HOW I DO IT

• Novel knot tying technique for robot-assisted surgery

  Guru A. Khurshid, Sheikh Raashid Mohd, Raza J. Syed, Stegemann P. Andrew, Nyquist John, MD Department of Urology, Roswell Park Cancer Institute, Buffalo, New York, USA

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  Robot-assisted surgery has seen significant advancements in recent years, with dedicated training opportunities to acquire adequate skills. With improved degree of rotation and movement offered by the robot arm, newer techniques of knot tying need to be developed. Here we present a novel method of knot tying to help place a secure knot, especially with short suture length.

  Keywords: testosterone, hypogonadism, diagnosis,

  Aug 2012 (Vol. 19, Issue 4 , Page 6401)
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• Ureteroileal anastomotic strictures after a Bricker ileal conduit: 50 case assessment of the impact of conversion from a slit incision to a shield shaped ileotomy

  Cheng Marina , Looney W. Stephen , Brown A. James, MD Division of Urology, Medical College of Georgia, Augusta, Georgia, USA

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  PURPOSE: Ureteroileal anastomotic stricture is a late complication of Bricker ileal conduits. We report our utilization of a 'shield shaped' rather than a standard slit ileotomy. MATERIALS AND METHODS: We retrospectively reviewed a single surgeon's experience performing Bricker ileal conduits, initially using a slit incision, then a shield shaped ileotomy. Patient demographics, type of ileotomy, indication, history of prior radiation or chemotherapy, development of postoperative ureteroileal anastomotic stricture, date of stricture diagnosis, imaging modality, stricture treatment, outcome, and length of follow up were recorded. RESULTS: A total of 50 ileal conduit patients were identified between 2001-2009. A traditional slit incision ileotomy was performed in 25 patients (Group 1) and a shield shaped ileotomy was performed in the following 25 (Group 2). After excluding 1 patient in each group that died within 90 days postoperatively, a total of 95 renal units were anastomosed, (Group 1: 24 patients, 48 renal units, 2001-2005; and Group 2: 24 patients, 47 renal units, 2006-2009). A total of 8 (8.3%) ureteroileal anastomotic strictures were identified: 6 (12.5%) in Group 1, including 1 with bilateral strictures, and 2 (4.3%) in Group 2. Stricture diagnosis occurred at 1, 4, 4, 5, 14 and 42 months in Group 1, and at 6 and 10 months in Group 2. Mean follow up was 24.2 (2-85) months and 12.3 (2-26) months for each cohort, respectively. No increase in postoperative anastomotic leakage was identified. CONCLUSIONS: Modifying the standard ileotomy slit to a shield shaped incision does not eliminate postoperative anastomotic strictures. This technique provides greater visualization of the suture line, making it technically easier to perform.

  Keywords: posterior urethral valves, adulthood, late diagnosis, outcome,

  Apr 2011 (Vol. 18, Issue 2 , Page 5644)
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