RESUMEN

[This corrects the article DOI: 10.1016/j.prnil.2016.04.001.].

RESUMEN

PURPOSE: To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. METHODS: Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. RESULTS: We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. CONCLUSION: Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.

Asunto(s)

Adenoma Oxifílico/cirugía , Angiomiolipoma/cirugía , Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Nefrectomía/métodos , Complicaciones Posoperatorias/epidemiología , Adenoma Oxifílico/patología , Anciano , Angiomiolipoma/patología , Pérdida de Sangre Quirúrgica , Carcinoma de Células Renales/patología , Conversión a Cirugía Abierta , Bases de Datos Factuales , Femenino , Laparoscópía Mano-Asistida/métodos , Humanos , Estimación de Kaplan-Meier , Neoplasias Renales/patología , Laparoscopía/métodos , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Márgenes de Escisión , México , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Análisis Multivariante , Estadificación de Neoplasias , Tempo Operativo , Modelos de Riesgos Proporcionales , Procedimientos Quirúrgicos Robotizados/métodos , América del Sur , España , Carga Tumoral , Isquemia Tibia

RESUMEN

Pelvic exenteration is used in the treatment of several pelvic cancers, including those of the rectum, uterus, and bladder. We report the first case of robotic pelvic exenteration for the treatment of symptomatic prostate cancer involving the rectum and bladder. A six-port transperitoneal robotic approach was used. Bilateral extended lymphadenectomy up to the inferior mesenteric artery was performed. The rectum and bladder were removed en bloc, and a double-barrel anastomosis was then performed with both ureters being connected to the lower opening of the colostomy. Operative time was 249 minutes, and estimated blood loss was 600 mL. No intraoperative or postoperative complications were recorded. Biopsy of the rectum and bladder showed prostatic adenocarcinoma with a Gleason score of 9 (5+4), and 1 of 17 nodes was positive for cancer. Postoperative prostate-specific antigen level was 1.24 ng/mL. The patient is already 19 months after surgery with optimal quality of life. Thus pelvic exenteration is a feasible alternative for highly symptomatic prostate cancer involving adjacent pelvic organs.

Asunto(s)

Adenocarcinoma/cirugía , Escisión del Ganglio Linfático , Exenteración Pélvica/métodos , Neoplasias de la Próstata/cirugía , Neoplasias del Recto/cirugía , Procedimientos Quirúrgicos Robotizados , Neoplasias de la Vejiga Urinaria/cirugía , Adenocarcinoma/secundario , Anciano , Humanos , Metástasis Linfática , Masculino , Tempo Operativo , Exenteración Pélvica/efectos adversos , Pelvis , Neoplasias de la Próstata/patología , Neoplasias del Recto/secundario , Neoplasias de la Vejiga Urinaria/secundario

RESUMEN

For six decades, it has been a part of the conventional medical wisdom that higher levels of testosterone increase the risk of prostate cancer. This belief is mostly derived from the well-documented regression of prostate cancer after surgical or pharmacological castration. However, there is an absence of scientific data supporting the concept that higher testosterone levels are associated with an increased risk of prostate cancer. Moreover, men with hypogonadism have substantial rates of prostate cancer in prostatic biopsies, suggesting that low testosterone has no protective effect against the development of prostate cancer. Moreover, prostate cancer rate is higher in elderly patients when hormonal levels are low. These results argue against an increased risk of prostate cancer with testosterone replacement therapy.

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Por casi seis décadas ha sido parte de la cultura médica en general, que los niveles altos de testosterona incrementan el riesgo de padecer o agravar un cáncer de próstata. Esta creencia se ha derivado fundamentalmente de la bien documentada regresión del cáncer de próstata luego de la castración médica o quirúrgica. Sin embargo, no existe evidencia científica que apoye la idea de que niveles altos de testosterona están asociados con un incremento del riesgo de cáncer de próstata. Más aún, los hombres con hipogonadismo tienen una tasa substancialmente alta de cáncer de próstata detectado por biopsia, lo que sugiere que los niveles bajos de testosterona no tienen un efecto protector en el desarrollo de cáncer de próstata y, además, la tasa de cáncer de próstata es más alta en los pacientes de edades avanzadas cuando sus niveles hormonales son más bajos. Estos argumentos tienden a demostrar que no existiría un incremento del riesgo de padecer un cáncer de próstata asociado a la terapia de reemplazo con testosterona.

Asunto(s)

Terapia de Reemplazo de Hormonas/métodos , Neoplasias de la Próstata/cirugía , Testosterona/administración & dosificación , Anciano , Terapia de Reemplazo de Hormonas/efectos adversos , Humanos , Hipogonadismo/tratamiento farmacológico , Masculino , Orquiectomía/métodos , Neoplasias de la Próstata/epidemiología , Factores de Riesgo , Testosterona/efectos adversos

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OBJECTIVE: The basaloid carcinoma of the prostate (BC) is a rare malignant neoplasm arising from the basal cells of prostatic ducts and acini. We report a case and review the literature. METHODS: A 76-year-old man presented with symptoms of lower obstructive uropathy, the IPSS score was 29 and prostate specific antigen (PSA)of 0,924 ng /ml. Transurethral resection of prostate (TURP) was performed in September 2008, histopathological diagnosis was BC. In February 2009 laparoscopic radical prostatectomy was performed. RESULTS: Histopathological examination revealed a BC with adenoid cystic growth pattern, perineural infiltration and focal involvement of the left seminal vesicle. Immunohistochemically, the cells were negative for PSA, stained and were strongly positive for specific monoclonal antibodies anti-cytokeratin 34ßE12, p63 and BCL-2. The patient has 23 months of follow-up, with complete continence and no evidence of tumor recurrence. CONCLUSIONS: The BC is an extremely rare subtype of malignant tumors of the prostate, where immunohistochemistry plays a fundamental role in diagnosis.

Asunto(s)

Carcinoma Basocelular/patología , Neoplasias de la Próstata/patología , Anciano , Biomarcadores de Tumor/sangre , Carcinoma Adenoide Quístico/patología , Carcinoma Adenoide Quístico/cirugía , Carcinoma Basocelular/cirugía , Humanos , Laparoscopía , Masculino , Prostatectomía , Neoplasias de la Próstata/cirugía , Resección Transuretral de la Próstata

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OBJECTIVES: Vesicovaginal fistulas are uncommon and remain a surgical challenge. Abdominal hysterectomy remains their main cause. We present our experience in laparoscopic repair of vesicovaginal fistula. METHODS: Between January 2006 and January 2008, 8 laparoscopic transvesical procedures for VVF repair were performed at our institution (O'Connor technique). For each case we analyzed demographic and surgical variables as well as the outcome. Surgical technique is also described. RESULTS: Average patient age was 45 years. All patients had past history of hysterectomy and subsequent history of urine leak through vagina, with a mean evolution time of 22 months. The average operative time was 150 minutes and the mean hospital stay 4.7 days. All patients evolved without complications except one who had urinary tract infection (Pseudomonas aeruginosa) that was treated with antibiotics. After a mean follow up of 32 months, there were no recurrences. CONCLUSION: In experienced hands, transvesical transabdominal laparoscopic vesicovaginal fistula repair is a feasible and safe procedure, preserving all the advantages of minimally invasive surgery.

Asunto(s)

Procedimientos Quirúrgicos Ginecológicos/métodos , Laparoscopía/métodos , Fístula Vesicovaginal/cirugía , Adulto , Femenino , Humanos , Histerectomía , Persona de Mediana Edad , Suturas , Resultado del Tratamiento , Cateterismo Urinario

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OBJECTIVE: To report a case of ureteral inverted papilloma (IP) with laparoscopic resolution. METHODS: We report the case of a 30-year-old male patient who consulted for asymptomatic hematuria with the radiological finding of a filling defect at the distal right ureter. Ureteroscopy biopsy was not diagnostic, so laparoscopic ureterectomy with a Boari flap technique was performed. The pathology report showed a ureteral inverted papilloma. CONCLUSION: Laparoscopic ureteral replacement by Boari flap is a safe surgical alternative for defects in the distal ureter with the advantages of a minimally invasive procedure.

Asunto(s)

Papiloma Invertido/cirugía , Colgajos Quirúrgicos , Uréter/cirugía , Neoplasias Ureterales/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Adulto , Humanos , Laparoscopía , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Papiloma Invertido/patología , Procedimientos de Cirugía Plástica , Neoplasias Ureterales/patología , Obstrucción Ureteral/cirugía , Ureteroscopía , Urografía

RESUMEN

OBJECTIVE: Present the case of a patient with a discontinuous intrabdominal splenogonadal fusion with an associated germ cell tumor. METHODS: A case of a man of 29 years with bilateral cryptorchidism and left intra-abdominal discontinuous splenogonadal fusion associated with seminoma as an accidental finding in the context of a robotic pyeloplasty due to ipsilateral ureteropelvic junction stenosis. RESULTS: The total operative time was 80 minutes (atrophic gonad removal and pyeloplasty by the Anderson-Hynes technique) with an estimated blood loss less than 100 cc. The hospitalization time was less than 36 hrs. The pathology and immunohistochemical report was compatible with intratubular germ cell neoplasia (seminoma). CONCLUSION: The splenogonadal fusion is an uncommon pathology. While a high clinical suspicion may avoid unnecessary orchiectomy in young patients, its association with disorders such as cryptorchidism should make us suspect the possible presence of a concomitant germ cell neoplasia.

Asunto(s)

Criptorquidismo/complicaciones , Neoplasias de Células Germinales y Embrionarias/complicaciones , Neoplasias de Células Germinales y Embrionarias/cirugía , Robótica , Bazo/anomalías , Enfermedades del Bazo/cirugía , Enfermedades Testiculares/cirugía , Testículo/anomalías , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Niño , Humanos , Masculino , Orquiectomía , Bazo/patología , Enfermedades del Bazo/patología , Enfermedades Testiculares/patología , Testículo/patología , Procedimientos Quirúrgicos Urológicos Masculinos/instrumentación

RESUMEN

OBJECTIVE: To describe a case of renal angiomyolipoma treated by robotic assisted surgery. METHOD AND RESULTS: We report the case of a 26 year old females patient, in the context of third month pregnancy, who was diagnosed of spontaneous self-limited retroperitoneal hemorrhage due to renal angiomyolipoma. The patient was treated conservatively until normal delivery. At the 3rd month postpartum a robot-assisted (Da Vinci S) nephron sparing surgery (partial nephrectomy) was performed. CONCLUSION: Despite being a benign tumor, there are cases in which the renal angiomyolipoma requires surgical treatment. To our knowledge, after a thorough review of the literature, this would be the first reported case of angiomyolipoma treated with conservative surgery with robotic assistance (Da Vinci S-HD).

Asunto(s)

Angiomiolipoma/cirugía , Neoplasias Renales/cirugía , Nefrectomía/métodos , Robótica/métodos , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Embarazo , Complicaciones Neoplásicas del Embarazo/cirugía

RESUMEN

OBJECTIVE: To report an unusual case of renal tumor and review the literature. METHODS: We present a 20 years old female with a history of acute right pyelonephritis. The ultrasound study revealed a tumor-like image in the lower pole of the right kidney . The CT-scan showed a mixed solid and cystic mass of 7 cm. in the lower pole of the right kidney. RESULTS: A right laparoscopic partial nephrectomy was performed. The total operative time was 90 minutes, with 24 minutes of warm ischemia. The estimated blood loss was 50 ml. and the length of stay (LOS) 36 hours. The pathology findings confirm a mixed epithelial and stromal tumor (MEST) of the kidney. CONCLUSION: Mixed epithelial and stromal tumor (MEST) of the kidney is a benign and rare condition that doesn't show a clear difference with other renal tumors in image studies. Nephron-sparing surgery with margin study is the standard treatment when is feasible.

Asunto(s)

Carcinoma/patología , Neoplasias Renales/patología , Neoplasias Complejas y Mixtas/patología , Células del Estroma/patología , Carcinoma/cirugía , Femenino , Humanos , Neoplasias Renales/cirugía , Neoplasias Complejas y Mixtas/cirugía , Nefrectomía , Pielonefritis/diagnóstico por imagen , Pielonefritis/etiología , Pielonefritis/patología , Tomografía Computarizada por Rayos X , Ultrasonografía , Adulto Joven

RESUMEN

OBJECTIVE: Bladder hemangioma is a benign rare lesion. There are no pathognomonic clinical signs and management is controversial due to the bleeding risk. We report a bladder cavernous hemangioma resolved using bipolar transurethral resection. METHODS: We review the case of a female patient who presented with asymptomatic hematuria. On cystoscopy we discovered a reddish sessile lesion compatible with bladder hemangioma. We describe the diagnostic work up, surgical management and review other therapeutic alternatives for these lesions. RESULTS: Fifty five year old healthy female patient consulting for total painless hematuria. Cystoscopic evaluation revealed a 1 cm diameter sessile reddish elevated lesion near the bladder neck. We performed a transurethral endoscopic resection using the Gyrus Bipolar resectoscope®. Pathologic report concluded cavernous angioma. CONCLUSION: Bladder hemangiomas are benign and rare lesions. Clinical presentation has no pathognomonic signs although gross painless hematuria is the most frequent complain. Management is controversial due to the bleeding risk of this highly vascularized lesion. However, it appears that small lesions could be treated using transurethral resection. Although they have a benign course, follow up is mandatory to detect recurrence or residual disease.

Asunto(s)

Cistoscopía , Hemangioma/cirugía , Neoplasias de la Vejiga Urinaria/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Femenino , Hemangioma/patología , Humanos , Persona de Mediana Edad , Uretra/cirugía , Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/patología , Procedimientos Quirúrgicos Urológicos/instrumentación

RESUMEN

OBJECTIVE: Transurethral resection (TUR) is highly effective in the local control of superficial bladder cancer. However, the recurrence rate can reach 80% of the cases. Adjuvant intravesical chemotherapy may decrease significantly tumor recurrence. We describe a bladder adverse reaction to mitomycin C as adjuvant therapy for non-invasive bladder cancer METHODS: Three patients with diagnosis of pTa G1 urothelial carcinoma were treated by TUR plus an instillation of 40 mg. of mitomicin C. A month later, the patients were attended for dysuria and hematuria. Cystoscopy and bladder biopsy were performed in all cases. RESULTS: Multiple sessile lesions suspicious of tumor recurrence were found on cystoscopy. The histopathological diagnosis disclosed the existence of severe atypia of the urothelium and stromal changes similar to those observed after radiotherapy CONCLUSIONS: Adjuvant intravesical chemotherapy with mitomycin C may cause local reactions with macroscopic patterns similar to tumoral recurrences.

Asunto(s)

Antineoplásicos/efectos adversos , Carcinoma de Células Transicionales/tratamiento farmacológico , Mitomicina/efectos adversos , Recurrencia Local de Neoplasia/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Vejiga Urinaria/efectos de los fármacos , Administración Intravesical , Anciano , Antineoplásicos/administración & dosificación , Antineoplásicos/farmacología , Antineoplásicos/uso terapéutico , Carcinoma de Células Transicionales/diagnóstico , Carcinoma de Células Transicionales/patología , Carcinoma de Células Transicionales/cirugía , Quimioterapia Adyuvante , Terapia Combinada , Cistoscopía , Diagnóstico Diferencial , Disuria/inducido químicamente , Disuria/patología , Hematuria/inducido químicamente , Hematuria/patología , Humanos , Masculino , Persona de Mediana Edad , Mitomicina/administración & dosificación , Mitomicina/farmacología , Mitomicina/uso terapéutico , Recurrencia Local de Neoplasia/diagnóstico , Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugía

RESUMEN

OBJECTIVES: To report our experience in a series of bilateral synchronous laparoscopic adrenalectomies detailing technique and results. METHODS: A total of 242 laparoscopic adrenalectomies were performed in an 8 year period at our institution. Twenty four out of these were bilateral. Of the 24 patients, 22 (92%) were bilateral and synchronous. Mean patient age was 41.4 years (range 17 to 72 years) and male to female ratio was 1:2.1. RESULTS: Mean adrenal size was 5.5 cm (range 2 to 11 cm). In order of frequency, pathological finding was: pheochromocytoma, cushing`s disease, metastatic lesions, hyperaldosteronism, congenital adrenal hyperplasia, myelolipoma and adrenal adenoma. Complete adrenalectomy was performed in 36 cases (82%) while in 8 cases (18%) partial adrenalectomy was preferred. Mean operative time was 78.6 minutes (range 25 to 210 min) being 79.5 min and 77 min for right and left adrenalectomies respectively. Mean operative bleeding was 63 ml (range 0 to 500 ml). Only one patient received blood transfusion. Intraoperative complications occurred in only one patient (2%), a small tear in the renal vein that was successfully controlled by intracorporeal suturing. Mean hospital stay was 3.2 days (range 2 to 5 days). CONCLUSION: We believe that laparoscopic synchronous bilateral adrenalectomy is a feasible, safe and reproducible technique that should be considered of choice for the management of benign bilateral adrenal pathology.

Asunto(s)

Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía/métodos , Laparoscopía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto Joven

RESUMEN

OBJECTIVE: Congenital adrenal hyperplasia (CAH) is an uncommon syndrome which represents a therapeutic challenge. We analyzed the role of bilateral simultaneous laparoscopic adrenalectomy in the management of CAH. MATERIAL AND METHODS: : Between October 2004 and September 2006, three female patients underwent bilateral simultaneous laparoscopic adrenalectomy for CAH. Data were retrospectively collected. Variables analyzed were persistence of CAH clinical signs, variations in 17 OH progesterone level and corticoid medication, operative time, median blood loss, postoperative pain, hospital stay, and body image perception after surgery. RESULTS: Median age was 16.3 years. Complete regression of virilization signs, acne and hyperpigmentation was achieved in one case. The other two cases showed partial regression of signs. Levels of 17 OH progesterone reached normal parameters in all cases. Steroids doses were lowered and given only for replacement purposes. Mean operative time was 125, 65 and 60min for whole, right and left procedure, respectively. Median blood loss remained under 50ml in all cases and there were no complications. Median postoperative pain level was 5 according to visual analog pain scale. Median hospital stay was 4 days. CONCLUSION: Bilateral simultaneous laparoscopic adrenalectomy shows all the advantages of minimally invasive surgery, and appears a viable alternative to medical management, which is not exempt from complications.

Asunto(s)

Hiperplasia Suprarrenal Congénita/cirugía , Adrenalectomía/métodos , Laparoscopía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Adolescente , Femenino , Humanos , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

Retroperitoneal Laparoscopic Lymph node Dissection (RPLND) seems to offer similar staging accuracy and long term outcomes to Open RPLND. It is also a reasonable option in terms of morbidity. However, solid laparoscopic skills are necessary to safely perform this surgery. In the following article, we assess indications, access, surgical technique, complications and controversies of the laparoscopic RPLND.

Asunto(s)

Laparoscopía , Escisión del Ganglio Linfático/métodos , Neoplasias Testiculares/cirugía , Humanos , Laparoscopía/métodos , Masculino , Espacio Retroperitoneal

RESUMEN

OBJECTIVES: Crossed fused renal ectopia is a rare congenital anomaly. We report the case of a 3 year old boy with diagnosis of right crossed fused renal ectopia, history of recurrent urinary tract infection and previous failure of surgical treatment. METHODS: Three year old boy with diagnosis of right crossed fused renal ectopia of the inferior moiety underwent a laparoscopic heminephrectomy of the inferior renal unit, due to severe hydronephrosis and recurrent urinary tract infections. RESULTS: A laparoscopic right heminephrectomy of the inferior renal moiety was performed uneventfully. Operation room time was 200 minutes and there were no perioperative complications. Patient was discharged 18 hours after the procedure. After 5 years of follow up patient remains asymptomatic with good renal function. CONCLUSIONS: The laparoscopic approach is an acceptable option to treat this anomaly, with all the advantages of minimally invasive surgery.

Asunto(s)

Riñón/anomalías , Riñón/cirugía , Laparoscopía , Nefrectomía/métodos , Preescolar , Humanos , Masculino

RESUMEN

SUMMARY OBJECTIVES: The experience of a renowned Latin American laparoscopic center is reported and the differences with the open technique are thoroughly discussed. METHODS: During a 7 year period a total of 85 laparoscopic cystectomies were performed; in 92%of the cases urinary diversion was performed extracorporeally. This accounted for: 14 anterior exanterations, 50 radical cystoprostatectomies, 7 radical cystectomies and 14 simple cystectomies. Male to female ratio was 3:1. Mean patient age was 63 years (range 29 to 83). Mean Body Mass Index (BMI) was 28 kg/m2(range 20 to 47). Operative data and long term results are analyzed. RESULTS: All 85 procedures were completed laparoscopically without need for conversion to open surgery. Orthotopic neobladder, Santiago pouch, Studer, Fontana and Le Bag were performed in 42, 13, 16, 12 and 1 case respectively. Ileal conduit, Indiana pouch and Mainz II were employed in 24, 10 and 9 cases respectively. All Mainz II were performed intracorporeally. Mean operative time and blood loss were 279 minutes (range 180 to 375) and 436 ml (range 50 to 1.500) respectively. A total of 8 patients (11%) presented perioperative complications: 5 vascular lesions, 2 eviscerations and 2 septicemias. Delayed complications were observed in 7 cases (9%); 3 urinary sepsis, 1 ureteral stenosis, 2 spontaneous ruptures and 1 mesenteric ischemia. Mean hospital stay was 8.8 days (range de 4 to 28). There was no operative mortality. Mean follow-up was 18 months (range 2 to 68 months). Ten patients (13%) presented disease progression and death. CONCLUSIONS: Laparoscopic radical cystectomy is associated with diminished operative bleeding, time to oral intake and hospital stay. Though this is a reproducible technique it demands a very long learning curve.

Asunto(s)

Cistectomía/métodos , Laparoscopía , Neoplasias de la Vejiga Urinaria/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

OBJECTIVES: We present our initial experience with transumbilical surgery in a simple nephrectomy performed with a flexible cystoscope and standard laparoscopic instruments. METHODS: A 15 year-old child, with severe left renal parenchyma atrophy, secondary to recurrent urinary tract infection (UTI) complicated with left pyelonephritis. Decision for simple nephrectomy was taken and we planned to perform a single port laparoscopic nephrectomy. In the lumbotomy position, two 5mm ports were insertend through a 3 cm umbilical incision. One trocar permitted the progression of the flexible cystoscope (Olympus) and the other the entrance of the PKS Plasma Trissector. The latter was then changed for a 10mm port to allow the entrance of the Weck clips. A Maryland grasper for countertraction was placed without port in the lef-upper quadrant and progressed directly into de peritoneal cavity under direct vision. RESULTS: The standard laparoscopic steps were duplicated uneventfully. Mean operative time was 90 minutes and mean blood loss was 200 mL. Hospital stay was 18 hours. No transfusion was needed. CONCLUSION: Single port urologic surgery will expand in the future. There is lack of commercial availability of the ideal hardware needed for the procedures. Versatility of urologic instruments allow for its use in different settings.

Asunto(s)

Cistoscopios , Enfermedades Renales/cirugía , Riñón/cirugía , Laparoscopios , Laparoscopía/métodos , Nefrectomía/métodos , Adolescente , Atrofia , Humanos , Riñón/patología , Enfermedades Renales/complicaciones , Masculino , Pielonefritis/complicaciones , Ombligo , Infecciones Urinarias/complicaciones

RESUMEN

INTRODUCTION: Natural orifice transluminal endoscopic surgery (NOTES) is an emerging technique, which allows to performed surgical procedures avoiding any surgical scars. However there are some problems due to the lack of equipment available for these procedures. The aim of these study is to present our initial experience with the transvaginal nephrectomy NOTES using standard laparoscopic instruments. MATERIAL AND METHODS: Two female patients 23 and 29 years old, both of them with diagnosis of recurrent urinary tract infection and renal atrophy. A transvaginal simple nephrectomy was performed using a transvaginal Access for the camera port and two abdominal work ports of 10 and 3 mm. RESULTS: Total operation room time was 120 min in the first case and 40 min. in the second with an average blood loss of 200 cc. There were no perioperative complications, and both patients was discharged 36 hours after the surgery CONCLUSION: Laparoscopic nephrectomy with transvaginal NOTES assistance is technically feasible with the use of standard laparoscopic instruments. Special Access trocars and instruments development for this procedure will allow to perform a pure technique without the use of abdominal incisions.

Asunto(s)

Laparoscopios , Laparoscopía/métodos , Nefrectomía/métodos , Adulto , Diseño de Equipo , Femenino , Humanos , Vagina , Adulto Joven