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Introduction: The objective of the present study was to evaluate the results of laparoendoscopic single-site (LESS) pyeloplasty and pyelolithotomy, which were performed concurrently in patients with pelviureteric junction obstruction (PUJO) and renal stones., Technical Considerations: Four patients with PUJO and renal stones underwent pyelolithotomy performed concurrently with LESS pyeloplasty. In 3 patients, a 2.5-cm incision was made in the umbilical region. In the fourth patient, the 2.5-cm vertical incision was made at a site 7 cm below the umbilical region because of a stone in the right lower calyx. After dissection of the pelviureteric junction, an incision of approximately 1 cm was made along the presumed transection line of the renal pelvis. The pyelolithotomy was performed using a 24F rigid nephroscope through a SILS port. Dismembered pyeloplasty was performed after extraction of the renal stones was completed. The mean operation time was 277 minutes (range, 225-373), and the mean lithotomy time was 31 minutes (range, 20-50). No intraoperative or postoperative complications were observed. For all 4 patients, discharge from the hospital was possible after a mean of 3.4 postoperative days (range, 3-4). All patients became stone free. Postoperative ultrasound revealed that hydronephrosis improved in all patients. In all patients, resolution of the symptoms was confirmed., Conclusion: LESS nephrolithotomy with pyeloplasty is a safe and effective procedure with a good cosmetic result for patients with PUJO and renal stones., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To evaluate the hemostatic effect of newly developed medical adhesive in animal partial nephrectomy models., Materials and Methods: A total of 30 experimental rabbits were used in the first study. After clamping the renal vessels, partial nephrectomy was performed up to the opening of the calices. Bioglue was applied to the resection stumps using the new glue (group 1, n = 10) or fibrin glue (group 2, n = 10) for 2 minutes, and the blood loss was measured after unclamping the vessels. Simple unclamping without glue (group 3, n = 10) was also evaluated. For the second study, we used 9 dogs with blood pressure monitoring. After preparation similar to that for the first study, the new glue was applied in 3 dogs (group 4), fibrin glue in 3 dogs (group 5) and no glue in 3 dogs (group 6). Histologic evaluation was performed at 7 days and 1 month after surgery., Results: The mean blood loss was significantly less in group 1 (1.45 g) than in groups 2 (6.59 g) and 3 (19.77 g; P <.001 for both). It was also significantly less in group 4 (12.5 g) than in group 5 (182.5 g; P <.001). Group 4 maintained their initial blood pressure throughout the study, but a significant decrease was observed in group 5. No hematoma was observed at day 7., Conclusion: The new glue showed acceptable hemostasis when applied to the resection stumps after partial nephrectomy in both the rabbit and the dog models. These findings indicate that it could be useful for hemostasis after partial nephrectomy., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objectives: To develop a new shape memory alloy probe for percutaneous treatment of renal cell carcinoma (RCC) by electrovaporization, and investigate its efficacy and safety in experimental models., Methods: The shape memory alloy electrode can be manipulated to any shape at room temperature and regains its original shape at >or=65 degrees C. By adding a high-frequency electric current to the probe, the electrodes quickly regain their original shape and vaporize tissues into a spherical defect. The performance of this probe was tested using agar, dog kidney, and rat RCC models. The treatment effect was evaluated by magnetic resonance imaging and histologic examination., Results: In the agar model, the electrovaporization inside the spherical electrode was successfully achieved in several seconds, with all power outputs tested. The area of >or=60 degrees C extended about 5 mm beyond the periphery of the vaporized part and corresponded with the histologic findings on the dog kidney that an irreversible heat denaturation occurred to the same extent. The study on the RCC model also confirmed that about 5-mm extent of heat denaturation was seen in the muscular tissue adjacent to the tumor. In the study using the RCC model, some remaining tissues close to the tumor were observed after vaporization. However, dynamic magnetic resonance imaging demonstrated no enhancement in this area and no viable tumor cells were documented by histologic examination., Conclusions: This novel tissue ablation system has potential as a viable option for percutaneous treatment of renal tumors., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Objectives: To determine the diagnostic performance of dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) in the identification of intraprostatic cancer foci related to cancer volume at histopathology, in patients with clinically localized cancer treated by radical prostatectomy, with whole-mount histopathologic sections as the reference standard., Methods: Eighty-three consecutive radical prostatectomy specimens from patients referred for a prostate-specific antigen elevation were correlated with prebiopsy MRI. MRI results ranked on a 5-point scale were correlated with the findings of histopathology maps in 8 prostate sectors, including volume, largest surface area, and percentage of Gleason grade 4/5. The area under the receiver operating characteristic curve was used., Results: Median prostate-specific antigen was 8.15 ng/mL. DCE-MRI was suspicious in 55 (66%) out of 83 patients. A separate cancer foci (mean 2.55 per patient) was present in 212 (34%) of 664 octants and DCE-MRI was suspicious in 68 of 212. Sensitivity and specificity of DCE-MRI at score 3.4 or 5 for identification of cancer foci at any volume was 32% and 95%, respectively. For identification of cancer foci > 0.5 mL, the sensitivity and specificity were 86% and 94%, respectively, with the under the receiver operating characteristic curve of 0.874. Mean volume of DCE-MRI detected and missed cancers were 2.44 mL (0.02-14.5) and 0.16 mL (0.005-2.4), respectively. Sensitivity and specificity of DCE-MRI for identification of > 10% of Gleason grade 4/5 were 81% and 82%, respectively., Conclusions: DCE-MRI can accurately identify intraprostatic cancer foci. Possible applications are guidance for biopsies, selection of patients for watchful waiting, and focal treatment planning.

Objectives: To present an initial experience with robotic natural orifice translumenal surgery (R-NOTES) in reconstructive urology using the da Vinci surgical system., Methods: In 10 female farm pigs (mean weight, 34.5 kg), 10 pyeloplasties (right 5, left 5), 10 partial nephrectomies (right 5, left 5), and 10 radical nephrectomies (right 5, left 5) were performed. The robot telescope and the first robotic arm were placed through a single 2-cm umbilical incision, and the second robotic arm was placed through the vagina., Results: All 30 R-NOTES procedures were performed successfully without any addition of laparoscopic port or open conversion. Mean length of the umbilical incision was 2.6 cm. Mean operative time was 154 minutes, and mean estimated total blood loss was 72 mL. Mean warm ischemia time in the partial nephrectomy group was 25.4 minutes. There were no intraoperative complications. There were no robotic system failures during the entire experiment. We did not find any significant difference when comparing right-side and left-side procedures. When analyzing the learning curve, only robot preparation time reached a statistically significant inverse correlation with increasing number of cases (r = -0.72, P = .018)., Conclusions: Robotic NOTES pyeloplasty, partial nephrectomy, and radical nephrectomy are feasible and safe in the porcine model. This approach has the potential for a less morbid and scarless outcome. Intracorporeal suturing is significantly enhanced using the robot, especially through the challenging translumenal natural orifice approach. Further development of robots adaptive to NOTES would boost efforts toward clinical NOTES applications.