Vol. 191, No. 4S, Supplement, Sunday, May 18, 2014 THE JOURNAL OF UROLOGY� e353

Source of Funding: None.

PD13-03ENDOCKSCOPE: USING MOBILE TECHNOLOGY TO CREATEGLOBAL POINT OF SERVICE ENDOSCOPY

Renai Yoon*, Samir Shreim, Atreya Dash, Ralph Clayman,William Sohn, Hak J. Lee, Orange, CA

INTRODUCTION AND OBJECTIVES: Technological advancesin mobile technology have served as a precursor to new innovations inhealthcare. Herein, we present our findings in the use of the 2nd gen-eration Endockscope, a specialized lens and docking system with anincorporated LED light source that promotes the coupling of a smart-phone (iPhone 4S) with modern fiber-optic endoscopes.

METHODS: Measurements were performed to compare theweight (lbs) and lumens output (lux) of the Endockscope system withincorporated LED light source to standard HD endoscopic equipmentwith wired xenon light source. A cost comparison was also done tocompare the two systems. Image resolution (line pairs/mm) wascompared using a USAF resolution target (Edmund Optics, NJ) andflexible cystoscope (Storz, Germany) coupled to both the Endockscope-iPhone and a HD camera (Storz H3-Z Versatile HD Camera). A 30�

laparoscope and a Munsell ColorChecker chart were used to comparecolor resolution. Finally, cystoscopic and ureteroscopic images taken ofa porcine model with both systems were blindly compared and evalu-ated by 5 expert endoscopists using a Likert scale.

RESULTS: The weight of the Endockscope system with incor-porated LED light source was 0.67 lbs and the Storz HD camera andlight cable was 2.07 lbs. The incorporated LED light source yielded3.27% of the lumens output of a standard xenon light source (1589.4 vs.48580 lux). The overall cost of the mobile-coupled system with incor-porated LED light source was $624 compared to $64,378 for a standardsystem. The image resolution was same for both systems (4.49 vs 4.49lp/mm). Blue (DE ¼ 36.5 vs. 35.8) and green (DE ¼ 33.3 vs. 39.6)demonstrated similar color resolution for both systems. Red (DE ¼ 33.3vs. 14.1) demonstrated better color resolution for Storz HD Camera.Evaluation of cystoscopic images acquired with the Storz camera weresuperior in image (4.4 vs. 3.2), color (4.0 vs. 2.8), and overall quality(4.2 vs. 3.4) (p¼ 0.001, .016. 0.049). Evaluations of ureteroscopic im-ages yielded no statistical difference in image quality (4.2 vs. 3.4) andcolor (3.6 vs. 3.2) (p¼ 0.120, 0.310), while overall quality was superior

for the Storz system (4.1 vs. 3.2) (p¼0.027). All experts concluded thatthe images taken acceptable for therapeutic and diagnostic use.

CONCLUSIONS: The Endockscope system demonstrated theoptimized coupling of modern endoscopes to a mobile device. Themobile coupled device with incorporated LED light source was found tobe lighter and less expensive in comparison to standard systems. Thedevice also acquired images of the same resolution and color andyielded overall good reviews by experts.

Source of Funding: none

PD13-04LAPAROSCOPIC RENAL DENERVATION IN PATIENTS WITHTREATMENT-RESISTANT HYPERTENSION.

Aurn Panackal*, Muscat, Oman; Sunil Sinha, Cape town, South Africa

INTRODUCTION AND OBJECTIVES: Activation of renal sym-pathetic nerves is the key to pathogenesis of essential hypertension.We aimed to assess effectiveness and safety of laparoscopic renaldenervation for reduction of blood pressure in patients with treatment-resistant hypertension.

METHODS: 7 pt were identified with treatment resistant hy-pertension having a baseline systolic blood pressure of 160 mm Hg,despite taking three or more antihypertensive drugs. They underwentlaparoscopic renal denervation of both kidneys, with subsequent follow-up of 1 year. Primary endpoints were office blood pressure at 1, 3, 6, 9,and 12 months after the procedure.

RESULTS: The baseline mean office blood pressure were 177/101 mm Hg and they were on mean 5(4-10) antihypertensive medica-tions. Office blood pressures after procedure for four patients werereduced by -60/-30, -20/-10, +05/+05, +10/+5, and +15/+5 mmHg andother three patients -60/-30, +20/+10, +30/+11, +35/+11, and +30/+10mm Hg at 1, 3, 6, 9, and 12 months, respectively. No procedure-relatedcomplication or renal function impairment or deterioration was recorded.

CONCLUSIONS: Laparoscopic renal denervation had moder-ate effect on four patients causing sustained blood-pressure reduction,but other three patients had no effect on blood pressure at one yearfollow up, even though there was an initial drop in blood pressure in allpatients. Nevertheless prospective randomized controlled trials willhave to confirm the therapeutic effects and further implications of thisnew therapeutic modality.

Source of Funding: nad

PD13-05LAPAROSCOPIC BILATERAL RENAL DENERVATION FORREFRACTORY HYPERTENSION

Shakir Tabrez*, Mohan Keshavamurthy, Premkumar Krishnappa,Uday Bhaskar, Sreeharsha H, Mohan Balaiah Ashwathaiya,Seetha Belavadi, Bangalore, India

INTRODUCTION AND OBJECTIVES: Refractory or resistanthypertension is conventionally defined as systolic or diastolic bloodpressure that remains uncontrolled despite sustained therapy with atleast three different classes of antihypertensive agents. There is anincreased risk of cardiovascular and cerebrovascular events in suchpatients. A novel yet effective approach to manage such patients islaparoscopic bilateral renal sympathectomy.

METHODS: Between February 2012 and May 2013, we had 6patients referred to us who were diagnosed with refractory hyperten-sion. All secondary causes of hypertension were ruled out by relevantinvestigative modalities. The mean systolic blood pressure in thesepatients was 181.5 mm Hg and the mean diastolic pressure was105 mm Hg. One of the 6 patients had undergone a percutaneouscatheter based radiofrequency ablation of the renal sympathetic sys-tem, following which the hypertension relapsed. After ruling out allcauses of secondary hypertension, through relevant investigations and

e354 THE JOURNAL OF UROLOGY� Vol. 191, No. 4S, Supplement, Sunday, May 18, 2014

an endocrinologist opinion, these patients were counseled regardingthe surgical procedure. All patients underwent a Laparoscopic BilateralRenal Denervation, under general anaesthesia. With the patients oncorresponding flank positions - both kidneys, renal arteries and veinsand both renal pelves were denuded of all sympathetic tissue. Meanage of the patients was 47.75 (range 37 e 56) and female to male ratiowas 1:1.

RESULTS: The mean operative time was 153.25 minutes(range 135 e 180 minutes). And blood loss was insignificant. Meanhospital stay was 3.25 days. No post operative complications wereencountered. No case required a conversion to open surgery. Bloodpressure normalized in all 6 patients with 1 patient not requiring anyantihypertensive medication at all afterward. 5 of the 6 patients havebeen maintaining normal blood pressures on 1 antihypertensive medi-cation and show no relapse on followup.

CONCLUSIONS: Refractory hypertension which is treatmentresistant has an increased risk of cardiovascular and cerebrovascularevents, which may prove potentially life threatening. Laparoscopicbilateral renal denervation could prove to be a very efficient procedurein effectively treating these patients with minimal side effects and nocomplications.

Source of Funding: None

PD13-06FAVORABLE OUTCOMES OF GASLESS SINGLE-PORTCLAMPLESS PARTIAL NEPHRECTOMY USING NEW THREEDIMENSIONAL HEAD-MOUNTED DISPLAY SYSTEM(ROBOSURGEON SYSTEM)

Kazunori Kihara, Kazutaka Saito*, Yasukazu Nakanishi, Toshiki Kijima,Soichiro Yoshida, Junichirou Ishioka, Yoh Matsuoka, Noboru Numao,Fumitaka Koga, Hitoshi Masuda, Yasuhisa Fujii, Tokyo, Japan

INTRODUCTION AND OBJECTIVES: A novel head-mounteddisplay (HMD) system, which we developed with technical support fromSony Corporation, offers simultaneous, high quality magnified 3D im-agery right in front of the eyes. This affordable display system alsoprovides various images, in addition to those from the endoscope, suchas the ultrasound probe. The application of the 3D-HMD system togasless single-port clampless partial nephrectomy (PN), the concept ofwhich has been presented (EAU2010 V4; AUA 2012 #1105), has beenreported at EAU and AUA (EAU2013 V21; AUA2013 #840). We eval-uated the surgical outcomes in initial 111 cases of 3D-HMD gaslesssingle-port clampless PN.

METHODS: Between November 2011 and September 2013,111 consecutive patients with renal tumors suggestive of RCC under-went gasless single-port clampless PN in an attempt to accomplish theprocedure without vascular clamping and renorraphy using 3D-HMDsystem. Surgical procedures were completed via a single port, of whichthe diameter was typically around 4 cm. Intraoperative ultrasonographywas employed to score precise surgical margin. Ultrasonic coagulatingdevices were chiefly used for tumor excision. Perioperative complica-tions were graded according to the Clavien-Dindo classification.

RESULTS: Median PADUA score was 8 (range, 6-12). Vascularclamping was required in 6 patients (5%). Median (range) operative timeand blood loss were 221 min (100-437) and 368 mL (0-4114), respec-tively. Three patients (3%) required blood transfusion. Nine major(8%, grade 3a urinary leakage) and 10 minor (9%) complications wereobserved. No pseudoaneurysm was observed. Of 105 RCC patients,surgical margin was positive in 2 patients (2%) and most positive marginsites underwent thermal degeneration pathologically. None experiencedacute renal failure, required dialysis, or newly developed CKD of eGFR<45 mL/min/1.73 m2 postoperatively. Median percent change in eGFRat 1 months after PN was -4.9% (-46.1 to +28.1).

CONCLUSIONS: A new 3D head-mounted display system isfeasible and may facilitate maneuverability and safety in gassless sin-gle-port clampless PN.

Source of Funding: none

PD13-07DELIVERY OF UPPER TRACT CHEMOTHERAPY TO PATIENTSWITH URINARY DIVERSION: A NOVEL APPROACH

Gina Badalato, Ruslan Korets, Justin Matulay*, Mantu Gupta, NewYork, NY

INTRODUCTION AND OBJECTIVES: Patients with urinarydiversion and upper tract recurrence who are not candidates for ne-phrectomy pose a therapeutic conundrum. Use of a nephrostomy tubefor chemotherapy delivery to the upper tract is wrought with increasedrisk of sepsis. Delivery via reflux or via repeated weekly catherization ofthe renal pelvis can be difficult and/or unreliable in this subset. Hereinwe describe a novel delivery technique for patients who have a uri-nary diversion.

METHODS: For patients with an ileal conduit, a 10.2F Mac-Loc� 45 cm nephroureteral catheter is placed with the pigtail resting inthe renal pelvis and the distal aspect inside the ostomy bag. The distalaspect is delivered by cutting the bag, delivering the luer-lock portionthrough the hole, and connecting it directly to IV tubing that allows forweekly instillation of chemotherapy under gravity via a buretrol cham-ber. Following infusion, a new bag is placed onto the stoma, replacingthe distal catheter tip into the bag. For patients with an Indiana pouch ororthotopic neobladder a 7Fr 70-cm single pigtail nephroureteral catheteris placed with the pigtail portion in the renal pelvis and the distal aspectinside the reservoir. The distal tip is cystoscopically grasped anddelivered through the stoma/ urethra and chemotherapy is administeredvia a buretrol infusion device as above. Following chemotherapyadministration, the distal catheter tip is pushed back into the reservoirwith a cystoscope. After completing a treatment series, the catheter issimply removed.

RESULTS: In this pilot investigation 25 instillations were per-formed using the above techniques, including 14 induction treatmentsand 11 maintenance sessions. There were no technical difficulties withany of the instillations, except one instance of catheter obstruction frommucous that was easily cleared by flushing normal saline. No cases ofurosepsis occurred, and no antibiotics were routinely administered atthe time of the procedures. One patient developed mild hematuriafollowing a maintenance session that was associated with urinary tractinfection; he responded to antibiotics and catheter exchange over aguidewire. There were no chemotherapy-related complications.

CONCLUSIONS: Patients with upper tract disease and a uri-nary diversion who are not candidates for nephrectomy can bemanaged successfully while maintaining a closed system using anephroureteral catheter for weekly instillations of chemotherapy. Thisrepresents an excellent and safe alternative to chemotherapy deliveryvia a nephrostomy tube.

Source of Funding: None