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Parekattil S, Yeung LL, Su LM. Intraoperative Tissue Characterization and Imaging. Urol Clin North Am 2009; 36:213-21, ix. [DOI: 10.1016/j.ucl.2009.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rassweiler J, Baumhauer M, Weickert U, Meinzer HP, Teber D, Su LM, Patel VR. The Role of Imaging and Navigation for Natural Orifice Translumenal Endoscopic Surgery. J Endourol 2009; 23:793-802. [DOI: 10.1089/end.2008.0127] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Fried NM, Lagoda GA, Scott NJ, Su LM, Burnett AL. Laser stimulation of the cavernous nerves in the rat prostate, in vivo: optimization of wavelength, pulse energy, and pulse repetition rate. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:2777-80. [PMID: 19163281 DOI: 10.1109/iembs.2008.4649778] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The cavernous nerves on the prostate surface are responsible for erectile function. Improved diagnostic techniques are necessary for identification of the nerves during prostate cancer surgery and preservation of sexual function after surgery. Electrical mapping of the nerves has been used as an intra-operative tool during prostate surgery, but it has proven inconsistent and unreliable. Non-contact optical stimulation of the cavernous nerves in the rat prostate has recently been demonstrated as a potential alternative to electrical nerve stimulation. The purpose of this study is to optimize the laser parameters to provide the maximum intracavernosal pressure response after optical nerve stimulation in the rat prostate. Optimal laser nerve stimulation parameters provided comparable response to electrical nerve stimulation. Optical nerve stimulation may represent a potential intra-operative diagnostic technique for use in laparoscopic and robotic nerve-sparing prostate cancer surgery.
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Parekattil SJ, Atalah HN, Holland D, Dahm P, Vieweg JW, Su LM. DIAMOND 4-ARM PORT CONFIGURATION FOR SINGLE DOCKING ROBOTIC RENAL SURGERY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pavlovich CP, Mettee LZ, Su LM, Jarow JP, Trock BJ. NIGHTLY SILDENAFIL IS UNNECESSARY AFTER MINIMALLY-INVASIVE NERVE-SPARING RADICAL PROSTATECTOMY: ON-DEMAND SILDENAFIL PROVIDES EQUIVALENT RESTORATION OF ERECTILE FUNCTION. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61375-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Levinson AW, Ward NT, Pierorazio PM, Mettee LZ, Su LM, Pavlovich CP. EXPLORING THE IIEF-5: HOW BOTHERED ARE MEN WITH SEVERE ED BY THEIR CONDITION? J Urol 2009. [DOI: 10.1016/s0022-5347(09)61054-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Su LM, Vagvolgyi BP, Agarwal R, Reiley CE, Taylor RH, Hager GD. Augmented Reality During Robot-assisted Laparoscopic Partial Nephrectomy: Toward Real-Time 3D-CT to Stereoscopic Video Registration. Urology 2009; 73:896-900. [DOI: 10.1016/j.urology.2008.11.040] [Citation(s) in RCA: 208] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 10/25/2008] [Accepted: 11/23/2008] [Indexed: 11/28/2022]
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Secin FP, Savage CJ, Abbou CC, de la Taille A, Salomon L, Rassweiler J, Hruza M, Rozet F, Cathelineau X, Janetschek G, Tuerk IA, Gill IS, Kaouk JH, Martínez-Piñeiro L, Pansadoro V, Emiliozzi P, Bjartell A, Jiborn T, Eden C, Van Velthoven R, Stolzenburg JU, Su LM, Vickers AJ, Touijer KA, Guillonneau B. COMPARISON OF THE LEARNING CURVES FOR OPEN AND LAPAROSCOPIC RADICAL PROSTATECTOMY: AN INTERNATIONAL MULTICENTER STUDY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)62291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bivalacqua TJ, Pierorazio PM, Su LM. Open, laparoscopic and robotic radical prostatectomy: optimizing the surgical approach. Surg Oncol 2009; 18:233-41. [PMID: 19286370 DOI: 10.1016/j.suronc.2009.02.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
As advances in the understanding of prostatic anatomy led to improvements in functional and oncologic outcomes after prostatectomy of the past few decades, advances in technology and surgical technique have made minimally-invasive prostate surgery a reality. Today patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past including open, laparoscopic and robot-assisted laparoscopic radical prostatectomy. Advantages and disadvantages exist for each modality and lead to subtle differences in the technical execution of the procedure. Evidence from centers of excellence and from experienced surgeons demonstrates that both laparoscopic and robotic-assisted laparoscopic radical prostatectomy appear to be comparable to outcomes achieved with open radical retropubic prostatectomy series. Individual surgeon skill, experience and clinical judgment are likely the stronger predictors of outcome rather than the technique chosen. However, learning curves, oncologic outcomes and cost-efficacy remain important considerations in the dissemination of minimally-invasive prostate surgery. A greater appreciation of the periprostatic anatomy and further modification of surgical technique will result in continued improvement in functional outcomes and oncological control for patients undergoing radical prostatectomy, whether by open or minimally-invasive surgery.
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Levinson AW, Ward NT, Sulman A, Mettee LZ, Link RE, Su LM, Pavlovich CP. The Impact of Prostate Size on Perioperative Outcomes in a Large Laparoscopic Radical Prostatectomy Series. J Endourol 2009; 23:147-52. [PMID: 19125654 DOI: 10.1089/end.2008.0366] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gonzalgo ML, Patil N, Su LM, Patel VR. Minimally invasive surgical approaches and management of prostate cancer. Urol Clin North Am 2008; 35:489-504, ix. [PMID: 18761202 DOI: 10.1016/j.ucl.2008.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For clinically localized prostate cancer, radical prostatectomy remains the "gold standard" treatment. New forms of minimally invasive therapies are sought out by patients, however, because of the potential morbidity associated with open surgery. With quality-of-life aspects influencing patient decision making, minimally invasive therapeutic modalities have generated great interest among patients. Laparoscopic radical prostatectomy, robotic-assisted laparoscopic prostatectomy, brachytherapy, cryotherapy, and high-intensity focused ultrasound are all considered to be minimally invasive treatment options for the management of clinically localized prostate cancer.
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Sur RL, Wagner AA, Albala DM, Su LM. Critical role of the assistant in laparoscopic and robot-assisted radical prostatectomy. J Endourol 2008; 22:587-9; discussion 589-90. [PMID: 18324900 DOI: 10.1089/end.2007.9837] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The literature on standard laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) is replete with technical descriptions of the primary surgeon's responsibility, but deficient with regard to the detailed role of the assistant surgeon. This video paper describes the critical role of the assistant surgeon and provides tips for the assistant to facilitate these operations.
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Levinson AW, Su LM, Agarwal D, Sroka M, Jarrett TW, Kavoussi LR, Solomon SB. Long-term oncological and overall outcomes of percutaneous radio frequency ablation in high risk surgical patients with a solitary small renal mass. J Urol 2008; 180:499-504; discussion 504. [PMID: 18550123 DOI: 10.1016/j.juro.2008.04.031] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Indexed: 12/15/2022]
Abstract
PURPOSE We present long-term outcomes in patients receiving RFA for solitary small renal masses. MATERIALS AND METHODS We reviewed the overall oncological and survival outcomes of patients with a solitary renal mass treated with radio frequency ablation in whom it had been at least 40 months since treatment. Patients were offered radio frequency ablation due to the high risk of surgical management and surgeon preference. Followup consisted of serum creatinine measurement, physical examination and serial contrast enhanced computerized tomography or magnetic resonance imaging. RESULTS The 31 patients received a total of 34 radio frequency ablation treatments to a 1.0 to 4.0 cm solitary renal mass (median 2.0). Mean followup in survivors was 61.6 months (median 62.4, range 41 to 80). There was 1 primary treatment failure, which was successfully retreated. There were 3 recurrences 7, 13 and 31 months after radio frequency ablation, respectively. The overall recurrence-free survival rate was 90.3%. There was a 100% metastasis-free and disease specific survival rate in the cohort. Overall patient survival was 71.0% since 9 died of nonrenal cell carcinoma causes. Of the 31 patients 18 had pathologically confirmed renal cell carcinoma. In these 18 cases the actuarial disease specific, metastasis-free, recurrence-free and overall survival rates were 100%, 100%, 79.9% and 58.3%, respectively, at a mean of 57.4 months of followup. In the entire cohort the difference between the pretreatment and the last known serum creatinine level was 0.15 mg/dl (p = 0.06). CONCLUSIONS In patients who have limited life expectancy or are high risk surgical candidates radio frequency ablation provides reasonable long-term oncological control and it may have a role in the management of small renal masses. Meticulous long-term followup is required in patients receiving radio frequency ablation.
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Levinson AW, Ward NT, Sanda MG, Wei JT, Su LM, Litwin MS, Pavlovich CP. COMPARISON OF VALIDATED INSTRUMENTS TO MEASURE SEXUAL FUNCTION IN A COHORT OF PREOPERATIVE PROSTATE CANCER PATIENTS. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61056-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Roberts WB, Tseng K, Pavlovich CP, Chan D, Su LM, Walsh PC, Han M. PERIOPERATIVE COMPLICATIONS OF RADICAL PROSTATECTOMY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61633-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gonzalgo ML, Magheli A, Brotzman M, Su LM. SINGLE SURGEON COMPARISON BETWEEN CONVENTIONAL LAPAROSCOPIC AND ROBOT-ASSISTED RADICAL PROSTATECTOMY: PATHOLOGICAL AND FUNCTIONAL OUTCOMES. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Roberts WB, deAlmeida e Paula F, Lepper F, Su LM. TECHNIQUE OF LEFT ROBOT-ASSISTED LAPAROSCOPIC NEPHROURETERECTOMY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60454-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bivalacqua TJ, Schaeffer EM, Alphs H, Mettee L, Wagner AA, Su LM, Pavlovich CP. Intraperitoneal effects of extraperitoneal laparoscopic radical prostatectomy. Urology 2008; 72:273-7. [PMID: 18355906 DOI: 10.1016/j.urology.2007.12.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 11/24/2007] [Accepted: 12/05/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare routine radiologic and laboratory findings after extraperitoneal and transperitoneal laparoscopic radical prostatectomy (eLRP, tLRP) and assess relevant clinical correlations. METHODS Fifty consecutive eLRP and tLRP (laparoscopic and robot-assisted) were evaluated. Preoperative complete metabolic panel and complete blood count were determined, and these serum tests and amylase and lipase level measurements were repeated postoperatively. Ten consecutive eLRP and tLRP patients also underwent flat and upright abdominal x-rays. Operative time, perioperative complications, length of hospital stay, and amount of narcotic used were measured for each group. RESULTS On postoperative day 1, all eLRP patients evaluated (100%) had radiographic free air in the abdomen, as did 80% of the tLRP patients. Only 1 of 50 patients (2%) had elevated aspartate aminotransferase (eLRP), 2 of 50 (4%) had elevated alanine aminotransferase (both eLRP), and 4 of 50 (8%) had elevated amylase (3 eLRP, 1 tLRP). Postoperative narcotic usage (eLRP 25 +/- 3 mg versus tLRP 23 +/- 5 mg morphine equivalents) and operative times (eLRP 3.6 +/- 0.1 hours versus tLRP 3.8 +/- 0.1 hours) were similar between the groups. Length of hospital stay was lower in the eLRP compared with the tLRP group (1.9 +/- 0.1 days versus 2.2 +/- 0.1 days, P <0.05). Perioperative complications did not differ significantly between groups. CONCLUSIONS Extraperitoneal LRP and tLRP patients had comparable perioperative outcomes, and few had abnormal serum metabolic laboratory values postoperatively. Unexpectedly, abdominal free air was found in all eLRP patients evaluated radiographically on postoperative day 1, a finding that should be interpreted as normal and not specific for bowel injury in this context.
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Fried NM, Lagoda GA, Scott NJ, Su LM, Burnett AL. Noncontact Stimulation of the Cavernous Nerves in the Rat Prostate Using a Tunable-Wavelength Thulium Fiber Laser. J Endourol 2008; 22:409-13. [DOI: 10.1089/end.2008.9996] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pavlovich CP, Trock BJ, Sulman A, Wagner AA, Mettee LZ, Su LM. 3-year actuarial biochemical recurrence-free survival following laparoscopic radical prostatectomy: experience from a tertiary referral center in the United States. J Urol 2008; 179:917-21; discussion 921-2. [PMID: 18207191 DOI: 10.1016/j.juro.2007.10.067] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE We performed a prospective analysis of pathological and oncological outcomes following laparoscopic radical prostatectomy at a medical center in the United States. MATERIALS AND METHODS A total of 528 men underwent laparoscopic radical prostatectomy between April 2001 and August 2005. We excluded 4 open surgical conversions (0.8%) and 16 men (3.0%) without followup. The remaining 508 men had a mean preoperative prostate specific antigen of 6.0 ng/ml (range 0.3 to 27) and Gleason score of 6.3 (range 6 to 10). Stage was cT1b in 1 case (0.2%), cT1c in 350 (68.9%), cT2a in 135 (26.6%), cT2b in 21 (4.1%) and cT2c in 1 (0.2%). Of the patients 89% underwent cavernous nerve preservation. Biochemical recurrence was defined and timed at the first prostate specific antigen of 0.2 ng/ml or greater if at repeat testing it remained 0.2 ng/ml or greater. RESULTS Mean followup was 13.2 months (median 12, range 2 to 52). Pathological stage was pT0N0/Nx in 2 men (0.4%), pT2N0/Nx in 414 (81.5%), pT3aN0/Nx in 72 (14.2%), pT3bN0/Nx in 17 (3.3%) and pT2-3N1 in 3 (0.6%). Positive margin rates increased with higher stage (8.2% in pT2 and 39.3% in pT3 cases, p <0.0001). Three-year actuarial biochemical recurrence-free survival was 98.2% for pT2N0/Nx and 78.7% for pT3N0/Nx/N1 disease (p <0.0001), and it was 94.5% overall. Multivariate analysis controlling for age, preoperative prostate specific antigen, postoperative Gleason score and stage, and margin status showed that only Gleason score (greater than vs less than 7) and stage (pT3 or any N1 vs pT2) predicted biochemical progression. CONCLUSIONS Laparoscopic radical prostatectomy can provide excellent cancer control outcomes for clinically localized prostate cancer with high actuarial biochemical recurrence-free survival rates at 3 years.
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Abstract
PURPOSE OF REVIEW Laparoscopic radical prostatectomy is now considered the standard of care at many centers for the treatment of localized prostate cancer. As with other surgical approaches, there has been an evolution in surgical techniques. Critical evaluation of the effects of these changes on clinical and pathologic outcomes continues. RECENT FINDINGS The technique of nerve sparing laparoscopic radical prostatectomy should attempt to mimic the techniques and outcomes of open surgery, while maintaining the advantages of reduced blood loss and morbidity, and greater visualization. Long-term functional and oncologic outcomes appear equivalent to open surgery. Surgical approaches based upon recent anatomic studies of the periprostatic neuroanatomy continue to spur both advances and debate. Athermal dissection near the neurovascular bundle, along with high release of the surrounding fascia, may hasten recovery of erectile function. Techniques of sparing or reconstructing the puboprostatic ligaments and support of the bladder are evolving in efforts to improve continence results. Debate over the merits of transperitoneal vs. extraperitoneal approaches to laparoscopic prostatectomy continues. SUMMARY Nerve sparing laparoscopic radical prostatectomy, although technically challenging, has proven to be an excellent alternative for dedicated centers wishing to provide a minimally invasive surgical option to their patients with localized prostate cancer.
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Richstone L, Baldinger L, Rastinehad AR, Permpongkosol S, Jarrett TW, Su LM, Pavlovich CP, Kavoussi LR. 1230: Conversion During Laparoscopic Surgery: Frequency, Indications, and Risk Factors. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Levinson AW, Ward NT, Mettee LZ, Rais-Bahrami S, Su LM, Pavlovich CP. 614: What is the Oncologic Significance of the Positive Margin at a Site of Capsular Incision in Laparoscopic Radical Prostatectomy? 5-Year Results of Biochemical Disease Free Survival. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Sulman A, Piacitelli JE, Su LM. V351: Robotic Prostatectomy: Reservoir Management in Patients with Pre-Existing Inflatable Penile Prosthesis. J Urol 2007. [DOI: 10.1016/s0022-5347(18)32138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Permpongkosol S, Link RE, Su LM, Romero FR, Bagga HS, Pavlovich CP, Jarrett TW, Kavoussi LR. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol 2007; 177:580-5. [PMID: 17222637 DOI: 10.1016/j.juro.2006.09.031] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Indexed: 01/09/2023]
Abstract
PURPOSE We assessed the complications associated with urological laparoscopic surgery at a single high volume center during a 12-year period. MATERIALS AND METHODS A retrospective chart analysis was performed, focusing on complications associated with 2,775 laparoscopic surgeries occurring between 1993 and 2005. These included radical nephrectomy (549), partial nephrectomy (345), donor nephrectomy (553), simple nephrectomy (186), pyeloplasty (301), nephroureterectomy (105), retroperitoneal lymph node dissection (86), renal ablation (81), adrenalectomy (106) and radical prostatectomy (463). Complication data were tabulated according to case number, procedure type, patient age, the American Society of Anesthesiologists score, conversion status, length of hospitalization, Clavien classification system and annual complication rate during the study. Statistical analysis was performed with Fisher's exact and chi-square tests. RESULTS A total of 614 complications (22.1%) occurred within each group, broken down into laparoscopic radical nephrectomy (20%), laparoscopic partial nephrectomy (28%), laparoscopic donor nephrectomy (28%), laparoscopic simple nephrectomy (15%), laparoscopic pyeloplasty (13.3%), laparoscopic nephroureterectomy (40.9%), laparoscopic retroperitoneal lymph node dissection (26.7%), laparoscopic renal tumor ablation (18.6%), laparoscopic adrenalectomy (25.4%) and laparoscopic radical prostatectomy (15%). Total intraoperative and postoperative complication rates were 4.7% and 17.5%, respectively. Vascular injuries were the most common intraoperative complications. Annual complication rates plateaued in the year 2000 and were not significantly different during the ensuing 4 years (p >0.05). Complications correlated with a greater American Society of Anesthesiologists score as well as a longer hospital stay (p <0.05). CONCLUSIONS The data presented here help define the complication rates for laparoscopic urological procedures in experienced hands at a high volume institution.
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