PD21-08 ADVANTAGES AND TECHNICAL CHALLENGES OF LIGHTED URETERAL STENTS DURING LAPAROSCOPIC BOWEL SURGERY.

Abstract

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy and Robotics: Benign Disease1 Apr 2015PD21-08 ADVANTAGES AND TECHNICAL CHALLENGES OF LIGHTED URETERAL STENTS DURING LAPAROSCOPIC BOWEL SURGERY. Danny Huynh, Lucas Hockman, Jerry Trulson, and Mark Wakefield Danny HuynhDanny Huynh More articles by this author , Lucas HockmanLucas Hockman More articles by this author , Jerry TrulsonJerry Trulson More articles by this author , and Mark WakefieldMark Wakefield More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1437AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the increased use of laparoscopic colorectal surgery over the past 2 decades, iatrogenic ureteral injuries have become an increasing concern. Ureteral stent placement prior to laparoscopic surgery has assisted in the identification of the ureters but has not significantly decreased the number of ureteral injuries. Infrared-lighted ureteral stents (LUS) have been developed to improve ureteral identification but it is unclear whether this has translated to decreased ureteral injuries. We investigated the use of these LUS at our institution over a two-year period. METHODS A retrospective review was performed of all laparoscopic bowel resections done with the aid of LUS at the University of Missouri-Columbia from May 2006 to July 2008. Twenty patients were identified with a total of 29 LUS placement attempts. Each case was evaluated for success of ureteral identification and safety of LUS placement. In all cases the Stryker InfraVision Ureteral Kit was used. LUS were placed by one of four attending urologists. All LUS were removed prior to patient awakening. RESULTS The 20 identified surgeries included 7 low anterior resections, 5 colostomy reversals, 4 sigmoidectomies, 3 Hartman's procedures and 1 completion proctatectomy. Of the 29 placement attempts (unilateral or bilateral), 25 were successful. All illuminated and allowed for identification of the ureter except one, which was identified via palpation. No ureteral injuries were sustained during laparoscopic dissection. Of the four placement failures, 2 were secondary to ureteral narrowing requiring 5 fr catheters, one ureteral flap was created requiring ureteroscopy for indwelling stent placement and one ureteral perforated was encountered requiring indwelling stent placement. The overall complication rate was 13.8% (4/29) and ureteral injury rate was 6.9% (2/29). CONCLUSIONS Once placed, LUS do allow for identification of the ureter during laparoscopic bowel resection. However, due to technical difficulties with the stents themselves, complications were encountered during placement. The ureteral injury rate with the LUS was 6.9% which is higher than that reported for colorectal surgery alone (0.2-4.5%). Technical challenges with LUS placement limit its utility in laparoscopic bowel surgery and may lead to unnecessary risk. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e474 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Danny Huynh More articles by this author Lucas Hockman More articles by this author Jerry Trulson More articles by this author Mark Wakefield More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...