UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 Robot Assisted Ileal Replacement of Ureter Sunny Goel (1) (1) BLK Super Speciality Hospital, New Delhi Introduction andObjectives: Ileal replacement of ureter for multiple ureteric stricture can be done via open/laparoscopic techniques. We herein present a case of robotic ileal replacement of ureter Methods: We present a case of a 31-year-old female with history of left flank pain, intermittent type. She had a h/o GUTB for which she took ATT for 6 months. On evaluation, she was found to have moderate to severe left global gross HDN with thinning of cortex at upper pole, irregular thick wall throughout its length with areas of narrowing and dilatations in left ureter till VUJ s/o inflammatory pathology. Patient underwent Lt PCN insertion f/b robotic ileal replacement of ureter. Results: Patient planned for robotic ileal replacement of ureter. Robotic assisted ileal replacement of ureter done as shown in video. Histopathology report showed granulomatous inflammation. Patient recovered well in post op period. Drain removed on POD3. DJ stent removed after 4 weeks. She was started on ATT. Conclusions: Robot assisted ileal replacement of ureter is a procedure which can help in quick recovery, can be done via a small incision approach, decreased morbidity. V-10091 Laparoscopic Partial Nephrectomy in a Patient with “Toxic” Fat and No Intra-Operative Ultrasound Christine Joy Castillo (1) (1) Jose R. Reyes Memorial Medical Center Introduction and Objectives: Nephron- sparing surgery is the treatment of choice in renal tumors less than 4 cm. In certain cases, “toxic” peri- renal fat is encountered which is thick and adherent to the renal capsule. Identification of the tumor is difficult without intra-operative ultrasound. We aim to demonstrate how to proceed with laparoscopic partial nephrectomy even when dealing with a lot of adherent peri- nephric fat and absence of ultrasound. Methods: A 64-year-old male with incidental finding of a 3.3 x 2.9 x 3.7 cm enhancing left renal mass underwent laparoscopic partial nephrectomy Results: The total operative time was 3 hours and 22mins andwarm ischemia time was 19 mins. The estimated blood loss was minimal. The patient was discharged stable on the third hospital day. Upon follow up, histopath revealed renal cell carcinoma, with negative margins of resection. Conclusions: Laparoscopic partial nephrectomy can be done without intra- operative ultrasound in select cases with “toxic” fat. Careful correlation of CT scan images and intra-operative anatomy is a must. Finding an area of normal kidney first is key to avoid disrupting the tumor or the renal capsule. V-10155 V-10146 Laparoscopic Pyelolithotomy: Its Role and Our Experience Clarissa Gurbani (1) (1) Tan Tock Seng Hospital Introduction and Objectives: We present our preliminary experience with laparoscopic pyelolithotomy for the treatment of multiple stones within a malrotated kidney. Methods: Laparoscopic pyelolithotomy was chosen to avoid the potential risks of pleural and lung injury associated with a supra-12th rib puncture in percutaneous nephrolithotomy (PCNL). Results: Total operative time was 209 minutes. Recovery was uneventful and the patient was confirmed as stone-free on post-operative imaging. Removal of the drain and indwelling catheter was performed on day 1 and day 7 respectively. The patient was medically fit for discharge on post-operative day 2. Outpatient retrieval of the ureteric stent was performed at 6 weeks. Conclusions: Laparoscopic pyelolithotomy is a safe treatment modality with good stone-free rates for patients with large stones within malrotated and high-positioning kidneys, especially where conventional percutaneous methods are associated with difficulty or risky access. Sandwiched Posterior-Anterior Reconstructed Tissue-Glued Anastomosis (SPARTAN) in RARP: A Consistently Reproducible Urethro-Vesical Anastomosis for Early Catheter Removal and Continence Recovery Wei Xiang Alvin Low (1) (1) Singapore General Hospital Introduction and Objectives: Restoration of supporting structures around the urethral rhabdosphincter is key to preservation of continence mechanism post-RARP. This video aims to: (1) present the step-by-step SPARTAN technique, a novel easy-to-perform, simplified total anatomical reconstructed UV anastomotic technique incorporating the application of fibrin sealant for added water-tightness; (2) report the short- to intermediate-term outcomes on early day-4 catheter removal and continence recovery. Methods: This video presents a single-surgeon 20-patient RARP series performed with a standardized SPARTAN UV anastomotic technique. Post-operative outcomes measured were the success rate of early catheter removal and continence outcome. The stepby-step SPARTAN technique is outlined sequentially as follows: (1) modified Rocco’s Stitch for posterior musculofascial plate reconstruction; (2) the same modified Rocco’s Stitch is used to incorporate the 6 O’clock UV anastomosis; (3) completion of anastomosis by Velthoven technique; (4) application of peri?anastomotic fibrin sealant; and (5) anterior reconstruction. Results: The patient cohort consists of 85% (17/20 patients) low- or intermediate-risk cases by D’Amico classification, and 85%had nerve-sparing RARP. About two-third (75%) of these patients had recovered continence by day-30 post-catheter removal as defined by the usage of one or no safety-liner per-day. Two patients had immediate continence recovery. Ten patients had cystogram at day-4 with none showed any sign of urinary leakage and all but one had successful trial removal of catheter. Conclusions: SPARTAN is a consistently reproducible, tension-free, water- tight UV anastomotic trechnique in RARP that allows for early catheter removal and continence recovery. V-10077 26