy laparoscopic RPLND, 171
small bowel obstruction, 176Complications of laparoscopic pelvic organ prolapse
intraoperative/perioperative complications, 249tbowel injury, 255infection, 256lower urinary tract injury, 254–255, 255tvaginal injury, 255–256
long-term complicationsdyspareunia and bowel dysfunction, 257mesh erosion or extrusion, 256–257recurrence of pelvic organ prolapse,
257–258voiding dysfunction, 257
Complications of LPNarterial injury, 154hemorrhage
intraoperative bleeding, 147–148postoperative bleeding, 149–150
hemorrhagic congestion, 155infection, 154–155in the largest series, 149tLPN for solid renal masses, indications, 143LPN, goal, 143NSS, cancer control, 143PSMs
management, 152prevention, 152
RAP, 154risk factors, 155surgical technique
control of the vessels, 144follow-up, 146reconstruction, 144–146tumor excision, 144See also Surgical technique, LPN
urinary leakagemanagement, 151prevention, 151
urinary obstruction, 154WIT
management, 153prevention, 153–154
Complications of pediatric urologic surgeryaccess
bowel perforation, 284fentry-related complications, 283–284epigastric vessel injury at trocar insertion site, 284fiatrogenic iliac vessel injury, 285fimproper port closure, complications, 286insufflatant migration, complications, 286location of port placement, variations, 285port placement and operative strategy, 283fvascular/visceral injury by aggressive needle placement,
284, 284fVeress needle technique, peritoneal approach, 283f
anesthesiacardiac arrhythmias, 281CO2 insufflation due to increased IAP, 280oxygen impairment, 281
complication rates for laparoscopic renal procedures inpediatric population, 281t
complication rates for laparoscopic surgery in pediatricpopulation, 280t
during endoscopic surgery, 281fintraoperative
vascular injury, 286–287viscous injury, see Viscous injury
positioningadequate padding of pressure points, reduced risk of
injury, 282preoperative undocking of robot, 282proper fixation of patient to the bed, 282rate of neuromuscular injuries, 282shear size of the da Vinci R© robot wrt patient, critical
factor, 282, 282fpostoperative
anticipation of risks by surgeons, 289growing level of surgeon experience, benefits, 289infection and herniation, 289
312 Subject Index
Complications of pediatric urologic surgery (cont.)large vessel bleeds, 288spontaneous ventilation impairment, 288Veress needle technique, caution, 289
Complications of RARCaccording to Dindo–Clavien classification system, 238t–239tcystectomy-related complications
bowel leak/enterocutaneous fistula, 242bowel obstruction, 241–242hemorrhage, 237–240prolonged postoperative ileus, 240–241rectal injury, 240venous thromboembolism, 242–243wound infection/fascial dehiscence, 243
diversion-related complicationsureteroenteric anastomotic stricture, 243urine leak, 243
Complications of robotic-assisted laparoscopic surgeryClavien classification of surgical complications, 91tdoulogenic complications
breakage, 96burns, 97ECM or PSM malfunction, 96electrical events, 96–97survey of AEs reported to the FDA MAUDE, 95, 96t
‘FDA approval,’ 93iatrogenic complications
hemorrhage, 93MAUDE, application/limitations, 94non-injurious complications, 95port site hematoma, 93in robotic environment, 93survey of AEs by FDA MAUDE, 95
robotic accidents, 97–98robotic surgery, advantages/disadvantages, 93technical terms used
associated with da Vinci Surgical SystemTM, 92tdoulogenic complications, 92ECM, 92executor/effector unit, 92iatrogenic complications, 92marginal manipulator, 92PSM, 92“robotic,” 91–92
types of complications in RALP, 93, 94tComplications of robotic partial nephrectomy
diagnosis of complicationsbowel injury, 164–165hemorrhage, 164renal insufficiency, 166rhabdomyolysis, 165urine leak, 163–164See also Diagnosis of RALPN complications
intra-operative complications, 162literature
contemporary RALPN series, 162ttypes of complications of RALPN, 162t
partial nephrectomyLPN, 159RALPN, 159treatment of renal tumors, 159
post-operative complications, 162pre-operative technique
bowel preparation, 159identification of renal veins, 160instruments used, 160landmarks identified, 160laparoscopic ultrasound probe, tumor exposure, 160patient positioning, 159positioning of robotic ports, 159, 160frobotic vs. laparoscopic partial nephrectomy, 161
treatment/prevention of complicationsbowel injury, 167–168hemorrhage, 167renal insufficiency, 168rhabdomyolysis, 168urine leak, 166–167See also Treatment/prevention of RALPN complications
Complications of robotic prostatectomyanesthesia-related complications (<0.1%)
corneal abrasions, 202fluid management, 201increased intraabdominal pressure, effects, 201infiltration of intravenous fluids, prevention, 201–202sinus bradycardia, 201
bowel complications (0.2%), 206–207delayed complications
continence, 208potency, 208
lymphocele (0.2%), 207medical complications (0.5%)
low incidence of, factors, 207–208non-vascular access-related complications (0.1%)
open/closed technique, study, 202–203subcutaneous emphysema and air embolism (0%), 202visceral injury (0.1%), 202–203
postoperative anemia and blood transfusionacute postoperative hemorrhage (1.9%), 205meticulous hemostasis, 205patients with chronic anticoagulation, 205
postoperative ileus (0.7%), 206rectal injury (0.3%)
in patients with clinical T3/Gleason 8 or 9 disease, 204posterolateral effects, 204post-operative, repair of, 204recto-vesical fistula, 204
retropubic radical prostatectomy, complication rates, 197technique of VIP
apical dissection and urethral transection, 199bladder neck transection and posterior dissection, 198developing extraperitoneal space, 198lymph node dissection, 198nerve sparing, 198–199patient positioning and port placement, 198patient selection, 198postoperative care, 200–201specimen retrieval, 200suprapubic catheter placement, 200urethrovesical anastomosis, 199–200
treatment of prostate cancer (US), 197ureteral injury (<0.1)
during extended pelvic lymphadenectomy, 204
Subject Index 313
ureteral orifice obstruction during urethrovesicalanastomosis, 204
urinary ascites (0.7%)chemical peritonitis/ileus, 205early continence prevention by two-layer anastomosis,
206patients with unexplained postoperative pain after 48h,
management, 206furinary retention (1.5%), 207vascular complications (<0.1%)
access related, 203access unrelated, 203–204
Complications of single port laparoscopic/robotic surgerysingle port surgery
flexible tip laparoscopes/coaxial flexible operatinginstruments, 261
intraoperative image of multichannel port, 262fLESS surgery, 262natural orifice translumenal endoscopic surgery, 262pain control and cosmesis, benefits, 262selected single port urologic surgery series, 263t
single port surgical complicationsbowel/ureteral injuries, 263Clavien Classification system of long/short-term
complications, 264conversions from single port to standard laparoscopic
procedures, complications, 264–265German study of complication rates, 263–264patient selection, 265reconstructive procedures, complications, 265R-Port device, use of, 264scar image after single port laparoscopic donor
nephrectomy, 266fsingle port laparoscopic surgery in urology (Kaouk and
colleagues), 264single port urologic surgery (Rane and colleagues), 264vascular/infectious complications, 263
Continence, 208Corneal abrasions, 202CPK, see Creatinine phosphokinase (CPK)C-reactive proteins, 24–25Creatinine phosphokinase (CPK), 133, 165, 168Crushing and trapping accidents, 97Cryotherapy, 212, 264, 267, 269, 272Cytokines, 23–28, 36
DDeep venous thrombosis (DVT), 5, 51, 54–56, 82, 93, 115t,
118, 127, 133, 207–208, 241, 243, 264, 298–299Delay under anesthesia (DUA), 95–96Denonvilliers’ fascia, 198–199, 199f, 208, 214, 215f, 220,227Desmopressin, 62Devascularization injury, 63Diagnosis of RALPN complications
bowel injuryrecognized/unrecognized, evaluation of, 164–165
hemorrhagehematuria, delayed hemorrhage, 164immediate post-operative bleeding, effects/prevention,
164
intra-operative hemorrhage, prevention, 164mild gross hematuria, detection, 164post-operative hemorrhage, 164
renal insufficiencyrenal ischemia, 166renal ultrasound, 166renal vascular occlusion, 166WIT, study reports, 166
rhabdomyolysisfasciotomy for compartment syndrome, 165operative intervention for gluteal compartment
syndrome, 165risk factors, 165
urine leakCT urogram study, 164f, 165maximal drainage of urinary tract, methods, 164methylene blue injection into renal pelvis, 163ureteral catheter placement, 163
Diaphragmatic/pleural injuries, 110, 111fDirect nerve injuries, 36, 38Distal ureteral tumors, 116Diuresis, 5, 37, 133, 154, 168Donor medical complications
long-term complications of renal loss and donor safety,139–140
Donor surgical complicationspositioning and surgical entry
DVT, 133pulmonary edema, 133rhabdomyolysis, 133trocar injuries, 133
Doulogenic complications, 92breakage, 96burns, 97ECM or PSM malfunction, 96electrical events, 96–97survey of AEs reported to the FDA MAUDE,
95, 96tDUA, see Delay under anesthesia (DUA)Duodenal artery bleeding, 124Duodenal injury
dissection-related, treatment of, 124duodenal artery bleeding, 124
DVT, see Deep venous thrombosis (DVT)
EECM, see Endoscopic camera manipulator (ECM)ECM/PSM malfunction, 96Ejaculatory dysfunction, 175Electrical events in doulogenic complications,
94t, 96–97Endopyelotomy, 62Endoscopic camera manipulator (ECM), 92, 92tEnergy devices, 5Epigastric vessel injury, repair methods, 48
Carter-Thomason device, 48continuous venous oozing, 48ffascial closures devices, 48Foley catheter, use of, 48open suture ligation via cut-down technique, 48
314 Subject Index
Erectogenic nerve preservation, anatomyfascial planes surrounding prostate capsule
capsular incision, 222LPF, 221prostatic fascia/levator fascia, 221
NVB/CNcross section of adult prostate with NVB situated
posterolaterally, 220fIHP, role in erection/ejaculation/urinary continence, 219
the tri-zonal conceptanatomic findings from cadaveric dissections, 221NVBs in prostatic fossa after removal of prostate gland,
222fperiprostatic nerves, surgical zones, 220, 222f
variations of course of neurovascular bundles, 219ESS, see European scoring system (ESS)European scoring system (ESS), 118
FFascial closures devices, 48FH, see Fractionated heparin (FH)Fiber-optic laryngoscopy, 12Fibrin glue, 61, 144–145, 150, 174Flank position for urologic procedures
advantages, 36neuromuscular complications
brachial plexus injury, 37peroneal nerve injury, 36sciatic nerve injury, 36shoulder pain, 36
FloSeal, 109–110, 134, 150, 166–167,223, 272
Foley catheter, 48, 61–62, 66–67, 69–70, 69f, 129, 137,163, 166–167, 173, 178, 180t, 183–184, 187, 189,193–194, 198–200, 199f, 203, 205, 207, 215f, 248,250, 255, 284, 287–288
Fractionated heparin (FH), 56, 298FRC, see Functional residual capacity (FRC)Functional residual capacity (FRC),
14, 16, 281Furosemide, 37, 154, 168
GGastrointestinal/solid organ injuries
location of injury/treatment and outcome, 76tpancreatic injury, 79recognized bowel injury
large thermal injury and bowel resection,77–79, 78f
small thermal injury and repair, 77, 77fsplenic injury, control of, 79ten patients with laparoscopic bowel injury,
summary of, 75tunrecognized bowel injury, signs/symbols, 79, 79t
GCS, see Graduated compression stockings (GCS)German Urologic Association (GUA), 119Gibson incision, 116, 119Graduated compression stockings (GCS), 56, 243Graft extraction, injuries during
bladder perforation, 137graft injury, 137–138
Graft injury, 137–138GUA, see German Urologic Association (GUA)Gynecologic laparoscopy, 46, 63, 295, 297
HHALNU, see Hand-assisted laparoscopic nephroureterectomy
(HALNU)HALRN, see Hand-assisted laparoscopic renal surgery
(HALRN)Hand-assisted laparoscopic nephrectomy, 131–132Hand-assisted laparoscopic nephroureterectomy (HALNU), 85Hand-assisted laparoscopic renal surgery (HALRN), 82Harmonic scalpel (Ethicon), 49, 108f, 128, 134, 145Hasson technique, 74, 128, 133, 283, 300Hematopoiesis, 23Hematuria, 53, 64, 117, 124, 154, 164, 167, 180t, 181t, 203,
250–251, 255, 271, 287–288Hemorrhage, LPN complications
intraoperative bleedingcase study, 148during parenchymal resection, 147–148upon renal revascularization, 148
postoperative bleedingacute, 149delayed, 149management, 149prevention, 150
Hemorrhagic congestion, 155HLA-DR, see Human leukocyte antigen DR (HLA-DR)Hormonal complications, postoperative, 110
hypotension, cause/treatment, 110inadequate steroid replacement, effects, 110serum/urine hormone levels, preoperative evaluation, 110
Human leukocyte antigen DR (HLA-DR), 26
IIatrogenic complications, 92
hemorrhage, 93MAUDE, application/limitations, 94non-injurious complications, 95port site hematoma, 93in robotic environment, 93survey of AEs by FDA MAUDE, 95
ICIQ-SF, see International Consultation on IncontinenceQuestionnaire-Short Form (ICIQ-SF)
ICP, see Intracranial pressure (ICP)IHP, see Inferior hypogastric plexus (IHP)Impact or collision accidents, 97Inferior hypogastric plexus (IHP), 212, 216, 219, 222Informed consent, definition, 296Injury to blood vessels
bleeding in dorsal venous complexpostoperative duplex scanning, 51prevention, robotic techniques, 50, 50f4th arm/dissecting robotic arms, use in suture prepared,
50, 51fvessel repair under optimal control, 50, 51f
Subject Index 315
collateral circulation, outcomes, 49dissection/trocar or Veress needle insertion, cause, 48increase of intraabdominal pressure to 25 mmHg, 50laparoscopic suction devices with laparotomy pads, 48–49,
49frenal artery injury
monopolar electrocautery/surgical clips for hemostasis,49
tools used for repair, 49Interleukin-1 (IL-1), 24, 26Intermittent pneumatic compression (IPC), 56, 243, 298International Consultation on Incontinence Questionnaire-Short
Form (ICIQ-SF), 213Intracranial pressure (ICP), 4Intra-operative complications of LRN/LNU, 115t
bowel and visceral injury, see Bowel/visceral injury duringLRN
injury to adjacent structuresduodenal injury, treatment, 124liver injury by port placement, 124pancreatic injury, 124splenic injury, 124
port site injuries, placement/closure, 118–119prolonged operative time, 118vascular injury, see Vascular complications
Intraoperative vascular complicationsvascular injury during abdominal access
aortic/vena caval bifurcation at umbilicus, cause of, 47correct placement of Veress needle, 47inadequate reporting of major injuries, consequences, 47injury to epigastric vessels, repair methods, 48mortality rates, access-related vascular injuries, 46safer laparoscopic techniques/devices, 47surgeon experience, critical factor, 47–48trocar-related injuries, 46
Intra-peritoneal insufflation, 14–15IPC, see Intermittent pneumatic compression (IPC)Ischemic colonic stenosis, 123
JJackson–Pratt drainage time, 61
LLaparoendoscopic single-port surgery for donor nephrectomy,
132Laparoendoscopic single-site (LESS) surgery, 262Laparoscopic and robotic adrenal surgery, complications of
access-related complicationscauses, 106open access technique, safer method, 106
bowel injuries, 108–109complications of retroperitoneal laparoscopic
adrenalectomy, 111complications of robotic-assisted adrenalectomy, 111diaphragmatic/pleural injuries, 110indications and techniques
categories, 103laparoscopic adrenalectomy, contradictions, 104large/small adrenal lesions, indications, 104
left retroperitoneal laparoscopic adrenalectomy, 106left transperitoneal laparoscopic/robotic adrenalectomy,
105operative approaches, 104retroperitoneal approach, 105–106right retroperitoneal laparoscopic adrenalectomy, 106right transperitoneal laparoscopic/robotic adrenalectomy,
104–105liver, pancreas, and splenic injury, 109–110postoperative hormonal complications, 110vascular complications
adrenal vein ligation, 107bipolar vessel-sealing devices, 107hemorrhage, prevention, 107injury to IVC at junction of right adrenal vein by
adrenalectomy, 107, 108fintraoperative bleeding, management, 107–108
Laparoscopic and robotic pyeloplasty, complications ofdiagnosis of complications
CT, study of choice, 183CT urogram demonstrating small leak, 183, 184fKUB demonstrating left ureteral stent out of position
following robotic pyeloplasty, 183, 184fretroperitoneal bleeding, diagnosis, 183
literatureconversion of LP to OP, study, 179intraoperative complication rates, study, 178–179minimally invasive pyeloplasty in upper urinary tract
anamolies, 179postoperative complication rates, LP/RALP study, 179,
180t–181ttypes of laparoscopic reconstruction, 178urinary leak, risk factors, 181
operative planningbowel preparation prior to surgery, 181diuretic renal scans, 181preoperative planning, steps, 181secondary repair considerations, 181surgeon’s preference/experience of minimally
invasive/RALP surgery, 181–182transperitoneal/retroperitoneal approach, selection of,
182prevention of complications
aberrant vessels, detection, 183anastomotic suturing by robotic assistance, 182fibrosis prevention around ureter, 182Laparoscopic Doppler probe, identification of crossing
vessels, 183, 183flaparoscopic suturing, 182peri-operative care, 182spatulation of ureter with Potts scissors, 182furine leak management, 183urinoma formation, reduced risk of, 183
procedureanastomosis by robotic techniques, 178, 178fpatient positioning, 177prophylactic antibiotics administration, 177renal pelvis and ureter dissection, 177, 178fstone removal after UPJ obstruction, 177–178trocar placement, 177ureteral stent, postoperative removal, 178
316 Subject Index
Laparoscopic and robotic pyeloplasty (cont.)RALP/LP, benefits over laparoscopy, 177treatment of complications
early restricturing, treatment, 185hematoma management, 184repeat stenting/nephrostomy tube placement for acute
obstruction, 185stent obstruction/migration, 184urinary leakage, management, 184
Laparoscopic and robotic ureteral surgery, complications ofdiagnosis of complications
bleeding signs, 193–194renal ultrasound, obstruction/clot evaluation, 194urinoma differentiated from urine leak by CT scan, 193,
194fliterature
complications of ureteral reimplantation, 190–191complications of ureteroureterostomy and other ureteral
surgery, 191–192management of complications
bleeding, 194recurrence of primary ureteral stricture, 195stent migration, 195tension at anastomosis, 194–195urinary extravasation, 194
operative techniquesinfrequently performed ureteral procedures, 189–190ureteral reimplantation, 189ureteroureterostomy, 187–188
prevention and managementlaparoscopic/robotic urologic reconstructive procedures,
193preoperative preparation and planning, 192–193
UPJO, treatment options, 187vesicoureteral reflux disease/ureteral strictures, treatment,
187Laparoscopic apical prolapse repair
laparoscopic uterosacral fixation, 253sacrocolpopexy
hysterectomy, higher incidence of mesh erosion, 254port placement, 254fsurgical principles of open abdominal sacrocolpopexy,
253–254Laparoscopic Burch coloposuspension, complications of,
247–248intraoperative/perioperative complications
excessive blood loss, 250–251perioperative morbidities, 251small bowel obstruction, 251transient urinary retention, management of, 251unrecognized bowel injury, 250vaginal injury, 250wound infection, 251
long-term complicationspelvic organ prolapse, 252urinary retention, 251–252urinary urgency, 251
lower urinary tract injuryfluoroscopic cystogram/CT, diagnostic study, 250intraoperative complications, 249tintraoperative detection, 250
post-operative bladder injury, symptoms, 250post-operative presentation of sutures, 250tack erosion into bladder, cases, 250
Laparoscopic cholecystectomy, 23–26, 93, 261, 295, 302Laparoscopic cystocele repair
Behnia-Willison reports on, 253pubocervical fascia, identification, 253transvaginal colporrhaphy with/without biograft, 252–253
Laparoscopic donor nephrectomy, 5, 73, 121–122, 127–140,266f, 300
Laparoscopic donor nephrectomy, complications ofcase description, 128–129comparing alternative laparoscopic surgical techniques
hand-assisted laparoscopic nephrectomy, 131–132laparoendoscopic single-port surgery for donor
nephrectomy, 132retroperitoneoscopic donor nephrectomy, 132robotic-assisted laparoscopic donor nephrectomy, 132
donor complications, see Donor medical complications;Donor surgical complications
injuries during graft extractionbladder perforation, 137graft injury, 137–138
overall complication ratesBMI above 30 kg/m2, higher complication rate, 129donor characteristics, 130tgraft/recipient complications, 131intraoperative/postoperative complications, 131Kocak classification scheme, 131largest study in Maryland, reports, 129, 130tmodification of Clavien classification system (Kocak),
129operative outcomes, 130t
recipient complicationseffects of pneumoperitoneum on the graft, 138–139ureteral strictures and complications, 139WIT, 138
renal mobilizationgeneral anatomic considerations, 134
vascular dissection and hilar controldissection and ligation of tributary vessels, 135lymphatic injury and chylous ascites, 136renal artery and vein division, 135–136secondary sensory complications, 136–137
Laparoscopic Doppler probe, 160, 164, 183, 183fLaparoscopic gas insufflation physiology
CO2, role, 20‘ideal’ insufflation gas, 19nitrous oxide as an insufflant, 20pneumoperitoneum effects, 19
Laparoscopic nephroureterectomy (LNU), 28, 85, 113–125,116, 143
Laparoscopic orchiopexy, 278, 302Laparoscopic partial nephrectomy (LPN), 29–30, 59, 60f, 62,
64f, 85, 93, 143–155, 159, 161–162, 166, 267–268,302
Laparoscopic pelvic organ prolapsecomplications, see Complications of laparoscopic pelvic
organ prolapseprocedures for management
laparoscopic apical prolapse repair, 253–254
Subject Index 317
laparoscopic cystocele repair, 252–253laparoscopic rectocele repair, 253
treatment oflaparoscopic/robotic-assisted procedures, long-term
efficacy, 252laparoscopic sacrocolpopexy, 252pelvic compartments, defects in, 252
Laparoscopic pyeloplasty (LP), 62, 85–86, 177, 180t, 181t, 187,192–193, 282f, 302
Laparoscopic pyeloplasty, urinary complicationsclot formation due to postoperative bleeding, 62diagnosis/management, 62Foley catheter drainage/JJ stents for maximum drainage, 62robotic-assisted LP/conventional LP, meta-analysis, 63urinary extravasation, improper management
scarring, 62ureterocalicostomy for repeat pyeloplasty, 62
Laparoscopic radical nephrectomy (LRN), 28–29, 49, 55f, 81f,82, 113–125, 143–144, 268, 301
Laparoscopic radical prostatectomy (LRP), 55, 67, 87f, 88, 93,214, 223, 225
Laparoscopic reconstruction, typesAnderson–Hynes dismembered pyeloplasty, 178Y–V plasty, 178
Laparoscopic rectocele repairkey steps, 253transvaginal approach, 253
Laparoscopic retroperitoneal lymph node dissection (LRPLND),45, 86, 171–176
Laparoscopic/robotic reconstructive procedureslaparoscopic Burch colposuspension, 247–248
complications of, 248–252See also Burch coloposuspension, laparoscopic
pelvic floor disordersadvantages of laparoscopic approach, 247
pelvic organ prolapsecomplications of, 254–258laparoscopic procedures for management, 252–254laparoscopic treatment of, 252See also Laparoscopic pelvic organ prolapse
SUIlaparoscopic treatment for, 247other laparoscopic procedure for, 248See also Stress urinary incontinence (SUI)
Laparoscopic/robotic urologic reconstructive procedures,complications
bleeding, 193recurrence of primary pathology, 193stent migration (proximal or distal), 193tension at anastomosis, 193urinary extravasation, 193
Laparoscopic RPLND, complications ofbleeding and vascular injury
intraoperative bleeding, control, 173–174IVC/aortic injuries, 174laceration of the aorta, control, 174vascular clamping and intracorporeal suturing, 174
chylous ascites, 175–176ejaculatory dysfunction, 175intraoperative/early postoperative/delayed postoperative,
173
laparoscopic RPLND, procedureport placement, 171, 172fposterior peritoneum incision, 172postoperative management, 173precaval residual mass dissection following
chemotherapy, 173fretrocaval dissection by “split-and-roll” technique,
172–173, 173fspermatic cord dissection, 172, 172f
organ injurybowel injury, 174cholecystectomy for gallbladder injury, 174clinical diagnosis, 174intestinal abrasions, use of silk suture, 174mesenteric artery injury, 175pancreatic injury, 174renal vascular injury, 175splenic/liver injury, treatment, 174–175unrecognized ureteral injuries, symptoms, 174ureter injury, prevention, 174
RPLND, treatment of NSGCTindications in low-stage NSCGT, 171postchemotherapy laparoscopic RPLND, 171
small bowel obstruction, 176Laparoscopic surgery and systemic immune response
cell-mediated immunity and response to surgical trauma, 25cytokine/acute-phase proteins response to injury
C-reactive proteins, 24hematopoiesis/leukopoiesis, regulation of, 23IL-6 levels, prolonged tissue injury, 24sources of cytokines, 23TNF-α and IL-1, response to injury, 24
cytokine/acute-phase response on pneumoperitoneumblood analysis, immune/stress response, 25CRP levels, laparoscopic/open cholecystectomy study,
24IL-6 levels, laparoscopic/mini-cholecystectomy groups,
25IL-6 levels, open/laparoscopic nephrectomy in porcine
model, 24effects on cell-mediated inflammatory response
HLA-DR expression, 26neutrophil function, post laparotomy/laparoscopy,
25–26PHA skin testing, 26
effects on peritoneal immunityinsufflation of CO2, effects, 27laparoscopy/laparotomy effects on peritoneal host
defenses in pigs, 27L. monocytogenes administration in mice, study, 27
peritoneal immunity and immune response to surgerycellular response to intraperitoneal inflammation, phases,
26peritoneal macrophages, role, 26TNF and IL-6 levels, cytokine response, 26
Laparoscopic suturing, complications, 182Laparoscopic ultrasound probe, 160Laparoscopy and tumor immunity
port-site metastases, 28–29Lapra-Ty clips, 108, 109f, 144–145, 160, 167, 182Laparoscopic ablation technique, 268
318 Subject Index
Laparoscopic effects on urine outputadequate fluid maintenance, 5diuresis, laparoscopic donor nephrectomy, 5oliguria, 5
Laparoscopic pelvic organ prolapse, complications ofintraoperative/perioperative complications, 249t
bowel injury, 255infection, 256lower urinary tract injury, 254–255, 255tvaginal injury, 255–256
long-term complicationsdyspareunia and bowel dysfunction, 257mesh erosion or extrusion, 256–257recurrence of pelvic organ prolapse, 257–258voiding dysfunction, 257
Laryngeal mask airway (LMA), 12Lateral pelvic fascia (LPF), 219–220, 220f, 221f, 222–225, 226fLateral prostatic fascia nerve-sparing technique, 197LDUH, see Low-dose unfractionated heparin (LDUH)Left retroperitoneal laparoscopic adrenalectomy, 106Left transperitoneal laparoscopic/robotic adrenalectomy
extensive splenic mobilization, 105left adrenal vein identification/dissection, 105trocar positioning, 105
LESS surgery, see Laparoendoscopic single-site (LESS) surgeryLeukopoiesis, 23Ligasure (Valley Lab), 49LigaSure vessel-sealing device, 120Listeria monocytogenes, 27Liver, pancreas, and splenic injury, 109–110LMA, see Laryngeal mask airway (LMA)LMWH, see Low molecular weight heparin (LMWH)LNU, see Laparoscopic nephroureterectomy (LNU);
Laparoscopic nephroureterectomy (LNU)Long/short urine leaks, management, 61Low-dose unfractionated heparin (LDUH), 56Lower tract urinary complications
anastomotic leaks after robotic/laparoscopic prostatectomybladder neck contractures, risk, 67LRP, anastomotic leakage after, 67–68RALP, study results (450 patients review), 67scarring, 67
bladder injuries, 67presentations of anastomotic leaks, 68–70, 68f–69f
follow-up CT cystogram with no leak, 70fLow molecular weight heparin (LMWH), 56LP, see Laparoscopic pyeloplasty (LP)LPF, see Lateral pelvic fascia (LPF)LPN, see Laparoscopic partial nephrectomy (LPN)LPN, urinary leakage after
diagnosis, 60–61kidney obstruction, importance, 60urethral catheter, use of, 60urinary extravasation after LPN, 60f
future direction, 62leak-specific complication rate, 60management of urine leaks
concomitant retrograde pyelogram, 61Jackson–Pratt drain as siphon to keep leak open, 61flong/short urine leaks, 61placement of ureteral stents, 61
prolonged leakage prevention, 61–62urostomy collection appliance, 61
overall urologic complication rate, 60urologic complication rate, LPN/OPN groups, 60
LRN, see Laparoscopic radical nephrectomy (LRN)LRN/LNU, complications, 114t
complications affecting oncologic outcometumor seeding prevention, 125TUR site recurrence, factors, 125urologic literature of port site recurrence, cases, 125
ESS classification of laparoscopic procedures, 118intra-operative complications, 115t
bowel and visceral injury, see Bowel/visceral injuryduring LRN
injury to adjacent structures, 124port site injuries: placement and closure, 118–119prolonged operative time, 118vascular injury, see Vascular injury during LNU
laparoscopic learning curve of complication rates, 118tpost-operative complications, 115t, 124surgical approach
management of the distal ureter for nephroureterectomy,116–117
retroperitoneal, 116transperitoneal, 113–115
LRP, see Laparoscopic radical prostatectomy (LRP)LRPLND, see Laparoscopic retroperitoneal lymph node
dissection (LRPLND)Lymphangiography, 175Lymphatic injury and chylous ascites, 136Lymphoceles, 173, 175, 207–208Lymphoscintigraphy, 175
MMAG3, see Tc-99m mercaptotriacetylglycine (MAG3)Male continence mechanism, anatomy of
dual basis for continence control, 212male urethral sphincter complex, components, 212, 213furethral rhabdosphincter, 212
Male cystoprostatectomy, operative stepsanterior exposure and apical dissection, 235–236control of vascular pedicles and mobilization of NVB, 235crossing of the ureter, 236development of anterior rectal space, 234–235, 235fdevelopment of lateral pelvic space, 234, 235fdevelopment of periureteral space, 234
anatomical landmarks for the technique of spaces, 234fsurgical development of avascular spaces, 233–234
Malpractice and minimally invasive urologic surgeryanesthetic considerations
increased intraabdominal pressure, effects, 298for patients with COPD, 298physiologic changes to be monitored by anesthesiologist,
298bowel injury, 300–301conversion to open
simple/donor nephrectomy, conversion rates, 301DVT
non-randomized study, 298patients at high risk, heparin treatment, 298
Subject Index 319
pneumatic compression devices, use of, 298risk factors, 298–299
fundamental principles, minimally invasive techniques, 295informed consent
Australian Law Reform Commission document,disclosure of risks, 296
Bolitho case, 296case of Canterbury v. Spence (1972), 296case of Natanson v. Kline (1960), 296critical elements of, 296tdegree of disclosure, 296electronic consent form system, emergence of, 297English tort law, 296factors to be considered, 296, 297tpre-operative documentation in medical records, 297Schloendorff v. Society of New York Hospitals (1914),
view of ‘informed consent,’ 296laparoscopic access
10-step guidelines for closed lapproscopic access, 299tstudy of bowel or retroperitoneal vascular injuries, 299study of trocar injuries, 299trocar entry technique, advantages over Veress needle
technique, 299patient positioning
rhabdomyolysis, increased risk of renal failure, 298ulnar neuropathy, 298
pediatric population, unique aspectsbladder injuries during laparoscopic orchiopexy, 302non-access related complications, 301–302
specific considerations in urologydecision of laparoscopic/robotic approach, criteria,
297–298laparoscopic operations, morbidity/mortality rates, 297risks factors for increased complications, 297
vascular injuryhemostasis, importance, 300injury to epigastric vessels, 300intra-operative management, 300self-locking clip, warning against use, 300
wound closure, 301Mannitol, 22, 37, 138, 144, 154, 160–161, 168Manufacturer and User Facility Device Experience (MAUDE),
94MAUDE, see Manufacturer and User Facility Device
Experience (MAUDE)MAUDE database, 94MDCTA, see Multidetector CT angiogram (MDCTA)Mechanical part accidents, 97–98Metabolic changes and procedure duration
patients with COPD, postoperative care, 5retroperitoneoscopic approach, 5venous stasis, obese patients, 5
Metabolic/renal complications and immunologic implicationscardiovascular consequences of laparoscopic surgery
CO2 absorption and hypercarbia, effect of, 22pneumoperitoneum, mechanical effects of, 21–22renal perfusion and function, effects, 22–23
CO2 gas physiology, 20laparoscopic gas insufflation physiology, 19–20laparoscopic surgery and systemic immune response
cell-mediated immunity and response to surgical trauma,25
cytokine and acute-phase proteins response to injury,23–24
effects of pneumoperitoneum on acute-phase responseand cytokines, 24–25
effects on cell-mediated inflammatory response, 25–26effects on peritoneal immunity, 27–28peritoneal immunity and immune response to surgery,
26–27laparoscopy and tumor immunity
open/laparoscopic radical nephrectomy, comparitivestudy, 28
port-site metastases, 28–29role of laparoscopy on tumor growth, experimental
study, 28renal function complications following laparoscopy
laparoscopic partial nephrectomy, 29–30WIT, impact on renal function, 30
MHC-II molecule, see Class II major histocompatibility(MHC-II) molecule
Minimally invasive urologic surgery, medicolegal aspectsdefinitions
elements of negligence, 294factors determining whether a duty of care exists, 294oncology and endourology, clinical areas in suts, 294Tort law, 293
future considerationsexpert testimony, 303innovations in minimally invasive surgery, 302tort reform, 303training and credentialing, 302–303
and malpracticeanesthetic considerations, 298bowel injury, 300–301conversion to open, 301DVT, 298–299fundamental principles, analysis from minimally
invasive techniques, 295informed consent, 296–297laparoscopic access, 299–300patient positioning, 298pediatric population, unique aspects, 301–302specific considerations in urology, 297–298vascular injury, 300wound closure, 301See also Malpractice and minimally invasive urologic
surgeryoverview of the problem
patients affected by medical errors, reports, 293Montsouris technique, 197Multidetector CT angiogram (MDCTA), 120, 128
NNatural orifice translumenal endoscopic surgery (NOTES), 262Nephron-sparing surgery (NSS), 143, 151, 267Nerve preservation and cancer control
Cornell risk-stratified approachathermal robotic nerve-sparing technique, modifications,
227
320 Subject Index
Nerve preservation and cancer control (cont.)Grade 1 approach, 227Grade 2 approach, 227Grade 3 approach, 227Grade 4 approach, 227planes of dissection for differing grades (I–IV) of nerve
sparing, 227frisk-stratified algorithm, 226f
Neuromuscular complicationsin obese patients, 37overstretching of brachial plexus, 37peroneal nerve injury, 36sciatic nerve injury, 36shoulder pain, 36
Neuropathic pain mechanisms, 36Neurovascular bundles (NVB), 198, 205, 212, 216, 219–223,
222f, 235Non-absorbable polymer ligating (NPL) locking clips, 121Nonseminomatous germ cell tumors (NSGCT), 171NOTES, see Natural orifice translumenal endoscopic surgery
(NOTES)NSGCT, see Nonseminomatous germ cell tumors (NSGCT)NSS, see Nephron-sparing surgery (NSS)NVB, see Neurovascular bundles (NVB)
OOAB, see Overactive bladder (OAB)Obesity hypoventilation syndrome, 11Obstructive sleep apnea (OSA), 11Oliguria, 5
ADH, role in, 22ONUs, see Open nephroureterectomies (ONUs)Open duodenojejunostomy, 124Open Hassan technique, 46Open nephroureterectomies (ONUs), 117Open suture ligation via cut-down technique, 48Operative approaches, adrenal surgery
laparoscopic approach, 104lateral transperitoneal technique, 104
robotic approachthree- or four arm robot, use of, 104
Operative strategies for preservation of sexual functionalternatives to electrocautery
control of lateral prostatic pedicles using atraumaticbulldog clamps, 223f
intraoperative use of KTP laser to mobilize NVB, 224fmaneuvers in radical retropubic prostatectomy, 222nerve reconstruction, 224periprostatic planes of fascial dissection, 224–225
Operative techniques, laparoscopic/robotic ureteral surgeryinfrequently performed ureteral procedures
retrocaval ureter, management, 190RPF, open surgical management, 189–190
ureteral reimplantationanti-reflux procedure, selective cases, 189port placement, 189, 189f
ureteroureterostomyanastomosis of ureter, sutures used, 188complications, 191–1925-Fr open-ended catheter, placement of, 188
port placement, 188, 188frobotic-assisted vs. laparoscopic ureteroureterostomy,
188under undue tension, procedures, 188, 189f
Opsins, 26Organ injury, RPLND complications
bowel injury, 174cholecystectomy for gallbladder injury, 174clinical diagnosis, 174intestinal abrasions, use of silk suture, 174mesenteric artery injury, 175pancreatic injury, 174renal vascular injury, 175splenic/liver injury, treatment, 174–175unrecognized ureteral injuries, symptoms, 174ureter injury, prevention, 174
OSA, see Obstructive sleep apnea (OSA)Overactive bladder (OAB), 251
PPancreatic injury, 79, 82, 110, 124, 174Patient positioning
energy devices, use of, 5lateral decubitus positioning, 5reverse Trendelenburg (head-up) position, 4–5Trendelenburg (head-down tilt) position, 4
Patient side manipulators (PSM), 92Pediatric urologic surgery
complicationsaccess, 283–286anesthesia, 280–282intraoperative, 286–288positioning, 282postoperative, 288–289See also Complications of pediatric urologic surgery
contraindicationsbowel obstruction, 279peritonitis, 279pregnancy, 279role of endoscopic surgery, pediatric urology, 279uncorrectable coagulopathy, 279
laparoscopy versus robotic surgerycost aspects, 280robot disadvantage, immensity of equipment for infant
use, 280robotic interface, advantages to surgeon, 280
patient selectionage/size of patient population, challenges, 279fetal laparoscopic/robotic procedures in animal models,
attempts, 279procedures
endoscopic, in pediatric urologic population, 278fextirpative surgery, 278laparoscopic orchiopexy, 278for neurogenic patients, 279non-palpable testes, diagnosis of, 278reconstructive surgery, 278robotic surgery, 279
Pediatric urologic surgery, complications ofaccess
Subject Index 321
bowel perforation, 284fentry-related complications, 283–284epigastric vessel injury at trocar insertion site, 284fiatrogenic iliac vessel injury, 285fimproper port closure, complications, 286insufflatant migration, complications, 286location of port placement, variations, 285port placement and operative strategy, 283fvascular/visceral injury by aggressive needle placement,
284, 284fVeress needle technique, peritoneal approach, 283f
anesthesiacardiac arrhythmias, 281CO2 insufflation due to increased IAP, 280oxygen impairment, 281
complication rates for laparoscopic renal procedures inpediatric population, 281t
complication rates for laparoscopic surgery in pediatricpopulation, 280t
during endoscopic surgery, 281fintraoperative
vascular injury, 286–287viscous injury, see Viscous injury
positioningadequate padding of pressure points, reduced risk of
injury, 282preoperative undocking of robot, 282proper fixation of patient to the bed, 282rate of neuromuscular injuries, 282shear size of the da Vinci R© robot wrt patient, critical
factor, 282, 282fpostoperative
anticipation of risks by surgeons, 289growing level of surgeon experience, benefits, 289infection and herniation, 289large vessel bleeds, 288spontaneous ventilation impairment, 288Veress needle technique, caution, 289
PEEP, see Positive end-expiratory pressure (PEEP)Pelvic floor disorders, 247Pelvic floor muscle therapy, 214Penile erection, 219Perioperative pulmonary complications (PPCs), 10Peroneal nerve injury, 36PFT, see Pulmonary function testing (PFT)PHA, see Phytohemagglutinin (PHA)Physiological changes with immune function, 5–6Physiology of laparoscopy and pneumoperitoneum
background, 3cerebral blood flow
rise in ICP, causes, 4CO2 embolus
“air lock” in atrium, 5effects on urine output
adequate fluid maintenance, 5diuresis, laparoscopic donor nephrectomy, 5oliguria, 5
metabolic changes and procedure durationpatients with COPD, postoperative care, 5retroperitoneoscopic approach, 5venous stasis, obese patients, 5
patient positionenergy devices, use of, 5lateral decubitus positioning, 5reverse Trendelenburg (head-up) position, 4–5Trendelenburg (head-down tilt) position, 4
pediatricslow pulmonary reserve in children/neonates, 4
physiological changes with immune function, 5–6pulmonary/cardiovascular/hemodynamic effects by CO2
insufflationarrhythmias, 4bradycardia, 4pressure effects of 10 and 20 mmHg pneumoperitoneum,
4trenin–angiotensin–aldosterone stimulation, 4
Phytohemagglutinin (PHA), 26Pickwickian Syndrome, see Obesity hypoventilation syndromePluck technique, 116PNB, see Predominant neurovascular bundle (PNB)Pneumothorax/hemothorax, 271Pneumovax vaccine, 124PNP, see Proximal neurovascular plate (PNP)Polysomnography, 11Port placement injury
bowel injury, 118–119trocar site hernias, 119vascular injury, 118–119
Port site injuries, 118–119Port-site metastases
abdominal wall metastases, cases, 29incidence of metastases, 28–29localization of tumor metastases, factors, 29tumor seeding, experimental/clinical studies, 29
Positional/neuromuscular complications, 36tcompartment syndrome
signs/risk factors, 38WLCS, cause/treatment, 38
direct nerve injuries, 38neuromuscular injury-associated pain, mechanisms
peripheral/central pathway, 36neuromuscular injury associated with robotic surgery
patient position for renal/adrenal laparoscopic surgery,36
patient position for robotic radical prostatectomy, 36patient positions, commonly used, 36
patient positioning considerationsin obese patients, 37pelvic surgery, Trendelenburg in conjunction with
lithotomy position, 37pressure evaluation in skin-to-table surface interfaces, 37radical prostate surgery, exaggerated lithotomy position,
37urologic procedures, flank position, see Flank position
for urologic proceduresprevention
careful patient positioning, 39design of laparoscopic instruments, improvements in, 40gel padding and egg crate for patient positioning, 39lithotomy positioning, WLCS, 40novel/ergonomic position, laparoscopic kidney surgery,
39
322 Subject Index
Positional/neuromuscular complications (cont.)partial flank positioning, 39rhabdomyolysis prevention, 40
rhabdomyolysis, 37–38surgeon’s neuromuscular complications
robotic-assisted laparoscopic surgery vs. standardlaparoscopic surgery, 39
Positive end-expiratory pressure (PEEP), 17Positive surgical margins (PSMs)
clamped/unclamped LPN, study, 152cohort study of 56, 152
overall and cancer specific survival rates, 152management, 152prevention
three-dimensional preoperative imaging/intraoperativeultrasound, 152
tumor resection in bloodless field, 152study of 511 LPN cases, results, 151survey results (Breda), 151
Posterior reconstruction of Denonvilliers’ musculofascial plate(PRDMP), 214, 215f
Postoperative anemia/blood transfusion, robotic prostatectomyacute postoperative hemorrhage (1.9%)
management of postoperative hypotension, algorithm,205f
meticulous hemostasis, 205patients with chronic anticoagulation, 205
Postoperative vascular complicationsdelayed presentation of injuries, reasons/symptoms, 52–53hemorrhagic complications, 52
CT after laparoscopic partial nephrectomy, 52, 53f, 55frenal angiography of patient, 53, 54frenal artery pseudoaneurysm/AVF, 52selective angiographic embolization, treatment, 53
patients at riskdevelopment of DVT, risk factors, 56FH/SCD for venous thrombosis prophylaxis, study, 56pulmonary embolism, common cause of death, 55thromboembolism risk, grouping factors, 56thromboprophylaxis, therapies used, 56
venous thromboembolismDVT/PE, study in prostate cancer patients, 55DVT, risk of, 54prevention, recommendations, 56
Postprostatectomy erectile dysfunction, risk factorspenile erection/tumescence, 219
cholinergic/non-adrenergic non-cholinergic mechanisms,219
sexual dysfunction, 219Postprostatectomy incontinence (PPI), 212
assessmentICIQ-SF/standardized 1-h pad test, 213–214initial evaluation factors of PPI, 213pelvic floor muscle therapy, 214urodynamic studies and urethrocystoscopy, 214
risk factors, 212Potency, 208Pouch of Douglas, 234PPCs, see Perioperative pulmonary complications (PPCs)PPI, see Postprostatectomy incontinence (PPI)
PRDMP, see Posterior reconstruction of Denonvilliers’musculofascial plate (PRDMP)
Predominant neurovascular bundle (PNB), 220Preoperative preparation/planning, laparoscopic/ robotic
ureteral surgeryCT/MR urography, ureteral stricture assessment, 192CT scan, hydronephrosis assessment, 192robotic techniques, advantages, 192transperitoneal/extraperitoneal approach, selection criteria,
193ureteral reconstructive surgical techniques, 192t
Proximal neurovascular plate (PNP), 220PSM, see Patient side manipulators (PSM)PSMs, see Positive surgical margins (PSMs)Pulmonary edema, causes, 15, 131, 133, 139Pulmonary function testing (PFT)
arterial blood gas measurement, 10spirometry, 10
Pulmonary thromboembolization, 14
RRadiofrequency ablation (RFA), 267RALP, see Robotic-assisted laparoscopic prostatectomy
(RALP); Robotic-assisted laparoscopic pyeloplasty(RALP)
RAP, see Renal artery pseudoaneursym (RAP)RARC, see Robot-assisted radical cystectomy (RARC)RARC, technique of
complications, see Complications of RARClymph node dissection, 236–237operative steps for male cystoprostatectomy, 233–236
RCC, see Renal cell cancer (RCC); Renal cell carcinoma (RCC)Recipient complications
effects of pneumoperitoneum on the graft, 138–139ureteral strictures and complications, 139WIT, 138
Release and roll technique, RARC, 236–237Renal artery and vein division, 135–136Renal artery pseudoaneursym (RAP), 52, 154Renal cell cancer (RCC), 267Renal cell carcinoma (RCC), 125Renal function complications following laparoscopic renal
surgery, 29–30Renal hilar vascular anatomy, 120–121Renal hilum, methods of hemostasis, 121–122Renal insufficiency, 29Renal mobilization
anatomic considerationsunique to left kidney, 134unique to right kidney, 134
Retrocaval ureter, 190Retrograde ureteropyelography, 64Retroperitoneal fibrosis (RPF), 189Retroperitoneal laparoscopic adrenalectomy, complications of,
111Retroperitoneoscopic donor nephrectomy, 132Retropubic radical prostatectomy, 197Reverse nephropexy, 188, 189fRFA, see Radiofrequency ablation (RFA)Rhabdomyolysis
Subject Index 323
clinical post-operative symptoms, 37ischemia/death of muscle cells, 37patient positioning, 37prevention, 40risk factors, laparoscopic surgery, 38tissue injury, degree of, 37treatment, 37
Right retroperitoneal laparoscopic adrenalectomy, 106Right transperitoneal laparoscopic/robotic adrenalectomy
liver mobilization, 104right adrenal vein identification/dissection, 104–105trocar positioning, 104
Robot-assisted radical cystectomy (RARC), 233–244Robotic accidents
crushing and trapping accidents, 97impact or collision accidents, 97mechanical part accidents, 97–98
Robotic-assisted adrenalectomy, complications of, 111Robotic-assisted laparoscopic donor nephrectomy, 132Robotic-assisted laparoscopic prostatectomy (RALP), 67Robotic-assisted laparoscopic pyeloplasty (RALP), 177Robotic-assisted laparoscopic surgery, complications of
Clavien classification of surgical complications, 91tdoulogenic complications
breakage, 96burns, 97ECM or PSM malfunction, 96electrical events, 96–97survey of AEs reported to the FDA MAUDE, 95, 96t
‘FDA approval,’ 93iatrogenic complications
hemorrhage, 93MAUDE, application/limitations, 94non-injurious complications, 95port site hematoma, 93in robotic environment, 93survey of AEs by FDA MAUDE, 95
robotic accidents, 97–98robotic surgery, advantages/disadvantages, 93technical terms used
associated with da Vinci Surgical SystemTM, 92tdoulogenic complications, 92ECM, 92executor/effector unit, 92iatrogenic complications, 92marginal manipulator, 92PSM, 92“robotic,” 91–92
types of complications in RALP, 93, 94tRobotic-assisted vs. laparoscopic ureteroureterostomy, 188Robotic partial nephrectomy, complications of
diagnosis of complicationsbowel injury, 164–165hemorrhage, 164renal insufficiency, 166rhabdomyolysis, 165urine leak, 163–164See also Diagnosis of RALPN complications
intra-operative complications, 162literature
contemporary RALPN series, 162t
types of complications of RALPN, 162tpartial nephrectomy
LPN, 159RALPN, 159treatment of renal tumors, 159
post-operative complications, 162pre-operative technique
bowel preparation, 159identification of renal veins, 160instruments used, 160landmarks identified, 160laparoscopic ultrasound probe, tumor exposure, 160patient positioning, 159positioning of robotic ports, 159, 160frobotic vs. laparoscopic partial nephrectomy, 161
treatment/prevention of complicationsbowel injury, 167–168hemorrhage, 167renal insufficiency, 168rhabdomyolysis, 168urine leak, 166–167See also Treatment/prevention of RALPN complications
Robotic prostatectomy, complications ofanesthesia-related complications (<0.1%)
corneal abrasions, 202fluid management, 201increased intraabdominal pressure, effects, 201infiltration of intravenous fluids, prevention, 201–202sinus bradycardia, 201
bowel complications (0.2%), 206–207delayed complications
continence, 208potency, 208
lymphocele (0.2%), 207medical complications (0.5%)
low incidence of, factors, 207–208non-vascular access-related complications (0.1%)
open/closed technique, study, 202–203subcutaneous emphysema and air embolism (0%), 202visceral injury (0.1%), 202–203
postoperative anemia and blood transfusionacute postoperative hemorrhage (1.9%), 205meticulous hemostasis, 205patients with chronic anticoagulation, 205
postoperative ileus (0.7%), 206rectal injury (0.3%)
in patients with clinical T3/Gleason 8 or 9 disease, 204posterolateral effects, 204post-operative, repair of, 204recto-vesical fistula, 204
retropubic radical prostatectomy, complication rates, 197technique of VIP
apical dissection and urethral transection, 199bladder neck transection and posterior dissection, 198developing extraperitoneal space, 198lymph node dissection, 198nerve sparing, 198–199patient positioning and port placement, 198patient selection, 198postoperative care, 200–201specimen retrieval, 200
324 Subject Index
Robotic prostatectomy (cont.)suprapubic catheter placement, 200urethrovesical anastomosis, 199–200
treatment of prostate cancer (US), 197ureteral injury (<0.1)
during extended pelvic lymphadenectomy, 204ureteral orifice obstruction during urethrovesical
anastomosis, 204urinary ascites (0.7%)
chemical peritonitis/ileus, 205early continence prevention by two-layer anastomosis,
206patients with unexplained postoperative pain after 48h,
management, 206furinary retention (1.5%), 207vascular complications (<0.1%)
access related, 203access unrelated, 203–204
Robotic radical prostatectomy, 36Robotic radical prostatectomy, methods/maneuvers of
improvementnerve preservation and cancer control, 225–226optimizing continence recovery
anatomy of male continence mechanism, 213ART, 216–218PPI assessment, 213–214PPI, risk factors, 212surgical maneuvers, see Surgical maneuvers for
optimizing continence outcomesurinary incontinence, effects/treatment, 212
optimizing sexual outcomesbalancing nerve preservation with cancer control, see
Nerve preservation and cancer controlerectogenic nerve preservation, anatomy, 219–221postprostatectomy erectile dysfunction, risk factors,
218–219preservation of sexual function, operative strategies,
see Operative strategies for preservation of sexualfunction
Robotic vs. laparoscopic partial nephrectomy, 161RPF, see Retroperitoneal fibrosis (RPF)R-Port device, use in single port surgery, 264
SSacrocolpopexy, 252–258, 254f, 255tSantorini plexus, 199, 213fScarring treatment, 62SCD, see Sequential compression devices (SCD)Sciatic nerve injury, 36Secondary sensory complications, vascular dissection, 136–137Sequential compression devices (SCD), 5, 50, 56, 159,
177, 200Sexual health inventory for men (SHIM), 208SHIM, see Sexual health inventory for men (SHIM)Single port laparoscopic/robotic surgery, complications of
single port surgeryflexible tip laparoscopes/coaxial flexible operating
instruments, 261intraoperative image of multichannel port, 262fLESS surgery, 262
natural orifice translumenal endoscopic surgery, 262pain control and cosmesis, benefits, 262selected single port urologic surgery series, 263t
single port surgical complicationsbowel/ureteral injuries, 263Clavien Classification system of long/short-term
complications, 264conversions from single port to standard laparoscopic
procedures, complications, 264–265German study of complication rates, 263–264patient selection, 265reconstructive procedures, complications, 265R-Port device, use of, 264scar image after single port laparoscopic donor
nephrectomy, 266fsingle port laparoscopic surgery in urology (Kaouk and
colleagues), 264single port urologic surgery (Rane and colleagues), 264vascular/infectious complications, 263
SMA injury, see Superior mesenteric artery (SMA) injurySmall bowel obstruction, 176Soluble tumor necrosis factor receptors (sTNFR), 24Spermatic cord, 172, 172fSpirometry, 10–11Splenectomy, 79, 124, 134, 269tSplenic injury after LRN/LNU
Pneumovax vaccine, post-splenectomy patients, 124treatment, 124
Splenic injury controlbiocompatible liquid polymers, 79splenectomy, 79
Stapler malfunction, 51–52Stent migration (proximal or distal), 193STEP procedure, 74–75sTNFR, see Soluble tumor necrosis factor receptors (sTNFR)Stress urinary incontinence (SUI)
laparoscopic Burch coloposuspension, see Burchcoloposuspension, laparoscopic
laparoscopic treatment, 247other laparoscopic procedures
laparoscopic-assisted suburethral sling placement, 248use of robotic system, 248
Subcutaneous emphysema, 202SUI, see Stress urinary incontinence (SUI)Superior mesenteric artery (SMA) injury, 120Surgical approach for LRN/LNU
management of distal ureter for nephroureterectomydirect cystoscopic visualization technique/modifications,
116–117LNUs/ONUs, comparitive study, 117mitomycin C induction, 116pluck technique, 116renal dissection in case of tumors, 116
retroperitonealaccess to renal hilum, 116Gaur’s technique, 116initial incision at 12th rib, 116port-site incision, 116
transperitonealdissection of kidney/Gerota’s fascia, 114trocar positioning, 113–114
Subject Index 325
Surgical maneuvers for optimizing continence outcomesbladder neck mucosal eversion, 215BNI, 215optimizing preservation of urethral rhabdosphincter length,
214PRDMP, 214, 215fpreservation of bladder neck and internal sphincter, 214–215preservation of neurovascular bundles and continence
nerves, 216preservation of puboprostatic ligaments and arcus tendineus,
216Surgical technique, LPN
control of vesselsapplication of tourniquet around renal artery, 145fapplication of tourniquet around renal vein, 146fself-made Rummel tourniquet for temporary occlusion,
144ffollow-up
CT or MRI scanning, 146renal function evaluation with 99mTc-MAG3, 146
reconstructionapproximation of interstitial tissue (medulla), 145, 148ffibrin injection, 145oxidized regenerated cellulose placement under suture,
145, 148frenal parenchymal repair by Vicryl suture, 144–145,
148frenal perfusion, 145tightened suture secured by non-resorbable clips, 145,
148ftumor excision
in a bloodless field, 144, 147finduction of ischemia using the Rummel tourniquet, 144,
147fuse of cold Endo-Scissors, aim, 144
Surgicel, 134, 150, 160, 167, 174, 272
TTA stapler, see Thoracoabdominal (TA) staplerTCC, see Transitional cell carcinoma (TCC)Tc-99m mercaptotriacetylglycine (MAG3), 64Thermal ureteral injury, 174Thoracoabdominal (TA) stapler, 121TissueLink R© device, 160, 167Tort law, 293Tort reform, 303Total peripheral nutrition (TPN), 271TPN, see Total peripheral nutrition (TPN)Transitional cell carcinoma (TCC), 85–86, 125Transurethral resection (TUR), 125, 240, 294, 297Treatment of rhabdomyolysis, 37Treatment/prevention of RALPN complications
bowel injuryintra-operative consultation, 168laparotomy, unrecognized bowel injuries, 168
hemorrhagearterial bleeding, control of, 167hemostatic agents, use of, 167immediate/delayed, treatment strategies, 167
renal angiogram of kidney before/after superselectivearterial embolization, 165f, 167
TissueLink R©device, prevention of bleeding off-clamp,167
renal insufficiencyadministration of furosemide, effects, 168administration of mannitol, effects, 168clamping of renal artery, control of bleeding, 168minimizing ischemia, techniques, 168
rhabdomyolysisCK for clinical analysis, 168compartment syndrome, treatment, 168urine alkalinization management, 168
urine leakcombination of sutured surgical bolster and Floseal R©,
166JP drain fluid creatinine, assessment, 166multiple synthetic compounds, use of, 166serial imaging, improvement of urinoma,
166–167Trocar site hernias, 79–82, 80f
closure of fascial defects, benefits, 81formation, influencing host factors, 81higher incidence in closed laparoscopy, 81incidence in gynecologic literature, 81incisional/extraction site hernias, risk factors,
81–82, 81fhand-assisted laparoscopic radical nephrectomy, 82
from 8 mm robotic trocar, 81fparaumbilical region, development site, 81
Tumor necrosis factor (TNF-α), 24TUR, see Transurethral resection (TUR)
UUPJ, see Ureteropelvic junction (UPJ)UPJO, see Ureteropelvic junction obstruction (UPJO)Upper tract urinary complications, 59
ureterolysis, 59urinary complications after laparoscopic pyeloplasty, see
Laparoscopic pyeloplasty, urinary complicationsurinary complications after LPN, see LPN, urinary leakage
afterUreteral injuries
gynecologic laparoscopy, risk factors, 63intra-operative management
laparoscopic uretero-ureterostomy for ureter injured withsuture, 63
tension-free anastomosis, ureter repair, 64, 64fureteral identification, 63
mechanisms ofdivision, ligation, and cauterization, 63
postoperative managementcolorenal fistulas due to prolonged urinoma, 65, 66fCT scans, location/extent of leak determination, 64, 65fproximal ureteral injury, repair techniques, 65retrograde ureteropyelography, 64ultrasound and MAG3 renal scans, 64ureteral stricture formation, complication, 65–66ureterovaginal fistula, diagnosis, 66urinoma treatment, 64, 65f
326 Subject Index
Ureteral reimplantation, 189complications
complication rates, study, 190laparoscopic and robotic-assisted complications, 191tpatient study with laparoscopic ureteroneocystostomy,
190–191postoperative complications, 190urine leak/urinoma, 190
Ureterocalicostomy, 62, 180t, 185Ureterolysis, 59, 188, 192, 250Ureteropelvic junction obstruction (UPJO), 86, 187Ureteropelvic junction (UPJ), 154, 179Ureteroureterostomy, 187–188
anastomosis of ureter, sutures used, 1885-Fr open-ended catheter, placement of, 188port placement, 188, 188frobotic-assisted vs. laparoscopic ureteroureterostomy, 188under undue tension, procedures, 188, 189f
Ureterovaginal fistula, diagnosis, 66“pad test,” 66
Urethral rhabdosphincter, 212, 213f, 214, 215f, 216,217f, 218f
Urinary and urologic complicationslower tract urinary complications
anastomotic leaks after robotic or laparoscopicprostatectomy, 67–68
bladder injuries, 67presentations of anastomotic leaks, 68–70
upper tract urinary complications, 59urinary complications after laparoscopic pyeloplasty,
62–63urinary leakage after LPN, 60–62
ureteral injuriesintra-operative management, 63–64postoperative management, 64–66
Urinary extravasation, 60f, 62, 181–182, 193–194Urinary leakage, LPN complications
frequency of occurrence, 150management, 151
intra-/post-operative, 151overall incidence rates, 150prevention
hemostatic agents/sealants, use of, 151ureteral stent placement for methylene blue injection,
151urinary fistula, suture repair, 150
Urinary obstruction, 154Urinary peritonitis, 205–206Urostomy collection appliance, 61
VVascular complications
incidenceconversion to open surgery, 46dissection injuries, urologic procedure, 45stapler malfunction/accidental dislodgement of vascular
clip, 46trocar-related injuries, nonurologic procedure, 45urologic malignancy, complication, 45
injury to major blood vessels, 48–51
intraoperative, see Intraoperative vascular complicationskey to management, 45postoperative complications, see Postoperative vascular
complicationsstapler malfunction, 51–52
Vascular dissection and hilar controldissection and ligation of tributary vessels, 135lymphatic injury and chylous ascites, 136renal artery and vein division, 135–136secondary sensory complications, 136–137
Vascular injury during LNUadrenal vascular injury
adrenal hemorrhage, 120bleeding, source of, 119–120
control by LigaSure vessel-sealing device, 120renal hilum, methods of hemostasis
failure of hemostatic devices, 121failure of NPL locking clips, 121, 122non-locking titanium clip devices, problems, 122renal artery stump with non-locking metal clip distal to
locking clips, 122frenal artery with two locking/non-locking metal clips
placed distally, 122fstapled and transected renal vein, 123funbladed Endo-GIA stapler, 123fvenous/arterial, endovascular stapler/clip complications,
121–122SMA injury, 120variability in renal hilar vascular anatomy
bleeding from vena cava at hilum, 121Japanese cadaver study, 120LRN/LNU cases of conversion to open surgery,
120–121MDCTA, 120renal vein hemorrhage, 121
Vasoactive substances, 26Vattikuti Institute Prostatectomy (VIP), 197Veil of Aphrodite, see Lateral prostatic fascia nerve-sparing
techniqueVenous thromboembolism, 19, 54–56, 242–243, 298
See also Deep venous thrombosis (DVT)Veress needle approach, 74Vesicovaginal fistula, 66
“double dye pad test,” 66VIP, see Vattikuti Institute Prostatectomy (VIP)VIP technique, robotic prostatectomy
apical dissection and urethral transection, 199bladder neck transection/posterior dissection, 198developing extraperitoneal space, 198lymph node dissection, 198nerve sparing
minimal bipolar coagulation, 198“Veil of Aphrodite” (high anterior release/curtain
dissection), 198patient positioning and port placement, 198patient selection, 198postoperative care
complications in 4,000 patients undergoing VIT, 201tdata collection, 201early ambulation, 200heparin, thromboembolic prophylaxis, 200
Subject Index 327
ketorolac/oral acetaminophen with codeine, pain control,200
liquid diet, recommended, 200–201specimen retrieval, 200suprapubic catheter placement, 200, 200furethrovesical anastomosis
causative factors, 199randomized control study, 199sutures run from 4 o’clock to 11 o’clock position, 200suturing of puboprostatic ligament, 199f, 2003-zero double-armed monofilament sutures to form
posterior plate, 1993-zero double-armed monofilament sutures, use of, 199
Visceral and gastrointestinal complicationsanesthesia, 73bowel complications associated with access
access techniques to peritoneum/retroperitoneum, 74major/minor complications, 74
bowel complications in specific procedures, 83t–84tlaparoscopic and robot-assisted adrenalectomy, 82laparoscopic and robot-assisted laparoscopic pyeloplasty,
85–86laparoscopic and robot-assisted LNU, 85laparoscopic and robot-assisted LPN, 85laparoscopic and robot-assisted LRPLND, 86laparoscopic and robot-assisted nephrectomy, 82–85laparoscopic and robotic-assisted laparoscopic radical
prostatectomy, 88laparoscopic and robotic radical cystectomy, 86–87
gastrointestinal/solid organ injuries, 75–79patient selection, 73trocar site and incisional hernias, 79–82
See also Trocar site herniasViscous injury
hollow viscous injury, 287–288solid organ injury, 288
WWarm ischemia time (WIT)
functional recovery/safety limits, 152management
WIT in open surgery, classification, 153prevention
ischemia, protective mechanisms, 154perfusion reinstitution after suture, 153replacement of knotting by clips, 153retroperitoneal approach, 153techniques of regional hypothermia (WIT>30 min),
153–154transperitoneal approach, 153
study of LPN patients with WIT>30 min, 152–153Well leg compartment syndrome (WLCS)
cause, 38risk factors, 38treatment, 38
WIT, see Warm ischemia time (WIT)WLCS, see Well leg compartment syndrome (WLCS)