Minimally-Invasive UroLift for BPH - Kurt Strom MD, Loveland, Colorado, USA

In this video, minimally-invasive UroLift implantation for BPH and its indications, benefits, and placement technique is discussed. Kurt Strom MD, Loveland, Colorado, USA

Bladder Cancer: DaVinci Robotic Cystectomy - Kurt Strom MD, Loveland, Colorado, USA

Robotic radical cystectomy with bilateral pelvic lymph node dissection is demonstrated in this video. Continent neobladder / ileal conduit formation is not shown in this video.

Robotic / DaVinc Partial Nephrectomy; Kurt Strom MD, Joshua Holyoak MD, University of Missouri

Eliminating Global Renal Ischemia by Selective Renal Arterial Clamping in Robot-Assisted Partial Nephrectomy Kurt Strom, Joshua Holyoak*, Columbia, MO, USA.

Robotic Surgery, DaVinci™ Robotic Surgery, Partial Nephrectomy, Renal Cell Carcinoma, Kidney Cancer, Nephron-Sparing Surgery, Urologic Oncology

INTRODUCTION AND OBJECTIVES: Many techniques have been investigated to diminish intraoperative renal ischemia including partial hilar clamping, selective renal parenchymal clamping, and even zero-ischemia partial nephrectomies. We describe a selective clamping of a segmental renal artery branch during a robot-assisted laparoscopic partial nephrectomy.

METHODS: A 59 year old female underwent robot-assisted laparoscopic partial left nephrectomy for a 4.3 cm anterior lower pole tumor. After careful dissection of the main and segmental renal arteries, the segmental branch was clamped prior to removing the tumor with intraoperative ultrasound guidance. The deep tumor bed renorrhaphy was completed using the single pass suturing technique.

RESULTS: Selective clamping of a segmental renal artery supplying the tumor spared the kidney from complete ischemia. Warm ischemia time for the lower pole segment was 20 minutes. The patient lost 350cc of blood, her creatinine was unchanged, and she was discharged home on post-operative day #3. Final pathology showed T1a grade 2 clear cell carcinoma with negative margins.

CONCLUSIONS: Segmental renal arterial clamping during robot-assisted partial nephrectomy is feasible and prevents exposing the whole kidney to the effects of warm ischemia time.

DaVinci™ Robotic Left Adrenalectomy for Pheochromocytoma - Kurt Strom MD & Thomas Blomquist MD

DaVinci™ Robotic Left Adrenalectomy for Pheochromocytoma - Kurt Strom MD & Thomas Blomquist MD - Loveland, Colorado

Robotic Left RPLND (Retroperitoneal Lymph Node Dissection) / Modified Template - Kurt Strom MD

Robotic Left RPLND (Retroperitoneal Lymph Node Dissection) / Modified Template - Kurt Strom MD

Loveland, Colorado, USA

Urethral Prolapse Repair, Kurt Strom MD, Joshua Holyoak MD, Scott Matz MD, Female Urology

Modification of the Four-Quadrant Excisional Technique for Urethral Prolapse Repair
Kurt Strom, Joshua Holyoak, Scott Matz*, Columbia, MO

INTRODUCTION AND OBJECTIVES: Various treatments have been described for the treatment of urethral prolapse and include excision and suture reapproximation of the mucosal edges, ligation of the prolapsed urethra over a catheter with eventual tissue sloughing, cauterization, cryosurgery, bladder neck suspension, and, urethral fixation with a retropubic sling. We demonstrate a modification of the four-quadrant excision technique.

METHODS: The patient is positioned in dorsal lithotomy. Next, a weighted vaginal speculum and stay sutures for labial retraction are placed. An 18 French metal sound is then inserted into the urethra allowing for easy placement of four holding sutures into the four quadrants of the urethra. After placement of the holding sutures, the modification we present consists of passage of two mucosal trapping sutures. These are placed before excision of each quadrant to prevent the retraction of the inner urethral mucosal edge into the bladder. The metal sound is removed and then the first trapping suture is placed in the vertical plane by entering on the dorsum of the outer base of the prolapsed uretha, passing through the tissue, and entering the inner base of the dorsal urethral mucosa. Once inside the urethra, the needle is passed into the ventrum of the inner base of the prolapsed urethra, through the tissue and out through the outer base of the ventral aspect. The same maneuver is performed in the horizontal plane in a similar fashion. Each quadrant is then excised.

RESULTS: With the incised inner mucosal edge held in position by the trapping sutures, the approximation of the mucosal edges with twelve simple interrupted sutures consisting of 4-O chromic is precise. The patient had a catheter placed which was removed on post-operative day three and to date is without symptoms.

CONCLUSIONS: The use of trapping sutures allow for a more careful excision of the prolapsed urethra with a precise reapproximation of the mucosal edges.

Robotic Intracorporeal Ileal Conduit - Kurt Strom MD

Total robotic intracorporeal urinary diversion with Wallace ureterointestinal anastomsosis is presented here. Major surgery is performed with unique minimally-invasive surgical techniques with small incisions, less morbidity, minimal blood loss and quicker recovery times. Complex robotic surgical procedures like this are performed here in Loveland, Colorado, USA.
Kurt Strom MD