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Arkoudis NA, Reppas L, Spiliopoulos S. Image-guided percutaneous cholecystostomy: challenging the norms. Abdom Radiol (NY) 2024; 49:939-941. [PMID: 38294540 DOI: 10.1007/s00261-023-04173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
Image-guided percutaneous cholecystostomy (IGPC) is a widely recognized and regularly employed procedure in numerous institutions, serving as an indispensable cornerstone in the management of patients with acute cholecystitis. The most up-to-date literature has found that the transperitoneal route is at least as safe as the transhepatic route and that both the trocar and Seldinger techniques are equally safe and effective. The above novel insights may offer reassurance and alleviate concerns among operators performing IGPC by dispelling the fixation on previously established beliefs and thus providing flexibility, which lightens the load on the operator. Future studies could further investigate these findings and shed light on potential disparities in the safety and efficacy profiles associated with the subcostal and intercostal approaches, different drainage catheter sizes, and/or the impact of operator experience on complication rates.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Lazaros Reppas
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
- 2nd Department of Radiology, Interventional Radiology Unit, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, Interventional Radiology Unit, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece
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Shrivastava N, Bhargava P, Sharma G, Choudhary GR. Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a systematic review and meta-analysis. World J Urol 2024; 42:83. [PMID: 38358565 DOI: 10.1007/s00345-024-04796-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Robot-assisted partial nephrectomy (RAPN) can be performed either by a transperitoneal (TP) or a retroperitoneal (RP) approach. However, the superiority of one approach over the other is not established. Hence, the primary aim of this review was to compare perioperative outcomes between these two surgical approaches. METHODS Literature was systematically searched to identify studies reporting perioperative outcomes following TP RAPN and RP RAPN. The study protocol was registered with PROSPERO (CRD42023399496). The primary outcome was comparing complication rates between the two approaches. RESULTS This review included 22 studies, 5675 patients, 2524 in the RP group, and 3151 in the TP group. The overall complications were significantly lower in the RP group [Odds ratio (OR) 0.80 (0.67, 0.95), p = 0.01]. However, the rate of major complications was similar between the two groups. The operative time was significantly shorter with the RP group [Mean Difference (MD)-16.7 (- 22.3, - 11.0), p = < 0.0001]. Estimated blood loss (EBL) and need for blood transfusion (BT) were significantly lower in the RP group. There was no difference between the two groups for conversion to radical nephrectomy [OR 0.66 (0.33, 1.33), p = 0.25] or open surgery [OR 0.68 (0.24, 1.92, p = 0.47] and positive surgical margins [OR 0.93 (0.66, 1.31, p = 0.69]. Length of stay (LOS) was shorter in the RP group [MD - 0.27 (- 0.45, - 0.08), p = < 0.00001]. CONCLUSIONS RP approach, compared to TP, has significantly lower complication rates, EBL, need for BT and LOS. However, due to the lack of randomized studies on the topic, further data is required.
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Affiliation(s)
- Nikita Shrivastava
- Department of Urology, DKS Super Specialty Hospital and Postgraduate Institute, Raipur, India
| | - Priyank Bhargava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, India
| | - Gopal Sharma
- Department of Urologic Oncology and Robotic Surgery, Medanta-The Medicity, Gurugram, Haryana, 122001, India.
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Bourgi A, Ayoub E, Merhej S, Souky J, Roupret M, Bruyère F. A comparison of perioperative outcomes of transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a systematic review. J Robot Surg 2023; 17:2563-2574. [PMID: 37596485 DOI: 10.1007/s11701-023-01685-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/16/2023] [Indexed: 08/20/2023]
Abstract
RAPN can be carried out via a transperitoneal or retroperitoneal approach. The choice between the two approaches is open to debate and usually based on surgeon preference. The perioperative outcomes of transperitoneal robot-assisted partial nephrectomy versus retroperitoneal robot-assisted partial nephrectomy were compared. A systematic review of the literature was performed up to May 2020, using PubMed, Cochrane, Scopus and Ovid databases. Articles were selected according to a search strategy based on PRISMA criteria. Only studies comparing TRAPN with RRAPN were eligible for inclusion. Eleven studies were included in the quantitative synthesis. Baseline demographics (age, BMI, ASA, tumour size, and RENAL nephrometry score), intraoperative data (operative time, estimated blood loss, and warm ischaemia time) and postoperative outcomes (major complications according to Clavien-Dindo, length of hospital stay (LOS) and positive surgical margin rate) were recorded. A total of 3139 patients were included (2052 TRAPN vs. 1087 RRAPN). There was no significant difference in demographic variables (age, BMI), tumour size (p = 0.06) nor the nephrometry score (p = 0.20) between the two groups. Operative time (p = 0.02), estimated blood loss (p < 0.00001) and LOS (p < 0.00001) were significantly lower in the RRAPN group. No differences were found in major postoperative complications (Clavien-Dindo > 3; p = 0.37), warm ischaemia time (p = 0.37) or positive surgical margins (p = 0.13). Future researchers must attempt to achieve adequately powered, expertise based, multi-surgeon and multi-centric studies comparing TRAPN and RRAPN. RRAPN gives similar outcomes to TRAPN. RRAPN is associated with reduced operative time and LOS. Ideally, surgeons should be familiar and competent in both RAPN approaches and adopt a risk-stratified and patient-centred individualised approach, dependent on the tumour and patient characteristics. RAPN is feasible via two approaches. The retroperitoneal approach seems to be associated with a shorter operation time and hospital stay.
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Affiliation(s)
- Ali Bourgi
- Department of Urology, University Hospital of Tours, 2 Boulevard Tonnellé, Tours, Loire Valley, France.
| | - Elias Ayoub
- Department of Urology, chu Poitiers, Poitiers, France
| | - Sleiman Merhej
- Department of Urology, Saint Joseph University, Damascus Road, PO-BOX: 17-5208, Beirut, Lebanon
| | - Josee Souky
- Department of Urology, University Hospital of Tours, 2 Boulevard Tonnellé, Tours, Loire Valley, France
- Department of Urology, chu Poitiers, Poitiers, France
- Department of Urology, Saint Joseph University, Damascus Road, PO-BOX: 17-5208, Beirut, Lebanon
- Department of Urology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Morgan Roupret
- Department of Urology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Franck Bruyère
- Department of Urology, University Hospital of Tours, 2 Boulevard Tonnellé, Tours, Loire Valley, France
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Fouche D, Chenais G, Haissaguerre M, Bouriez D, Gronnier C, Collet D, Tabarin A, Najah H. Risk factors for intraoperative complications, postoperative complications, and prolonged length of stay after laparoscopic adrenalectomy by transperitoneal lateral approach: a retrospective cohort study of 547 procedures. Surg Endosc 2023; 37:7573-7581. [PMID: 37442834 DOI: 10.1007/s00464-023-10148-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/19/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) is the gold standard for the resection of most adrenal lesions. A precise delineation of factors influencing its outcomes is lacking. The aim of this study was to assess factors associated with intraoperative complications, postoperative complications, and prolonged length of stay (LOS) after LA. METHODS Patients who underwent LA from 1999 to 2021 in a single-academic-institution were included. Patient and disease-specific data, intraoperative complications, postoperative complications according to Dindo-Clavien (DC) scale, and LOS were recorded. Predictive factors of complications and prolonged LOS were determined by logistic regression. RESULTS We identified 530 patients who underwent 547 LA. Intraoperative complications occurred in 33 patients (6.0%). Postoperative complications ≥ DC grade 2 occurred in 73 patients (13.35%); severe postoperative complications ≥ DC grade 3 in 14 patients (2.56%). Postoperative complications were positively associated with age ≥ 72 (OR 1.14 [95% CI 1.02-1.29]), intraoperative complications (OR 1.36 [95% CI 1.14-1.63]), and negatively associated with non functional adenomas (OR 0.88 [95% CI 0.7-0.99]), and right adrenalectomy (OR 0.91 [95% CI 0.86-0.97]). Severe postoperative complications were positively associated with chronic obstructive pulmonary disease (COPD, OR 1.08 [95% CI 1.00-1.17]), and negatively associated with right adrenalectomy (OR 0.97 [95% CI 0.92-0.99]). Prolonged LOS was associated with age ≥ 72 (OR 1.21 [95% CI 1.05-1.41]), and COPD (OR 1.20 [95% CI 1.01-1.44]). CONCLUSIONS LA remains safe when performed by surgeons with expertise. Right adrenalectomy resulted in less postoperative overall and severe complications. The risk-benefit equation should be carefully assessed before left LA in older patients with COPD.
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Affiliation(s)
- Donatien Fouche
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Gabrielle Chenais
- University of Bordeaux, INSERM, BPH U1219, F-33000, Bordeaux, France
| | - Magalie Haissaguerre
- Endocrinology Department, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Damien Bouriez
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Caroline Gronnier
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Denis Collet
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Antoine Tabarin
- Endocrinology Department, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Haythem Najah
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France.
- Department of Endocrine Surgery, Hôpital Haut Lévêque, University Hospital of Bordeaux, Avenue Magellan, 33604, Pessac, France.
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Pathak NJ, Ganpule AP, Shetty R, Balaji S, Shete N, Singh A, Sabnis RB, Desai MR. Study of the predictive factors affecting outcomes of patients undergoing transperitoneal laparoscopic donor nephrectomy. Int Urol Nephrol 2023; 55:2457-2464. [PMID: 37421510 DOI: 10.1007/s11255-023-03699-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE We aim to study the preoperative and intraoperative factors and compare against specific outcomes in patients undergoing transperitoneal laparoscopic donor nephrectomy and see if we could find what were the predictive factors for these outcomes. METHODS This is a prospective cohort study done in a single high-volume transplant center. 153 kidney donors were evaluated over a period of 1 year. The preoperative factors such as age, gender, smoking status, obesity, visceral obesity, perinephric fat thickness, number of vessels, anatomic abnormalities, comorbidities, and side of kidney and intraoperative factors such as lay of colon on the kidney, height of splenic or hepatic flexure of colon, loaded or unloaded colon, and sticky mesenteric fat were compared against specific outcomes such as duration of surgery, duration of hospital stay, postoperative paralytic ileus, and postoperative wound complications. RESULTS Multivariate logistic regression models were used to study the variables of interest against the various outcomes. There were three positive risk factors for increased hospital stay, which were perinephric fat thickness and height of splenic or hepatic flexure of colon and smoking history. There was one positive risk factor for postoperative paralytic ileus which is lay of colon with relation to kidney and there was one positive risk factor for postoperative wound complication which was visceral fat area. CONCLUSION The predictive factors for adverse postoperative outcomes after transperitoneal laparoscopic donor nephrectomy were perinephric fat thickness, height of splenic or hepatic flexure, smoking status, lay or redundancy of colon with relation to kidney and visceral fat area.
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Affiliation(s)
- Niramya J Pathak
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
| | - Arvind P Ganpule
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Raisa Shetty
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Sudharsan Balaji
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Nitiraj Shete
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abhishek Singh
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Ravindra B Sabnis
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mahesh R Desai
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Zhu PY, Wang L, Li KP, Yin S, Chen XB. Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and pooled analysis of comparative outcomes. World J Surg Oncol 2023; 21:163. [PMID: 37248555 DOI: 10.1186/s12957-023-03046-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND The debate on whether to choose a transperitoneal (TP) or retroperitoneal (RP) approach for treating upper urinary tract urothelial carcinoma (UTUC) with laparoscopic surgery has been drawing attention. This study aimed to systematically review and meta-analyze the existing evidence regarding oncologic and perioperative outcomes of transperitoneal laparoscopic radical nephroureterectomy (TLNU) and retroperitoneal laparoscopic radical nephroureterectomy (RLNU) in managing UTUC. METHODS A comprehensive literature search was conducted using PubMed, Scopus, Embase, and Google Scholar for identifying randomized controlled trials (RCTs) and observational studies that evaluated the outcomes of TLNU and RLNU for UTUC. Continuous variables were represented by weighted mean difference (WMD) and standard mean difference (SMD), while binary variables were represented by odds ratio (OR), with 95% confidence intervals (CIs). The quality was assessed using the Newcastle-Ottawa scale. A sensitivity analysis was performed to evaluate the robustness of the estimates. RESULT Six observational studies were incorporated into this meta-analysis. The overall TLNU was associated with significantly shorter operating time (WMD - 19.85; 95% CI - 38.03 to - 1.68; P = 0.03); longer recovery time of intestinal function (SMD 0.46; 95% CI 0.08 to 0.84; P = 0.02). However, the terms of estimated blood loss (WMD - 5.72; 95% CI - 19.6 to - 8.15; P = 0.42); length of stay (WMD - 0.35; 95% CI - 1.61 to 0.91; P = 0.59), visual analog pain scale (WMD - 0.38; 95% CI - 0.99 to 0.84; P = 0.22); drainage duration (WMD - 0.22; 95% CI - 0.61 to 0.17; P = 0.26); overall complication rates (OR 1.24; 95% CI 0.58 to 2.63; P = 0.58); local recurrence rate (OR 0.6; 95% CI 0.3 to 1.21; P = 0.16); distant metastasis (OR 0.94; 95% CI 0.04 to 20.77; P = 0.97); 1-year overall survival (OS) (OR 0.45; 95% CI 0.1 to 2.01; P = 0.3) showed no difference between TLNU and RLUN. CONCLUSION TLNU provides similar surgical outcomes and oncologic results compared to RLUN; however, TLNU has a shorter procedure time and prolonged intestinal function recovery time. Due to the heterogeneity among the studies, randomized clinical trials with follow-ups in the long term are required to obtain more definite results. TRIAL REGISTRATION www.crd.york.ac.uk/prospero/ , identifier CRD42023388554.
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Affiliation(s)
- Ping-Yu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
| | - Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Kun-Peng Li
- Department of Urology, Affiliated Hospital of Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Xiao-Bin Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
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Lv Z, Chen G, Li Y, Li J, Hu A, Yu X. Perioperative results of single-port vs multi-port robotic-assisted radical prostatectomy via peritoneal approach: a meta-analysis. J Robot Surg 2023:10.1007/s11701-023-01589-9. [PMID: 37052809 DOI: 10.1007/s11701-023-01589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023]
Abstract
To compare the perioperative outcomes of single-port robotic-assisted radical prostatectomy (SP-RARP) and multiport robotic-assisted radical prostatectomy (MP-RARP) via transperitoneal approach, we conducted a comprehensive database search of eligible studies up to October 2022 and compared their results. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and a leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias. A total of six articles were included, involving 926 patients, among which 256 underwent SP-RARP and 670 underwent MP-RARP. Comparing the two, SP-RARP was associated with shorter hospitalization time (- 0.5 days; 95% CI - 1.02, - 0.06, p < 0.05) and less intraoperative blood loss (- 29.88 ml; 95% CI - 45.66, - 14.10, p < 0.05). However, there were no significant differences in any complications, operative time, positive surgical margins, or short-term follow-up outcomes (continence and potency at 3 months). These findings provide reference data for the selection of surgical methods in performing transperitoneal RP and support further research on the broad applicability of the SP platform.
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Affiliation(s)
- Zongying Lv
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Guiyuan Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yugen Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Junyang Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Anneng Hu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaodong Yu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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Wang L, Li KP, Liu Y, Yin S, Zhu PY. Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy for large-volume renal carcinoma (> 7 cm): a systematic review and pooled analysis of comparative outcomes. World J Surg Oncol 2023; 21:86. [PMID: 36894912 PMCID: PMC9997016 DOI: 10.1186/s12957-023-02967-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Recently, there has been a significant amount of debate concerning the question of whether laparoscopic surgery should be performed transperitoneally or retroperitoneally for treating large renal tumors. AIM The purpose of this research is to conduct a comprehensive review and meta-analysis of the previous research on the safety and efficacy of transperitoneal laparoscopic radical nephrectomy (TLRN) and retroperitoneal laparoscopic radical nephrectomy (RLRN) in the treatment of large-volume renal malignancies. METHODS An extensive search of the scientific literature was carried out utilizing PubMed, Scopus, Embase, SinoMed, and Google Scholar in order to locate randomized controlled trials (RCTs) and prospective and retrospective studies that compared the effectiveness of RLRN versus TLRN in the treatment of for large renal malignancies. For the purpose of comparing the oncologic and perioperative outcomes of the two techniques, data were taken from the research studies that were included and pooled together. RESULTS A total of 14 studies (five RCTs and nine retrospective studies) were incorporated into this meta-analysis. The overall RLRN had an association with significantly shorter operating time (OT) (MD [mean difference]: - 26.57; 95% CI [confidence interval]: - 33.39 to - 19.75; p < 0.00001); less estimated blood loss (EBL) (MD: - 20.55; CI: - 32.86 to - 8.23; p = 0.001); faster postoperative intestinal exhaust (MD: - 0.65; CI: - 0.95 to - 0.36; p < 0.00001). The terms of length of stay (LOS) (p = 0.26), blood transfusion (p = 0.26), conversion rate (p = 0.26), intraoperative complications (p = 0.5), postoperative complications (p = 0.18), local recurrence rate (p = 0.56), positive surgical margin (PSM) (p = 0.45), and distant recurrence rate (p = 0.7) did not show any differences. CONCLUSIONS RLRN provides surgical and oncologic results similar to TLRN, with potential advantages regarding shorter OT, EBL, and postoperative intestinal exhaust. Due to the high heterogeneity among the studies, long-term randomized clinical trials are required to obtain more definitive results.
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Affiliation(s)
- Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Kun-Peng Li
- Department of Urology, Affiliated Hospital of Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Ying Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Ping-Yu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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Zhang QB, Huang YS, Yan L, Liu Z, Xu ZH, Gu GL. Comparison of lateral transperitoneal versus retroperitoneal laparoscopic adrenalectomy for pheochromocytoma: a single-centre retrospective study. Updates Surg 2023. [PMID: 36842133 DOI: 10.1007/s13304-023-01475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
Laparoscopic adrenalectomy (LA) has became the standardized treatment for pheochromocytoma. The aim of this study was to evaluate outcomes of lateral transperitoneal and retroperitoneal LA for pheochromocytoma. Between January 2011 and December 2021, 142 patients with pheochromocytoma underwent LA via lateral transperitoneal (123 patients) or retroperitoneal (19 patients) approaches. Data of these patients were assessed to investigate the differences in perioperative outcomes and intraoperative haemodynamic parameters between the two procedures. Clinical parameters at presentation were comparable between the two groups, except for tumour size, which was larger in the transperitoneal group (50 [10-115] mm vs 35 [7-110] mm, P = 0.012). There were no significant differences between the two groups in terms of operation time, estimated blood loss, intraoperative transfusion rate, incidence of complications, conversion to open surgery, postoperative analgesic requirement, time to first oral intake, or mean hospital stay. Intraoperative haemodynamic parameters of the two groups were similar. After adjusting for tumour size using propensity score matching, both perioperative outcomes and haemodynamic parameters were still comparable. Lateral transperitoneal and retroperitoneal laparoscopic adrenalectomies provide similar perioperative and haemodynamic outcomes for surgical resection of pheochromocytoma.
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Rastogi V, Kim NH, Marcaccio CL, Patel PB, Varkevisser RRB, de Bruin JL, Verhagen HJM, Schermerhorn ML. Retroperitoneal versus Transperitoneal Approach for Open Repair of Complex Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2022:S1078-5884(22)00332-X. [PMID: 35605910 DOI: 10.1016/j.ejvs.2022.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/03/2022] [Accepted: 05/14/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Several studies have demonstrated advantages of the retroperitoneal approach (RP) over the transperitoneal approach (TP) for infrarenal abdominal aortic aneurysm (AAA) repair. We performed a retrospective analysis comparing the outcomes of TP versus RP surgical approach for open complex AAA (cAAA) repair and evaluated their relative use over time. METHODS Patients undergoing open repair for intact cAAA (juxtarenal, suprarenal, or type-IV thoracoabdominal aortic aneurysms) between 2011-2019 were identified in the National Surgical Quality Improvement Program (NSQIP). The primary outcome was perioperative death. Secondary outcomes included perioperative complications and approach usage over time. We performed multivariable adjustment by creating propensity scores and using inverse probability-weighted logistic regression. RESULTS Among 1,195 patients identified, 729 (61%) underwent cAAA repair via a TP approach and 466 (39%) underwent repair via an RP approach. Compared with a TP approach, RP patients more frequently had a supracoeliac clamp position (32% vs. 20%, p<.001) and concomitant renal revascularization (30% vs. 18%, p<.001). After adjustment, an RP approach was associated with lower odds of perioperative mortality (4.0% vs. 7.2%; OR:0.54; 95%CI:0.32-0.91; p=.022). Furthermore, an RP approach was associated with lower odds of any major complication (24% vs. 30%; OR:0.73; 95%CI:0.56-0.94), cardiac complications (4.9% vs. 8.2%; OR:0.60; 95%CI:0.37-0.96), wound complications (2.1% vs. 6.0%; OR:0.34; 95%CI:0.17-0.64), and postoperative sepsis (0.8% vs. 2.4%; OR:0.37; 95%CI:0.12-0.99). The proportion of repairs using an RP approach decreased from 2011-2015 to 2016-2019 (42% vs. 35%, p=.020), particularly for supra-renal and type-IV thoracoabdominal aneurysms (49% vs 37%, p=.023). CONCLUSION In open cAAA repair, the RP approach may be associated with lower perioperative mortality and morbidity compared with the TP approach. However, we found that the relative usage of the RP approach is decreasing over time, even in suprarenal/type-IV TAAA's, and repairs utilizing a supracoeliac clamping site. Increased utility of the RP approach, when appropriate, may lead to improved outcomes following open cAAA repair.
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Zhang Y, Zhou H, Tuo ZT, Wang J, Sun C, Bi L. Extraperitoneal laparoscopic radical cystectomy with intracorporeal neobladder: a comparison with transperitoneal approach. World J Surg Oncol 2022; 20:130. [PMID: 35459251 PMCID: PMC9034519 DOI: 10.1186/s12957-022-02587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Bladder cancer is one of the most common genitourinary cancers. Traditional transperitoneal radical cystectomy is the gold standard treatment for muscle-invasive bladder cancer. Our study was to compare the perioperative and oncological outcomes of extraperitoneal laparoscopic radical cystectomy (ELRC) with intracorporeal neobladder versus transperitoneal urinary diversion for bladder cancer. Method A total of 113 patients who underwent laparoscopic radical cystectomy performed at our center were included in this retrospective study. The perioperative data of the extraperitoneal laparoscopic radical cystectomy (ELRC) with intracorporeal urinary diversion (ICUD) and transperitoneal laparoscopic radical cystectomy (TLRC) with ICUD groups were compared. The demographic, perioperative, oncological, and complication data were collected and analyzed. Results In total, 113 patients were enrolled for the final analysis. The median follow-up period was 22 months. The ELRC group had shorter interval to flatus (p < 0.001), solid food (p < 0.001), shorter length of hospital stay (p < 0.01), and fewer early gastrointestinal complications (p < 0.05). Furthermore, urinary continence, recurrence-free, cancer-specific, and overall survival rates and recurrence patterns did not significantly differ. Conclusions Surgical technique of ELRC with ICUD can achieve the established oncologic criteria of TLRC, and such technique can improve perioperative and early postoperative outcomes.
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Affiliation(s)
- Ying Zhang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, 668 Furong Road, Hefei, 230032, Anhui, China
| | - Huan Zhou
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, 668 Furong Road, Hefei, 230032, Anhui, China
| | - Zhou Ting Tuo
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, 668 Furong Road, Hefei, 230032, Anhui, China
| | - Jinyou Wang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, 668 Furong Road, Hefei, 230032, Anhui, China
| | - Chenyu Sun
- Internal Department, AMITA Health Saint Joseph Hospital, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA
| | - Liangkuan Bi
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, 668 Furong Road, Hefei, 230032, Anhui, China.
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12
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Rastogi V, Marcaccio CL, Patel PB, Varkevisser RRB, Patel VI, Soden PA, de Bruin JL, Verhagen HJM, Schermerhorn ML. A Retroperitoneal Operative Approach is Associated with Improved Perioperative Outcomes Compared with a Transperitoneal Approach in Open Repair of Complex Abdominal Aortic Aneurysms. J Vasc Surg 2022; 76:354-363.e1. [PMID: 35276265 PMCID: PMC9329186 DOI: 10.1016/j.jvs.2022.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Several studies have demonstrated advantages of a retroperitoneal approach (RP) over a transperitoneal approach (TP) during open repair of infrarenal abdominal aortic aneurysms (AAA). We compared outcomes following open repair of complex AAA (cAAA) using an RP versus a TP approach and evaluated the relative use of these approaches over time. METHODS We identified all patients undergoing open intact cAAA repair in the Vascular Quality Initiative (VQI) from 2003-2019 and created 1:1-propensity score-matched cohorts based on operative approach (RP vs. TP). The primary outcome was perioperative mortality. Secondary outcomes included perioperative complications and approach usage over time. To create 1:1-propensity score-matched cohorts, patients were matched for demographics, comorbidities and anatomic/intraoperative characteristics including proximal clamp site and renal revascularization. Approach usage over time was determined by plotting the proportion of RP usage over time for the overall open cAAA cohort and subgroups of repairs utilizing a supraceliac cross clamp, repair with concomitant renal revascularization, and repairs in high volume centers (highest quintile: >11 cases/year). RESULTS Of 4,613 patients, 2,843 (62%) patients underwent open cAAA repair by TP approach and 1,770 (38%) patients by RP approach. In 1,256 matched pairs, RP approach was associated with lower risk of perioperative mortality compared with TP approach (3.9% vs. 6.8%/RR 0.57 [95%CI 0.41-0.80], p=.001). Furthermore, RP approach was associated with lower risk of cardiac complication (7.2% vs. 9.6%/RR 0.75 [95%CI 0.58-0.98]), bowel ischemia (3.1% vs. 5.4%/RR 0.56 [95%CI 0.39-0.84]) and postoperative dialysis (3.3% vs. 5.5%/RR 0.59 [95%CI 0.41-0.87]). Overall, there was a lower proportion of patients who underwent repair via an RP approach over time (-1.0%/year [-1.5 - -0.5], p<.001), and a similar trend in decrease was found within patients undergoing repair with a supraceliac clamp (-2.3%/year [-3.6 - -1.0], p<.001) and in high-volume hospitals (-2.1%/year [-3.4 - -0.8], p=.001), although no statistically significant decrease in RP usage was found in patients undergoing concomitant renal revascularization (-0.9%/year [-2.6 - 0.8], p=.28). CONCLUSION For open cAAA repair, an RP approach is associated with lower perioperative mortality and complications compared with a TP approach. However, relative usage of the RP approach is decreasing over time. Increased adoption of an RP approach, when appropriate, may lead to improved outcomes following open cAAA repair.
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Affiliation(s)
- Vinamr Rastogi
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christina L Marcaccio
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Priya B Patel
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rens R B Varkevisser
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Virendra I Patel
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Medical Center, New York, NY
| | - Peter A Soden
- Division of Vascular Surgery and Endovascular Surgery, Brown University Medical Center, Providence, RI
| | - Jorg L de Bruin
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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13
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Liu Z, Li DW, Yan L, Xu ZH, Gu GL. Comparison of lateral transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy. BMC Surg 2021; 21:432. [PMID: 34930214 PMCID: PMC8686258 DOI: 10.1186/s12893-021-01422-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/01/2021] [Indexed: 12/27/2022] Open
Abstract
Background There is a lack of data regarding the appropriateness of transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy. The aim of this study is to compare lateral transperitoneal and retroperitoneal approach for left-sided and right-sided laparoscopic adrenalectomy respectively. Methods Between January 2014 and December 2019, 242 patients underwent left-sided and 252 patients underwent right-sided laparoscopic adrenalectomy. For left side, transperitoneal approach was used in 132 (103 with tumors < 5 cm and 29 with tumors ≥ 5 cm) and retroperitoneal approach in 110 (102 with tumors < 5 cm and 8 with tumors ≥ 5 cm). For right side, transperitoneal approach was used in 139 (121 with tumors < 5 cm and 18 with tumors ≥ 5 cm) and retroperitoneal approach in 113 (102 with tumors < 5 cm and 11 with tumors ≥ 5 cm). Patient characteristics and perioperative outcomes were recorded. For each side, both approaches were compared for tumors < 5 cm and ≥ 5 cm respectively. Results For left-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time, less blood loss and longer time to oral intake. For left-sided tumors ≥ 5 cm, the peri-operative data of both approaches was comparable. For right-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time and less blood loss. For right-sided tumors ≥ 5 cm, the peri-operative data was comparable. Conclusions Lateral transperitoneal and retroperitoneal approach are both effective for laparoscopic adrenalectomy. Lateral transperitoneal approach is faster with less blood loss for tumors < 5 cm.
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Affiliation(s)
- Zhao Liu
- Department of Urology, Qilu Hospital, Shandong University, No 107, Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Da-Wei Li
- Department of Urology, Qilu Hospital, Shandong University, No 107, Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Lei Yan
- Department of Urology, Qilu Hospital, Shandong University, No 107, Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Zhong-Hua Xu
- Department of Urology, Qilu Hospital, Shandong University, No 107, Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Gang-Li Gu
- Department of Urology, Qilu Hospital, Shandong University, No 107, Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China.
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14
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Miyano G, Masuko T, Ohashi K, Hamano A, Suda K, Seo S, Ochi T, Koga H, Lane GJ, Tada M, Yanai T, Yamataka A. Recovery of bowel function after transperitoneal or retroperitoneal laparoscopic pyeloplasty. A multi-center study. Pediatr Surg Int 2021; 37:1791-1795. [PMID: 34498175 DOI: 10.1007/s00383-021-04990-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
AIM To document the recovery of bowel function (BF) in children after transperitoneal (TP) or retroperitoneal (RP) laparoscopic pyeloplasty. METHODS Data were obtained retrospectively from four centers between 2008 and 2019 for TP (n = 51) and RP (n = 58). Each surgeon chose which technique to perform. RESULTS Subject demographics were not significantly different. Differences in operative times were not significant (RP: 241 min versus TP: 225 min). Mean duration/requirement for postoperative epidural/intravenous analgesia were not significantly different (TP: 1.4 days versus RP: 1.3 days) and (TP: 66.7% versus RP: 67.2%), respectively. Postoperative nasogastric (NG) intubation was more common in RP (TP: 19.6% versus RP: 44.8%; p < .05). NG aspiration (TP: 0.15 mL/kg/hr versus RP: 0.16 mL/kg/hr), nausea (TP: 31.4% versus RP: 17.2%), and vomiting (TP: 19.6% versus RP: 15.5%) were not significantly different. There were no perioperative complications (including ileus). Abdominal distention was problematic in one case per group (TP: 2.0% versus RP: 1.7%). Times for oral liquid (TP: 0.69 day versus RP: 0.83 day), solid food (TP: 0.88 day versus RP 1.07 days), and the first bowel movement (TP: 2.86 days versus RP: 2.79 days), were not significantly different. CONCLUSIONS BF recovery would appear to be consistent, independent of technique.
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Affiliation(s)
- Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takayuki Masuko
- Department of Pediatric Urology, Saitama Children's Hospital, Saitama, Japan
| | - Kensuke Ohashi
- Department of Pediatric Urology, Ibaraki Children's Hospital, Ibaraki, Japan
| | - Atsushi Hamano
- Department of Urology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kazuto Suda
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Shogo Seo
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Minoru Tada
- Department of Pediatric Urology, Ibaraki Children's Hospital, Ibaraki, Japan
| | - Toshihiro Yanai
- Department of Pediatric Urology, Saitama Children's Hospital, Saitama, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
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15
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Zhang W, Xia L, Han X, Ju X, Wu X, Chen X. Extraperitoneal laparoscopy for para-aortic lymphadenectomy in endometrial carcinoma staging: an approach with higher efficiency. World J Surg Oncol 2021; 19:323. [PMID: 34743715 PMCID: PMC8573921 DOI: 10.1186/s12957-021-02416-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Removing more inframesenteric nodes is not only significantly increases the likelihood of finding metastasis for endometrial cancer, but also can add survival advantage. As most patients diagnosed with endometrial cancer are overweight or obesity, a high efficiency approach is important. Aim of this study was to compare the surgical outcomes of extraperitoneal laparoscopic, transperitoneal laparoscopic, and laparotomic para-aortic lymphadenectomy in endometrial carcinoma staging. Methods We retrospectively reviewed data of all patients diagnosed with primary endometrial carcinoma who were treated at the Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center from 1 January 2017 to 31 December 2019. The numbers of para-aortic lymph nodes, surgical time, complications, blood loss and hospital stay were compared. The patients’ medical records and pathological reports were carefully reviewed. Statistical significance was defined as p < 0.05. Results We retrospectively compared patients who underwent extraperitoneal laparoscopy (Group E, n = 20), transperitoneal laparoscopy (group T, n = 21), and laparotomy (group L, n = 135). The median number of para-aortic lymph nodes was significantly higher in group E than in groups T and L (9.5, 5, and 6, respectively; p = 0.004 and 0.0004, respectively). All patients in group E underwent successfully dissection to the renal vessel level. The median operation time was significantly shorter in group L than in groups T and E (94, 174, and 233 min, respectively; p < 0.0001). The median estimated blood loss volume was higher in group L than in groups T and E (200, 100, and 142.5 ml, respectively; all comparisons p < 0.001), and the length of hospital stay was significantly longer in group L than in Groups T and E (6, 5, and 6 days, respectively; all comparisons p < 0.001). Conclusion The extraperitoneal laparoscopic approach for staging endometrial carcinoma harvested higher numbers of para-aortic lymph nodes which could be considered for endometrial carcinoma staging, especially for para-aortic lymph node harvest. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02416-x.
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Affiliation(s)
- Wei Zhang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lingfang Xia
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaotian Han
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xingzhu Ju
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaohua Wu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaojun Chen
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
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16
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Zia H, Khatami F, Aghamir SMK. U-shape incision on prostate capsule: New intraperitoneal laparoscopic technique in simple prostatectomy: A case report. Ann Med Surg (Lond) 2021; 69:102787. [PMID: 34522377 DOI: 10.1016/j.amsu.2021.102787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction and importance: Laparoscopy is a known technique for simple prostatectomy using intraperitoneal or extraperitoneal approaches. In the present study, a novel method is suggested for easier access to the whole body and even the head of the adenoma. Case presentation This method was performed on 6 patients with prostate hyperplasia. This was intraperitoneal method, started with 4–6 trocars and two transverse incisions on both sides of the endopelvic fascia. the prostate capsule is detected (using a Foley catheter balloon); the prostate capsule is transversely opened by a U-shape incision in a 0.5–1cm distance from the bladder neck to reach the adenoma and is dissected under the capsule to separate the capsule from the prostate. By ligashour capsule is opened laterally to the endopelvic fascia and separated from the prostate and gland is removed. Clinical discussion The mean operation time was 114 minutes and the average intraoperative bleeding was 244.1 cc. IPSS (International Prostate Symptom Score), Q Max, and post-void residue, changes were significant with p-value = 0.003, respectively; however, pre and postoperative Hemoglobin was imprecise. The mean postoperative urinary leakage is reported at 22 cc. Conclusion In short, this technique provides a better vision to prostate adenoma and the results can be compared with other laparoscopic approaches. Yet, larger sample sizes in different centers are required for determining realistic results. The new U-shape intraperitoneal simple laparoscopic prostatectomy method is quite uncomplicated and accessible for all surgeons. A novel method is suggested for the head of the adenoma. This technique can be compared with other laparoscopic approaches.
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17
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Sarhan OM. Laparoscopic nephrectomy in children: Does the approach matter? J Pediatr Urol 2021; 17:568.e1-568.e7. [PMID: 34053858 DOI: 10.1016/j.jpurol.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 04/11/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVE Laparoscopic nephrectomy (LN) is an established technique for the management of benign non-functioning kidneys in children. It can be performed either by the transperitoneal (TP) or retroperitoneal (RP) approach. The aim of this study was to compare safety and efficacy of TP with RP approach for LN in children. STUDY DESIGN Between 2007 and 2019, 79 consecutive pediatric patients with benign non-functioning kidneys underwent laparoscopic nephrectomy by a single surgeon. Patients were categorized into two groups according to the approach; Group 1 included 41 patients who underwent transperitoneal laparoscopic nephrectomy (TPLN), while Group 2 included 38 patients who underwent retroperitoneal laparoscopic nephrectomy (RPLN). Comparison was done between the two groups regarding the mean operative time, complications, time to resume oral intake, need for postoperative analgesia and postoperative hospital stay. RESULTS Laparoscopic nephrectomy was successfully completed in 75 of the 79 cases. Four cases were converted to open surgery: 3 from the TPLN group and one from the RPLN group (p = 0.34). There was statistically significant difference between the two groups in terms of estimated blood loss (p = 0.013), time to resume oral intake (p = 0.001) and postoperative hospital stay (p = 0.024). Overall, there was no statistically significant difference as regard mean operative time, overall complication rate, and postoperative analgesia need. DISCUSSION LN is now an established technique in children and surgeon experience is a limiting factor. This experience should be gained progressively with respect to both TP and RP approaches to deal with different indications by optimal approach. Both TP and RP approaches are excellent approaches and it is up to individual surgeons, based on their experience, which approach they select. In this study, a comparative study was made between both TP and RP approaches for pediatric LN. There was no statistically significant difference between the two approaches as regard success rate, mean operative time, need for postoperative analgesia and overall complication rate. In the meantime, RPLN had the advantage of lower intraoperative blood loss, shorter time to resume oral intake and shorter hospital stay. CONCLUSIONS Laparoscopic nephrectomy in children may be performed by transperitoneal or retroperitoneal approaches, obtaining equal safety and efficacy. The retroperitoneal approach seems to be advantageous in terms of lower intraoperative blood loss, time to resume oral intake and shorter postoperative hospital stay.
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Affiliation(s)
- Osama M Sarhan
- Mansoura Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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18
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Carbonara U, Eun D, Derweesh I, Capitanio U, Celia A, Fiori C, Checcucci E, Amparore D, Lee J, Larcher A, Patel D, Meagher M, Crocerossa F, Veccia A, Hampton LJ, Montorsi F, Porpiglia F, Autorino R. Retroperitoneal versus transepritoneal robot-assisted partial nephrectomy for postero-lateral renal masses: an international multicenter analysis. World J Urol 2021; 39:4175-4182. [PMID: 34050813 DOI: 10.1007/s00345-021-03741-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/20/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To assess the outcomes of retroperitoneal robot-assisted partial nephrectomy (r-RAPN) in a large cohort of patients with postero-lateral renal masses comparing to those of transperitoneal RAPN (t-RAPN). METHODS Patients with posterior (R.E.N.A.L. score grading P) or lateral (grading X) renal mass who underwent RAPN in six high-volume US and European centers were identified and stratified into two groups according to surgical approach: r-RAPN ("study group") and t-RAPN ("control group"). Baseline characteristics, intraoperative, and postoperative data were collected and compared. RESULTS Overall, 447 patients were identified for the analysis. 231 (51.7%) and 216 (48.3%) patients underwent r-RAPN and t-RAPN, respectively. Baseline characteristics were not statistically significantly different between the groups. r-RAPN group reported lower median operative time (140 vs. 170 min, p < 0.001). No difference was found in ischemia time, estimated blood loss, and intraoperative complications. Overall, 47 and 54 postoperative complications were observed in r-RAPN and t-RAPN groups, respectively (20.3 vs. 25.1%, p = 0.9). 1 and 2 patients reported major complications (Clavien-Dindo ≥ III grade) in the retroperitoneal and transperitoneal groups (0.4 vs. 0.9%, p = 0.9). There was no difference in hospital re-admission rate, median length of stay, and PSM rate. Trifecta criteria were achieved in 90.3 and 89.2% of r-RAPN and t-RAPN, respectively (p = 0.7). CONCLUSION r-RAPN and t-RAPN offer similar postoperative, functional, and oncological outcomes for patients with postero-lateral renal tumors. Our analysis suggests an advantage for r-RAPN in terms of shorter operative time, whereas it does not confirm a difference in terms of length of stay, as suggested by previous reports.
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Affiliation(s)
- Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA.,Department of Urology, University of Bari, Bari, Italy
| | - Daniel Eun
- Department of Urology, Temple University, Philadelphia, PA, USA
| | | | - Umberto Capitanio
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Jennifer Lee
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Alessandro Larcher
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Devin Patel
- Department of Urology, UCSD, San Diego, CA, USA
| | | | | | | | - Lance J Hampton
- Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA
| | - Francesco Montorsi
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
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Uy M, Cassim R, Kim J, Hoogenes J, Shayegan B, Matsumoto ED. Extraperitoneal versus transperitoneal approach for robot-assisted radical prostatectomy: a contemporary systematic review and meta-analysis. J Robot Surg 2021. [PMID: 33905056 DOI: 10.1007/s11701-021-01245-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/19/2021] [Indexed: 12/29/2022]
Abstract
We aim to evaluate the differences in peri-operative characteristics, surgical complications, and oncological and functional control between the extraperitoneal RARP (EP-RARP) and transperitoneal RARP (TP-RARP). A comprehensive database search was performed up to March 2021 for eligible studies comparing outcomes between EP-RARP versus TP-RARP. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO. A leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias. A total of 16 studies were included with 3897 patients, including 2201 (56.5%) EP-RARPs and 1696 (43.5%) TP-RARPs. When compared to TP-RARP, EP-RARP offers faster operative time (MD - 14.4 min; 95% CI - 26.3, - 2.3), decreased length of post-operative stay (MD - 0.9 days, 95% CI - 1.3, - 0.4), and decreased rates of post-operative ileus (RR 0.2, 95% CI 0.1, 0.7) and inguinal hernia formation (RR 0.2, 95% CI 0.1, 0.5). There were no significant differences in total complications, estimated blood loss, positive surgical margins, or continence at 6 months. In this review, EP-RARP delivered similar oncological and functional outcomes, while also offering faster operative time, decreased length of post-operative stay, and decreased rates of post-operative ileus and inguinal hernia formation when compared to TP-RARP. These findings provide evidence-based data for surgical approach optimization and prompts future research to examine whether these findings hold true with recent advances in single-port RARP and outpatient RARP.
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20
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Song P, Shu M, Peng Z, Yang L, Zhou M, Wang Z, Lu N, Pei C, Dong Q. Transperitoneal versus retroperitoneal approaches of pyeloplasty in management of ureteropelvic junction obstruction: A meta-analysis. Asian J Surg 2021; 45:1-7. [PMID: 33867239 DOI: 10.1016/j.asjsur.2021.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 02/08/2023] Open
Abstract
The aim of this study was to evaluate the benefits and safety of transperitoneal and retroperitoneal pyeloplasty for ureteropelvic junction obstruction by a meta-analysis. We searched the databases including PubMed, Cochrane Library and Embase database from their inception to December 1st, 2020. Relevant literatures comparing retroperitoneal pyeloplasty with transperitoneal pyeloplasty were identified. A meta-analysis was conducted with Revman 5.3. The main outcomes included success rate, operative time, hospital stay, conversion rate of open surgery, overall complications, and detailed postoperative complications/indicators. 15 studies with 1881 patients were included. The results revealed that there were no significant differences between two approaches in success rate [OR = 1.51, 95%CI (0.94, 2.41), p = 0.09], hospital stay [MD = 0.21, 95%CI (-0.12, 0.54), p = 0.21] and overall complications [OR = 1.07, 95%CI (0.76, 1.50), p = 0.69]. The retroperitoneal approach was associated with longer operative time [MD = -26.91, 95%CI (-40.97, -12.84), p < 0.001], higher conversion rate [OR = 0.23, 95%CI (0.11, 0.47), p < 0.001] than the transperitoneal approach. As for the detailed postoperative complications/indicators, there were no significant differences between two approaches in the urinary leak, mild hematuria, fever, UPJO recurrence, infection and subcutaneous emphysema, as well as split renal function, renal pelvis anteroposterior diameter. The funnel plots showed that there were no obvious publication biases in our analysis. Therefore, we concluded that transperitoneal and retroperitoneal approaches had similar benefits and safety in success rate, hospital stay, overall complications and detailed postoperative complications/indicators. However, retroperitoneal was associated with longer operative time and higher conversion rate than transperitoneal approach. With the limitations of our study, additional high-quality studies are still essential for further evaluation.
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Affiliation(s)
- Pan Song
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Mengxuan Shu
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Zhufeng Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Luchen Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Mingzhen Zhou
- The Second Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Zirui Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Ni Lu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Caixia Pei
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Qiang Dong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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21
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Ye K, Zhong Z, Zhu L, Ren J, Xiao M, Liu W, Xiong W. Modified transperitoneal versus retroperitoneal laparoscopic radical nephroureterectomy in the management of upper urinary tract urothelial carcinoma: Best practice in a single center with updated results. J Int Med Res 2021; 48:300060520928788. [PMID: 32538682 PMCID: PMC7297496 DOI: 10.1177/0300060520928788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Radical nephroureterectomy remains the gold standard for the surgical treatment of upper urinary tract urothelial carcinoma (UTUC). Based on previous research, we prospectively compared the advantages of transperitoneal laparoscopic radical nephroureterectomy (TLNU) with a three-port technique in a single position versus retroperitoneal laparoscopic radical nephroureterectomy (RLNU). Methods We evaluated 48 patients diagnosed with UTUC at our institution from January 2015 to October 2019. The patients underwent either TLNU (n = 24) or RLNU (n = 24). We randomly assigned the patients to each technique group based on their body mass index because our experience has shown that the body mass index is the main interfering factor for this surgery. The baseline characteristics and perioperative outcomes were compared between the groups. Results We found no significant differences in the baseline characteristics, time until recovery of intestinal function, or postoperative hospital stay between the two groups. However, the TLNU group had a shorter operation time and better postoperative pain control than the RLNU group. Conclusion Modified TLNU is associated with a shorter operative time and less severe postoperative pain compared with RLNU. Both techniques are safe and reliable with adequate management, and their therapeutic effects are comparable in other aspects.
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Affiliation(s)
- Kun Ye
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Uro-Oncology Institute of Central South University, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhaohui Zhong
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Uro-Oncology Institute of Central South University, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liang Zhu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Uro-Oncology Institute of Central South University, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiannan Ren
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Uro-Oncology Institute of Central South University, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ming Xiao
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Uro-Oncology Institute of Central South University, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wentao Liu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Uro-Oncology Institute of Central South University, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Xiong
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Uro-Oncology Institute of Central South University, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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22
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Bhandarkar KP, Paul A, Mishra P, Taghizadeh A, Garriboli M. Perioperative morbidity of paediatric laparoscopic nephrectomy by transperitoneal and retroperitoneal approaches- any difference? Scand J Urol 2021; 55:257-261. [PMID: 33825673 DOI: 10.1080/21681805.2021.1908419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Minimal invasive approaches for paediatric nephrectomy include transperitoneal (TP) and retroperitoneal (RP); both having advantages and disadvantages. We aimed to ascertain if there was any difference in perioperative morbidities between these two approaches. METHODS We performed a retrospective review of laparoscopic TP and RP nephrectomies performed in our institution over 10 years from May 2009 till May 2019. Outcome measures included intraoperative complications, prolonged requirement of opioid analgesics (more than 24 h), hospital stay, incidence of wound infection and urinary tract infections. Data were analysed using Fisher's exact test and Mann Whitney test. RESULTS A total of 152 nephrectomies were performed in 139 patients; 81 were TP and 71 were RP. Age ranged from 8 months to 16 years. Median hospital stay was 2 days in both groups. There were no intraoperative complications. Outcome measures were sub-categorised as follows. Requirement of opioid analgesia for more than 24 h was documented in 2 patients in each group, leading to longer hospital stay of 3 days. A febrile urinary tract infection requiring antibiotics was detected in 4; 1 in TP and 3 in RP. Wound infection requiring antibiotics occurred in 1 patient (in RP group). No statistically significant difference was found between the two groups in any of the subcategories. CONCLUSION TP and RP nephrectomy have similar perioperative morbidity. The decision to utilise either approach should be dependent on the surgeon's skills and experience and appropriately tailored to individual patient needs.
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Affiliation(s)
| | - Anu Paul
- Paediatric Urology, Evelina London Children's Hospital, London, UK
| | - Pankaj Mishra
- Paediatric Urology, Evelina London Children's Hospital, London, UK
| | - Arash Taghizadeh
- Paediatric Urology, Evelina London Children's Hospital, London, UK
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, UK.,Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London, UK
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23
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Saifee Y, Bhatia S, Chamania CS, Salgia P, Kriplani J, Sepaha A. Introduction of Laparoscopic Donor Nephrectomy: Challenges, Outcomes and Success Strategies. Int J Organ Transplant Med 2021; 12:23-31. [PMID: 34987730 PMCID: PMC8717876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Laparoscopic live donor nephrectomy (LLDN) has become the standard of care and is popular among most of the transplant centers across the globe. Despite proven advantages of LLDN, some transplantation centers hesitate to start the program because of issues concerning donor safety and allograft function. OBJECTIVE To discusses the main barriers for creating a successful LLDN program, strategies that allowed us to start a successful LLDN program along with the study results. METHODS The donors undergoing LLDN from December 2016 to February 2018 were enrolled in the study and prospectively evaluated. LLDN were performed by two senior surgeons alternately with assistance by the laparoscopic urologist in all cases. Also, in the present study, two technical alterations were done in the standard surgical technique of transperitoneal LDN. The first important modification made was the use of two additional ports for use by laparoscopic urologists. The second modification involved dissection on both poles of the kidney before hilar dissection. RESULTS A total of 112 transperitoneal LLDN were performed during the study period. The mean (range) of operation time was 117.5 (81-158) min; the ischemia time was 194 (171-553) sec. Only one patient needed conversion to open surgery. No other major peri-operative or posto-perative complications occurred. All kidney grafts were functioning well. CONCLUSION With proper planning, team approach, and few technical modifications, introduction of LLDN is safe and effective.
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Affiliation(s)
- Y. Saifee
- Correspondence: Dr. Yusuf Saifee, Consultant Urologist, Department of Urology, Choithram Hospital and Research Centre, Manik Bagh Road, Indore, Madhya Pradesh, India-452014.Tel: +91-756-786-6653,E-mail:
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24
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Chen X, Wang Y, Gao L, Song J, Wang JY, Wang DD, Ma JX, Zhang ZQ, Bi LK, Xie DD, Yu DX. Retroperitoneal vs transperitoneal laparoscopic lithotripsy of 20-40 mm renal stones within horseshoe kidneys. World J Clin Cases 2020; 8:4753-4762. [PMID: 33195643 PMCID: PMC7642540 DOI: 10.12998/wjcc.v8.i20.4753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Horseshoe kidney (HK) with renal stones is challenging for urologists. Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports, the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.
AIM To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.
METHODS This was a retrospective study of 12 patients with HK and a limited number (n ≤ 3) of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy (June 2012 to May 2019). The perioperative data of both groups were compared including operation time, estimated blood loss, postoperative fasting time, perioperative complications and stone-free rate (SFR).
RESULTS No significant difference was observed for age, gender, preoperative symptoms, body mass index, preoperative infection, hydronephrosis degree, largest stone diameter, stone number and isthmus thickness. The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29 ± 0.49 and 2.40 ± 0.89 d, respectively (P = 0.019). There was no significant difference in operation time (194.29 ± 102.48 min vs 151.40 ± 39.54 min, P = 0.399), estimated blood loss (48.57 ± 31.85 mL vs 72.00 ± 41.47 mL, P = 0.292) and length of hospital stay (12.14 ± 2.61 d vs 12.40 ± 3.21 d, P = 0.881) between the retroperitoneal and transperitoneal groups. All patients in both groups had a complete SFR and postoperative renal function was within the normal range. The change in estimated glomerular filtration rate (eGFR) from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was -3.86 ± 0.69 and -2.20 ± 2.17 mL/(min·1.73 m2), respectively (P = 0.176). From the preoperative stage to the 3-mo follow-up, the absolute change in eGFR values for patients in the retroperitoneal group and the transperitoneal group was -3.29 ± 1.11 and -2.40 ± 2.07 mL/(min·1.73 m2), respectively (P = 0.581).
CONCLUSION Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.
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Affiliation(s)
- Xin Chen
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Yi Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg 66421, Germany
| | - Jin Song
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Jin-You Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Deng-Dian Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Jia-Xing Ma
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Zhi-Qiang Zhang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang-Kuan Bi
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Dong-Dong Xie
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - De-Xin Yu
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
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25
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Porpiglia F, Mari A, Amparore D, Fiori C, Antonelli A, Artibani W, Bove P, Brunocilla E, Capitanio U, Da Pozzo L, Di Maida F, Gontero P, Longo N, Marra G, Rocco B, Schiavina R, Simeone C, Siracusano S, Tellini R, Terrone C, Villari D, Ficarra V, Carini M, Minervini A. Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project). Surg Endosc 2020; 35:4295-4304. [PMID: 32856156 PMCID: PMC8263535 DOI: 10.1007/s00464-020-07919-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN). MATERIAL AND METHODS All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score. RESULTS 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p < 0.0001. CONCLUSIONS The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.
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Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Andrea Mari
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Walter Artibani
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Pierluigi Bove
- Department of Urology, University Hospital of Tor Vergata, Rome, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Da Pozzo
- Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabrizio Di Maida
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Nicola Longo
- Department of Urology, University Federico II of Naples, Naples, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Bernardo Rocco
- Department of Urology, Fondazione IRCCS Ca' Granda' Ospedale Maggiore Policlinico' Policlinico' University of Milan, Milan, Italy.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Claudio Simeone
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Salvatore Siracusano
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Riccardo Tellini
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Carlo Terrone
- Department of Urology, University of Genova, Genova, Italy
| | - Donata Villari
- Department of Urology, Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Ficarra
- Department of Human and Paediatric Pathology, Gaetano Barresi, Urologic Section, University of Messina, Messina, Italy
| | - Marco Carini
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Andrea Minervini
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy. .,Department of Urology, Careggi Hospital, San Luca Nuovo, University of Florence, Florence, Italy.
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26
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Lee W, Tang J, Li A, Zhu Y, Ling X, Cang J, Jiang S, Fang F. Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy on postoperative hepatic and renal function. Gland Surg 2020; 9:759-766. [PMID: 32775266 DOI: 10.21037/gs-20-533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In this retrospective study, we evaluated the effect of two approaches of robotic-assisted laparoscopic radical prostatectomy (RALP). The first approach was pneumoperitoneum via transperitoneal (TP-RALP), and the second approach was extraperitoneal (EP-RALP) on visceral function. We aimed to provide clinical evidence for the perioperative safety with RALP and to help the surgical team choose an appropriate approach for those with hepatic or renal insufficiency. Methods One hundred and fifty-seven eligible prostate cancer patients from 2015 to 2019 were included in this study. The postoperative related laboratory tests were compared between transperitoneal and extraperitoneal. The primary endpoint was hepatic and renal function. We also evaluate the intraoperative amount of bleeding, the length of postoperative hospital stays, the occurrence of postoperative complications (lymphatic leakage, bleeding, and infection), and the prostate-specific antigen (PSA). Results Postoperative total bilirubin and bound bilirubin in both groups were significantly increased, while total protein, albumin, globulin, urea, and uric acid were significantly decreased (P<0.05). The total protein, albumin, and globulin are significantly higher in the EP-RALP group than in the TP-RALP group (P<0.05) postoperatively. There are no statistical differences in estimated glomerular filtration rate (eGFR) and creatinine clearance (CCR) between these two groups, postoperatively. Conclusions RALP had a significant effect on hepatic function after both TP-RALP and EP-RALP approaches, while the latter showed a lesser extent. Our results suggested that pneumoperitoneal pathways have significant effects on protein consumption. Thus, we should require a more cautious choice of surgical approaches when it comes to patients with impaired hepatic function or under risk of hepatic malfunction.
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Affiliation(s)
- Weishan Lee
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Tang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ailun Li
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiqi Zhu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaomin Ling
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Cang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuai Jiang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fang Fang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Manno S, Dell'Atti L, Cicione A, Spasari A. Safety and efficacy of transperitoneal laparoscopic nephron sparing surgery in patients with previous abdominal surgery. Urologia 2020; 88:14-20. [PMID: 32484072 DOI: 10.1177/0391560320921728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of this study is to assess the safety and feasibility of the transperitoneal laparoscopic approach during nephron sparing surgery in patients with previous abdominal surgery. PATIENTS AND METHODS We retrospectively analyzed patients undergoing transperitoneal laparoscopic partial nephrectomy for renal masses. All patients had received a diagnosis of cT1a renal exophytic mass (⩽5 cm). Patients were divided into two groups, those with and without previous abdominal surgery. Patients with solitary kidney or major previous abdominal surgery were excluded in this study. The operative time, estimated blood loss, length of stay, surgical complications, and positive surgical margins were recorded to compare outcomes among two groups. RESULTS Of the 157 patients who were included in our study, 71 (45.3%) had a history of abdominal surgery (Group 1), while the remaining 86 (54.7%) had not (Group 2). Cholecystectomy was the most common previous surgery performed near the renal fossa. Patients with previous abdominal surgery experienced increased operative time (111.5 vs 83.2 min; p = 0.001). However, no statistically significant difference was found in estimated blood loss (122.1 vs 114.4 mL; p = 0.363), length of stay (4.1 vs 3.8 days; p = 0.465), rate of conversion to open surgery (2.8% vs 2.3%; p = 0.234), and rate of complications (p = 0.121). However, operative time (p = 0.003) and length of stay (p < 0.001) were greater in patients with versus those without previous open cholecystectomy. CONCLUSION Our results suggest that laparoscopic partial nephrectomy after minor previous abdominal surgery is safe and feasible in selected patients affected by renal masses with low nephrometry score. However, previous cholecystectomy results in an increased risk of conversion to open surgery and longer hospital stay in patients undergoing right laparoscopic partial nephrectomy.
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Affiliation(s)
- Stefano Manno
- Urology Unit, Hospital "Pugliese Ciaccio," Catanzaro, Italy
| | - Lucio Dell'Atti
- Institute of Urology, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy
| | - Antonio Cicione
- Institute of Urology, University Hospital "S. Andrea," Roma, Italy
| | - Angelo Spasari
- Urology Unit, Hospital "Pugliese Ciaccio," Catanzaro, Italy
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Ottlakan A, Paszt A, Simonka Z, Abraham S, Borda B, Vas M, Teleky B, Balogh A, Lazar G. Laparoscopic transperitoneal and retroperitoneal adrenalectomy: a 20-year, single-institution experience with an analysis of the learning curve and tumor size [lap transper and retroper adrenalectomy]. Surg Endosc 2020; 34:5421-7. [PMID: 31953726 DOI: 10.1007/s00464-019-07337-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 12/24/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The superiority of laparoscopic transperitoneal (TP) versus retroperitoneal (RP) adrenalectomy is an ongoing debate. METHODS Data from 163 patients (TP: n = 135; RP: n = 28) undergoing minimally invasive adrenalectomy were analyzed. Both operative [intraoperative blood loss, previous abdominal surgery, conversion rate, operative time and tumor size] and perioperative [BMI (body mass index), ASA (American Society of Anesthesiologists) score, time of hospitalization, time of oral intake, histology and postoperative complications] parameters were compared. Both the learning curve (LC) and tumor size were analyzed. RESULTS We found significant differences in the mean operative time (p = 0.019) and rate of previous abdominal surgery (p = 0.038) in favor of TP. Significantly larger tumors were removed with TP (p = 0.018). Conversion rates showed no significant difference (p = 0.257). Also, no significant differences were noted for time of hospitalization, intraoperative blood loss and postoperative complications. In terms of the LC, we saw significant differences in previous abdominal surgery (p = 0.015), conversion rate (p = 0.011) and operative time (p = 0.023) in favor of TP. Large (LT) and extra-large tumors (ELT) were involved in 47 lesions (LT: 40 vs. ELT: 7), with a mean tumor size of 71.85 and 141.57 mm, respectively. Mean intraoperative blood loss was 64.47 ml vs. 71.85 ml, time of hospitalization was 5.10 vs. 4.57 days and mean operative time was 76.52 vs. 79.28 min for LT and ELT, respectively. CONCLUSION A shorter operative time and lower conversion rate in favor of TP were noted during the learning curve. TP proved to be more effective in the removal of large-, extra-large and malignant lesions. The RP approach was feasible for smaller, benign lesions, with a more prolonged learning curve.
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Jiang YL, Qian LJ, Li Z, Wang KE, Zhou XL, Zhou J, Ye CH. Comparison of the retroperitoneal versus Transperitoneal laparoscopic Adrenalectomy perioperative outcomes and safety for Pheochromocytoma: a meta-analysis. BMC Surg 2020; 20:12. [PMID: 31931809 PMCID: PMC6958587 DOI: 10.1186/s12893-020-0676-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 01/06/2020] [Indexed: 01/12/2023] Open
Abstract
Background To compare the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy with those of retroperitoneal laparoscopic adrenalectomy for patients with pheochromocytoma. Methods We searched PubMed, EMBASE and the Cochrane Central Register for studies from 1999 to 2019 to assess the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy and the retroperitoneal approach for laparoscopic adrenalectomy in patients with pheochromocytoma. After data extraction and quality assessments, we used RevMan 5.2 to pool the data. Results Four retrospective studies were obtained in our meta-analysis. Patients who underwent retroperitoneal laparoscopic adrenalectomy were associated with shorter operative time (WMD: 34.91, 95% CI: 27.02 to 42.80, I2 = 15%; p < 0.01), less intraoperative blood loss (WMD: 139.32, 95% CI: 125.38 to 153.26, I2 = 0, p < 0.01), and a shorter hospital stay (WMD: 2, 95% CI: 1.18 to 2.82, I2 = 82%, p < 0.01) than patients who underwent transperitoneal laparoscopic adrenalectomy. No significant differences were found in the complication rate (OR: 1.58, 95% CI: 0.58 to 4.33, I2 = 0; p = 0.38) or in the incidence of hemodynamic crisis (OR: 0.74, 95% CI: 0.19 to 2.94, p = 0.67) between the two groups. Conclusion Retroperitoneal laparoscopic adrenalectomy could achieve better perioperative outcomes than the transperitoneal approach for patients with pheochromocytoma.
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Affiliation(s)
- Yu-Li Jiang
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| | - Lu-Jie Qian
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| | - Zhen Li
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Kang-Er Wang
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Xie-Lai Zhou
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Jin Zhou
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Chun-Hua Ye
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.
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Klap J, Butow Z, Champy CM, Masson-Lecomte A, Defontaines J, De la Taille A, Salomon L. 1,000 Retroperitoneoscopic Procedures of the Upper Urinary Tract: Analysis of Complications. Urol Int 2019; 102:406-412. [PMID: 30840956 DOI: 10.1159/000497038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/16/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate risk factors and complications of retroperitoneoscopic procedures of upper urinary tract and adrenal gland. METHODS From 1994 to 2016, 1,000 retroperitoneal laparoscopies were performed - 476 nephrectomies, 201 adrenalectomies, 103 partial nephrectomies, 91 pyeloplasties, 70 nephro-ureterectomies, and 59 miscellaneous surgeries (diverticulectomy). Data collection was prospective. We analyzed age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, operative time, blood loss, hospitalization stay and complications. Risks factors were explored with univariate and multivariate analysis. RESULTS The mean BMI was 25 and median ASA 2. The mean operative time was 136 mn, mean blood loss 149 mL. There were 49 conversions. Of the patients, 41 required re-interventions, predominantly due to urinary fistula or post-operative bleeding. Post-operatively, 145 complications were recorded. In multivariate analysis, partial nephrectomies (OR 2.12, p = 0.031, 95% CI [1.07-4.22]) and pyeloplasties (OR 1.97, p = 0.02, 95% CI [1.11-3.48]) were significantly more at risk of complication than nephrectomies. An ASA score of 3 was also a significant risk factor of complications (OR 2.3, p = 0.014, 95% CI [1.17-4.47]) and an increased BMI carried a higher risk of conversion. There was no significant difference of conversion or complication rates between the first and last 500 patients. CONCLUSIONS Upper urinary tract and adrenal surgeries can be performed by retroperitoneal laparoscopy. This surgical technic is safe and reproducible. The choice of the technic must be oriented by ASA, BMI and the type of surgery.
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Affiliation(s)
- Julia Klap
- Department of Urology, Hôpital Henri Mondor, Créteil, France,
| | - Zentia Butow
- Department of Urology, Hôpital Henri Mondor, Créteil, France
| | - Cecile M Champy
- Department of Urology, Hôpital Henri Mondor, Créteil, France
| | | | | | | | - Laurent Salomon
- Department of Urology, Hôpital Henri Mondor, Créteil, France
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Dell'Oglio P, De Naeyer G, Xiangjun L, Hamilton Z, Capitanio U, Ripa F, Cianflone F, Muttin F, Schatteman P, D'Hondt F, Ma X, Bindayi A, Zhang X, Derweesh I, Mottrie A, Montorsi F, Larcher A; ERUS Educational Working Group and the YAU working group on robot-assisted surgery. The Impact of Surgical Strategy in Robot-assisted Partial Nephrectomy: Is It Beneficial to Treat Anterior Tumours with Transperitoneal Access and Posterior Tumours with Retroperitoneal Access? Eur Urol Oncol 2021; 4:112-6. [PMID: 31411997 DOI: 10.1016/j.euo.2018.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022]
Abstract
Available comparison of transperitoneal robot-assisted partial nephrectomy (tRAPN) and retroperitoneal robot-assisted partial nephrectomy (rRAPN) does not consider tumour's location. The aim of this study was to compare perioperative morbidity, and functional and pathological outcomes after tRAPN and rRAPN, with the specific hypothesis that tRAPN for anterior tumours and rRAPN for posterior tumours might be a beneficial strategy. A large global collaborative dataset of 1169 cT1-2N0M0 patients was used. Propensity score matching, and logistic and linear regression analyses tested the effect of tRAPN versus rRAPN on perioperative outcomes. No differences were observed between rRAPN and tRAPN with respect to complications, operative time, length of stay, ischaemia time, median 1-yr estimated glomerular filtration rate (eGFR), and positive surgical margins (all p>0.05). Median estimated blood loss and postoperative eGFR were 50 versus100ml (p<0.0001) and 82 versus 78ml/min/1.73 m2 (p=0.04) after rRAPN and tRAPN, respectively. At interaction tests, no advantage was observed after tRAPN for anterior tumours and rRAPN for posterior tumours with respect to complications, warm ischaemia time, postoperative eGFR, and positive surgical margins (all p>0.05). The techniques of rRAPN and tRAPN offer equivalent perioperative morbidity, and functional and pathological outcomes, regardless of tumour's location. PATIENT SUMMARY: Robot-assisted partial nephrectomy can be performed with a transperitoneal or a retroperitoneal approach regardless of the specific position of the tumour, with equivalent outcomes for the patient.
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Novotny R, Chlupac J, Marada T, Borovicka V, Vik V, Voska L, Janousek L, Fronek J. Transabdominal two-cavity approach for radical nephrectomy combined with inferior vena cava thrombectomy for malignant thrombus caused by renal cell carcinoma: a case series. J Med Case Rep 2018; 12:313. [PMID: 30355283 PMCID: PMC6201631 DOI: 10.1186/s13256-018-1845-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advanced renal cell carcinoma in some cases causes malignant intravascular thrombus with the potential for growth into the inferior vena cava or even the right atrium. Renal cell carcinoma is accompanied by malignant intravascular thrombus in up to 10% of cases. We present an overview of three patients diagnosed as having renal cell carcinoma with malignant intravascular thrombus requiring radical nephrectomy combined with inferior vena cava thrombectomy. CASE PRESENTATION Three patients diagnosed as having renal cell carcinoma were indicated for renal cell carcinoma combined with inferior vena cava thrombectomy between 2014 and 2017 at our department: a 69-year-old white Caucasian woman, a 74-year-old white Caucasian woman, and a 58-year-old white Caucasian woman. According to the Novick classification of inferior vena cava tumor thrombus, there was one infrahepatic (level II) and two supradiaphragmatic (level IV) malignant intravascular thrombi. The average age of these patients was 67 years (range 58-74 years). All patients underwent radical nephrectomy combined with inferior vena cava thrombectomy through transabdominal approach. In patients with level IV malignant intravascular thrombus, transesophageal echocardiogram was used to guide the placement of the inferior vena cava cross-clamp above the diaphragm. In one patient the pericardium was opened to place a cross-clamp above a tumor just below the right atrium. There were no postoperative mortalities to date with an average follow-up of 23 months (range 2-48 months). To date, no patient has demonstrated recurrent inferior vena cava malignant intravascular thrombus requiring secondary inferior vena cava thrombectomy or any other treatment. A comparison of estimated blood loss and transfusion rate was not significantly different in all three cases. CONCLUSION Despite the technical complexity of the procedure, caval thrombectomy combined with radical nephrectomy currently represents the only radical treatment for renal cell carcinoma accompanied by malignant intravascular thrombus with good mid-term oncological outcomes.
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Affiliation(s)
- R Novotny
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic
| | - J Chlupac
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - T Marada
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic
| | - V Borovicka
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic
| | - V Vik
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic
| | - L Voska
- Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - L Janousek
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic.,First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Fronek
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Videnska1958/9, 14021, Prague, Czech Republic. .,First Faculty of Medicine, Charles University, Prague, Czech Republic. .,Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Affiliation(s)
- C Nomine-Criqui
- Service de chirurgie digestive, hépatobiliaire, endocrinienne, et cancérologique, Hospital Brabois-Adultes, université de Lorraine, CHU de Nancy, 11, allée du Morvan, 54511 Vandœuvre-les-Nancy, France
| | - S Moog
- Service de chirurgie digestive, hépatobiliaire, endocrinienne, et cancérologique, Hospital Brabois-Adultes, université de Lorraine, CHU de Nancy, 11, allée du Morvan, 54511 Vandœuvre-les-Nancy, France
| | - L Bresler
- Service de chirurgie digestive, hépatobiliaire, endocrinienne, et cancérologique, Hospital Brabois-Adultes, université de Lorraine, CHU de Nancy, 11, allée du Morvan, 54511 Vandœuvre-les-Nancy, France
| | - L Brunaud
- Service de chirurgie digestive, hépatobiliaire, endocrinienne, et cancérologique, Hospital Brabois-Adultes, université de Lorraine, CHU de Nancy, 11, allée du Morvan, 54511 Vandœuvre-les-Nancy, France; Unité Inserm U954 « Nutrition - génétique et exposition aux risques environnementaux », faculté de médecine, université de Lorraine, 54511 Vandœuvre-les-Nancy, France.
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Ng ZQ, Musk G, Rea A, He B. Transition from laparoscopic to retroperitoneoscopic approach for live donor nephrectomy. Surg Endosc 2017; 32:2793-2799. [PMID: 29218666 DOI: 10.1007/s00464-017-5981-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Laparoscopic donor nephrectomy has become the standard of care due to multiple benefits. Currently, there are various techniques employed with two different approaches: transperitoneal (TLDN) or retroperitoneoscopic (RLDN) approach. There is a lack of data to determine which technique is superior, although the RLDN offers an anatomical advantage by avoidance of manipulation of the intraperitoneal organs. The aims of this study were to explore the merits of RLDN to TLDN and assess the learning curve of transition from TLDN to RLDN. METHODS From January 2010 to February 2017, 106 live donor nephrectomies were performed: 56 by TLDN and 50 by RLDN. Data on patient demographics, perioperative parameters, analgesic consumption, pain scores, and kidney graft function were collected and analysed. Data were compared with a Student's t test or Mann-Whitney test. A CUSUM analysis was performed to investigate the learning curve. RESULTS All live donor nephrectomies were successful with no conversion to open surgery. There was no blood transfusion, readmission, or mortality. No postoperative complications were graded over Clavien II. Kidney function was comparable in both groups. The follow-up period ranged from 3 to 78 months. CONCLUSION Retroperitoneoscopic live donor nephrectomy is a safe approach with comparable results to TLDN. RLDN has an anatomical advantage as it avoids manipulating the intraperitoneal organs and retains a virgin abdomen and hence translates to a lower perioperative complication risk.
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Affiliation(s)
- Zi Qin Ng
- WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, WA, Australia. .,WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Gabrielle Musk
- Animal Care Services, University of Western Australia, Perth, WA, Australia
| | - Alethea Rea
- Centre for Applied Statistics, University of Western Australia, Perth, WA, Australia
| | - Bulang He
- WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, WA, Australia. .,School of Surgery, University of Western Australia, Perth, WA, Australia. .,WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
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Abu-Ghanem Y, Dotan Z, Ramon J, Zilberman DE. Retzius space reconstruction following transperitoneal laparoscopic robot-assisted radical prostatectomy: does it have any added value? J Robot Surg 2018; 12:475-9. [PMID: 29181778 DOI: 10.1007/s11701-017-0768-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/19/2017] [Indexed: 12/31/2022]
Abstract
Retzius space sparing (RSS) during laparoscopic robot-assisted radical prostatectomy (RALP) has been offered as an approach that reduces perioperative complications and enables faster gaining of full urinary continence due to bladder anatomy preservation. Retro and transperitoneal techniques have been proposed, whereby RSS has been implemented. We sought to explore whether Retzius space reconstruction (RSR) following transperitoneal RALP will be an advantageous step as well. A prospective registry database of 102 consecutive transperitoneal RALP cases performed by a single surgeon was reviewed. The Retzius space had been opened by dissecting the bladder away from the anterior abdominal wall to the level of both internal rings. In the last 51 cases (RSR group), the peritoneal layer had been sutured back, thus repositioning the bladder back to the anterior abdominal wall and reconstructing the Retzius space. Perioperative factors were analyzed and compared between the two groups. Demographic and perioperative data did not differ between the two groups. RSR group demonstrated shorter length of stay (LOS) compared with the control group (p = 0.01), as well as faster urinary continence recovery (i.e., 0 pads) (p = 0.01). Moreover, lower numbers of Clavien-Dindo class 3 complications and 12 mm port-site hernias (p = 0.03) were seen in the RSR group compared with the control group. RSR following transperitoneal RALP is a simple and efficient step that potentially reduces early and late post-operative complications, shortens LOS and accelerates full urinary continence.
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Kallidonis P, Rai BP, Qazi H, Ganzer R, Do M, Dietel A, Liatsikos E, Ghulam N, Kyriazis I, Stolzenburg JU. Critical appraisal of literature comparing minimally invasive extraperitoneal and transperitoneal radical prostatectomy: A systematic review and meta-analysis. Arab J Urol 2017; 15:267-279. [PMID: 29234528 PMCID: PMC5717458 DOI: 10.1016/j.aju.2017.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/03/2017] [Accepted: 07/22/2017] [Indexed: 11/27/2022] Open
Abstract
Objectives To systematically review studies comparing extraperitoneal (E-RP) and transperitoneal minimally invasive radical prostatectomy (T-RP). Methods The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in September 2015. Several databases were searched including Medline and Scopus. Only studies comparing E-RP and T-RP (either laparoscopic or robot-assisted approach) were evaluated. The follow-up of the included patients had to be ≥6 months. Results In all, 1256 records were identified after the initial database search. Of these 20 studies (2580 patients) met the inclusion criteria. The hospital stay was significantly lower in the E-RP cohort, with a mean difference of −0.30 days (95% confidence interval [CI] −0.35, −0.24) for the laparoscopic group and 1.09 days (95% CI −1.47, −0.70) for the robotic group (P < 0.001). Early continence rates favoured the E-RP group, although this was statistically significant only in the laparoscopic group (odds ratio [OR] 2.52, 95% CI 1.72, 3.70; P < 0.001). There was no statistically significant difference between the E-RP and T-RP cohorts for 12-month continence rates for both the laparoscopic (OR 1.55, 95% CI 0.89, 2.69; P = 0.12) and robotic groups (OR 3.03, 95% CI 0.54, 16.85; P = 0.21). The overall complication and ileus rates were significantly lower in the E-RP cohort for both the laparoscopic and robotic groups. The symptomatic lymphocele rate favoured the T-RP cohort, although this was statistically significant only in the laparoscopic group (OR 8.69, 95% CI 1.60, 47.17; P = 0.01). Conclusion This review suggests that the extraperitoneal approach is associated with a shorter hospital stay, lower overall complication rate, and earlier return to continence when compared to the transperitoneal approach. The transperitoneal approach has a lower lymphocele rate.
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Key Words
- (E-)(T-)RP, (extraperitoneal) (transperitoneal) radical prostatectomy
- BTR, blood transfusion rate
- EBL, estimated blood loss
- Extraperitoneal
- LOS, length of hospital stay
- Laparoscopy
- MD, mean difference
- MIRP, minimally invasive radical prostatectomy
- Minimally invasive
- OR, odds ratio
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PSM, positive surgical margin
- Prostatectomy
- Robotic
- STROBE, Reporting of Observational Studies in Epidemiology
- Transperitoneal
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Affiliation(s)
- Panagiotis Kallidonis
- Department of Urology, University of Leipzig, Leipzig, Germany.,Department of Urology, University of Patras, Patras, Greece
| | | | - Hasan Qazi
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Roman Ganzer
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Minh Do
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Anja Dietel
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Evangelos Liatsikos
- Department of Urology, University of Leipzig, Leipzig, Germany.,Department of Urology, University of Patras, Patras, Greece
| | - Nabi Ghulam
- Department of Urology, Ninewells Hospital, Dundee, UK
| | - Iason Kyriazis
- Department of Urology, University of Leipzig, Leipzig, Germany.,Department of Urology, University of Patras, Patras, Greece
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Gözen AS, Badawy H, Teber D, Assem A, Rassweiler J. Outcome of laparoscopic upper pole heminephroureterectomy in children: A two-centre experience. Arab J Urol 2016; 14:287-291. [PMID: 27900219 PMCID: PMC5122799 DOI: 10.1016/j.aju.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To report our multicentre experience and outcomes with laparoscopic transperitoneal and retroperitoneal upper pole heminephroureterectomy (HNU) in children with renal duplex systems and impaired upper pole. PATIENTS AND METHODS Laparoscopic HNU was performed in 22 children (15 girls, seven boys) with a mean age of 5.9 years. A retroperitoneal approach was used in 17 patients and a transperitoneal approach in the remaining five, between 2005 and 2010. Urinary tract infection was the initial presenting symptom in all children except for one with urinary retention caused by a large ureterocele. Voiding cystourethrography and renal scintigraphy revealed dual collecting systems on the right side in 11 and on the left in 11 cases. The upper pole collecting system was non-functioning in all cases. Postoperative ultrasonography was done at 1 and 3 months, with renal scintigraphy at 3 months, to check the remaining function of the lower moiety. RESULTS Overall, the mean operation time was 152 min (144 min for retroperitoneal and 160 min for transperitoneal). Blood loss was 10-50 mL and there were no intraoperative complications. The mean (SD) hospitalisation and postoperative follow-up were 3.5 (1.25) days and 22 (9.83) months, respectively. Postoperative recovery was uneventful and at the 3-month follow-up renal scintigraphy revealed no parenchymal loss of the remaining renal moiety. CONCLUSION Laparoscopic HNU in children can be performed via transperitoneal or retroperitoneal approach, both with low morbidity and with the typical benefits of laparoscopic surgery.
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Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Haytham Badawy
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Dogu Teber
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Akram Assem
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Jens Rassweiler
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
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Abstract
Background and Objective: The present study retrospectively analyzed the data of 213 patients who underwent laparoscopic ureterolithotomy. Methods: We retrospectively analyzed the data of 213 patients, in whom we performed conventional laparoscopic ureterolithotomy from April 2006 and January 2015 based on the diagnosis of an upper or middle ureteral stone. Patients with large ureteral stones (>15 mm) or a history of failed shock-wave lithotripsy or ureteroscopy were included in the study. Although the retroperitoneal approach was preferred for 170 patients, the transperitoneal approach was used in the remaining 43 patients. Results: The mean patient age was 39.3 ± 12.0 years (range, 18–73). The study population was composed of 78 (26.7%) female and 135 (63.3%) male patients. The mean stone size was 19.7 ± 2.5 mm. The mean operative time was 80.9 ± 10.9 minutes, and the mean blood loss was 63.3 ± 12.7 mL. Intraoperative insertion of a double-J catheter was performed in 76 patients. The overall stone-free rate was 99%. No major complication was observed in any patient. However, conversion to open surgery was necessary in 1 patient. Conclusion: With high success and low complication rates, laparoscopic ureterolithotomy is an effective and reliable method that ensures quick recovery and may be the first treatment option for patients with large, impacted ureteral stones, as well as for those with a history of failed primary treatment.
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Affiliation(s)
- Selçuk Şahin
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Bekir Aras
- Department of Urology, Dumlupinar University, Kutahya, Turkey
| | - Mithat Ekşi
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Nevzat Can Şener
- Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Volkan Tugču
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Kurt O, Buldu I, Turan C, Yazici CM. Does laparoscopic transperitoneal simple nephrectomy for inflammatory and non-inflammatory kidneys differ? Springerplus 2016; 5:1358. [PMID: 27588251 DOI: 10.1186/s40064-016-2945-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022]
Abstract
Background Laparoscopic simple nephrectomy is the standard procedure for the removal of non-functioning benign kidney. It can be performed transperitoneally or retroperitoneally. There are several studies comparing the results of transperitoneally or retroperitoneally laparoscopic nephrectomy but there are limited numbers of study comparing results of laparoscopic transperitoneal simple nephrectomy in non-inflammatory and inflammatory non-functioning kidneys. The aim of this study was to compare the results of laparoscopic transperitoneal simple nephrectomy in non-inflammatory and inflammatory non-functioning kidneys. Results We retrospectively reviewed the records of patients who underwent laparoscopic nephrectomy for various inflammatory and non-inflammatory renal conditions at our institution from May 2012 to October 2015. We divided the patients in two groups. Group 2 involved the kidneys with stone disease and/or hydronephrosis, patients with previous renal surgery and patients with the history of recurrent infections. Group 1 involved the patients who had non-functioning kidney without these properties. All the surgeries were performed by transperitoneal approach and peroperative blood loss, operation time, hospitalization time, postoperative creatinine changes and haemoglobin drop were compared between groups. There were 22 patients with inflammatory and 27 patients with non-inflammatory non-functioning kidney. Operation time, peroperative blood loss, hospitalization time, postoperative haemoglobin drop and creatinine difference were not statistically different between groups. Surgical side and the presence of previous surgery did not affect the surgical results of inflammatory and non-inflammatory kidney nephrectomy. The only difference was postoperative fever which was more frequent after the nephrectomy of inflammatory kidney. Conclusions On the basis of our experience, surgical results of transperitoneal laparoscopic simple nephrectomy did not differ between inflammatory and non-inflammatory kidneys. Surgical times were higher in inflammatory group even if the difference was not significant.
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Sahin S, Resorlu B, Eksi M, Aras B, Atar A, Tugcu V. Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis. Pak J Med Sci 2016; 32:570-4. [PMID: 27375691 PMCID: PMC4928400 DOI: 10.12669/pjms.323.9938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To compare the safety and effectiveness of flexible ureteroscopy (F-URS) with transperitoneal laparoscopic ureterolithotomy (TPLU) in cases of obstructive pyelonephritis secondary to large proximal ureteral stones. Methods: A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU (Group I), and 20 patients were treated with F-URS (Group II). Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group. Results: It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone- free rate (100% vs 80%. p=0.043) and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain (p=0.008), a shorter hospital stay (p<0.001) and a faster return to daily activities (p<0.001). Conclusions: The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities.
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Affiliation(s)
- Selcuk Sahin
- Selcuk Sahin, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Berkan Resorlu
- Berkan Resorlu, Department of Urology, Ondokuz Mayis Univercity, Faculty of Medicine, Samsun, Turkey
| | - Mithat Eksi
- Mithat Eksi, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Bekir Aras
- Bekir Aras, Department of Urology, Dumlupinar Univercity, Faculty of Medicine, Kutahya, Turkey
| | - Arda Atar
- Arda Atar, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Volkan Tugcu
- Volkan Tugcu, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
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Liu W, Wang Y, Zhong Z, Jiang H, Ouyang S, Zhu L, Xu R. Transperitoneal versus retroperitoneal laparoscopic nephroureterectomy in the management of upper urinary tract urothelial carcinoma: a matched-pair comparison based on perioperative outcomes. Surg Endosc 2016; 30:5537-41. [PMID: 27129558 DOI: 10.1007/s00464-016-4922-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Radical nephroureterectomy is considered as the gold standard for the surgical treatment of upper urinary tract urothelial carcinoma (UTUC). Laparoscopic radical nephroureterectomy (LNU) can be performed via the transperitoneal (TLNU) or retroperitoneal (RLNU) approach, and each one has its own advantages and limitations. Our study was conducted to describe the difference between TLNU and RLNU by comparing the perioperative outcomes. METHODS From January 2009 to October 2014, 68 patients underwent TLNU or RLNU at our center were retrospectively collected and 1:1 matched for age, body mass index and tumor side. Baseline characteristics and perioperative outcomes were evaluated and compared, respectively. RESULTS There were no significant differences between the TLNU and RLNU group in terms of baseline characteristics, operating time, estimated blood loss, visual analogue pain scale, cosmetic results, intraoperative and postoperative complication rate. Compared to TLNU approach, RLNU was associated with a quicker time to first oral intake (2.9 vs 2.0 days, p = 0.02) and hospital discharge (6.7 vs 5.6 days, p = 0.02). CONCLUSION Both transperitoneal and retroperitoneal laparoscopic approaches are safe and effective methods for treatment of UTUC. Retroperitoneal approach has the advantage in terms of quicker bowel recovery and shorter hospital discharge.
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Lee YS. Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy as part of staging operation for early ovarian cancer and high grade endometrial cancer. J Gynecol Oncol 2016; 27:e32. [PMID: 27029753 PMCID: PMC4823363 DOI: 10.3802/jgo.2016.27.e32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/24/2016] [Accepted: 01/25/2016] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this paper was to demonstrate the techiniqes of single-port laparoscopic transperitoneal infrarenal paraaortic lymphadenectomy as part of surgical staging procedure in case of early ovarian cancer and high grade endometrial cancer. Methods After left upper traction of rectosigmoid, a peritoneal incision was made caudad to inferior mesenteric artery. Rectosigmoid was mobilized, and then the avascular space of the lateral rectal portion was found by using upward traction of rectosigmoid mesentery. Inframesenteric nodes were removed without injury to the ureter and the left common iliac nodes were easily removed due to the upward traction of the rectosigmoid. The superior hypogastric plexus was found overlying the aorta and sacral promontory, and presacral nodes were removed at subaortic area. Peritoneal traction suture to right abdomen was needed for right para-aortic lymphadenectomy. After right lower para-aortic node dissection, operator was situated between the patient’s legs. After upper traction of the small bowel, left upper para-aortic nodes were removed. To prevent chylous ascites, we used hemolock or Ligasure application (ValleyLab Inc.) to upper part of infrarenal and aortocaval nodes. Results Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy was performed without serious perioperative complications. Conclusion Even though the technique of single-port surgery is still a difficult operation, the quality of single-port laparoscopic transperitoneal infrarenal para-aortic node dissection is excellent, especially mean number of para-aortic nodes. In cases of staging procedures for ovary and endometrial cancer, single-port transperitoneal para-aortic lymphadenectomy is acceptable as an oncologic procedure.
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Affiliation(s)
- Yoon Soon Lee
- Department of Obstetrics and Gynecology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea.
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Wetterlin JJ, Blackwell RH, Capodice S, Kliethermes S, Quek ML, Gupta GN. Robotic-assisted laparoscopic partial nephrectomy: A comparison of approaches to the posterior renal mass. World J Clin Urol 2016; 5:60-65. [DOI: 10.5410/wjcu.v5.i1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/09/2015] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate outcomes of robotic-assisted laparoscopic partial nephrectomy performed for posterior renal tumors via a transperitoneal or retroperitoneal approach.
METHODS: Retrospective review was performed for patients who underwent robotic-assisted laparoscopic partial nephrectomy (RALPN) for a posterior renal tumor between 2009-2015. Patient demographic characteristics, operative factors, pathology, oncologic outcomes, renal function, and tumor complexity were obtained. Radius of the tumor, exophytic/endophytic properties of the tumor, nearness of tumor to the collecting system, anterior/posterior position, location relative to the polar line (RENAL) nephrometry scores were calculated. nephrometry scores were calculated. The operative approach was determined by the primary surgeon.
RESULTS: A total of 91 patients were identified who underwent RALPN for a posterior renal tumor. Fifty-four procedures were performed via the retroperitoneal (RP) approach, and 37 via the transperitoneal (TP) approach. There were no significant differences in patient factors (race, sex, age and body mass index), RENAL nephrometry scores, tumor size, conversion rates, or margin status. Among procedures performed on-clamp, there was no significant difference in warm ischemia times. Total operative time (180.7 min for RP vs 227.8 min for TP, P < 0.001), robotic console time (126.9 min for RP vs 164.3 min for TP, P < 0.001), and median estimated blood loss (32.5 mL for RP vs 150 mL for TP, P < 0.001) were significantly lower via the RP approach. Off-clamp RALPN was performed for 31 (57.4%) of RP procedures vs 9 (24.3%) of TP procedures. Oncologic and renal functional outcomes were equivalent.
CONCLUSION: The RP approach to RALPN for posterior renal tumors is superior with regard to operative time and blood loss and the ability to be performed off-clamp.
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Singh V, Sinha RJ, Gupta DK, Kumar V, Pandey M, Akhtar A. Prospective randomized comparison between transperitoneal laparoscopic pyeloplasty and retroperitoneoscopic pyeloplasty for primary ureteropelvic junction obstruction. JSLS 2016; 18:JSLS-D-13-00366. [PMID: 25392671 PMCID: PMC4208907 DOI: 10.4293/jsls.2014.00366] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: To compare laparoscopic transperitoneal versus retroperitoneoscopic pyeloplasty for primary ureteropelvic junction obstruction in a prospective randomized manner and assess overall results with long-term follow-up. Methods: In this prospective study, from 2008 to 2012, 112 cases of primary ureteropelvic junction obstruction were randomized in a 1:1 ratio into 2 groups. Group I included patients who underwent transperitoneal laparoscopic pyeloplasty, and group II consisted of patients who underwent retroperitoneoscopic laparoscopic pyeloplasty. Demographic and clinical characteristics and postoperative and operative data were collected and analyzed. The statistical analysis was performed with the Fisher exact test, χ2 test, and Mann-Whitney U test for independent groups, and P < .05 was considered statistically significant. Results: The total operative time and intracorporeal suturing time were significantly higher in group II than in group I (P < .001). The visual analog scale score for pain on postoperative day 1 and the requirement for tramadol were significantly higher in group I than in group II (P = .004). The hospital stay and the rate of temporary ileus were significantly greater (P < .036 and P < .02, respectively) in group I than in group II. The success rate of transperitoneal laparoscopic pyeloplasty versus retroperitoneoscopic laparoscopic pyeloplasty was 96.4% versus 96.6% with a mean follow-up period of 30.75 ± 4.85 months versus 30.99 ± 5.59 months (P < .88). Conclusion: Transperitoneal laparoscopic pyeloplasty is associated with significantly greater postoperative pain, a higher tramadol dose, a higher rate of ileus, and a longer hospital stay in comparison with retroperitoneoscopic laparoscopic pyeloplasty. Although the operative time for retroperitoneoscopic laparoscopic pyeloplasty is significantly longer, the success rate remains the same for both procedures.
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Affiliation(s)
- Vishwajeet Singh
- Department of Urology, King George's Medical University, Lucknow, India
| | - Rahul Janak Sinha
- Department of Urology, King George's Medical University, Lucknow, India
| | | | - Vikas Kumar
- Department of Urology, King George's Medical University, Lucknow, India
| | - Mohit Pandey
- Department of Radiodiagnosis, King George's Medical University, Lucknow, India
| | - Asif Akhtar
- Department of Psychiatry, King George's Medical University, Lucknow, India
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Nour HH, Elgobashy SE, Elkholy A, Kamal AM, Roshdy MA, Elbaz AG, Riad E. Laparoscopic management of distal ureteric stones in a bilharzial ureter: Results of a single-centre prospective study. Arab J Urol 2015; 13:182-6. [PMID: 26413344 PMCID: PMC4563007 DOI: 10.1016/j.aju.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/08/2015] [Accepted: 06/15/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine the efficacy and safety of the laparoscopic management of an impacted distal ureteric stone in a bilharzial ureter, as bilharzial ureters are complicated by distal stricture caused by the precipitation of bilharzial ova in the distal ureter. These cases are associated with poorly functioning and grossly hydronephrotic kidneys that hinder the endoscopic manipulation of the coexistent distal high burden of, and long-standing, impacted stones. PATIENTS AND METHODS We used laparoscopic ureterolithotomy, with four trocars, to manage 51 bilharzial patients (33 men and 18 women; mean age 40.13 years) with distal ureteric stones. The ureter was opened directly over the stone and the stone was extracted. A JJ stent was inserted into the ureter, which was then closed with a 4-0 polyglactin running suture. RESULTS The mean stone size was 2.73 cm. Conversion to open surgery was required in only one patient. The mean operative duration was 92 min, the postoperative pain score was 20-60, the mean (range) number of analgesic requests after surgery was 1.72 (1-3), comprising once in 21 patients, twice in 23 and thrice in seven. The mean hospital stay was 2.74 days, and the total duration of follow-up was 7-12 months. The stone recurred in four patients and a ureteric stricture was reported in two. All patients were rendered stone-free. CONCLUSION Laparoscopy is a safe and effective minimally invasive procedure for distal ureteric stones in a bilharzial ureter with hydronephrosis.
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Affiliation(s)
- Hani H. Nour
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
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Iavazzo C, Gkegkes ID. Robotic retroperitoneal lymph node dissection in gynaecological neoplasms: comparison of extraperitoneal and transperitoneal lymphadenectomy. Arch Gynecol Obstet 2015; 293:11-28. [PMID: 26188777 DOI: 10.1007/s00404-015-3814-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The main aim of our study is to review the till now available literature data on the role of robotic retroperitoneal lymph node dissection in gynaecological cancers by comparing the extraperitoneal versus the transperitoneal approach. METHODS A thorough and systematic search was performed in electronic databases of PubMed and Scopus. RESULTS The extraperitoneal approach is described in 148 patients. The age of the patients ranged from 26 to 78 years. The indications included cervical, endometrial and ovarian carcinoma in 113, 22 and 12 patients, respectively. The operative time ranged between 45 and 410 min. The number of dissected lymph nodes ranged from 3 to 25, while only 13 of them were found to be positive. The mean estimated blood loss during the operation was 77 ml (range <50-200 ml). Seven cases were converted to open. The duration of hospital stay ranged from 2 to 14 days. The transperitoneal approach is described in 898 patients. The age of the patients ranged from 15 to 89 years. Cervical, endometrial and ovarian carcinomas were the principal neoplasias present in 248, 449 and 164 patients, respectively. The operative time ranged from 19 to 633 min. The number of dissected lymph nodes ranged from 1 to 54, while the total number of patients with positive lymph nodes dissected was 56 patients. The estimated blood loss during the operation varied between 20 and 1800 ml. Only 9 out of 898 patients were converted to open. The duration of hospital stay ranged from 1 to 40 days. CONCLUSION A reliable definition of the "kind" of lymphadenectomy used in each study is the first step in order to reach safe conclusions. The lack of comparative studies, especially the randomized ones, cannot help us draw any safe conclusion regarding both the clinical outcomes and the possibility of any superiority of these different approaches (extraperitoneal and transperitoneal).
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Affiliation(s)
- Christos Iavazzo
- Gynaecological Oncology Department, Christie Hospital, Manchester, UK. .,, 38, Seizani Str., Nea Ionia, 14231, Athens, Greece.
| | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
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