HOW I DO IT

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Single-port robotic laparoscopic ureterocalicostomy: surgical technique and clinical outcomes
Xu J. Alex, Lin S. Jeffery, Chen Yen Po, Carbunaru Samuel, Lee S. Yeonsoo, Zhao C. Lee Department of Urology, NYU Langone Health, New York, New York, USA

Introduction: We describe a method of robotic ureterocalicostomy (RALUC) with the Da Vinci Single Port (SP) platform and present clinical outcomes in our cohort of patients. Materials and methods: We retrospectively reviewed all patients undergoing RALUC with the SP platform in a single-institution, IRB-approved database between 2020-2023. Demographics, preoperative, intraoperative, and postoperative outcomes were collated. Surgical success was defined as freedom from hardware, avoidance of additional surgical reconstruction, and no obstruction on follow up imaging/ureteroscopy. An incision is made 1/3rd the distance from anterior superior iliac spine to the umbilicus. The retroperitoneal space is entered and SP Access Port is placed. The psoas is identified and concomitant ureteroscopy is used to identify the ureter. The ureter is dissected to the most proximal aspect and transected. The remaining proximal ureteral stump is suture ligated. The lower pole parenchyma is removed to access the calyx. Absorbable barbed suture is used to control parenchymal bleeding and evert the mucosal edge of the calyx. Barbed suture is then used for the ureterocaliceal anastomosis over a ureteral stent. Results: Six patients underwent RALUC. Retroperitoneal approach was used for 5/6 cases. Prior ureteral surgery had been performed in 4/6 patients. Fifty percent of cases included an additional procedure with a median operative time of 248 minutes. One patient required nephrostomy tube placement postoperatively. Median follow up was 10.35 months with surgical success rate of 67%. Conclusions: SP RALUC is a safe and feasible option for proximal ureteral reconstruction in patients with unfavorable upper urinary tract anatomy or in salvage cases.

Keywords: robotics, reconstruction, ureterocalicostomy, ureteral reconstruction, pyeloplasty,
Dec 2024 (Vol. 31, Issue 6 , Page 12072)
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How I Do It: EnPlace sacrospinous ligament fixation
Chughtai Bilal, Codelia-Anjum Alia, Elterman S. Dean, Pillalamarri Nirmala, Lucente Vincent Department of Urology, Northwell Health, Manhasset, New York, USA

Pelvic organ prolapse (POP) is a common condition that significantly impairs a woman's quality of life. Currently a range of interventions from non-surgical to surgical options exist, all with their unique advantages and disadvantages. Among these, the EnPlace system stands out as a truly minimally invasive transvaginal percutaneous device designed to repair apical POP by bilaterally anchoring sutures to the sacrospinous ligaments. Readers will familiarize themselves with the EnPlace, relevant historical studies, and the technique for EnPlace transvaginal percutaneous sacrospinous ligament fixation for hysteropexy or colposuspension.

Keywords: pelvic organ prolapse, EnPlace system, minimally invasive transvaginal device,
Oct 2024 (Vol. 31, Issue 5 , Page 12022)
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How I Do It: Holmium laser cystolitholapaxy and enucleation of the prostate for benign prostatic hyperplasia
Gao M. Bruce, Saadat Seyedamirvala, Choi J. H. Edward, Jiang James, Das K. Akhil Department of Urology, University of California, Irvine, Orange, California, USA

Holmium enucleation of the prostate (HoLEP) is a gold-standard, size-independent surgical treatment for benign prostatic hyperplasia (BPH) distinguished for its efficacy in tissue removal, shorter catheterization durations, lower transfusion rates, and decreased hospital stays when compared to transurethral resection of the prostate (TURP). The objective of this article is to demonstrate the step-by-step procedure of holmium laser cystolitholapaxy and enucleation of the prostate for BPH, emphasizing a top-down modified two-lobe technique with early apical release which enhances visualization and irrigation flow during the enucleation process.

Keywords: prostate, BPH, HoLEP, cystolitholapaxy, holmium,
Jun 2024 (Vol. 31, Issue 3 , Page 11904)
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How I Do It: Teaching holmium laser enucleation of the prostate (HoLEP)
Pérez-Londoño Agustín, Abello Alejandro, Gershman Boris, Korets Ruslan Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Holmium laser enucleation of the prostate (HoLEP) is considered a size-independent technique to treat benign prostatic hyperplasia. This safe and effective procedure is increasingly being adopted in urology training programs worldwide, yet limited teaching strategies have been described. Endoscopic handling during HoLEP allows for a simultaneous interaction between the surgeon and trainee, facilitating a guided teaching strategy with increasing difficulty as experience grows. In this article, we describe our stepwise approach for teaching HoLEP as part of a structured surgical training curriculum. We also evaluate the association of our method with intraoperative efficiency parameters and immediate postoperative surgical outcomes of 200 HoLEP procedures.

Keywords: benign prostatic hyperplasia, HoLEP, surgical education, training,
Apr 2024 (Vol. 31, Issue 2 , Page 11848)
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Use of the Schelin Catheter for transurethral intraprostatic anesthesia prior to Rezūm treatment
Hamouda Aalya, Ibrahim Ahmed, Corsi Nicholas, Siena Giampaolo, Elterman S. Dean, Chughtai Bilal, Bhojani Naeem, Sessa Francesco, Rivetti Anna, Secco Silvia, Zorn C. Kevin Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada

Minimally invasive surgery techniques (MIST) have become newly adopted in urological care. Given this, new analgesic techniques are important in optimizing patient outcomes and resource management. Rezūm treatment (RT) for BPH has emerged as a new MIST with excellent patient outcomes, including improving quality of life (QoL) and International Prostate Symptom Scores (IPSSs), while also preserving sexual function. Currently, the standard analgesic approach for RT involves a peri-prostatic nerve block (PNB) using a transrectal ultrasound (TRUS) or systemic sedation anesthesia. The TRUS approach is invasive, uncomfortable, and holds a risk of infection. Additionally, alternative methods such as, inhaled methoxyflurane (Penthrox), nitric oxide, general anesthesia, as well as intravenous (IV) sedation pose safety risks or mandate the presence of an anesthesiology team. Transurethral intraprostatic anesthesia (TUIA) using the Schelin Catheter (ProstaLund, Lund, Sweden) (SC) provides a new, non-invasive, and efficient technique for out-patient, office based Rezūm procedures. Through local administration of an analgesic around the prostate base, the SC has been shown to reduce pain, procedure times, and bleeding during MISTs. Herein, we evaluated the analgesic efficacy of TUIA via the SC in a cohort of 10 patients undergoing in-patient RT for BPH.

Keywords: BPH, Rezum, TRUS, PNB, Schelin Catheter, TUIA,
Feb 2024 (Vol. 31, Issue 1 , Page 11802)
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