Purpose: We performed a nonrandomized retrospective comparison of 2 techniques for laparoscopic p... more Purpose: We performed a nonrandomized retrospective comparison of 2 techniques for laparoscopic partial nephrectomy, that is without and with clamping the renal vessels. Materials and methods: Between December 1997 and February 2002, 28 consecutive patients underwent transperitoneal laparoscopic partial nephrectomy for renal tumor. In group 1 (12 patients) partial nephrectomy was performed with ultrasonic shears and bipolar cautery without clamping the renal vessels, while in group 2 (16 patients) the renal pedicle was clamped before tumor excision. In group 2 patients intracorporeal kidney cooling was achieved by a ureteral catheter connected to 4C solution. Intracorporeal freehand suturing techniques were used to close the collecting system when opened and approximate the renal parenchyma. Results: All procedures were successfully completed laparoscopically. Mean renal ischemia time +/- SD was 27.3 +/- 7 minutes (range 15 to 47) in group 2 patients. Mean laparoscopic operating time was 179.1 +/- 86 minutes (range 90 to 390) in group 1 compared with 121.5 +/- 37 minutes (range 60 to 210) in group 2 (p = 0.004). Mean intraoperative blood loss was significantly higher in group 1 than in group 2 (708.3 +/- 569 versus 270.3 +/- 281 ml., p = 0.014). Three patients in group 1 and 2 in group 2 required blood transfusions. Immediately postoperatively mean creatinine was 1.26 +/- 0.36 and 1.45 +/- 0.61 mg./dl. in groups 1 and 2, respectively (p = 0.075). Surgical margins were negative in all specimens. Pathological examination revealed renal cell cancer in 18 cases (stages pT1 in 17 and pT3a in 1), oncocytoma in 4, angiomyolipoma in 5 and renal adenoma in 1. Conclusions: Laparoscopic partial nephrectomy represents a feasible option for patients with small renal masses. Clamping the renal vessels during tumor resection and suturing the kidney mimics the open technique and seems to be associated with less blood loss and shorter laparoscopic operative time.
INTRODUCTION AND OBJECTIVE: The objectives of laparoscopic partial nephrectomy for renal cell car... more INTRODUCTION AND OBJECTIVE: The objectives of laparoscopic partial nephrectomy for renal cell carcinoma (RCC) should be similar to the open technique. Cold ischemia permits optimal tumor excision and reual reconstruction while preserving renal function. However, cold ischemia with laparoscopic partial nephrectomy remains unsolved. Our video presents a new technique obtaining cold ischemia during laparoscopy. METHODS: Cold ischemia is achieved by cold arterial renal perfusion. Prior to laparoscopy an angiocatheter is passed into the main renal artery through a femoral puncture. The renal artery is clamped by a tourniquet. The renal vein is secured with an umbilical tape, but not occluded. Perfusion is initiated with iced Ringer Lactate at 4 degrees celsius at a rate of 50 cc/min. Renal temperature is continously monitored with a thermoprobe residing in the parenchyma. When a parenchymal temperature of 25 degrees celsius is reached perfusion is reduced to maintain a steady state. Tumor excision is performed in a bloodless field with biopsy taken from the tumor bed. The collecting system is repaired, and renal reconstruction is performed using parenchymal sutures over a hemostatic bolster. All steps are done similar to the open partial nephrectomy. Between November 01 and September 02 nine patients (RCC: 8, pyelonephritic lower pole: 1) were operated using this technique. There were 6 men and 3 woman with a mean age of 52 years (29-67). Mean tumor size was 2.4 ern (2-3.5). RESULTS: Bloodless field was achieved in 8 cases and minor oozing from an accessory renal artery occured in one case. Total ischemia time was 27 to 71 minutes (mean 36 min). Renal hypothermia was maintained at 25 degrees celsius. Estimated blood loss was 30-650 cc (mean 135 cc); only one patient required transfusions. Adequate tumor excision with negative margins was acheived in all cases. One patient had a delayed bleeding which was managed by laparoscopic reexploration, No other postoperative complications were encountered. Postoperative renal function could be investigated in 4 patients with isotope nephrography and was essentially unchanged in all of them. CONCLUSIONS: Our initial experience of incorporating cold ischemia into laparoscopic partial nephrectomy shows the feasibility and safety of this technique. We believe this approach will allow duplication of the principles of the open procedure and makes laparoscopic partial nephrectomy for RCC and complex renal pathology safe and reliable. Source of Funding: None.
Background: Treatment with a natural bone mineral (NBM) and a guided tissue regeneration (GTR) ha... more Background: Treatment with a natural bone mineral (NBM) and a guided tissue regeneration (GTR) has been shown to promote periodontal regeneration. However, until now there are only very limited data on the long‐term clinical results following this regenerative technique.Aim: To present the 5‐year results of a prospective, randomized, controlled clinical study evaluating the treatment of deep intra‐bony defects either with open flap debridement (OFD) and a combination of an NBM and GTR (test) or OFD alone (control).Methods: Nineteen patients diagnosed with advanced chronic periodontitis, and each of whom displayed one intra‐bony defect, received randomly the test or the control treatment. Results were evaluated at baseline, at 1 and at 5 years following therapy.Results: No statistically significant differences in any of the investigated parameters were observed at baseline between the two groups. At 1 year after therapy, the test group showed a reduction in mean probing depth (PD) fr...
To report the three year results of a multi-center, randomized, patient and outcome assessor blin... more To report the three year results of a multi-center, randomized, patient and outcome assessor blinded trial of the Prostatic Urethral Lift (PUL) in men with bothersome lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). At 19 centers in North America and Australia, 206 subjects = 50 years old with International Prostate Symptom Score (IPSS) ≥ 13, peak flow rate (Qmax) ≤ 12 mL/s, and prostate volume between 30 cc-80 cc were randomized 2:1 to the PUL procedure or sham control. PUL involved placing permanent UroLift implants into the lateral lobes of the prostate to enlarge the urethral lumen. After randomized comparison at 3 months, PUL patients were followed to 3 years. LUTS severity (IPSS), quality of life, Qmax, sexual function, and adverse events were assessed throughout follow up. The therapeutic effect of PUL regarding IPSS was 88% greater than sham at 3 months. Average improvements from baseline through 3 years were significant for total IPSS (41.1%), ...
ABSTRACT Introduction For a therapy to become an important part of a provider armamentarium it mu... more ABSTRACT Introduction For a therapy to become an important part of a provider armamentarium it must be safer or better than existing therapies and be durable. The prostatic urethral lift offers rapid improvement in lower urinary tract symptoms associated with benign prostatic hyperplasia with minimal side effects. We report 2-year results of a multicenter, randomized, blinded trial of the prostatic urethral lift. Methods A total of 206 men 50 years old or older with an AUA-SI of 13 or greater, a peak flow rate of 12 ml per second or less and a 30 to 80 cc prostate were randomized 2:1 between the prostatic urethral lift and sham treatment. The prostatic urethral lift is performed by placing permanent transprostatic implants to lift apart the prostate lobes and reduce urethral obstruction. Sham treatment entailed rigid cystoscopy, a blinding screen and sounds that mimicked those of the prostatic urethral lift procedure. Patients were assessed for lower urinary tract symptoms, peak flow rate, quality of life and sexual function. Results The prostatic urethral lift reduced the AUA-SI 88% more than sham treatment (−11.1 vs −5.9, p = 0.003). Patients with the prostatic urethral lift experienced an AUA-SI reduction from 22.1 at baseline to 18.0 (−17%), 11.1 (−50%), 11.4 (−48%) and 12.5 (−42%) at 2 weeks, 3 months, and 1 and 2 years, respectively (p <0.0001). The peak flow rate was increased 4.2 ml per second at 3 months and 2 years (p <0.0001). By 2 years only 7.5% of patients required additional intervention for lower urinary tract symptoms. Adverse events were typically mild and transient. Encrustation did not develop on implants properly placed in the prostate. There was no occurrence of de novo sustained ejaculatory or erectile dysfunction. Conclusions The prostatic urethral lift preserves sexual function and provides rapid improvement in symptoms, flow and quality of life that are sustained to 2 years.
Purpose: We performed a nonrandomized retrospective comparison of 2 techniques for laparoscopic p... more Purpose: We performed a nonrandomized retrospective comparison of 2 techniques for laparoscopic partial nephrectomy, that is without and with clamping the renal vessels. Materials and methods: Between December 1997 and February 2002, 28 consecutive patients underwent transperitoneal laparoscopic partial nephrectomy for renal tumor. In group 1 (12 patients) partial nephrectomy was performed with ultrasonic shears and bipolar cautery without clamping the renal vessels, while in group 2 (16 patients) the renal pedicle was clamped before tumor excision. In group 2 patients intracorporeal kidney cooling was achieved by a ureteral catheter connected to 4C solution. Intracorporeal freehand suturing techniques were used to close the collecting system when opened and approximate the renal parenchyma. Results: All procedures were successfully completed laparoscopically. Mean renal ischemia time +/- SD was 27.3 +/- 7 minutes (range 15 to 47) in group 2 patients. Mean laparoscopic operating time was 179.1 +/- 86 minutes (range 90 to 390) in group 1 compared with 121.5 +/- 37 minutes (range 60 to 210) in group 2 (p = 0.004). Mean intraoperative blood loss was significantly higher in group 1 than in group 2 (708.3 +/- 569 versus 270.3 +/- 281 ml., p = 0.014). Three patients in group 1 and 2 in group 2 required blood transfusions. Immediately postoperatively mean creatinine was 1.26 +/- 0.36 and 1.45 +/- 0.61 mg./dl. in groups 1 and 2, respectively (p = 0.075). Surgical margins were negative in all specimens. Pathological examination revealed renal cell cancer in 18 cases (stages pT1 in 17 and pT3a in 1), oncocytoma in 4, angiomyolipoma in 5 and renal adenoma in 1. Conclusions: Laparoscopic partial nephrectomy represents a feasible option for patients with small renal masses. Clamping the renal vessels during tumor resection and suturing the kidney mimics the open technique and seems to be associated with less blood loss and shorter laparoscopic operative time.
INTRODUCTION AND OBJECTIVE: The objectives of laparoscopic partial nephrectomy for renal cell car... more INTRODUCTION AND OBJECTIVE: The objectives of laparoscopic partial nephrectomy for renal cell carcinoma (RCC) should be similar to the open technique. Cold ischemia permits optimal tumor excision and reual reconstruction while preserving renal function. However, cold ischemia with laparoscopic partial nephrectomy remains unsolved. Our video presents a new technique obtaining cold ischemia during laparoscopy. METHODS: Cold ischemia is achieved by cold arterial renal perfusion. Prior to laparoscopy an angiocatheter is passed into the main renal artery through a femoral puncture. The renal artery is clamped by a tourniquet. The renal vein is secured with an umbilical tape, but not occluded. Perfusion is initiated with iced Ringer Lactate at 4 degrees celsius at a rate of 50 cc/min. Renal temperature is continously monitored with a thermoprobe residing in the parenchyma. When a parenchymal temperature of 25 degrees celsius is reached perfusion is reduced to maintain a steady state. Tumor excision is performed in a bloodless field with biopsy taken from the tumor bed. The collecting system is repaired, and renal reconstruction is performed using parenchymal sutures over a hemostatic bolster. All steps are done similar to the open partial nephrectomy. Between November 01 and September 02 nine patients (RCC: 8, pyelonephritic lower pole: 1) were operated using this technique. There were 6 men and 3 woman with a mean age of 52 years (29-67). Mean tumor size was 2.4 ern (2-3.5). RESULTS: Bloodless field was achieved in 8 cases and minor oozing from an accessory renal artery occured in one case. Total ischemia time was 27 to 71 minutes (mean 36 min). Renal hypothermia was maintained at 25 degrees celsius. Estimated blood loss was 30-650 cc (mean 135 cc); only one patient required transfusions. Adequate tumor excision with negative margins was acheived in all cases. One patient had a delayed bleeding which was managed by laparoscopic reexploration, No other postoperative complications were encountered. Postoperative renal function could be investigated in 4 patients with isotope nephrography and was essentially unchanged in all of them. CONCLUSIONS: Our initial experience of incorporating cold ischemia into laparoscopic partial nephrectomy shows the feasibility and safety of this technique. We believe this approach will allow duplication of the principles of the open procedure and makes laparoscopic partial nephrectomy for RCC and complex renal pathology safe and reliable. Source of Funding: None.
Background: Treatment with a natural bone mineral (NBM) and a guided tissue regeneration (GTR) ha... more Background: Treatment with a natural bone mineral (NBM) and a guided tissue regeneration (GTR) has been shown to promote periodontal regeneration. However, until now there are only very limited data on the long‐term clinical results following this regenerative technique.Aim: To present the 5‐year results of a prospective, randomized, controlled clinical study evaluating the treatment of deep intra‐bony defects either with open flap debridement (OFD) and a combination of an NBM and GTR (test) or OFD alone (control).Methods: Nineteen patients diagnosed with advanced chronic periodontitis, and each of whom displayed one intra‐bony defect, received randomly the test or the control treatment. Results were evaluated at baseline, at 1 and at 5 years following therapy.Results: No statistically significant differences in any of the investigated parameters were observed at baseline between the two groups. At 1 year after therapy, the test group showed a reduction in mean probing depth (PD) fr...
To report the three year results of a multi-center, randomized, patient and outcome assessor blin... more To report the three year results of a multi-center, randomized, patient and outcome assessor blinded trial of the Prostatic Urethral Lift (PUL) in men with bothersome lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). At 19 centers in North America and Australia, 206 subjects = 50 years old with International Prostate Symptom Score (IPSS) ≥ 13, peak flow rate (Qmax) ≤ 12 mL/s, and prostate volume between 30 cc-80 cc were randomized 2:1 to the PUL procedure or sham control. PUL involved placing permanent UroLift implants into the lateral lobes of the prostate to enlarge the urethral lumen. After randomized comparison at 3 months, PUL patients were followed to 3 years. LUTS severity (IPSS), quality of life, Qmax, sexual function, and adverse events were assessed throughout follow up. The therapeutic effect of PUL regarding IPSS was 88% greater than sham at 3 months. Average improvements from baseline through 3 years were significant for total IPSS (41.1%), ...
ABSTRACT Introduction For a therapy to become an important part of a provider armamentarium it mu... more ABSTRACT Introduction For a therapy to become an important part of a provider armamentarium it must be safer or better than existing therapies and be durable. The prostatic urethral lift offers rapid improvement in lower urinary tract symptoms associated with benign prostatic hyperplasia with minimal side effects. We report 2-year results of a multicenter, randomized, blinded trial of the prostatic urethral lift. Methods A total of 206 men 50 years old or older with an AUA-SI of 13 or greater, a peak flow rate of 12 ml per second or less and a 30 to 80 cc prostate were randomized 2:1 between the prostatic urethral lift and sham treatment. The prostatic urethral lift is performed by placing permanent transprostatic implants to lift apart the prostate lobes and reduce urethral obstruction. Sham treatment entailed rigid cystoscopy, a blinding screen and sounds that mimicked those of the prostatic urethral lift procedure. Patients were assessed for lower urinary tract symptoms, peak flow rate, quality of life and sexual function. Results The prostatic urethral lift reduced the AUA-SI 88% more than sham treatment (−11.1 vs −5.9, p = 0.003). Patients with the prostatic urethral lift experienced an AUA-SI reduction from 22.1 at baseline to 18.0 (−17%), 11.1 (−50%), 11.4 (−48%) and 12.5 (−42%) at 2 weeks, 3 months, and 1 and 2 years, respectively (p <0.0001). The peak flow rate was increased 4.2 ml per second at 3 months and 2 years (p <0.0001). By 2 years only 7.5% of patients required additional intervention for lower urinary tract symptoms. Adverse events were typically mild and transient. Encrustation did not develop on implants properly placed in the prostate. There was no occurrence of de novo sustained ejaculatory or erectile dysfunction. Conclusions The prostatic urethral lift preserves sexual function and provides rapid improvement in symptoms, flow and quality of life that are sustained to 2 years.
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Papers by Shahram Gholami