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Biomedical subjects

S G Docimo

Publications and source records attributed to S G Docimo.

At least 37 records · Page 2Linked to original sources
PubMed1999

Detection of adenocarcinoma by urinary microsatellite analysis after augmentation cystoplasty.

Augmentation cystoplasty is associated with an increased risk of bladder cancer development between 10 and 20 years after augmentation. Using microsatellite analysis, we analyzed urine obtained before surgical resection of the malignant lesion from a patient who developed invasive adenocarcinoma after augmentation cystoplasty. Loss of heterozygosity was identified in both urine and tumor samples from this patient. This observation suggests that microsatellite urine analysis may be useful as a monitoring tool for patients after augmentation cystoplasty.

Adenocarcinoma↗
PubMed1999

Radially dilating trocar system for open laparoscopic access.

Laparoscopic access can be obtained quickly and without complication by placing a radially dilating trocar sleeve into the peritoneum through a 3-mm umbilical incision and dilating to 5 or 10 mm. This provides a tight seal without purse-string sutures. This is our preferred method of open laparoscopic access.

Adolescent↗
PubMed1999

Laparoscopic-assisted continent stoma procedures: our new standard.

OBJECTIVES: To compare standard surgery to laparoscopic-assisted surgery for the creation of continent stomas. Creation of an antegrade continent enema (ACE) and/or continent urinary (CU) stoma using the appendix may require a generous midline incision. A laparoscopic-assisted technique to reduce morbidity and improve cosmesis has been described for urologic reconstruction. METHODS: Between February 1996 and November 1998, 11 laparoscopic-assisted ACE and/or CU stomas were created. A 10-mm umbilical port and two 5-mm ports were used. The cecum, appendix, and ileum were delivered into the pelvis by laparoscopically mobilizing the ascending colon and hepatic flexure. Through a Pfannenstiel or small midline incision, 1 or 2 stomas were constructed in a standard fashion using the appendix and, when necessary, a segment of ileum or sigmoid colon. We compared these 11 cases with a cohort of 5 standard open cases performed during the same period. A midline incision was used in the open cases that extended above the umbilicus. Perioperative data and morbidity were compared. Patients undergoing simultaneous enterocystoplasty were excluded from both groups. RESULTS: The patients who underwent laparoscopic-assisted surgery (two CU, four ACE, five ACE plus CU) had a mean operative time of 6.1 hours, resumed a regular diet at 2.3 days, and had a mean hospital stay of 4.1 days. The patients who underwent the open procedure (three ACE plus CU, two ACE) averaged an equivalent operative time, but took longer to resume a regular diet (5.6 days; P <0.05) and had a longer mean hospital stay (7.4 days; P <0.05). There were no differences in perioperative complications. CONCLUSIONS: Laparoscopic-assisted creation of continent stomas resulted in a significantly more rapid recovery, with no increase in operative time. In addition, it resulted in a vastly improved cosmetic appearance.

Adolescent↗
PubMed1999

Feasibility of total intravesical endoscopic surgery using mini-instruments in a porcine model.

BACKGROUND AND OBJECTIVES: The aim of minimally invasive approaches to vesicoureteral reflux, such as endoscopic trigonoplasty, is to lower the morbidity of open procedures without compromising the results. Initial successes have not been sustained, mainly because of trigonal splitting, which results in the ureteral orifices returning to their preoperative positions. This study was designed to address trigonal splitting by mobilizing the ureters before repositioning them and to evaluate the feasibility of accomplishing this intravesically with 2- to 3-mm endoscopic mini-instruments. METHODS: Bilateral vesicoureteral reflux was surgically created in 10 minipigs. After radiologic confirmation of success 4 weeks later, modified trigonoplasty was performed by endoscopic intravesical mobilization of both ureters and incision of the trigonal mucosa using 2-mm instruments. The ureteral orifices were then advanced toward the midline and sutured in place. The initial surgical techniques were modified to permit the entire procedure to be performed endoscopically in the last four minipigs. Cystograms and intravenous urograms were obtained 4 weeks later. RESULTS: Two minipigs died postoperatively. Six of the remaining eight had persistent reflux, including three of the four in the group treated completely by endoscopic means. None of the dissected ureters showed evidence of stricture or necrosis. CONCLUSIONS: Although the procedure was not successful in correcting reflux in this model, this study demonstrates the feasibility of endoscopic ureteral mobilization. With current instrumentation, there is no significant technical obstacle to complete intravesical endoscopic surgery, including ureteral reimplantation.

Animals↗
PubMed1999

Laparoscopic assisted reconstructive surgery.

PURPOSE: We describe the use of laparoscopy to assist in performing complex pediatric reconstructive cases with the goals of improved cosmesis, and limited postoperative morbidity and adhesion formation. MATERIALS AND METHODS: Eight patients a mean age of 13.4 years underwent 8 laparoscopic assisted reconstructive procedures at our institution from June 1995 to February 1998. The group consisted of 5 patients with spina bifida, 1 with sacral agenesis, 1 with classic bladder exstrophy and 1 with bladder dysfunction secondary to posterior urethral valves. Information was obtained via personal communication and review of the hospital records. RESULTS: Eight successful laparoscopic assisted procedures were performed, including bladder augmentation and an appendiceal Mitrofanoff procedure in 4 cases as well as tapered ileal Mitrofanoff and Malone antegrade continence enema procedures in 1, and bladder augmentation, appendiceal Mitrofanoff and antegrade continence enema procedure, gastrocystoplasty removal, ileal augmentation and an appendiceal Mitrofanoff procedure, and an antegrade continence enema procedure in 1 each. The laparoscopic component of these operations included extensive mobilization of the right colon in all patients and complete appendiceal harvesting in 2. Reconstruction was then completed through a Pfannenstiel incision in 4 patients, previous low midline scar in 2 and a small midline incision in 2. Drains were placed via existing trocar sites and open incisions were carried through other sites whenever possible. Continent stomas were matured through a trocar site in all 8 cases. Final cosmesis was excellent. Operative time was comparable to that of similar open procedures and intraoperative blood loss was minimal. CONCLUSIONS: Laparoscopy may be used as a successful adjunct in complex pediatric reconstructive procedures to minimize disfiguring and morbid upper abdominal incisions, and decrease the risk of future adhesions.

Adolescent↗
PubMed1999

Single system ureteral ectopia in boys associated with bladder outlet obstruction.

PURPOSE: Ureteral ectopia is frequently associated with dysplasia of the associated renal segment in girls with ureteral duplication. However, single system ureteral ectopia is an uncommon anomaly more frequently noted in boys. We report on 6 boys with single system ureteral ectopia into the prostatic urethra above the verumontanum, who presented with radiological and clinical findings of bladder outlet obstruction. MATERIALS AND METHODS: Antenatal ultrasound in 3 boys demonstrated renal abnormalities and postnatal studies suggested the diagnosis of posterior urethral valve obstruction. Older boys presented with symptoms suggestive of bladder outlet obstruction. RESULTS: An ectopic ureter inserting into the prostatic urethra was noted in all 6 boys. The distal ureter was dilated elevating the bladder neck causing outlet obstruction. Surgical management consisted of nephrectomy and transurethral endoscopic incision of the distal ureter or nephroureterectomy with reconstruction of the prostatic urethra. In 2 younger boys voiding dysfunction with inability to empty developed. CONCLUSIONS: Single system ectopic ureters in boys may present with symptomatic and radiological findings resembling posterior urethral valves. Surgical treatment should include nephroureterectomy with reconstruction of the hypoplastic prostate. Some patients may have later voiding dysfunction.

Adolescent↗
PubMed1998

The "mini-perc" technique: a less invasive alternative to percutaneous nephrolithotomy.

The disadvantages of standard percutaneous nephrolithotomy (PCNL) as compared with ureteroscopy or extracorporeal shock-wave lithotripsy include increased blood loss, greater pain, and longer hospital stay. A 13-Fr "mini-perc" technique using a ureteroscopy sheath for PCNL was developed in an attempt to address these drawbacks. Nine "mini-percs" have been performed in patients aged 40-73 years with stone burdens of < or = 2 cm2. On average, patients had 1.4 stones with a cross-sectional area of 1.5 cm2. The mean total procedure time, estimated blood loss, and hematocrit decrease were 176 min, 83 ml, and 6.6%, respectively. On average, patients used 14 mg of parenteral morphine and stayed 1.7 days in the hospital. There was no procedure-related complication or transfusion. Eight of nine kidneys (89%) were stone-free on early follow-up at a mean of 3.8 weeks. As compared with standard PCNL, the "mini-perc" technique has similar early success rates in selected patients and may offer advantages with respect to hemorrhage, postoperative pain, and shortened hospital stays.

Adult↗
PubMed1998

Idiopathic anterior urethritis in prepubertal and pubertal boys: pathology and clues to etiology.

OBJECTIVES: Records were reviewed to examine the common features of boys with noninfectious anterior urethritis, and to describe the underlying pathology. METHODS: Five cases of anterior urethritis with features typical of this syndrome are reviewed. RESULTS: These cases demonstrate the typical appearance and in 1 case the pathologic diagnosis of squamous metaplasia of the bulbar urethra. CONCLUSIONS: Prepubertal urethrorrhagia is associated with squamous metaplasia of the urethra. The tendency to stricture formation may precede instrumentation of the urinary tract.

Adolescent↗
PubMed1998

Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique.

OBJECTIVES: To develop a less invasive method for performing percutaneous nephrolithotomy (PCNL) with the intent of decreasing the morbidity of the procedure in young children. METHODS: A novel percutaneous renal access technique ("mini-perc") was developed using an 11F peel-away vascular access sheath. Tract dilation and insertion of the sheath into the collecting system was performed with a single pass over an access wire. PCNL was performed using pediatric instruments and electrohydraulic lithotripsy. Sheath design improvements were implemented that make it specific for pediatric PCNL. RESULTS: Eleven procedures have been performed with the 11F sheath. Patient age ranged from 2 to 6 years (mean 3.4) and weight from 5 to 24 kg (mean 12.5). The average stone burden was 1.2 cm2. Mean procedure time, estimated blood loss, and length of hospitalization were 203 minutes, 25 mL, and 6 days, respectively. Six (85%) of 7 patients are currently stone free with an average follow-up of 12 weeks. No patient required transfusion, developed urosepsis, or had a procedure-related complication. One procedure was performed in an outpatient setting with no postoperative nephrostomy tube. CONCLUSIONS: The 11F "mini-perc" technique was successful in rendering 85% of patients stone free with minimal morbidity. Its advantages over obtaining access with standard 24 to 34F access sheaths include a smaller skin incision, single-step dilation and sheath placement, good working access for pediatric instruments, variable length, and lower cost. In addition, the hypothesized decrease in renal and body wall trauma may result in less pain, reduced severity or risk of complications, and shorter hospital stays including the possibility of performing "tubeless" outpatient PCNLs. Further study is needed to confirm these possibilities.

Child↗
PubMed1998

Cloacal exstrophy--improving the quality of life: the Johns Hopkins experience.

PURPOSE: Exstrophy of the cloaca is a multisystem anomaly involving the gastrointestinal, nervous, musculoskeletal and genitourinary tracts which should be managed with a multidisciplinary approach. Improvement in management has led to survival for the majority of infants, and the focus has shifted to improvement in quality of life. The experience with management of cloacal exstrophy at a large center is evaluated. MATERIALS AND METHODS: Demographic data as well as functional results of management of the multiple anomalies in 37 patients with cloacal exstrophy were evaluated. Surgical reconstruction was aimed at providing the best functional and cosmetic results. RESULTS: Average patient age at review was 13.6 years. Most patients (32 of 37) had undergone an initial attempt at bladder closure from birth to greater than 24 months of age. Colostomy was performed when possible and if initial ileostomy was performed, the bowel was augmented later with the hindgut segment. When the hindgut segment was not used for bowel reconstruction, it was preserved for bladder augmentation or genital reconstruction. While urinary continence was achievable in many children, it was usually after augmentation and/or continent diversion. CONCLUSIONS: Improvements in perinatal management have increased survival in cloacal exstrophy. Therefore, the focus of reconstruction has shifted to reduction in the numbers of incontinent stomas, assistance with ambulation and improved cosmesis. All of these goals are achievable using a multidisciplinary approach to the management of this complex anomaly.

Abnormalities, Multiple↗
PubMed1998

International surgical telementoring: our initial experience.

INTRODUCTION: Telesurgical laparoscopic telementoring has successfully been implemented between the Johns Hopkins Bayview Medical Center and the Johns Hopkins Hospital in 27 prior operations. In this previously reported series, telerobotic mentoring was achieved between two institutions 3.5 miles away. We report our experience in performing two international surgical telementoring operations. PURPOSE: To determine the clinical utility of international surgical telementoring during laparoscopic surgical procedures. METHOD: A laparoscopic adrenalectomy was telementored between Innsbruck, Austria (5,083 miles) and Baltimore, MD. As well, a laparoscopic varicocelectomy was telementored between Bangkok, Thailand and Baltimore, MD (10,880 miles) both over three ISDN lines (384 kbps) with an approximate 1 sec delay. RESULTS: Both procedures were successfully accomplished with an uneventful postoperative course. CONCLUSION: International telementoring is a viable method of instructing less experienced laparoscopic surgeons through potentially complex laparoscopic procedures, as well as potentially improving patient access to specialty care.

Adrenalectomy↗
PubMed1998

Percutaneous cystolithotomy after augmentation cystoplasty: comparison with open procedures.

Percutaneous procedures for the removal of calculi from reconstructed bladders have not been compared in a single institution with traditional open methods. The records of patients undergoing seven percutaneous and six open procedures for the removal of calculi from augmented bladders were reviewed. Operative time, hospitalization time, complications, stone burden, and recurrence were compared. All patients were stone-free at the end of either one or two procedures. Four of six patients in the percutaneous group and four of six patients in the open group had recurrent bladder calculi during average follow-up of 30 months. The average hospital stay was 1.1 days for patients undergoing percutaneous procedures and 3.7 days for those undergoing open cystolithotomy. Narcotic use was significantly lower in the percutaneous group. Percutaneous cystolithotomy is safe, effective, and currently the preferred method for removing stones from an augmented bladder.

Child↗
PubMed1997

Telesurgical mentoring. Initial clinical experience.

BACKGROUND: Minimally invasive surgical techniques yield significant individual, economic, and social benefits when performed by experienced surgeons. Unfortunately, many of these techniques, such as laparoscopy, are associated with steep learning curves, and the incidence of complications has clearly been shown to be inversely related to experience. The initial high complication rate and the dearth of experienced endoscopic surgeons have raised concerns over training, granting of hospital privileges, and most importantly patient safety. The goal of this study was to employ current telecommunications technology in a system for the mentoring of relatively inexperienced surgeons. Therefore, we created a telesurgical system that would allow an endoscopic specialist at a central site to offer guidance and assistance to a surgeon during a laparoscopic procedure. METHODS: We developed a system that connected a central site and an operative site, a distance of approximately 3.5 miles, via a single T1 (1.54 Mbs) point-to-point communications link. The system provided real-time video display from either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, control of a robotic arm that manipulated the laparoscope, and access to electrocautery for tissue cutting or hemostasis. RESULTS: Seven patients underwent laparoscopic procedures using the telesurgical consultation system over the communications link. In all cases, the primary surgeon had limited experience with the laparoscopic approach but still had the basic skills required to obtain intraperitoneal access. All seven cases were completed successfully without complications. CONCLUSION: These initial studies have demonstrated the feasibility, effectiveness, and safety of telementoring. Telesurgical applications have the potential to greatly improve surgical education credentialing, and patient care by offering patients and their surgeons global access to surgical specialists.

Humans↗