@CanesDavid @jfunkmd @alextatem @AshleyGWinter @LauraBukavinaMD @DrCorriel @Cacciamani_MD @CaseySeidemanMD @SPuro88 @KeithKow

Another case of an electrical short in a Monopolar instrument. I want to raise this awareness with everyone to avoid inadvertent injury. The system doesn’t alert you so it’s up to you. If you see smoking off your wrist, return instrument for refund and switch to new one.

@ZhinaSadeghi Respectfully I can’t say I agree. I have an extensive experience w/revision pyeloplasty. Renal pelvis flaps are unreliable often due to aperistalsis and poor vascular supply. Buccal graft for this purpose is a reliable technique w/a 90% success rate.

@Urodoc46 Once in a while…

I’m specifically talking about spiral flaps (long skinny like the pictures in Campbells). I don’t love renal flaps & when I do, I really try to preserve existing vascularity and then check with ICG. But overall, buccal graft is my usual go to for revisions. Reliability is key.

It really is the only good way to approach this terrible complication. Open approach is much harder to surgeon and patients. Balloon dilation has a high failure rate and usually makes the problem worse.

A break in the insulation of a Monopolar instrument is not always obvious & can be dangerous. Cautery effect is muted since energy is not just being dispersed at the instrument tip as designed. Smoke at wrist is telltale. Videos show difference btwn damaged vs normal instrument.

People please stop placing Hemo-Lock weck clips next to the urinary tract! The literature has many examples of these clip erosions. I’ve removed so many during revision surgery: BN recon, pyeloplasty &ureter stricture cases. This one is a solitary kidney, revision pyeloplasty.

Pt w/pediatric reimplant, eventually had durasphere injection —>failed. Revising to non refluxing reimplant but must remove very intrusive durasphere that’s been injected medically+laterally along ureter sheath. I’ve done few of these but this one’s pretty bad. Interesting video.

@CanesDavid @SocietySURS @Endo_Society @RoboUro @TempleUrology @so_uro @AmerUrological Our experience have been transvesical multiport (3 robot, 1 5mm assist). But SP would probably be just as good.

@CanesDavid @SocietySURS @Endo_Society @RoboUro @TempleUrology @so_uro @AmerUrological 5 weeks. We’ve done these repairs on POD 1- 6 weeks out. We offer immediate repair in anyone at the time of discovery and will take patient transfers from outside hospitals and do same week repair. We offer this for iatrogenic ureteral repairs as well.

Thank you to my friend @SAlabdlhadi for another gracious invitation to Kuwait &the amazing hospitality. Sabah Al Ahmad Urology Center robotic program is truly a shining beacon of excellence in the gulf region. Thanks to the Ministry of Health for the generous support! @KUWAIT_MOH

@Issarami @TempleUrology @Endo_Society @RoboUro @SocietySURS Goals of bx 1) r/o malignancy 2) send for IGG4 staining. The IGG4 staining helps the rheumatologists in classifying and choosing course of medical management. There really needs to be multidisciplinary guidelines set for this unfortunate disease.

@RoboticsUrology Yes! Our field only improves by challenging aged dogma set in the era of open surgery. Our tools are now different &we can offer better for our patients. Anastomotic leaks often do not need indefinite drainage if you can go in &fix it. Thanks for posting Mutahar! Merry Christmas!

@ysaralee @AmazonPub @LaneMoore28 Wow this is really cool. Very talented Yeonsoo!