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INTRODUCTION The objective of this study is to report a novel system of ‘mutual mentoring’ that overcomes the limited availability of laparoscopic mentors and allows progression from laboratory and fellowship experience into independent clinical practice. PATIENTS AND METHODS A total of 88 laparoscopic cases were performed during the fellowship. In the first 2 years as consultants, we (AJ and MS) performed 151 cases with mutual mentoring (simple nephrectomy [n = 28], radical nephrectomy [n = 35], nephro-ureterectomy [n = 19], pyeloplasty [n = 31], pelvic LND [n = 21], others [n = 17]). RESULTS Mutual mentoring has resulted in the successful introduction of laparoscopic services to two hospitals, allowing an exposure to an average of two cases a week. Complication rates are acceptable and objective measures such as conversion rates, operative time and blood loss appear to be improving. CONCLUSIONS Mutual mentoring allows for a greater through-put of cases, a high level of assistance, advice with intra-operative decisions and the potential to ‘share’ cases, reducing fatigue and increasing experience. It provides significant moral support in the difficult early days of starting the service. Its disadvantages are that it is time consuming and is geographically restrictive. Mutual mentoring has allowed us to introduce a laparoscopic service at our respective hospitals with high case-load acceptable complication rates.

Greater experience with urological laparoscopy has lead to increasing interest in its use for reconstructive surgery, such as pyeloplasty.A total of 124 cases of laparoscopic pyeloplasty were performed, of which 11 followed failed primary treatment done elsewhere, namely balloon dilation (3), endopyelotomy (3); open pyeloplasty (3), endopyelotomy plus balloon dilation (1) and open pyeloplasty plus balloon dilation (1). Nine patients had renal calculi. A 4 port, balloon dissecting, extraperitoneal laparoscopic approach was used in all except 1 patient, who had a horseshoe kidney, necessitating a transperitoneal approach.Operative time was 29 minutes longer in the secondary pyeloplasty group compared to primary cases (173.3 vs 144.0 minutes) but the conversion rate (0% vs 1.6%) and duration of postoperative hospitalization (2.8 nights each) were no greater. The complication rate was 3.6% and 9.1%, respectively. The success rate was 98.2% and 90.9% (p = 0.63) at a mean followup of 20.2 and 19.7 months, respectively. In the 9 patients with renal calculi a total of 18 calculi (94.7%) were successfully removed and the ureter was transposed medial to a crossing vessel in 50.0%. Trainee operating did not significantly prolong the procedure vs no training (162.0 vs 143.9 minutes, p = 0.06).Extraperitoneal laparoscopic dismembered pyeloplasty is capable of addressing all causes of ureteropelvic junction obstruction with excellent functional results and low morbidity, and with an operative time similar to that of open pyeloplasty. Secondary laparoscopic pyeloplasty does not increase hospitalization, conversion or complication rates.

Introduction: The literature-based evidence as to whether or not obesity has any impact on the outcomes of radical prostatectomy is contradictory. This study investigates the effect of obesity on the peri-operative parameters of patients undergoing laparoscopic radical prostatectomy (LRP). Materials and methods: The database entries and case notes of 532 consecutive patients undergoing LRP from March 2000 to August 2005 were retrospectively examined. Complete data were available on 505 (95%) patients, 108 (21%) of whom were obese (BMI ≥ 30 kg/m2). All patients had clinical stage T ≤ 3aN0M0 prostate cancer and had their procedure performed or supervised by the same surgeon. Results: Patients’ PSA, Gleason score, clinical stage and prostate weight were similar. Non-obese and obese patients mean values for operating time = 182 and 197 min (P = 0.01), blood loss = 310 and 350 ml (P = 0.66), hospital stay = 3.0 and 3.3 nights (P = 1.00) complications = 3.5% and 4.6% (P = 0.77), positive margins = 15.4% and 20.6% (P = 0.26) and biochemical recurrence = 3.8 and 3.7% (P = 1.00) at a mean follow-up of 9.7 and 12.0 months, respectively. Conclusion: The operating time was significantly longer for obese patients but this was only by a mean of 15 min. All other parameters were comparable in the two groups. Obese patients can expect a similar outcome to their non-obese counterparts following LRP when operated on be an experienced surgeon.

estimate -2.99, 95%CI -3.45,-2.53) but more anastomotic strictures (OR 1.40, 95%CI 1.04,1.87) and higher rates of salvage therapy (OR 3.67, 95%CI 2.81,4.81). Patients of high-volume MIRP experienced fewer anastomotic strictures (OR 0.93, 95%CI 0.87,0.99) and less salvage therapy (OR 0.92, 95%CI 0.88,0.98). CONCLUSIONS: Men undergoing MIRP vs. open radical prostatectomy have lower risk for perioperative complications and shorter lengths of stay, but are at higher risk for salvage therapy and anastomotic strictures. However, risk for these unfavorable outcomes decreases with increasing MIRP surgical volume.

Introduction: Recent evidence suggests that cavernous nerves run within layers of the lateral prostatic fascia. It has been proposed that a nerve sparing technique should therefore include preservation of this fascial layer in addition to the main bulk of the neurovascular bundle posterolateral to the prostate. Materials and methods: All patients on whom laparoscopic nerve-sparing prostatectomy was performed (potent patients

Octopine has been detected in normal tobacco leaf and stem tissue, normal sunflower stem tissue, pinto bean leaves, and normal tobacco callus tissue in culture. Octopine was identified in extracts by means of electrophoresis and chromatography in several solvent systems. Tobacco and sunflower tumor lines induced by various strains of Agrobacterium tumefaciens were found to contain from 1 to 240 times as much octopine as the normal plant tissues examined. Several strains of A. tumefaciens produce undifferentiated tobacco tumors containing high levels of octopine, but produce undifferentiated sunflower tumors containing normal levels of octopine and high levels of arginine. Further, strain CGIC of A. tumefaciens produces in tobacco an undifferentiated tumor which contains high levels of octopine and a teratoma which contains normal levels of octopine. This evidence shows that there is no consistent relationship between the causative strain of A. tumefaciens and the octopine content of the resulting crown gall tumor.