Biomedical subjects

Gary C Bellman

Publications and source records attributed to Gary C Bellman.

6 recordsLinked to original sources

PubMed2003

Use of fibrin glue in percutaneous nephrolithotomy.

OBJECTIVES: To report our experience with the use of fibrin glue during tubeless percutaneous nephrolithotomy. We addressed the safety of this approach and evaluated its use for any clinical benefit with respect to length of hospital stay, bleeding, analgesic usage, and urinary extravasation. METHODS: This was a retrospective review of 43 patients who underwent tubeless percutaneous nephrolithotomy. In 20 consecutive patients (one bilateral), percutaneous tracts were injected with 2 to 3 mL of Tissel Vapor Heated sealant at the conclusion of the procedure. The fibrin glue was instilled during simultaneous removal of the percutaneous sheath. These 20 patients were compared with a control group (23 consecutive patients) in which fibrin glue was not used. The length of hospitalization, hematocrit drop, analgesic use, stone burden, operative times, postoperative complications, and any noted computed tomography scan findings were compared. RESULTS: Postoperatively, the average length of hospital stay was less in the experimental than in the control group by 0.71 day (P <0.05). Differences in hematocrit drop between the experimental (6.8%) and control (5.6%) groups were not statistically significant. The total analgesic use was less in the experimental group, but the difference was not statistically significant. No statistical difference was found between the operative times for both groups. Postoperative fevers and wound seroma were noted in the experimental group. No abscesses or any significant changes along the percutaneous tracts were seen on postoperative computed tomography scans. In the control group, no procedure-related complications were noted. CONCLUSIONS: The use of fibrin glue is safe in percutaneous nephrolithotomy procedures and additional prospective randomized studies are needed to evaluate for any clinical benefit.

Adolescent↗

PubMed2002

Tubeless percutaneous renal surgery: review of first 112 patients.

OBJECTIVES: To assess the outcome and safety of the first 112 patients undergoing tubeless percutaneous renal surgery. METHODS: A total of 116 renal units in 112 patients underwent tubeless percutaneous renal surgery from December 1995 to November 2000 performed by a single urologist. The "tubeless" procedures consisted of nephrolithotripsy or endopyelotomy. An antegrade internal ureteral stent was placed during surgery, as was a Foley catheter for bladder drainage, in all patients. Nephrostomy tubes were not used in any patient. The incidence of complications, length of hospitalization, outcomes, transfusion requirements, stone burden, and stone-free rates were obtained by chart review. RESULTS: Of the 112 patients, 86 patients underwent percutaneous stone extraction and 26 patients underwent percutaneous antegrade endopyelotomy. In the group of patients undergoing percutaneous stone extraction, the mean stone burden was 3.30 cm(2). Patients stayed in the hospital an average of 1.25 days. A total of 5 patients required postoperative transfusions. One patient was found on readmission to have a pseudoaneurysm. A 93.0% stone-free rate was achieved. The correlations between transfusion rates, days of hospitalization, and outcome with stone burden were not statistically significant (P = 0.56, 0.78, and 0.18, respectively). For the endopyelotomy group, the mean length of hospitalization was 1.56 days. Only 1 patient required a transfusion, and 3 patients had postoperative complications. Of the 26 patients, 88.5% had a successful outcome from their endopyelotomy. CONCLUSIONS: Tubeless percutaneous renal surgery is a safe and effective procedure and can be performed in patients even with a moderate stone burden.

Adolescent↗

PubMed2002

Laparoscopic linear cutting stapler failure.

OBJECTIVES: To characterize the frequency and nature of problems with linear cutting staplers to help prevent complications in the future. These devices are often used during laparoscopic urologic procedures. METHODS: We retrospectively reviewed the experience with laparoscopic linear cutting staplers at two institutions routinely performing urologic laparoscopy and analyzed the difficulties with any staplers. Data from the Food and Drug Administration Center for Devices and Radiological Health were also examined to determine the prevalence and types of reported problems. RESULTS: In performing approximately 460 laparoscopic cases, we encountered 5 problems (1%) with endovascular gastrointestinal anastomosis staplers. Fifty-five additional cases in 50 patients were documented in the Food and Drug Administration database. Of the 55 patients, 15 (27%) required open conversion to manage the problem, 8 (15%) received blood transfusions, and 2 (4%) died postoperatively. Twenty-two events occurred during 19 laparoscopic donor nephrectomies (35%) without associated graft dysfunction, damage, or loss. All phases of instrument use were subject to problems; however, abnormal firing of the stapler and improper staple formation were the most common and morbid aspects of device malfunction. CONCLUSIONS: Despite the general reliability of linear cutting staplers, difficulties were encountered in every step of use. Most situations were successfully managed by prompt identification and appropriate intracorporeal maneuvers. Nevertheless, significant morbidity may occur, and conversion to an open operation should be considered. Many potential problems can be avoided by surgeon and staff education, and one should be aware of the alternative methods of tissue ligation currently available.

Equipment Failure↗

PubMed2002

Radiation protection during percutaneous nephrolithotomy: a new urologic surgery radiation shield.

BACKGROUND AND PURPOSE: As endourology becomes an important part of the practice of urology, the use of fluoroscopic guidance has increased the exposure of urologists to the possibly deleterious effects of radiation. There is a need for a method of radiation protection for percutaneous nephrolithotomy (PCNL), as the exposure from radiation scatter may be significant, depending on the difficulty of establishing access. PATIENTS AND METHODS: We ascertained the effectiveness of a newly modified radiation shield during PCNL. Exposure readings were taken using a thermoluminescent dose monitor placed different distances from the radiation source during six PCNLs. We compared the exposure readings with and without the shield. RESULTS: The shield was able to reduce the radiation by an average of 96.1% at a distance of 25 cm and 71.2% at a distance of 50 cm from the source. CONCLUSION: The shield can be used as one step toward the goal of reducing surgeon radiation exposure. Other methods, such as dose-minimizing imaging protocols and adaptation of equipment optimized to reduce exposure, are also important measures in creating a safe environment for both the urologist and the patient.

Adult↗

PubMed2002

Laparoscopic evaluation of indeterminate renal cysts: long-term follow-up.

PURPOSE: We present our long-term follow-up of patients who have undergone laparoscopic evaluation for their indeterminate renal cysts, specifically reporting those patients who were found to have cystic renal-cell carcinoma (RCC) and assessing the safety and efficacy of the procedure. PATIENTS AND METHODS: Fifty-seven patients with indeterminate renal cysts (28 Bosniak category II and 29 Bosniak category III) underwent laparoscopic evaluation between July 1993 and July 2000. A transperitoneal laparoscopic localization and aspiration of the cyst, cytologic analysis, and biopsy of the cyst wall and base were performed. A total of 11 patients were found to have cystic RCC. Patients with malignancy have been followed for a mean of 40 months (range 6-70 months), and five patients had 5 years or more of follow-up. RESULTS: Eleven patients (19% of the total) were found to have cystic RCC. Three of these patients had Bosniak category II cysts, and eight had category III cysts. All tumors were low grade (I or II), and the stages were T1-2, Nx-0, M0. There has been no evidence of laparoscopic port site or renal fossa tumor recurrence, local recurrence, or metastatic disease to date in these patients. There is no cancer-specific mortality. CONCLUSIONS: Long-term follow-up indicates that laparoscopic evaluation of indeterminate renal cysts is not associated with an increased risk of port site or retroperitoneal or peritoneal recurrence of RCC. It may save a patient from undergoing open surgery and should be considered as a diagnostic option for patients with indeterminate renal cysts.

Adolescent↗

PubMed2002

Blind percutaneous renal access.

We describe a technique of blind percutaneous renal access when retrograde/intravenous imaging is not possible. We present the surgical technique, the patient population, and situations in which the technique is used. Following a review of 40 accesses, we concluded that this technique is safe, simple, and effective. It also allows the urologist to act autonomously in obtaining renal access.

Adult↗