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Chiruvella M, Tamhankar AS, Ghouse SM, Bendigeri MT, Reddy Kondakindi PC, Ragoori D. Laparoscopic nephrectomy simplified - A "two-window technique" for safer approach to hilum for a novice. Indian J Urol 2018; 34:254-259. [PMID: 30337779 PMCID: PMC6174716 DOI: 10.4103/iju.iju_231_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Though the overall safety of laparoscopic nephrectomy (simple or radical) is well established, for a novice it remains a challenge. The classical description of laparoscopic nephrectomy entails dissection either from caudal to cephalad side or vice versa. Herein we describe our "two window technique" for managing renal hilum during laparoscopic (simple/radical) nephrectomy. Our main intention in description of this technique is to reduce the level of apprehension for a novice urologist for performing laparoscopic nephrectomy. After colon mobilization, sequential lower and upper windows are created around the hilum following which hilar vessels are dissected circumferentially when the hilum is at a stretch by traction from either of the window. There are multiple potential advantages of this method which includes easier and safer dissection especially for novice in this field by giving a safety window of application of vascular clamp in cases of vascular bleeds. Intrahilar dissection in stretched condition becomes safer with vision from all around 360° for safe application of Hem-o-lok® clips. Due to the widely exposed field, injuries to adrenal vein and lumbar veins would be minimized and the chances of missed accessory vessel would be minimized. En mass hilar control with vascular clamp in cases of partial nephrectomy is possible with same approach as well as the en block stapling is feasible in cases of nephrectomy. This needs a validation across multiple centers with comparative studies before considering it as a standard of practice. We sincerely believe that this is safe and easily reproducible by a novice.
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Affiliation(s)
- Mallikarjuna Chiruvella
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - Ashwin Sunil Tamhankar
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - Syed Mohammed Ghouse
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - Mohammed Taif Bendigeri
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | | | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
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Yüksel ÖH, Ötünçtemur A, Özbek E, Uruç F, Verit A. Should oncological cases of upper urinary system be excluded at the beginning of the laparoscopic learning curve? Int Braz J Urol 2016; 41:707-13. [PMID: 26401863 PMCID: PMC4756999 DOI: 10.1590/s1677-5538.ibju.2014.0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 10/28/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose: The place of oncological cases of upper urinary system in the laparoscopic learning curve was investigated. Materials and Methods: A total of 139 patients from two different centers underwent laparoscopic operations and were included in this retrospective study. Results: Mean operative times for oncological, and non-oncological cases were 101.3 (range 60-450), and 102.7 (45-490) minutes respectively. Fourty-two (31.3 %) patients were oncological cases. In 4 oncological cases, the surgeons switched to open surgery because of massive bleeding and six (14.2 %) oncological cases required blood transfusions during peri/postoperative periods. Pulmonary embolism was observed in one oncological case. In one non-oncological case, the surgeon switched to open surgery because of intestinal perforation and 10 (9.7 %) non-oncological cases needed blood transfusions during peri/postoperative periods. In addition, some complications such as intestinal perforation (n=1), mechanical ileus (n=1), and pulmonary embolism (n=1) were observed during postoperative period. Intestinal perforation was repaired using laparoscopic (n=1) method. Mechanical ileus was approached with open surgical technique. Mean hospital stay of the patients in the oncological and non-oncological series were 4.5 (3-23) and 4.5 (3-30) days respectively. Conclusion: We think that renal oncological cases should be included in the spectrum of laparoscopic indications even at the beginning of the learning curve. Certainly, we still share the opinion that cancer cases which require highly challenging surgeries like radical cystectomy, and prostatectomy should be postponed till to gaining of higher level of experience.
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Affiliation(s)
- Özgür Haki Yüksel
- Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Alper Ötünçtemur
- Okmeydani Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Emin Özbek
- Okmeydani Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Fatih Uruç
- Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
| | - Ayhan Verit
- Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey
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Jensen K, Bjerrum F, Hansen HJ, Petersen RH, Pedersen JH, Konge L. A new possibility in thoracoscopic virtual reality simulation training: development and testing of a novel virtual reality simulator for video-assisted thoracoscopic surgery lobectomy. Interact Cardiovasc Thorac Surg 2015; 21:420-6. [DOI: 10.1093/icvts/ivv183] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/08/2015] [Indexed: 12/28/2022] Open
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Yang DY, Monn MF, Bahler CD, Sundaram CP. Does robotic assistance confer an economic benefit during laparoscopic radical nephrectomy? J Urol 2014; 192:671-6. [PMID: 24747652 DOI: 10.1016/j.juro.2014.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE While robotic assisted radical nephrectomy is safe with outcomes and complication rates comparable to those of the pure laparoscopic approach, there is little evidence of an economic or clinical benefit. MATERIALS AND METHODS From the 2009 to 2011 Nationwide Inpatient Sample database we identified patients 18 years old or older who underwent radical nephrectomy for primary renal malignancy. Robotic assisted and laparoscopic techniques were noted. Patients treated with the open technique and those with evidence of metastatic disease were excluded from analysis. Descriptive statistics were performed using the chi-square and Mann-Whitney tests, and the Student t-test. Multiple linear regression was done to examine factors associated with increased hospital costs and charges. RESULTS We identified 24,312 radical nephrectomy cases for study inclusion, of which 7,787 (32%) were performed robotically. There was no demographic difference between robotic assisted and pure laparoscopic radical nephrectomy cases. Median total charges were $47,036 vs $38,068 for robotic assisted vs laparoscopic surgery (p <0.001). Median total hospital costs for robotic assisted surgery were $15,149 compared to $11,735 for laparoscopic surgery (p <0.001). There was no difference in perioperative complications or the incidence of death. Compared to the laparoscopic approach robotic assistance conferred an estimated $4,565 and $11,267 increase in hospital costs and charges, respectively, when adjusted for adapted Charlson comorbidity index score, perioperative complications and length of stay (p <0.001). CONCLUSIONS Robotic assisted radical nephrectomy results in increased medical expense without improving patient morbidity. Assuming surgeon proficiency with pure laparoscopy, robotic technology should be reserved primarily for complex surgeries requiring reconstruction. Traditional laparoscopic techniques should continue to be used for routine radical nephrectomy.
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Affiliation(s)
- David Y Yang
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - M Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Clinton D Bahler
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
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Hermans T, Pasmans H, Fossion L. Transperitoneal laparoscopic radical nephrectomy in a patient with severe scoliosis. Urology 2013; 82:485-8. [PMID: 23726164 DOI: 10.1016/j.urology.2013.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/31/2013] [Accepted: 03/02/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report the first case of a left transperitoneal laparoscopic nephrectomy in a patient with a severe left convex lumbar scoliosis and to elaborate on the technical difficulties of this procedure. METHODS The surgical procedure was performed by an experienced laparoscopic surgeon after rigorous pre-operative visualization of the altered visceral and vascular abdominal anatomy. A transperitoneal laparoscopic approach with an open introduction technique according to Hasson and a caudo-cranial dissection of the left renal hilum were performed to prevent major vascular and visceral injury in this challenging surgical procedure. RESULTS The operation time was 102 minutes and the estimated blood loss was 100 mL. The surgeon was able to complete the transperitoneal laparoscopic radical nephrectomy without complications. CONCLUSION Transperitoneal laparoscopic radical nephrectomy in patients with severe spinal deformities is feasible, but should only be performed by experienced laparoscopic surgeons to ensure patient safety and cancer control.
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Affiliation(s)
- Tom Hermans
- Department of Uro-oncology, Maxima Medical Center, The Netherlands.
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In 2013, Holmium Laser Enucleation of the Prostate (HoLEP) May Be the New ‘Gold Standard’. Curr Urol Rep 2012; 13:427-32. [DOI: 10.1007/s11934-012-0279-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Park YH, Baik KD, Lee YJ, Kim KT, Kim HH. Learning Curve Analysis for Laparoendoscopic Single-Site Radical Nephrectomy. J Endourol 2012; 26:494-8. [DOI: 10.1089/end.2011.0473] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yong Hyun Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Don Baik
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ju Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Taek Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Cruz JASD, Passerotti CC, Frati RMC, Reis STD, Okano MTR, Gouveia ÉM, Biolo KD, Duarte RJ, Nguyen H, Srougi M. Surgical Performance During Laparoscopic Radical Nephrectomy Is Improved With Training in a Porcine Model. J Endourol 2012; 26:278-82. [DOI: 10.1089/end.2011.0367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Carlo Camargo Passerotti
- Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
- Urology Department, College of Medicine, Nove de Julho University (UNINOVE), São Paulo, Brazil
| | | | | | | | - Éder Maxwell Gouveia
- Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Karlo Dornelles Biolo
- Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Ricardo Jordão Duarte
- Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Hiep Nguyen
- Department of Urology, Children's Hospital, Boston, Harvard Medical School, Boston, Massachusetts
| | - Miguel Srougi
- Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
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Rodriguez AR, Spiess PE. Editorial comment for Park et al. J Endourol 2012; 26:498. [PMID: 22214182 DOI: 10.1089/end.2011.0634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hara N, Kitamura Y, Saito T, Wakatsuki S, Sakata Y, Komatsubara S. Nephrectomy Plus Endoscopy-Assisted Intussusception Ureterectomy for Patients with Renal Pelvic Cancer: Long-Term Oncologic Outcomes in Comparison with Nephroureterectomy Plus Bladder Cuff Removal. J Endourol 2011; 25:691-7. [DOI: 10.1089/end.2010.0336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Noboru Hara
- Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yasuo Kitamura
- Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Toshihiro Saito
- Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Shunji Wakatsuki
- Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yasunosuke Sakata
- Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan
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Kural AR, Öbek C, Tuna MB, Akpinar H, Demirkesen O, Atug F, Tüfek İ. Conversion to Hand Assistance May Prevent Conversion to an Open Procedure in Standard Laparoscopic Nephrectomy. J Endourol 2010; 24:1297-300. [DOI: 10.1089/end.2010.0167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ali Riza Kural
- Department of Urology, Bilim University, Istanbul, Turkey
| | - Can Öbek
- Department of Urology, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Mustafa Bilal Tuna
- Department of Urology, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Haluk Akpinar
- Department of Urology, Bilim University, Istanbul, Turkey
| | - Oktay Demirkesen
- Department of Urology, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Fatih Atug
- Department of Urology, Bilim University, Istanbul, Turkey
| | - İlter Tüfek
- Department of Urology, Bilim University, Istanbul, Turkey
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Jeon SH, Han KS, Yoo KH, Choe BK, Seo IY, Lim JS, Ono Y. How Many Cases Are Necessary to Develop Competence for Laparoscopic Radical Nephrectomy? J Endourol 2009; 23:1965-9. [DOI: 10.1089/end.2008.0636] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Seung Hyun Jeon
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyung-Sik Han
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Koo Han Yoo
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Bong-Keun Choe
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ill Young Seo
- Departments of Urology, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae Sung Lim
- Department of Urology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yoshinari Ono
- School of Medical Welfare, Aichi Shukutoku University, Aichi, Japan
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