Biomedical subjects

Jihad Kaouk

Publications and source records attributed to Jihad Kaouk.

22 records · Page 2Linked to original sources

PubMed2004

Laparoscopic radical nephrectomy for large (greater than 7 cm, T2) renal tumors.

PURPOSE: Laparoscopic radical nephrectomy has emerged as a standard of care in appropriate candidates with clinical stage T1 renal tumors (7 cm or less). Herein we present our experience with laparoscopic radical nephrectomy for clinical stage T2 tumors (greater than 7 cm). MATERIALS AND METHODS: Patients undergoing laparoscopic radical nephrectomy between September 1997 and July 2003 were retrospectively subdivided into group LAPT1-166 with tumor size 7 cm and group LAPT2-65 with tumor size greater than 7 cm. Also, group LAPT2 was compared with a group of 34 contemporary, comparable patients undergoing open radical nephrectomy for tumor greater than 7 cm (group OPENT2). RESULTS: Compared with group LAPT1, group LAPT2 had younger patients, larger tumors and greater blood loss (100 vs 200 ml) (each p <0.001). Importantly operative time, analgesic requirements, hospital stay, and convalescence and complication rates were comparable. Group LAPT2 and group OPENT2 patients had similar sized tumors (9.2 and 9.9 cm, respectively) but shorter operative time (p = 0.03), lesser blood loss (p <0.001), shorter hospital stay (p <0.001) and more rapid convalescence (p = 0.02) occurred in LAPT2. CONCLUSIONS: Laparoscopic radical nephrectomy for stage T2 renal masses (greater than 7 cm) is feasible and efficacious. Laparoscopic nephrectomy offers the advantages of decreased blood loss, shorter hospital stay and more rapid recovery over open radical nephrectomy for comparable tumors greater than 7 cm. Although surgical outcomes are comparable with laparoscopic radical nephrectomy for smaller tumors (7 cm or less), adequate laparoscopic experience is necessary before performing radical nephrectomy for large T2 tumors.

Aged↗

PubMed2003

Laparoscopic inferior vena cava and right atrial thrombectomy utilizing deep hypothermic circulatory arrest.

BACKGROUND AND PURPOSE: Surgery for renal cancer associated with a level III or IV tumor thrombus often involves cardiopulmonary bypass, deep hypothermia, and exploration of the right atrium and inferior vena cava (IVC). This major open operation necessitates a large median sternotomy incision and a midline abdominal or chevron incision. Herein, we investigate the feasibility of purely laparoscopic IVC and right atrial thrombectomy utilizing deep hypothermic circulatory arrest. MATERIALS AND METHODS: In six male calves weighing 70 to 80 kg, the right common carotid artery and right internal jugular vein were cannulated for subsequent cardiopulmonary bypass. One laparoscopic team performed right radical nephrectomy and complete mobilization of the intra-abdominal IVC by a four-port approach. Simultaneously, a second laparoscopic team obtained three-port thoracoscopic access to incise the pericardium and expose the right atrium. In sequence, cardiopulmonary bypass, complete exsanguination, cardiac arrest, and core hypothermia of 18 degrees C were achieved. A coagulum thrombus was created by needle injection into the IVC. Combined laparoscopic and thoracoscopic incision, exploration, and thrombectomy of the IVC and the right atrium were then performed in a bloodless field. An angioscope was inserted inside the heart and the IVC to confirm complete thrombus clearance visually. The IVC and right atrium were then laparoscopically suture repaired, cardiopulmonary bypass was reestablished, and the animal was gradually rewarmed. Once sinus rhythm was reestablished at normal body temperature, the animal was weaned off the pump. RESULTS: The mean total operative time was 494.5 minutes (range 355-705 minutes). The mean time needed to lower the core temperature was 63.5 minutes (range 50-120 minutes), and the mean time required to rewarm the animal was 101.8 minutes (range 70-130 minutes). The mean blood volume drained into the pump was 2633.3 mL (range 1400-3200 mL), and the mean estimated blood loss was 350 mL (range 200-750 mL). Reestablishment of sinus cardiac rhythm and weaning off the pump was successful in all animals prior to acute euthanasia. CONCLUSIONS: Laparoscopic radical nephrectomy with thrombectomy for level III or IV tumor thrombi utilizing deep hypothermic circulatory arrest is feasible in the calf model using minimally invasive techniques exclusively. The procedure is technically complex and requires the combined efforts of expert urologic and cardiac operative teams. Survival studies are planned.

Animals↗

PubMed2003

Prospective comparison of 3-dimensional volume rendered computerized tomography and conventional renal arteriography for surgical planning in patients undergoing laparoscopic donor nephrectomy.

PURPOSE: We prospectively assessed the accuracy of 3-dimensional (3-D) volume rendered computerized tomography (CT) and conventional renal arteriography to visualize renovascular anatomy in patients undergoing laparoscopic donor nephrectomy. MATERIALS AND METHODS: A total of 60 consecutive patients undergoing laparoscopic donor nephrectomy (left side in 46 and right side in 14) prospectively underwent 3-D CT and renal angiography. A short videotape of 3-D CT was prepared using volume rendering software that demonstrated the anatomical location, number, anomalies and spatial interrelationships of the renal arteries and veins. These 3-D videotapes and arteriogram findings were directly correlated with intraoperative surgical findings at laparoscopy and during ex vivo bench preparation of the harvested kidney. The perceived intraoperative value of 3D-CT to delineate renovascular anatomical detail was scored subjectively by the laparoscopic surgeon for each case on a 10-point scale of 0--completely inaccurate to 10--completely accurate. RESULTS: There were no complications related to the 3-D CT protocol and volume rendering was successful in all patients. Three-D CT accurately identified the number of renal arteries in 59 patients (98%). In 1 patient with 3 renal arteries 3-D CT and arteriogram each identified only 2. In the 46 patients undergoing left donor nephrectomy 3-D CT accurately identified the number of veins and venous anomalies in 45 (98%), including 2 with a circumaortic left renal vein. Another case of circumaortic vein was misdiagnosed as 2 renal veins. On the right side in 14 patients 3-D CT accurately identified the renal veins in 13 (94%) and missed 1 vein in a patient with 2 renal veins. Angiography correctly identified the number of renal veins in only 52 cases (87%). Furthermore, it misdiagnosed all 3 cases of circumaortic left renal vein. The laparoscopic surgeon believed that 3-D CT accurately identified the location and anatomical interrelationship of the renal vessels with precision. Mean subjective score +/- SEM was 8.5 +/- 1 for the arterial system, 8.6 +/- 1.1 for the venous system and 9.2 +/- 0.5 for any vascular anomalies. CONCLUSIONS: Three-D CT accurately identifies renal vascular anatomy in a manner that may facilitate renal hilar dissection during laparoscopic donor nephrectomy, especially during the initial surgeon experience. This imaging modality integrates essential information from angiography, venography and excretory urography into a single study, and it can obviate the need for more invasive vascular imaging in most cases.

Angiography↗

PubMed1998

Feasibility of radiation and chemotherapy following cystectomy and orthotopic neobladder for invasive bladder cancer.

Orthotopic neobladder has become the standard of care in the selected patient undergoing cystectomy for invasive bladder cancer. It satisfies all the criteria for an ideal urinary alternative without compromising the delivery of needed adjuvant therapy or treatment for recurrent disease. Forty patients underwent orthotopic neobladder formation. Five patients received full course adjuvant chemotherapy without change in the dose, schedule, type or timing of the protocol because of the neobladder. Three patients received full dose XRT to recurrent pelvic masses without compromising the neobladder function. Systemic chemotherapy was given to 8 patients as per standard protocol for metastatic disease with no changes due to the presence of the neobladder.

Journal Article↗