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Elferink SEM, Bretveld R, Kwast ABG, Asselman M, Essink JGJ, Potters JW, van der Palen J. The effect of enhanced recovery after surgery (ERAS) in renal surgery. World J Urol 2024; 42:490. [PMID: 39162720 DOI: 10.1007/s00345-024-05176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/13/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVE To study the effect of ERAS on a textbook outcome (TO) after elective renal surgery. PATIENTS AND METHODS Retrospective study of all patients who underwent a robot-assisted laparoscopic partial or radical nephrectomy or robot-assisted laparoscopic radical nephroureterectomy in Medisch Spectrum Twente (MST), Enschede, the Netherlands. In total, 277 patients were included. 66 patients from 2018 to 2021 (pre-ERAS group) and 211 patients from 2021 to 2023 (ERAS group). TO is a maximum of two nights in the hospital after surgery, no severe complications during or after surgery ≥ grade IIIb, no blood transfusions, no intensive care, no readmissions, and no mortality within 30 days after surgery. Comparisons were made between the pre-ERAS and ERAS groups using unpaired t-test, Mann-Whitney U test, the chi-squared test or Fisher's exact test. Multivariate logistic regression was used to adjust for possible confounding. RESULTS TO was significantly (p = 0.005) better in the ERAS group (TO = 76.8%) compared to the pre-ERAS group (TO = 59.1%). Compared to a pre-ERAS patient, the adjusted odds ratio for achieving a TO as an ERAS patient is 2.1 (95% CI 1.15-3.78). CONCLUSIONS The implementation of ERAS showed a positive effect on the TO of elective renal surgery patients.
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Affiliation(s)
- Susan E M Elferink
- Value-Based Healthcare Group, Waardegedreven Zorg B42 Enschede, Medisch Spectrum Twente, Postbus 50000, 7500 KA, Enschede, The Netherlands
| | - Reini Bretveld
- Value-Based Healthcare Group, Waardegedreven Zorg B42 Enschede, Medisch Spectrum Twente, Postbus 50000, 7500 KA, Enschede, The Netherlands
| | - Annemiek B G Kwast
- Value-Based Healthcare Group, Waardegedreven Zorg B42 Enschede, Medisch Spectrum Twente, Postbus 50000, 7500 KA, Enschede, The Netherlands.
| | - Marino Asselman
- Department of Urology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Judith G J Essink
- Department of Urology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jan-Willem Potters
- Department of Anaesthetics, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
- Section cognition, Data and Education, Faculty of Behavioural, Management and Social sciences, University of Twente, Enschede, the Netherlands
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Mishra A, Shreevastava AK, Das RS. Technical and Anatomical Aspects of Retroperitoneoscopic Renal Surgery: A Summary of Tribulations and Resolutions Encountered at a Tertiary Care Institute of North India. Cureus 2024; 16:e59380. [PMID: 38817518 PMCID: PMC11139053 DOI: 10.7759/cureus.59380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Kidneys are a retroperitoneal organ but the widely practiced laparoscopic approach to renal surgery is transperitoneal due to the advantages of greater working space at the cost of entering the peritoneal cavity, risk of injury to intraperitoneal organs, and the increased risk of postoperative bowel complications. The classic open approach to kidney procedures has been the flank approach without violating the peritoneal cavity instead of the retroperitoneal approach to renal surgery with the advantages of direct access to the renal hilum, especially the renal artery. Being a technically challenging procedure, the retroperitoneoscopic approach is less practiced and needs an experienced surgical team. Through this study, we have tried to unveil the myths and illustrate the exact position of ports, which is the decisive initial step in retroperitoneoscopic surgery. MATERIAL AND METHODS This retrospective study was conducted at a developing tertiary center in northern India with novice staff mainly to determine the technical and anatomical caveats pertaining to the retroperitoneoscopic approach for renal surgeries, the challenges faced, and their resolutions. The decision for the site of incision for primary or camera port was taken only after a proper anatomical study of the cadavers and ongoing retroperitoneal surgical experience while treating various patients suffering from renal diseases. The study comprised eight patients, during the period from June 2023 to March 2024. Various parameters, such as demographic variables, diagnosis, mean operative time, estimated blood loss, technical difficulties encountered and their resolution, complications, and reasons for conversion were studied. A total of 15 cadavers were dissected during the above time period to study finer anatomical details of port positioning and other details. RESULTS After an elaborate study of 15 cadavers and thereafter performing surgery on eight patients during the above time period, surgery was successfully performed on six patients, and two patients needed conversion to open procedure due to dense adhesions and non-progression while complications occurred in two patients (peritoneal rent and renal vein injury), which were managed laparoscopically. CONCLUSION Nonetheless, restrictions of surgical space make retroperitoneoscopic space a challenging procedure but with elaborate experience, which we gained through cadaveric study, and surgical results obtained during the initial few cases such as the exact site of the primary port and technical intricacies, and handling of complications if and when faced, we hope our study will certainly make retroperitoneal space more amicable to urologists.
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Affiliation(s)
- Amit Mishra
- Urology, All India Institute of Medical Sciences, Raebareli, IND
| | | | - Rajat S Das
- Anatomy, All India Institute of Medical Sciences, Raebareli, IND
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Cauni VM, Tanase F, Mihai B, Gorecki GP, Ples L, Sima RM, Persu C. Single-Center Experience with Swiss LithoClast ® Trilogy for Kidney Stones. Diagnostics (Basel) 2023; 13:diagnostics13081372. [PMID: 37189473 DOI: 10.3390/diagnostics13081372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION PCNL remains the gold standard for larger kidney stones. Reducing the operating time of PCNL and its complication rate seems to be the next logical step in optimizing this classical technique. To achieve these objectives, some new methods of lithotripsy emerge. We present the data of a single, high-volume, academic center with combined ultrasonic and ballistic lithotripsy in PCNL using the Swiss LithoClast® Trilogy device. MATERIALS AND METHODS We designed a prospective, randomized study including patients who underwent PCNL or miniPerc with lithotripsy using the new EMS Lithoclast Trilogy or EMS Lithoclast Master. The procedure was carried out with all patients in prone position, by the same surgeon. The working channel size was 24 Fr-15.9 Fr. We evaluated the stones' features, operative time, fragmentation time, complications, stone clearance rate and stone-free rate. RESULTS Our study included 59 patients, 38 females and 31 males, of an average age of 54.5 years old. The Trilogy group included 28 patients and the comparator included 31 patients. Urine culture was positive in seven cases which required seven days of antibiotics. The mean stone diameter was 35.6 mm with a mean Hounsfield unit (HU) of 710.1. The average number of stones was 2.08 (6 complete staghorn stones and 12 partial staghorn stones). A total of 13 patients presented a JJ stent (46.4%). We found a very significant difference in all the parameters favoring the Trilogy device. The most important result in our opinion is the probe active time, which was almost six times shorter in the Trilogy group. The stone clearance rate was about double in the Trilogy group, leading to shorter overall and intra-renal operating times. The overall complication rate was 17.9% in the Trilogy group and 23% in the Lithoclast Master group. The mean hemoglobin drop was 2.1 g/dL with a mean creatinine rise of 0.26 mg/dL. CONCLUSIONS Swiss LithoClast® Trilogy, a device combining ultrasonic and ballistic energy, is a safe and efficient method of lithotripsy for PCNL, proving statistically significant benefits over its predecesor. It can achieve the goal of reducing complication rates and operative times for PCNL.
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Affiliation(s)
- Victor-Mihail Cauni
- Department of Urology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Florin Tanase
- Department of Urology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Bogdan Mihai
- Department of Urology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Gabriel-Petre Gorecki
- Department of Anesthesia and Intensive Care, CF2 Clinical Hospital, 011464 Bucharest, Romania
- Faculty of Medicine, Titu Maiorescu University, 031593 Bucharest, Romania
| | - Liana Ples
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- "Bucur" Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- "Bucur" Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Cristian Persu
- Department of Anesthesia and Intensive Care, CF2 Clinical Hospital, 011464 Bucharest, Romania
- Department of Urology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Kasap Y, Senel S, Tastemur S, Olcucuoglu E. Feasibility of E-PASS score to predict postoperative complications in laparoscopic nephrectomy. Int Urol Nephrol 2022; 54:2149-2156. [PMID: 35767201 DOI: 10.1007/s11255-022-03269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the usefulness of E-PASS score to predict postoperative complications after laparoscopic nephrectomy. METHODS Between 2008 and 2020, 424 patients (179 patients: simple nephrectomy, 158 patients: radical nephrectomy, 87 patients: donor nephrectomy) who underwent laparoscopic nephrectomy in our clinic, were included in the study. Patient groups separated according to the presence of postoperative complications were compared retrospectively regarding demographic, clinical, intraoperative, and postoperative data, comorbidities, and E-PASS scores (PRS, SSS, and CRS). The relationship between postoperative complications and E-PASS scores was examined. RESULTS Postoperative complications occurred in 43 (10.1%) of the patients. Age, previous abdominal/retroperitoneal surgery, radical nephrectomy rate of surgeries, operation time, amount of bleeding, need for blood transfusion, rate of conversion from laparoscopic surgery to open surgery, hospitalization time, E-PASS PRS, SSS, and CRS were statistically significantly higher in the group with postoperative complications. The cutoff value of the E-PASS CRS was - 0.2996 to predict the development of postoperative complications (AUC = 0.706; 95% CI 0.629-0.783; p < 0.001). According to multivariate analysis, presence of previous abdominal/retroperitoneal surgery (OR 2.977; 95% CI 1.502-5.899; p = 0.002), laparoscopic radical nephrectomy (OR 2.518; 95% CI 1.224-5.179; p = 0.012), conversion from laparoscopic surgery to open surgery (OR 4.869; 95% CI 1.046-22.669; p = 0.044) and E-PASS CRS > - 0.2996 (OR 2.816; 95% CI 1.321-6.004; p = 0.007) were found to be independent risk factors predicting postoperative complications. CONCLUSION The E-PASS scoring system is an effective and convenient system for predicting postoperative complications after laparoscopic nephrectomy.
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Affiliation(s)
- Yusuf Kasap
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Samet Senel
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9 Çankaya, Ankara, Turkey.
| | - Sedat Tastemur
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Erkan Olcucuoglu
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9 Çankaya, Ankara, Turkey
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Takahara K, Fukaya K, Nukaya T, Takenaka M, Zennami K, Ichino M, Sasaki H, Sumitomo M, Shiroki R. Perioperative and long-term functional outcomes of robot-assisted versus open partial nephrectomy: A single-center retrospective study of a Japanese cohort. Ann Med Surg (Lond) 2022; 75:103482. [PMID: 35386794 PMCID: PMC8978100 DOI: 10.1016/j.amsu.2022.103482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 12/01/2022] Open
Abstract
Objective This study aimed to compare the perioperative and long-term functional outcomes between robot-assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) in Japanese patients. Methods We retrospectively analyzed 242 patients who underwent either RAPN or OPN between 2007 and 2017 at our hospital. Propensity score matching was carried out between the two groups at a ratio of 1:1. Perioperative outcomes and postoperative estimated glomerular filtration rates (eGFR) were compared at one and three years of follow-up. Results After propensity score matching, we evaluated 39 patients from each group. The ischemia duration of the RAPN group was significantly shorter than that of the OPN group (18 vs. 24, p < 0.001). Moreover, the estimated blood loss (EBL) was significantly lower in the RAPN group than in the OPN group (50 vs. 174, p < 0.001). However, there were no significant differences in the postoperative eGFR between the two groups at one or three years of follow-up (OPN 54.8 vs. RAPN 61.2, p = 0.109, and OPN 54.8 vs. RAPN 55.5, p = 0.262, respectively). Conclusion RAPN resulted in shorter ischemia durations and lower rates of EBL than did OPN; however, no differences in long-term renal function were observed between RAPN and OPN in our propensity-score matched Japanese cohort. This study aimed to compare the perioperative and long-term functional outcomes of RAPN and OPN in Japanese patients. RAPN resulted in shorter ischemia durations and lower rates of estimated blood loss than OPN. No differences in long-term renal function were observed between RAPN and OPN.
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Maruyama R, Fukushima H, Fukuda S, Yasuda Y, Uehara S, Tanaka H, Kijima T, Yoshida S, Yokoyama M, Matsuoka Y, Saito K, Kihara K, Fujii Y. Nonuse of antimicrobial prophylaxis in clean surgeries for adrenal and renal tumors: Results of the risk-based strategy in 1362 consecutive patients. Int J Urol 2021; 28:1032-1038. [PMID: 34247430 DOI: 10.1111/iju.14642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the incidence of perioperative infections without antimicrobial prophylaxis in patients undergoing clean surgeries for adrenal and renal tumors. METHODS We prospectively enrolled 1362 consecutive patients who underwent minimally invasive adrenalectomy (n = 303), radical nephrectomy (n = 499), and partial nephrectomy (n = 560) using the gasless laparoendoscopic single-port surgery technique between 2005 and 2019. In 1059 patients, antimicrobial prophylaxis was not administered. The remaining 303 patients were considered at high risk for infection and received single-dose antimicrobial prophylaxis. The endpoint was the incidence of perioperative infections within 1 month from the surgery date. Perioperative infections were classified into surgical site infections, urinary tract infections, and remote infections. RESULTS Seventy-four patients whose collecting systems were opened during partial nephrectomy were excluded, and the remaining 1013 patients with nonuse of antimicrobial prophylaxis and 275 patients with single-dose antimicrobial prophylaxis were retrospectively analyzed. The incidence of superficial surgical site infections, deep/organ-space surgical site infections, urinary tract infections, and remote infections was 1.6%, 0.7%, 2.8%, and 1.3%, respectively, in patients with nonuse of antimicrobial prophylaxis and 0.4%, 1.8%, 1.5%, and 1.5%, respectively, in patients with single-dose antimicrobial prophylaxis. All patients who developed perioperative infections were successfully treated. No clinical or surgical variables were significantly associated with the incidence of surgical site infections. One limitation of the present study was its nonrandomized and noncontrolled design. CONCLUSIONS In minimally invasive clean surgeries for adrenal and renal tumors, antimicrobial prophylaxis is not necessary when individual risk of infection is considered low.
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Affiliation(s)
- Riko Maruyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yosuke Yasuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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Ölçücüoğlu E. Comparing the complications of laparoscopically performed simple, radical and donor nephrectomy. Turk J Med Sci 2020; 50:922-929. [PMID: 32490652 PMCID: PMC7379416 DOI: 10.3906/sag-1910-120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/31/2020] [Indexed: 11/03/2022] Open
Abstract
Bacground/aim The aim of this study was to compare the complications of laparoscopic simple, radical and donor nephrectomies
performed in a single center. Materials and methods The study was conducted on 392 patients who underwent laparoscopic nephrectomy in University of Health Sciences, Ankara Türkiye Yüksek İhtisas Training and Research Hospital between January 1, 2008 and January 30, 2019. Clinical and laboratory parameters were recorded. Postoperative complications were recorded and graded as per Clavien-Dindo classification (CDC). All analyses were performed on SPSS v21.0 (IBM Corp., Armonk, NY, USA). Results The mean age of the patients was 49.13 ± 15.45 years. The frequency of comorbidities and ASA scores were significantly higher in the laparoscopic radical nephrectomy (LRN) group than in the other groups (P < 0.001). Amount of bleeding was significantly lower in the laparoscopic donor nephrectomy (LDN) group compared to the other groups (P < 0.001). Classification of complications according to CDC showed that complications occurred in 17.01% (n = 25) of the LRN group, 7.02% (n = 12) of the laparoscopic simple nephrectomy (LSN) group, and 2.70% (n = 2) of the LDN group. Length of stay in hospital was significantly higher in the LRN group than in the LSN group (P < 0.001). Conclusion In this study, the frequency of complications in LRN procedures was found to be higher than the LSN and LDN procedures. Patients with LRN may have more adverse health conditions before the operation. Considering the results of this study, variables such as patient and hospital characteristics, surgeon experience and skills should be evaluated in future studies. In addition, it is important to determine the frequency of complications using a standardized classification in order to enable correct interpretation of results.
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Affiliation(s)
- Erkan Ölçücüoğlu
- Department of Urology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Demirdağ Ç, Çitgez S, Öbek C. Clavien System Classification of Complications Developed following Laparoscopic Urological Operations Applied in our Clinic. SISLI ETFAL HASTANESI TIP BULTENI 2019; 53:228-239. [PMID: 32377088 PMCID: PMC7192280 DOI: 10.14744/semb.2018.98700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/28/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We analyzed the complications of laparoscopic surgery using Clavien system classification on 396 urological procedures performed at our institution between 2005-2009. METHODS A retrospective analysis was performed, focusing on complications associated with 396 laparoscopic surgeries performed between 2005 and 2009, which included radical and simple nephrectomy (n=188), partial nephrectomy (n=29), pyeloplasty (n=78), sacrocolpopexy (n=16) and radical prostatectomy (n=85). Complication data were tabulated according to the case number, procedure type, patient age, the American Society of Anesthesiologists score (ASA), Clavien classification system and annual complication rate during this study. Statistical analysis was performed with Fisher's exact and chi-square tests. RESULTS A total of 75 patients had complications during the study period. Thus, the total postoperative complication rate was 18.9%. When sub-stratified to various surgical procedures, complication rates were: laparoscopic radical and simple nephrectomy (11.1%), laparoscopic partial nephrectomy (37.9%), laparoscopic pyeloplasty (15.3%), laparoscopic sacrocolpopexy (18.7%) and laparoscopic radical prostatectomy (32.9%). When the complications were classified according to Clavien Classification System stage 1, 2, 3, 4, 5, complication rate was observed in 11.6%, 13.8%, 1.2%, 1%, and 0% of patients, respectively. A correlation was not identified between ASA score and complication rate (p=0.02). CONCLUSION The data presented here would enable us to compare our complication rates objectively with world literature.
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Affiliation(s)
- Çetin Demirdağ
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Sinharib Çitgez
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Can Öbek
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Guo J, Zeng Z, Cao R, Hu J. Intraoperative serious complications of laparoscopic urological surgeries: a single institute experience of 4,380 procedures. Int Braz J Urol 2019; 45:739-746. [PMID: 31063283 PMCID: PMC6837612 DOI: 10.1590/s1677-5538.ibju.2018.0601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/30/2019] [Indexed: 11/26/2022] Open
Abstract
This study aimed to share a single institute experience of 4,380 procedures about in-traoperative serious complications of laparoscopic urological surgeries. From January 2005 to December 2013, 4,380 cases of laparoscopic urological surgeries were recruited in our department. The distribution, incidence, and characteristics of intraoperative serious complications were retrospectively sorted out and analyzed. The surgeries were divided into three groups: very difficult (VD), difficult (D), and easy (E). The com¬plication at Satava class II was defined to be serious. One hundred thirty one cases with intraoperative serious complications were found (3.0%). The incidence of these complications was significantly increased along with the difficulty of the surgeries (P<0.05). The highest morbidity of serious complication belonged to total cystectomy with a ratio of about 17% as compared with other surgeries (P<0.05). The types of these complications included small vascular injury demanding blood transfusion (101 cases, 77.1%), large vascular (venous and artery) injury (16 cases), hypercapnia & acidosis (8 cases), and organ injury (6 cases). The cases of conversion to open surgery were 37 (≤1%). There was no significant difference in the rates of conversion to open surgery among the three groups (P>0.05). The overall tendency of the intraoperative serious complications was decreasing with the time from 2005 to 2013. In conclusion, through standardized training including improving the surgical technique, being familiar with the anatomic relationship, and constantly summarizing the experience and lessons, laparoscopic surgery could be safe and effective with not only minimal invasion but also few complications.
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Affiliation(s)
- Ju Guo
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhigang Zeng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Runfu Cao
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jieping Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Suzuki T, Hattori R, Minagawa T, Uehara T, Ogawa T, Ishizuka O. Intestinal Injury by Heat Conduction from Surgical Sealing Devices. JSLS 2019; 23:JSLS.2018.00100. [PMID: 30846895 PMCID: PMC6400247 DOI: 10.4293/jsls.2018.00100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: There have been no investigations of intestinal injury induced by surgical sealing devices, especially focusing heat conduction from the back of active blades during laparoscopic surgery. Objective: This study of damage to the small intestine by heat conduction from the back of active blades both physically and histopathologically was performed to establish safe usage of surgical sealing devices. Materials and method: We compared seven types of bipolar sealing device and two types of ultrasonic coagulating shear in an animal model simulating laparoscopic surgery. Time-dependent changes in heat conduction from the back of active blades were measured using a direct contact thermometer during intracorporeal activation. Histopathological damage to the small intestine by the back of active blades in laparoscopic surgical application was evaluated. The backs of active blades were activated while attached to the serosa of the small intestine. The depths of histopathological changes were measured to evaluate the thermal effects of surgical sealing devices. Results: Most devices generated temperatures >70°C even on the back of active blades. There were no significant differences in duration for cooling to ≤50°C among these devices. All devices induced histopathological heat damage in the submucosal layer or deeper. Conclusions: Regardless of type, the backs of active blades of surgical sealing devices conduct high temperatures and can induce heat damage in the small intestine. Surgical sealing devices should not be activated while attached to surrounding tissue or organs in laparoscopic surgery.
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Affiliation(s)
- Toshiro Suzuki
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryouhei Hattori
- Department of Urology, Nagoya-daiichi Red Cross Hospital, Nagoya, Japan
| | - Tomonori Minagawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Teruyuki Ogawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
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Chaturvedi A, Shukair SA, Le Rolland P, Vijayvergia M, Gunn JW, Subramanian H. Blood vessel detection, localization and estimation using a smart laparoscopic grasper: a Monte Carlo study. BIOMEDICAL OPTICS EXPRESS 2018; 9:2027-2040. [PMID: 29760967 PMCID: PMC5946768 DOI: 10.1364/boe.9.002027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
For centuries, surgeons have relied on their sense of touch to identify vital structures such as blood vessels in traditional open surgery. Over the past two decades, surgeons have shifted to minimally invasive surgical (MIS) approaches, including laparoscopic surgery, which include benefits such as less scarring, less risk for infection, and quicker recovery times. In fact, some surgeries such as cholecystectomies have seen more than an 80% adoption of this technique because of those benefits. However, due to the fundamental challenges associated with using laparoscopic surgery, there has been a lower adoption in more complex specialties, such as colorectal and thoracic surgery, where the field of surgery has bleeding, fat, scar tissue, and adhesions. These problems are exacerbated by complicating factors such as inflammation, cancer, chronic disease, obesity, and re-operations. Importantly, surgeons will often convert from laparoscopy to open surgery if they can no longer proceed using the minimally invasive approach because of issues described with these complicating factors, thereby negating the benefits that the patient would have seen. When the surgeon does attempt these procedures with those issues, the surgery takes on average 30 min - 1 hour longer. A new method by which surgeons can visualize structures like blood vessels could reduce the conversion rates and operating time, thereby driving a greater adoption of laparoscopic surgery in these complex procedures. Here, we show that by adding near infrared (NIR) LEDs and a linear image sensor onto the opposing jaws of the laparoscopic graspers, blood vessels that are embedded within tissues can be detected and localized efficiently, even those not visible using current imaging techniques. We show the results of Monte Carlo simulations to support our claim, including that blood vessels ranging from 2 to 6 mm and buried under up to 1 cm of tissue can be detected. We also report developing a smart grasper handheld prototype to run ex vivo experiments. The results of these experiments matched with those of the Monte Carlo simulations and the estimated blood vessel size showed a strong correlation with the actual size. This technology will be incorporated into already existing laparoscopic tools to assist surgeons during MIS procedures.
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Xia L, Wang X, Xu T, Guzzo TJ. Systematic Review and Meta-Analysis of Comparative Studies Reporting Perioperative Outcomes of Robot-Assisted Partial Nephrectomy Versus Open Partial Nephrectomy. J Endourol 2017; 31:893-909. [DOI: 10.1089/end.2016.0351] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Xianjin Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Tianyuan Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Thomas J. Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Al-Qudah HS, Rodriguez AR, Sexton WJ. Laparoscopic Management of Kidney Cancer: Updated Review. Cancer Control 2017; 14:218-30. [PMID: 17615527 DOI: 10.1177/107327480701400304] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Laparoscopy has emerged as the preferred option for the surgical management of kidney cancer. Although many reports have been published regarding the operative outcome of renal cell carcinoma (RCC) and upper-tract transitional cell carcinoma (TCCA) treated laparoscopically, few review the oncologic outcome of these pathologies treated with laparoscopic techniques. METHODS We review the literature regarding the laparoscopic approaches, the complications related to laparoscopic surgery, and the long-term oncologic results of laparoscopic radical nephrectomy, partial nephrectomy, and nephroureterectomy. RESULTS Laparoscopic radical nephrectomy has become the new standard of care for most patients with suspected RCCs that are not amenable to nephron-sparing procedures. Laparoscopic techniques for managing RCC and TCCA are safe, follow well-established guidelines for surgical dissection, and meet or exceed perioperative convalescence and oncologic outcomes compared to traditional open procedures. The surgical techniques and the long-term outcome data for laparoscopic partial nephrectomy continue to mature. CONCLUSIONS Laparoscopy is a minimally invasive option available to most patients with kidney cancer. The immediate benefits of laparoscopy are well established and include less estimated blood loss, decreased pain, shorter perioperative convalescence, and improved cosmesis. Long-term oncologic outcomes of patients treated laparoscopically for kidney tumors resemble those of the open surgical approach.
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Affiliation(s)
- Hosam S Al-Qudah
- Genitourinary Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Zhu YC, Lin J, Guo YW, Zhang L, Zhu X, Tian Y. Modified Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy with a Mini-Open Muscle Splitting Gibson Incision. Urol Int 2016; 97:186-94. [DOI: 10.1159/000445909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/03/2016] [Indexed: 11/19/2022]
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Bastiampillai R, Lavallée LT, Cnossen S, Witiuk K, Mallick R, Fergusson D, Schramm D, Morash C, Cagiannos I, Breau RH. Laparoscopic nephroureterectomy is associated with higher risk of adverse events compared to laparoscopic radical nephrectomy. Can Urol Assoc J 2016; 10:126-31. [PMID: 27217860 DOI: 10.5489/cuaj.3362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Laparoscopic radical nephrectomy (LRN) and laparoscopic nephroureterectomy (LNU) are similar procedures and some surgeons may believe the perioperative risks are the same. The purpose of this study is to characterize and compare complications following LRN and LNU. METHODS A historical cohort of patients who received either LRN or LNU between 2006 and 2012 was reviewed from the National Surgical Quality Improvement Program (NSQIP) database. Patient characteristics, surgical characteristics, and perioperative outcomes up to 30 days postoperatively were abstracted. Unadjusted and adjusted associations between procedure (LRN or LNU) and any adverse event were determined. RESULTS During the study period, 4904 patients met study inclusion criteria; 4159 (84.8%) received a LRN while 745 (15.2%) received a LNU. Overall, 651 (13.3%) patients experienced at least one postoperative complication. LNU was associated with more complications than LRN (21% and 12%, respectively, p value <0.01). The most common complications were: bleeding requiring blood transfusion (9.0% LNU vs. 6.0% LRN), urinary tract infection (4.6% LNU vs. 1.5% LRN), wound infection (1.3% LNU vs. 1.8% LRN), and unplanned intubation (2.3% LNU vs. 0.9% LRN). After adjusting for potential confounders, LNU was associated with higher risk of any complication compared to LRN (relative risk [RR] 1.41, 95% confidence interval [CI] 1.16-1.72). Other variables independently associated with an increased risk of complications included: increasing patient age (RR 1.01, 95% CI 1.01-1.02), American Society of Anesthesiologists (ASA) classification ≥3 (RR 1.34, 95% CI 1.10-1.63), higher preoperative creatinine (RR 1.11, 95% CI 1.06-1.17), >4 units of blood transfused within 72 hours before surgery (RR 1.93, 95% CI 1.29-2.86), and operative time >6 hours (RR 2.17, 95% CI 1.71-2.75). CONCLUSIONS Postoperative complications within 30 days of surgery are common after LNU and LRN. Despite having technical similarities, LNU carries a significantly higher risk of developing short-term complications compared to LRN. This information should be considered when counseling patients prior to surgery. Notable limitations of this study included the lack of information on tumour stage and management of the distal ureter.
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Affiliation(s)
- Ravin Bastiampillai
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Sonya Cnossen
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Kelsey Witiuk
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Dean Fergusson
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - David Schramm
- Division of Otolaryngology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
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Vigneswaran HT, Lec P, Brito J, Turini G, Pareek G, Golijanin D. Partial Nephrectomy for Small Renal Masses: Do Teaching and Nonteaching Institutions Adhere to Guidelines Equally? J Endourol 2016; 30:714-21. [PMID: 27025539 DOI: 10.1089/end.2016.0112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The American Urological Association (AUA) guidelines recommend partial nephrectomy (PN) as the gold standard for treatment of small renal masses (SRMs). This study examines the change in utilization of partial and radical nephrectomies at teaching and nonteaching institutions from 2003 to 2012. MATERIALS AND METHODS The data sample for this study came from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2003 to 2012. International Classification of Diseases, Ninth Revision and Clinical Modification codes were used to identify patients undergoing PN and radical nephrectomy for renal masses limited to the renal parenchyma. Teaching hospitals were defined, but not limited to any institution with an American Medical Association-approved residency program. Linear regression, bivariate, multivariate, and odds ratio analysis were used to demonstrate statistical significance. RESULTS 39,685 patients were identified in teaching hospitals, and 22,239 were identified in nonteaching hospitals. Prior to the 2009 AUA guidelines, cumulative rates of PN were 33% vs 20% in teaching vs nonteaching hospitals (p < 0.0001) compared with postguideline rates of 48% vs 33% in teaching vs nonteaching hospitals (p < 0.0001). CONCLUSIONS During the 10-year study period, the use of PN to treat SRMs has significantly increased in both teaching hospitals and in nonacademic centers; however, these changes are occurring at a slower rate in nonteaching hospitals.
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Affiliation(s)
- Hari T Vigneswaran
- 1 Warren Alpert Medical School of Brown University , Providence, Rhode Island
| | - Patrick Lec
- 1 Warren Alpert Medical School of Brown University , Providence, Rhode Island
| | - Joseph Brito
- 2 Division of Urology, Rhode Island Hospital, Warren Alpert Medical School of Brown University , Providence, Rhode Island
| | - George Turini
- 2 Division of Urology, Rhode Island Hospital, Warren Alpert Medical School of Brown University , Providence, Rhode Island
| | - Gyan Pareek
- 3 Section of Minimally Invasive Urology, Warren Alpert Medical School of Brown University , Providence, Rhode Island
| | - Dragan Golijanin
- 3 Section of Minimally Invasive Urology, Warren Alpert Medical School of Brown University , Providence, Rhode Island
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Abstract
This review is being updated and replaced following the publication of a protocol (Krabbe L‐M, Kunath F, Schmidt S, Miernik A, Cleves A, Walther M, Kroeger N. Partial nephrectomy versus radical nephrectomy for clinically localized renal masses [Protocol]. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD012045. DOI: 10.1002/14651858.CD012045) for a new review with a narrower scope. It will remain withdrawn when the new review is published. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Ghulam Nabi
- University of DundeeDepartment of SurgeryDundeeUK
| | - Anne Cleves
- Cardiff University Velindre HospitalCancer Research Wales LibraryCardiffWalesUKCF14 2TL
| | - Mike Shelley
- Velindre NHS TrustCochrane Prostatic Diseases and Urological Cancers Unit, Research DeptVelindre RoadWhitchurchCardiffWalesUKCF4 7XL
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Preliminary evaluation of the SimPORTAL major vessel injury (MVI) repair model. Surg Endosc 2015; 30:1405-12. [DOI: 10.1007/s00464-015-4344-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 06/12/2015] [Indexed: 12/28/2022]
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Montes SFP, Rodríguez IG, Ugarteburu RG, Villamil LR, Mendez BD, Gil PS, Madera JM. Intraoperative laparoscopic complications for urological cancer procedures. World J Clin Cases 2015; 3:450-456. [PMID: 25984519 PMCID: PMC4419108 DOI: 10.12998/wjcc.v3.i5.450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/30/2015] [Accepted: 04/09/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution.
METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications.
RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery (radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery (radical prostatectomy and radical cystectomy).
CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications.
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Sureka SK, Srivastava A, Agarwal S, Srivastava A, An S, Singh S, Mittal V, Patidar N, Kapoor R, Ansari MS. Prevention of Orchialgia After Left-Sided Laparoscopic Donor Nephrectomy-A Prospective Study. J Endourol 2015; 29:696-9. [PMID: 25401724 DOI: 10.1089/end.2014.0645] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Etiology of orchialgia or testicular pain after laparoscopic donor nephrectomy (LDN) has been found to be related to injury of the spermatic plexus during gonadal (testicular) vein (GV) or ureteral ligation. This study aimed to evaluate and validate the impact of the level of ligation of GV and ureter in relation to the crossing of iliac vessels (CIV) on incidence of orchialgia. PATIENTS AND METHODS A prospective study was conducted on 70 males who underwent left LDN from January 2008 to December 2010 (group A) to determine the correlation between orchialgia and level of ligation of the GV and ureter with respect to CIV; this revealed that the ligation of the GV and/or ureter above the level of the CIV (level 1, n=40) is less likely to cause orchialgia than ligating them at or below (level 2, n=30). Subsequently, in 45 male patients (group B) for left LDN from January 2011 to June 2013, we ensured that clipping of the ureter and GV be performed above the CIV to validate the above findings. Patients with a history of scrotal pathology or surgical procedure were excluded. One-sided Z-test with pooled variance was used to calculate the sample size. RESULTS In group A, orchialgia was seen in 10 (14.3%) patients. The clipping of the ureter and GV at level 2 (orchialgia, n=9) was associated with a significantly higher incidence of orchialgia than clipping them at level 1 (orchialgia, n=1) (P=0.001,95% confidence interval=0.0707 to 0.2471). In group B, 43 patients were finally analyzed, and none had orchialgia. CONCLUSION The level of ligation of the GV and ureter has significant impact on the incidence of orchialgia. Ipsilateral testicular pain in patients with left-sided LDN is preventable, if the ureter and GV are ligated or clipped above the level of iliac vessels bifurcation.
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Affiliation(s)
- Sanjoy Kumar Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Shikhar Agarwal
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Alok Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Sachin An
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Sanjeet Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Varun Mittal
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Nitesh Patidar
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - M S Ansari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
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Stress predicts the trajectory of wound healing in living kidney donors as measured by high-resolution ultrasound. Brain Behav Immun 2015; 43:19-26. [PMID: 24973727 DOI: 10.1016/j.bbi.2014.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/06/2014] [Accepted: 06/15/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Psychological stress has been shown to be an influential factor on the rate of wound healing; however these findings have been demonstrated predominantly on artificially created wounds. Due to the absence of major co-morbidities, living kidney donors are a unique group in which to study this relationship. This study investigated the effect of preoperative stress and personality on surgical wound healing through the use of high-resolution ultrasound. METHODS Living kidney donors due to undergo a hand-assisted laparoscopic donor nephrectomy were asked to complete the Perceived Stress Scale, the Life Orientation Test-Revised and the Ten Item Personality Inventory prior to surgery. High-resolution ultrasound scans of surgical wounds were performed on the first three post-operative days and once following discharge (mean=15.3 days; s.d. 2.8). Two measurements from each image were obtained: wound width (size of wound) and median intensity (a marker of tissue fluid). Latent Growth Curve Models (LGCMs) were used to evaluate wound healing. RESULTS 52 living kidney donors participated. Higher pre-operative life stress, lower optimism and lower conscientiousness were associated with delayed wound healing in living kidney donors for both outcomes. Increased emotional stability was associated with faster wound healing as demonstrated by a change in median intensity. Possible confounding factors, such as age, BMI, smoking status, local anaesthetic use and wound drain placement were not influential. CONCLUSIONS This study, which measured wound healing in a novel patient sample using a novel technique, has demonstrated a negative association between stress and wound healing and the positive influence of optimism, conscientiousness and emotional stability.
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Xu Z, Zhang Z, Gao J, Wei Z, Xu X, Dong J, Tang H, Yi X, Tang C, Zhou W. A modified adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy. World J Surg Oncol 2014; 12:179. [PMID: 24902995 PMCID: PMC4062894 DOI: 10.1186/1477-7819-12-179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/29/2014] [Indexed: 11/15/2022] Open
Abstract
Background The objective of this study was to modify the adrenal gland-sparing strategy based on retroperitoneal laparoscopic radical nephrectomy by reviewing the anatomic relationship between the kidney and the adrenal gland. Methods From June 2010 to October 2012, a total of 68 patients (45 males and 23 females) with localized renal cell carcinoma were treated at our hospital. The study included 35 cases that were right side and 33 cases that were left, and average patient age was 54.06 years. The average tumor size was 4.7 cm. Tumors were classified via the TNM staging system. All patients underwent adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy. Results For each patient, surgery was successful without conversion to open surgery. The average operative time was 56.65 ± 26.60 min, and the mean blood loss was 70.61 ± 60.96 ml. All patients were discharged from the hospital 3 to 8 days after surgery. During surgery, the adrenal gland was slightly lacerated in three cases and the peritoneum showed perforation in six cases. Only one case recurred during the study follow-up. Conclusions Based on retroperitoneal laparoscopy radical nephrectomy, this effective adrenal gland-sparing surgery showed direct exposure of tissue and little interference of the upper pole of the kidney. Elevation of the adrenal gland could help with the complete dissection of the adrenal gland from the kidney. The separation of the kidney was rapid, simple and accurate. The probability of adrenal gland damage was reduced. This strategy is recommended for widespread use in T1-2 renal neoplasms.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Wenquan Zhou
- Department of Urology, Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, Nanjing 210002, China.
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Buethe DD, Spiess PE. Current management considerations for the incidentally detected small renal mass. Cancer Control 2014; 20:211-21. [PMID: 23811705 DOI: 10.1177/107327481302000309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Nephron-sparing treatments remain underutilized for the management of small renal masses despite a rise in incidentally detected renal cell carcinoma and a downward stage migration. METHODS Historical publications representative of currently accepted paradigms were reviewed, and the results of a contemporary scientific literature search conducted in PubMed focusing on studies involving humans, published in English, and inclusive of clinical trials, meta-analyses, randomized controlled trials, and practice guidelines are included. Results from contemporary retrospective trials augment the data when level I or II evidence is absent. RESULTS Phase III clinical trial results substantiate the long-held tenet that partial nephrectomy is equivalent to radical nephrectomy with respect to safety and oncologic efficacy. Further, minimally invasive techniques using laparoscopy and robotic assistance to achieve partial nephrectomy appear equally effective to traditional open techniques. Although no prospective randomized studies are available, large retrospective studies support the notion that active surveillance and thermal ablative techniques are viable options for carefully selected patients. CONCLUSIONS The management of small renal masses encompasses a host of therapeutic options, all of which must be considered and discussed with the individual patient.
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Affiliation(s)
- David D Buethe
- Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL 33612, USA
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Abstract
The authors conclude that single-site surgery is not without risk of serious complications and must be performed in selected cases by experienced surgeons. Background and Objectives: A 71-year-old man underwent a right simple nephrectomy via the laparoendoscopic single-site surgery (LESS) approach for intractable right flank pain and gross hematuria. A postoperative diagnosis of duodenal injury was suspected by physical findings and confirmed by computed tomography imaging. Methods: Emergency exploratory laparotomy revealed a <5-mm full-thickness perforation of the duodenum and an accompanying 1-cm seromuscular injury. Results: The subsequent postoperative course was unremarkable except for a right intraabdominal seroma that resolved without intervention. Conclusion: LESS nephrectomy is an effective surgical approach, but more data are needed regarding its surgical outcomes and complications. This case shows that the LESS approach is not without the risk of life-threatening complications, and it must be performed by experienced surgeons in select patients who are notably interested in improved cosmesis, after an informed consent that includes the potential for complications.
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Affiliation(s)
- Shreyas S Joshi
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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Arai K, Nishiyama T, Hara N, Kasahara T, Saito K, Takahashi K. Retroperitoneoscopic donor nephrectomy with a gel-sealed hand-assist access device. BMC Urol 2013; 13:7. [PMID: 23374442 PMCID: PMC3598922 DOI: 10.1186/1471-2490-13-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/30/2013] [Indexed: 11/22/2022] Open
Abstract
Background The hand-assisted technique enables the rapid extraction of the graft, shortening the warm ischemia time (WIT), and the retroperitoneoscopic approach is potentially associated with a less incidence of postoperative ileus in donor nephrectomy for living kidney transplantation. The aim of this study was to assess the efficacy and safety of retroperitoneoscopic donor nephrectomy with a gel-sealed hand-assist access device (GelPort), which is a wound sealing device that permits the access of the hand to the surgical field, free trocar site choice within it, and rapid conversion to open surgery if necessary, while preserving the pneumoperitoneum/pneumoretroperitoneum. Methods Seventy-five consecutive donors receiving this procedure were retrospectively studied. A 2-cm skin incision was made at the midpoint between the tip of the 12th rib and superior border of the iliac bone in the midaxillary line, through which retroperitoneal space was made. Preperitoneal wound with a 6 – 7-cm pararectal incision in the upper abdominal region was connected to the retroperitoneal space. A GelPort was put inside the pararectal surgical wound. The principle was pure retroperitoneoscopic surgery; hand-assist was applied for retraction of the kidney in the renal vessel control and graft extraction. Results The mean operation time including waiting time for recipient preparation was 242.2±37.0 (range: 214.0–409.0) min, and the mean amount of blood loss was 164.3±146.6 (range: 10.0–1020.0) ml. The mean WIT was 2.8±1.0 (range: 1.0–6.0) min. The shortage of renal vessels or ureter was observed in none of the grafts. No donor experienced blood transfusion, open conversion, or injury of other organs. Blood loss was greater in patients with body mass index (BMI) of 25 kg/m2 or higher than in those with BMI of <25 kg/m2 (218.4±98.8 vs. 154.8±152.1 ml, P=0.031). No donor had postoperative ileus or reported wound pain leading to decreased activity of daily life or wound cosmetic problem. Conclusions Retroperitoneoscopic hand-assisted donor nephrectomy with the mentioned approach was suggested to be a feasible option without compromising safety, although further improvement in surgical techniques is warranted.
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Affiliation(s)
- Kei Arai
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1, Niigata, 951-8510, Japan
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Chen Z, Xie JL, Zhou C, Chen X. Technical modifications of hand-assisted retroperitoneoscopic living donor nephrectomy: a single-center experience. Transplant Proc 2012; 44:1218-21. [PMID: 22663988 DOI: 10.1016/j.transproceed.2011.12.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 10/17/2011] [Accepted: 12/14/2011] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To report a single-center experience and technical modifications of hand-assisted retroperitoneoscopic living donor nephrectomy (HARLDN). METHODS A total of 78 living donors underwent HARLDN from June 2004 to November 2009. We used a three-port, finger-dissecting, routine retroperitoneal approach. After almost complete mobilization of the kidney, the renal pedicle was dissected to expose the renal vessels. The ureter was dissected and divided at the level of the iliac vessels. An approximately 7-cm Gibson incision was made as the hand-assisted port. The surgeon's hand was introduced through this incision directly. With hand assistance, the renal artery was clipped using two Hem-o-lok clips at the proximal end, and then sheared by scissors without any clips on the kidney side. The renal vein was controlled similarly. Then the kidney was rapidly removed through the incision by hand. RESULTS HARLDN was effectively and safely completed in 78 (100%) donors. No conversion to an open operation was necessary. The mean operative time and mean warm ischemic time were 121 minutes (range, 90-134) and 146 seconds (range, 112-247) respectively. The mean blood loss was 61 mL (range, 32-85). Clavien 1 complications including subcutaneous emphysema in 5.1% (4/78). The mean visual analog scales on postoperative days 1 to 5 were: 2.5, 1.2, 0.8, 0.5, and 0.1, respectively. The mean time to resume oral diet was 1.5 days. The mean hospital stay was 4.5 days (range, 4-5). The mean level of postoperative serum creatinines of the donors at 7 days and 1 month thereafter were 1.06 mg/dL (range, 0.74-1.43) and 1.15 mg/dL (range, 0.79-1.61) mg/dL, respectively. The mean level of postoperative serum creatinines of the recipients at 7 days and 1 month were 1.40 mg/dL (range 0.81-1.67) and 1.52 mg/dL (range, 0.76-1.83), respectively. The mean incision length was 6.5 cm (range, 6.0-7.2). CONCLUSIONS The modified HARLDN combines the purely laparoscopic technique with quicker, safer organ retrieval by the open access.
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Affiliation(s)
- Z Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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Rosoff JS, Fine RG, Velez MC, Del Pizzo JJ. Laparoendoscopic single-site radical nephrectomy for large renal masses. J Endourol 2012; 27:34-9. [PMID: 22984849 DOI: 10.1089/end.2012.0115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To report our operative experience and short-term outcomes for the laparoendoscopic single-site (LESS) management of large renal tumors and tumors of advanced stage. PATIENTS AND METHODS Ten consecutive patients underwent LESS-radical nephrectomy (RN) for large (≥ 7 cm) and/or locally advanced tumors (>T(2)). Intraoperative, postoperative, and short-term follow-up data were analyzed. RESULTS Median surgical time was 146 minutes (range 73-164 min), and median estimated blood loss was 100 mL (range 25-400 mL). No procedure needed conversion to open RN or hand-assisted laparoscopic RN. The median hospital stay was 47 hours (range 42 hours-12 days). One (10%) patient had a minor complication (postoperative fever treated with antibiotics) and one (10%) patient had a major complication (small bowel obstruction necessitating reoperation). Of the 10 tumors, 2 were pathologic stage T(1b), 4 were pathologic stage T(2), and 4 were stage T(3a). At a median follow-up of 12.3 months (range 1-16 mos), six (60%) patients were alive without evidence of recurrence, and 4 (40%) patients were alive with disease. Of those four patients, all four had known metastatic disease before surgery. CONCLUSION LESS-RN for large or advanced stage renal masses is a technically challenging operation. In experienced hands, however, it is a safe and feasible therapeutic option for the management of these tumors.
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Affiliation(s)
- James S Rosoff
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10065, USA.
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Kijima T, Masuda H, Yoshida S, Tatokoro M, Yokoyama M, Numao N, Saito K, Koga F, Fujii Y, Kihara K. Antimicrobial prophylaxis is not necessary in clean category minimally invasive surgery for renal and adrenal tumors: a prospective study of 373 consecutive patients. Urology 2012; 80:570-5. [PMID: 22743261 DOI: 10.1016/j.urology.2012.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 04/30/2012] [Accepted: 05/02/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the feasibility of the nonuse of antimicrobial prophylaxis (AMP) on the incidence of infectious complications after clean category minimally invasive surgery for renal and adrenal tumors. METHODS We evaluated 415 consecutive patients who underwent gasless laparoendoscopic single-port surgery (GasLESS) for renal or adrenal tumors between 2006 and 2010. Forty-two patients with poorly controlled diabetes mellitus, coexisting infection, or opening of the urinary tract during partial nephrectomy were excluded from this study. The remaining 373 patients underwent radical nephrectomy (n = 187), partial nephrectomy (n = 103), or adrenalectomy (n = 83) without AMP. Perioperative infections were categorized into superficial surgical site infection (SSI), deep SSI, and remote infection (RI) and graded using an established 5-grade modification of the original Clavien-Dindo classification system. We investigated the association between the incidence of infectious complications and clinical or perioperative factors. RESULTS Infectious complications occurred in 16 cases (4.3%), including 4 superficial SSIs (1.1%), 2 deep SSIs (0.5%), and 10 RIs (2.7%). Neither superficial SSI nor deep SSI was significantly associated with any clinical or perioperative factors. The incidence of RI, however, was associated with longer operative time and higher National Nosocomial Infection Surveillance (NNIS) risk index. All perioperative infections were successfully treated with antibiotics without surgical interventions. No infectious complications equal to or greater than grade IIIa occurred. CONCLUSION The nonuse of AMP and the on-demand use of antibiotics seem to be sufficient for perioperative infectious management in clean category minimally invasive surgery for renal and adrenal tumors.
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Affiliation(s)
- Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Srivastava A, Kapoor R, Srivastava A, Ansari MS, Singh M, Kapoor R. Orchialgia after laproscopic renal surgery: a common problem with questionable etiology. Are there any predictors? World J Urol 2012; 31:1153-7. [PMID: 22527670 DOI: 10.1007/s00345-012-0864-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Orchialgia after laproscopic renal surgery has been rarely reported in literature, and gonadal vein ligation is considered the main etiology. Our objective was to study the incidence, intensity and to find out any specific factors that could lead to orchialgia. MATERIALS AND METHODS All patients planned for laproscopic renal surgery between Jan 2009 and July 2011 had a history and physical examination before surgery, in postoperative period, and after discharge. Pain was scored on a standard 10-point scale approved by the NIH. Baseline, perioperative, and postoperative data were collected prospectively. RESULTS A total of 460 laproscopic renal surgeries were performed on males out of which 440 met our criteria of evaluation. A total of 38 patients had ipsilateral orchialgia (8.52 %). The pain was more common for left-sided procedures. Mean pain intensity was 3.2. On statistical analysis, there was no difference in the operative parameters between patients of pain and those without pain except that the level of ligation of ureter and that of gonadal vein were significantly associated with orchialgia (p value <0.001 and 0.003, respectively) with the odds ratio for ligating them below the crossing of iliac vessels being 6.443 (3.098-13.397) and 4.457 (2.165-9.176), respectively. CONCLUSION Ipsilateral orchialgia is common in patients undergoing laproscopic renal surgery specially after radical nephroureterectomy and nephrectomy specially when the ureter and gonadal vein are taken down at or below their crossing of iliac vessels. Taking down ureter above, rather than below, the iliac vessels whenever possible may be preventive as is the preservation of gonadal vein.
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Affiliation(s)
- Alok Srivastava
- Department of Urology and Renal Transplant, SGPGIMS, Lucknow, India,
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Direct upper kidney pole access and early ligation of renal pedicle significantly facilitates transperitoneal laparoscopic nephrectomy procedures: Tunc technique. Surg Laparosc Endosc Percutan Tech 2012; 21:453-7. [PMID: 22146171 DOI: 10.1097/sle.0b013e31823badc1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We modified our technique in transperitoneal laparoscopic nephrectomies and compared its results with the classical technique. Classical technique was performed in 85 cases (group 1). Modified technique (n=98) included direct kidney upper pole access and early ligation of renal pedicle (group 2). No significant differences were detected regarding mean patient age, intraoperative blood loss, and duration of hospital stay between the 2 groups (P>0.05). Mean operation time was 64.9 ± 19.3 and 28.2 ± 7.7 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including right nephrectomies was 68.7 ± 23.4 and 24.2 ± 6.3 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including left nephrectomies was 63.8 ± 17.1 and 33.6 ± 5.1 minutes, respectively in groups 1 and 2 (P=0.001). Similarly, mean operation time was significantly shorter in group 2 when analysis was performed among right and left radical and simple nephrectomies between the 2 groups (P=0.001). Direct upper kidney pole access and early ligation of renal pedicle seems to be significantly facilitating transperitoneal laparoscopic nephrectomy procedures.
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Nozaki T, Iida Y, Morii A, Fujiuchi Y, Fuse H. Laparoscopic radical nephrectomy under near real-time three-dimensional surgical navigation with C-arm cone beam computed tomography. Surg Innov 2012; 19:263-7. [PMID: 22298752 DOI: 10.1177/1553350611429690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to demonstrate the advantages of C-arm cone beam computed tomography for imaging guidance of laparoscopic radical nephrectomy (LRN). METHODS Four patients referred to the authors' institution for LRN were included in this study. To visualize the renal vascular anatomy, the Iopamiron 300 contrast agent was injected intravenously. The surgeon could adjust the viewing angle of the images and rotate the reconstructed three-dimensional (3D) image manually by using a mouse-like controller. Using the near real-time 3D navigation images, the surgeon was able to recognize the renal vascular anatomy, and more easily perform the LRN. RESULTS All procedures were successfully performed with a satisfactory diagnostic yield or therapeutic effect without procedure-related complications. CONCLUSION This novel technology has great potential for application in LRN because it enables accurate depiction of the renal vessels and increases surgeon confidence.
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Affiliation(s)
- Tetsuo Nozaki
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan.
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Milosevic I, Dorion H, Ricchiuti D. Incarcerated retroperitoneal hernia following total extraperitoneal laparoscopic radical nephrectomy. JSLS 2011; 15:424-6. [PMID: 21985740 PMCID: PMC3183559 DOI: 10.4293/108680811x13125733357115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This is a case report of an early high-grade small bowel obstruction due to a retroperitoneal hernia following laparoscopic radical nephrectomy. General and urologic surgeons should become familiar with the complications of these newer interventions. Small bowel obstruction (SBO) is a common entity encountered in surgical patients. The most common causes of the SBO range from postoperative adhesions to cancer. We present the case of a 55-year-old male who underwent a laparoscopic left radical nephrectomy and presented with an early SBO. An imaging study revealed an obstructive pattern with proximal dilated jejunum with decompressed distal small bowel. The patient underwent an exploratory laparotomy with extensive lysis of adhesions and release/resection of a long segment of incarcerated jejunum from an 8-cm retroperitoneal hernia in the left renal fossa. The patient was discharged home, and at 3-month follow-up no bowel complaints were reported.
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Affiliation(s)
- Igor Milosevic
- Department of Surgery, St. Elizabeth Health Center. Youngstown, Ohio, USA.
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Ito H, Makiyama K, Kawahara T, Sano F, Murakami T, Hayashi N, Miyoshi Y, Nakaigawa N, Yao M, Kubota Y. Retroperitoneoscopic radical nephrectomy with a small incision for renal cell carcinoma: comparison with the conventional method. J Negat Results Biomed 2011; 10:11. [PMID: 21846398 PMCID: PMC3169504 DOI: 10.1186/1477-5751-10-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 08/16/2011] [Indexed: 11/30/2022] Open
Abstract
purpose When retroperitoneoscopic radical nephrectomy for renal cell carcinoma was introduced into our institution, we performed a combined small skin incision method. In this method, a small incision was made to approach the retroperitoneal space prior to setting trockers and thereafter a LAPDISC was placed in the incision to start the retroperitoneoscopic procedure. In this study, we compared the outcomes between the combined small skin incision method ("A method" hereinafter) and the conventional method ("B method" hereinafter). material and methods Among the cases of T1N0M0 suspicious renal cell carcinoma treated at Yokohama City University between May 2003 and June 2009, the A method was performed in 51 cases and the B method was performed in 33 cases. The factors in the outcomes compared between the A and B methods were the duration of procedure, volume of bleeding, volume of transfusion, weight of the specimen, incidence of peritoneal injury, rate of conversion to open surgery, and perioperative complications. results The duration of the procedure was 214.4 ± 46.9 minutes in the A method group and 208.1 ± 36.4 minutes in the B method group (p = 0.518). The volume of bleeding and the weight of the specimen were 105.5 ± 283.2 ml and 335.1 ± 137.4 g in the A method group and 44.8 ± 116 ml (p = 0.247) and 309.2 ± 126 g (p = 0.385) in the B method group. There was no significant difference in all factors analyzed. conclusion The A method would be highly possible to produce stable results, even during the introduction period when the staff and the institution are still unfamiliar with the retroperitoneoscopic surgery.
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Affiliation(s)
- Hiroki Ito
- Department of Urology, Yokohama City University Graduate School of Medicine and School of Medicine, Yokohama, Japan.
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Moore NW, Nakada SY, Hedican SP, Moon TD. Complications of Hand-assisted Laparoscopic Renal Surgery: Single-center Ten-year Experience. Urology 2011; 77:1353-8. [DOI: 10.1016/j.urology.2010.11.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 09/18/2010] [Accepted: 11/09/2010] [Indexed: 11/15/2022]
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Abouassaly R, Yang S, Finelli A, Kulkarni GS, Alibhai SM. What is the best treatment strategy for incidentally detected small renal masses? A decision analysis. BJU Int 2011; 108:E223-31. [DOI: 10.1111/j.1464-410x.2011.10115.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Capolicchio JP, Saemi A, Trotter S, Plante MK. Retroperitoneoscopic Nephrectomy With a Modified Hand-assisted Approach. Urology 2011; 77:607-11. [PMID: 20708224 DOI: 10.1016/j.urology.2010.05.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 05/04/2010] [Accepted: 05/25/2010] [Indexed: 11/19/2022]
Affiliation(s)
- John-Paul Capolicchio
- Division of Urology, University of Vermont College of Medicine, Burlington, Vermont, USA.
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A Prospective Evaluation of the Utility of Laparoscopic Doppler Technology During Minimally Invasive Partial Nephrectomy. Urology 2011; 77:617-20. [DOI: 10.1016/j.urology.2010.05.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 04/10/2010] [Accepted: 05/05/2010] [Indexed: 11/24/2022]
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Kulkarni S, Emre S, Arvelakis A, Asch W, Bia M, Formica R, Israel G. Multidetector CT angiography in living donor renal transplantation: accuracy and discrepancies in right venous anatomy. Clin Transplant 2011; 25:77-82. [PMID: 20070320 DOI: 10.1111/j.1399-0012.2009.01193.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Kulkarni
- Department of Surgery, Section of Organ Transplantation & Immunology, Yale University School of Medicine, New Haven, CT 06410, USA.
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Affiliation(s)
- Sutchin R. Patel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stephen Y. Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Hemal AK. Laparoscopic retroperitoneal extirpative and reconstructive renal surgery. J Endourol 2011; 25:209-16. [PMID: 21231884 DOI: 10.1089/end.2010.0697] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Retroperitoneal laparoscopy for renal surgery is a viable and versatile alternative to transperitoneal access. Location of the kidneys in the retroperitoneum makes it an attractive approach. The development of both approaches paralleled during the last two decades; however, retroperitoneal laparoscopy witnessed a steep learning curve because of the constraint of working space, lack of obvious landmarks, and appropriate instrumentations. This approach has several advantages and is currently being used for extirpative and reconstructive procedures for various renal pathologic conditions. After creation of retroperitoneal space, the techniques can be tailored to the desired indication for successful culmination. The learning curve can be shortened by adequate training; subsequently, with experience, this can be used proficiently.
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Affiliation(s)
- Ashok K Hemal
- Department of Urology, Wake Forest University School of Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA.
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Abstract
The retroperitoneal laparoscopic approach to the kidney offers a minimally invasive access that mimics the open surgical techniques of renal surgery. It allows renal surgery without violation of the peritoneal cavity with its attendant complications such as bowel injury and ileus. Over the last two decades, all renal surgery has been shown to be feasible through this technique. This includes complicated procedures such as a donor nephrectomy and radical nephroureterectomy for upper tract transitional cell cancers. We began performing retroperitoneoscopic renal surgery in the early 1990s and have developed a number of modifications to existing techniques so as to make this surgery easy and cost effective. In this review, we discuss the evolution of retroperitoneoscopic renal surgery, the indications, techniques and outcome of all types of retroperitoneoscopic renal surgery.
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Capolicchio JP, Feifer A, Plante MK, Tchervenkov J. Retroperitoneoscopic living donor nephrectomy: initial experience with a unique hand-assisted approach. Clin Transplant 2010; 25:352-9. [PMID: 20636408 DOI: 10.1111/j.1399-0012.2010.01302.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The retroperitoneoscopic (RP) approach to live donor nephrectomy (LDN) may be advantageous for the donor because it avoids mobilization of peritoneal organs and provides direct access to the renal vessels. Notwithstanding, this approach is not popular, likely because of the steeper learning curve. We feel that hand-assistance (HA) can reduce the learning curve and in this study, we present our experience with a novel hand-assist approach to retroperitoneoscopic live donor nephrectomy (HARP-LDN). Over a one-yr period, 10 consecutive patients underwent left HARP-LDN with a mean body mass index of 29 and three with prior left abdomen surgery. The surgical technique utilizes a 7 cm, muscle-sparing incision for the hand-port with two endoscopic ports. Operative time was an average of 155 min., with no open conversions. Mean blood loss was 68 mL, and warm ischemia time was 2.5 min. Hospital stay averaged 2.7 d with postoperative complications limited to one urinary retention. Our modified HARP approach to left LDN is safe, effective and can be performed expeditiously. Our promising initial results require a larger patient cohort to confirm the advantages of the hand-assisted retroperitoneal technique.
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Affiliation(s)
- J-P Capolicchio
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
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Bird VG, Shields JM, Aziz M, De Los Santos R, Ayyathurai R, Ciancio G. Transperitoneal Laparoscopic Radical Nephrectomy for Patients With Dialysis-dependent End-stage Renal Disease: An Analysis and Comparison of Perioperative Outcome. Urology 2010; 75:1335-42. [DOI: 10.1016/j.urology.2009.10.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/17/2009] [Accepted: 10/12/2009] [Indexed: 11/26/2022]
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Inoue T, Takaaki I, Kinoshita H, Satou M, Oguchi N, Kawa G, Muguruma K, Murota T, Matsuda T. Complications of urologic laparoscopic surgery: a single institute experience of 1017 procedures. J Endourol 2010; 24:253-60. [PMID: 20064000 DOI: 10.1089/end.2009.0322] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We evaluated complications of urologic laparoscopic surgery at our institution. PATIENTS AND METHODS From December 1991 to January 2009, 1017 urologic laparoscopic surgical procedures were performed in Kansai Medical University, including 277 radical prostatectomies, 13 donor nephrectomies, 74 partial nephrectomies, 158 radical nephrectomies, 55 pyeloplasties, 97 nephrouretectomies, 54 simple nephrectomies, 128 adrenalectomies, 34 varicocelectomies, and 127 other procedures. Medical records of each procedure were retrospectively evaluated. The difficulty of each procedure was classified according to the European Scoring System (ESS). Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications, respectively. RESULTS Among the 1017 laparoscopic procedures, 148 complications occurred in 123 patients, resulting in a total complication rate of 14.6%. Conversion to open surgery occurred in 20 (1.9%) patients. Nephrouretectomy had the highest incidence of complications at 23.7%, which was significantly higher than that of other procedures classified as "difficult" group, according to the ESS (P < 0.05). Clavien grades I and II accounted for 73.8% of all the postoperative complications. We experienced one fatality that was caused by air embolism. CONCLUSION We evaluated the complications of each procedure using the ESS for classification of technical difficulty. Based on the results of our retrospective study, nephrouretectomy should be upgraded as "very difficult" group according to the ESS. Appropriate grading by technical difficulty is beneficial for the prevention of complications from laparoscopic surgery.
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Affiliation(s)
- Takaaki Inoue
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Dols LFC, Kok NFM, Terkivatan T, Tran TCK, d'Ancona FCH, Langenhuijsen JF, zur Borg IRAM, Alwayn IPJ, Hendriks MP, Dooper IM, Weimar W, Ijzermans JNM. Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial. BMC Surg 2010; 10:11. [PMID: 20338030 PMCID: PMC2856541 DOI: 10.1186/1471-2482-10-11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 03/25/2010] [Indexed: 11/30/2022] Open
Abstract
Background Transplantation is the only treatment offering long-term benefit to patients with chronic kidney failure. Live donor nephrectomy is performed on healthy individuals who do not receive direct therapeutic benefit of the procedure themselves. In order to guarantee the donor's safety, it is important to optimise the surgical approach. Recently we demonstrated the benefit of laparoscopic nephrectomy experienced by the donor. However, this method is characterised by higher in hospital costs, longer operating times and it requires a well-trained surgeon. The hand-assisted retroperitoneoscopic technique may be an alternative to a complete laparoscopic, transperitoneal approach. The peritoneum remains intact and the risk of visceral injuries is reduced. Hand-assistance results in a faster procedure and a significantly reduced operating time. The feasibility of this method has been demonstrated recently, but as to date there are no data available advocating the use of one technique above the other. Methods/design The HARP-trial is a multi-centre randomised controlled, single-blind trial. The study compares the hand-assisted retroperitoneoscopic approach with standard laparoscopic donor nephrectomy. The objective is to determine the best approach for live donor nephrectomy to optimise donor's safety and comfort while reducing donation related costs. Discussion This study will contribute to the evidence on any benefits of hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy. Trial Registration Dutch Trial Register NTR1433
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Abstract
BACKGROUND Surgical excision remains the core to the management of localised renal cancer and several studies have evaluated the safety and clinical effectiveness of laparoscopic surgery and other recently introduced interventions for the localised disease. OBJECTIVES To identify and review the evidence from randomised trials comparing different surgical interventions in localised renal cell carcinoma. SEARCH STRATEGY Randomised or quasi randomised trials comparing various surgical interventions in the management of adults with surgically resectable localised renal cancer. RCTs were identified by searching The Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2009), MEDLINE (Silver Platter, from 1966 to August 2009), EMBASE via Ovid (from 1980 to August 2009), and a number of other data bases. SELECTION CRITERIA Studies were assessed for eligibility and quality, and data from published trials were extracted by two reviewers. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS No randomised trials were identified meeting the inclusion criteria reporting on the comparison between open radical nephrectomy with laparoscopic approach or new modalities of treatment such as radiofrequency or cryoablation. Three randomised controlled trials compared the different laparoscopic approaches to nephrectomy (transperitoneal versus retroperitoneal) and found no statistical difference in operative or perioperative outcomes between the two treatment groups. There were several non-randomised and retrospective case series reporting various advantages of laparoscopic renal cancer surgery such as less blood loss, early recovery and shorter hospital stay AUTHORS' CONCLUSIONS The main source of evidence for the current practice of laparoscopic excision of renal cancer is drawn from case series, small retrospective studies and very few small randomised controlled trials. The results and conclusions of these studies must therefore be interpreted with caution.
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Affiliation(s)
- Ghulam Nabi
- Department of Surgery, University of Dundee, Dundee, Scotland, UK, DD1 9SY
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Sethi AS, Regan SM, Sundaram CP. The Use of a Doppler Ultrasound Probe During Vascular Dissection in Laparoscopic Renal Surgery. J Endourol 2009; 23:1377-82. [DOI: 10.1089/end.2009.0397] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amanjot S. Sethi
- Department of Urology, Kaiser Permanente Medical Center, Walnut Creek, California
| | - Stanton M. Regan
- Department of Urology, University of Toledo Medical Center, Toledo, Ohio
| | - Chandru P. Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
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Aguilera Bazán A, Pérez Utrilla M, Girón M, Cisneros Ledo J, de la Peña Barthel J. [Laparoscopic radical nephrectomy. Procedure, results, and complications]. Actas Urol Esp 2009; 33:544-9. [PMID: 19658308 DOI: 10.1016/s0210-4806(09)74188-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Surgery is the treatment of choice for clear cell renal carcinoma not responding to chemotherapy, radiotherapy, or immunotherapy. The surgical procedure used has evolved over time in the past 40 years, mainly because of the development and widespread use of diagnostic procedures such as ultrasonography and CT. As a direct consequence, parenchymal-sparing surgery was no longer only used for patients with solitary kidneys and its indication started to be extended to patients with tumors up to 4 cm in diameter, in whom it has been shown to be a safe and effective alternative to radical nephrectomy. The other important milestone in development of renal cancer surgery undoubtedly was the revolution started in the 90s with advent of laparoscopic renal surgery, which has become established over the past 20 years approximately. Laparoscopic surgery initially raised concern about oncological safety, but clinical series with sufficiently long follow-up times and large sample sizes are now available to consider the laparoscopic approach as a reliable procedure. Technological development has caused the laparoscopic technique to be no longer seen as a procedure for the future, but rather as an absolutely current technique which should be implemented in most urology departments. Implementation of any new procedure usually involves a number of complications which we should be prepared to assume, while making every effort to try and prevent them. It is therefore essential to develop, and to implement using common sense, a training program on the procedure. Selection of patients and conditions to be treated is a crucial part of such a program.
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