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Biomedical subjects

R Clayman

Publications and source records attributed to R Clayman.

8 recordsLinked to original sources
PubMed1996

Laparoscopic complications in markedly obese urologic patients (a multi-institutional review)

OBJECTIVES: Significant obesity is considered to be a relative contraindication to laparoscopic surgery. This study reviews the complications encountered in massively obese patients undergoing urologic laparoscopic surgery. METHODS: Body mass index (BMI) was used as an objective index to indicate massive obesity. Eleven institutions compiled retrospective data on 125 patients having a BMI greater than 30. Procedures performed included 76 pelvic lymph node dissections, 14 nephrectomies, 7 bladder neck suspensions, and 28 miscellaneous procedures. RESULTS: For the group as a whole, the mean BMI was 35.1 (range 30.1 to 57.2). Mean operative time was 202 minutes (range 60 to 480). Conversion to open surgery occurred in 15 of the 125 patients (12%). Complication rates (minor and major) were 22% (27 occurrences in 125 patients) intraoperatively and 26% (33 occurrences in 125 patients) postoperatively. The major complications included 2 trocar injuries to abdominal wall vessels, 1 bladder injury, 3 peripheral nerve injuries, 1 dysrhythmia, 1 deep vein thrombosis, 1 wound seroma, 1 nephrocutaneous fistula, 1 incisional hernia, and 1 death. CONCLUSIONS: In this review, complication rates for urologic laparoscopic surgery on massively obese patients were higher than in the general population undergoing laparoscopic surgery (0.3% to 21%).

Adolescent↗
PubMed1993

Outcome of secondary open surgical procedure in patients who failed primary endopyelotomy.

Endopyelotomy is an effective method for treating pelviureteric junction (PUJ) obstruction; however, up to 28% of patients fail endoscopic treatment and require a secondary open surgical procedure. Six patients underwent secondary open surgical procedures following failed endopyelotomy for primary PUJ obstruction at this institution. One patient had impaired renal function in the affected kidney prior to endopyelotomy and postoperative evaluation indicated further deterioration; nephrectomy was performed for chronic obstruction and pain. The remaining 5 patients underwent secondary open pyeloplasty. In 4 patients the operation was difficult and lengthy because of extensive periureteric fibrosis. Difficult dissection was associated with a repeat endoscopic attempt to repair the PUJ obstruction, urinoma formation or stent occlusion requiring intervention. A mean follow-up of 1.7 years demonstrated no radiographic or clinical evidence of recurrent obstruction in the 5 patients undergoing secondary open pyeloplasty; all 6 patients are currently asymptomatic.

Adult↗
PubMed1984

A logical approach to renal stone removal.

On the basis of experience with over 350 percutaneous stone extractions, a logical approach assuring a high success rate and minimizing complications is described. The importance of the position of the kidney in the body, the caliceal anatomy, the renal arterial anatomy, and the instrumentation used on puncture site selection are discussed. Strategies for removal of caliceal, pelvic, ureteral, and staghorn calculi, rationale, and treatment of complications are also described.

Humans↗
PubMed1982

Nephrostolithotomy: percutaneous techniques for urinary calculus removal.

Recently the technique of percutaneous nephrostomy has been modified to allow the percutaneous extraction of urinary calculi. This communication describes experience with the percutaneous extraction of 63 calculi from the urinary tract. An overall success rate of 87%, a low incidence of complications (about 3%), a fast recovery, and sooner return to work are obtained. Several technical variants including grasping, fragmentation, flushing, and removal under direct vision have been used. In most cases, a combination of the different techniques has to be used in one patient. Essential to the technique is the introduction of large dilators into the kidney.

Dilatation↗