Laparoscopic Transperitoneal Bladder Diverticulectomy: Surgical Technique

Abstract

A large bladder diverticulum causing poor emptying in an 84-year-old man was removed laparoscopically in a 6.5-h operation. The patient was discharged from the hospital on the third postoperative day, having had minimal analgesic requirements. A Council catheter and stylet in the diverticulum greatly facilitated identification of the sac with the laparoscope. Difficulties with intracorporeal knot tying were avoided by using the Lapra-Ty system. Experienced laparoscopic surgeons may find this method of diverticulectomy valuable. With experience, the operating time should be reduced.

Study of reorientational dynamics during real-time crystallization of absorbable poly(p-dioxanone) by dielectric relaxation spectroscopy

“…Because of the low glass-transition temperature (Ϫ10°C) of the homopolymer, these crystallizable materials, besides being well suited for surgical monofilaments, can be injectionmolded into a number of nonfilamentous surgical devices such as clips 3,4 and fasteners. 5 To obtain optimum mechanical and biological properties for future polymer devices will require a firm understanding of morphological development and, in particular, a knowledge of the crystallization process.…”

Congenital Vesical Diverticulum in a 38-year-old Female

“…(a) Large diverticula (b) Complications of incomplete emptying including stone formation (5-16%) [2] recurrent urinary tract infections (13-73%) [2] (c) Spontaneous rupture (d) Vesico-ureteral reflux [6] (e) In 0.8-10% of diverticula there is a risk of developing mucosa metaplasia secondary to urinary carcinogens in stagnant diverticulum urine [7]. The tumour, mostly transitional cell carcinoma, has a very poor prognosis (58% survival in 2 years) [3,4] usually due to its high grade and very early wall penetration.…”

“…The transvesical submucosal method involves the dissection of the mucosal sac of the diverticulum followed by closure of the diverticulum opening [8]. Both open methods carry a significant morbidity related to surgery as well as an increased risk of rectal, vesical and urethral injury [6].…”

Management of Bladder Diverticula in the Pediatric Population

“…While there have been several reports of laparoscopic bladder diverticulectomy in adults [13][14][15][16][17][18], we have located only one previous report on pediatric laparoscopic extravesical bladder diverticulectomy in the literature that also described concurrent nephroureterectomy in a 6-year-old child [19]. In this approach, identification of the diverticulum from outside of the bladder can be difficult [15]. To facilitate the identification of the diverticulum from the outer surface of the bladder, various surgical techniques have been applied previously.…”