RESUMEN
OBJECTIVE: To evaluate the results of the first 100 hand-assisted donor nephrectomies in our hospital. DESIGN: Prospective, descriptive. METHOD: In the period January 2000-July 2004, 100 consecutive donors underwent laparoscopic nephrectomy as part of a living-related kidney transplantation at the Academic Medical Center in Amsterdam, the Netherlands. The operation was performed laparoscopically using a hand port (hand-assisted nephrectomy). The incision made for the hand port was also used for the removal of the kidney. RESULTS: Mean operating time was 168 min (range: 88-285). Median warm ischaemia time was 3 min (1.0-4.5) and median blood loss was 50 ml (20-1500). None of the operations required conversion to an open procedure and there were no deaths among donors or recipients. Postoperatively, 12 complications occurred in 10 donors. Median hospital stay for the donors was 5 days. In 3 recipients, the transplanted kidney had to be removed within 14 days. 1n 3 other recipients, surgical re-intervention was necessary due to urological complications. One-year graft survival was 94%. CONCLUSION: Hand-assisted laparoscopic donor nephrectomy was a safe and minimally invasive procedure for renal transplantation in this patient series.
Asunto(s)
Trasplante de Riñón , Donadores Vivos , Nefrectomía/métodos , Adulto , Anciano , Pérdida de Sangre Quirúrgica , Femenino , Supervivencia de Injerto , Humanos , Isquemia/epidemiología , Isquemia/etiología , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Países Bajos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of the study was to evaluate feasibility and safety of restorative proctectomy with ileal pouch anal anastomosis (IPAA) through a Pfannenstiel incision after prior laparoscopic colectomy. METHODS: Seventeen patients who underwent restorative proctectomy after laparoscopic emergency colectomy for ulcerative colitis (UC) were prospectively evaluated. Results were compared with results of a group of 21 case matched patients that had restorative proctectomy and IPAA via a midline incision in the same period. RESULTS: Median operation time was longer, although not significantly, in patients who had a restorative proctectomy through a pfannenstiel (186 min) compared to a restorative proctectomy through a midline incision (158 min). Procedure related complications were comparable between the groups, respectively, 1 of 17 patients in the pfannenstiel group and 3 of 21 patients in the median laparotomy group. Median hospital stay in the pfannenstiel group was 10 days and in the midline group 12 days. CONCLUSIONS: After laparoscopic assisted emergency colectomy for ulcerative colitis, restorative proctectomy is feasible and can be performed safely through a Pfannenstiel incision.
Asunto(s)
Colitis Ulcerosa/cirugía , Proctocolectomía Restauradora/métodos , Adulto , Colectomía/métodos , Urgencias Médicas , Estudios de Factibilidad , Femenino , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reoperación , Resultado del TratamientoRESUMEN
BACKGROUND: Hand-assisted laparoscopic donor nephrectomy (HLDN) may have advantages over laparoscopic donor nephrectomy, such as shorter learning curve, operation and warm ischaemia times. The aim of this study was to evaluate the feasibility and safety of HLDN. METHODS: Between January 2000 and October 2002, 50 consecutive HLDN procedures were performed through a low transverse abdominal incision, 23 right sided and 27 left sided. RESULTS: The median age of the donors was 44 years. No HLDN required conversion to an open procedure. The median operating time for HLDN was 153 min. The median warm ischaemia time was 3 (range 1.0-4.5) min and the median blood loss was 50 (range 20-500) ml in both left- and right-sided procedures. Eight patients suffered ten minor complications during their admission. The duration of hospital stay was 5 days for donors. Three recipients developed graft failure owing to acute rejection, renal vein thrombosis and ischaemic necrosis. CONCLUSION: Both left- and right-sided HLDN procedures were feasible and safe through a low transverse abdominal incision.
Asunto(s)
Trasplante de Riñón/métodos , Laparoscopía/métodos , Nefrectomía/mortalidad , Adulto , Anciano , Pérdida de Sangre Quirúrgica , Estudios de Factibilidad , Rechazo de Injerto/etiología , Supervivencia de Injerto , Humanos , Isquemia/etiología , Donadores Vivos , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios ProspectivosRESUMEN
BACKGROUND: Robot-assisted surgery is thought to facilitate complex laparoscopic movements, enhancing advanced laparoscopic procedures. OBJECTIVE: To evaluate the benefit of robotic assistance for laparoscopic vascular surgery. DESIGN: Experimental study using prosthetic conduits in a laparoscopic training box. METHODS: Two surgeons each performed 40 laparoscopic vascular anastomoses alternating with and without robotic assistance. A Zeus-Aesop surgical Robotic system trade mark with 3-D visualisation was used. Each surgeon made 40 anastomoses in total, using different prostheses (5 mm PTFE and 16 mm Dacron) and suture material (Prolene and PTFE). A time-action analysis was performed to evaluate surgical performance. Primary efficacy parameters were quality and leakage of the anastomosis, total time and total number of actions. RESULTS: Equal quality scores and anastomotic leakage were achieved with both techniques. Robotic assistance resulted in significant longer suture and knot tying time and significant more actions were needed compared to the manual laparoscopic procedures. Significant more failures occurred during the robot-assisted procedures. CONCLUSION: In this study, robotic (Zeus-Aesop) assistance did not improve the laparoscopic performance of the surgeon whilst making vascular anastomoses.
Asunto(s)
Implantación de Prótesis Vascular/métodos , Laparoscopía/métodos , Robótica , Anastomosis Quirúrgica , HumanosRESUMEN
BACKGROUND: In our department, we routinely use a combined exocrine-endocrine function test to evaluate the pancreatic function in chronic pancreatitis i.e. urinary para amino benzoic acid (PABA) recovery and pancreatic polypeptide secretion in response to a meal and glucose tolerance test. AIM: To study the relationship between changes in morphology and exocrine/endocrine function in patients with chronic pancreatitis. PATIENTS AND METHODS: In 103 patients with chronic pancreatitis seen by our department for evaluation of pancreatic function between 1989 and 1999, we retrospectively analysed the correlation between morphology (Cambridge-score) and function. Furthermore the differences in presentation, function and morphology between patients with alcohol-induced chronic pancreatitis and idiopathic chronic pancreatitis were evaluated. RESULTS: Significant correlation were found for both PABA recovery and pancreatic polypeptide secretion with morphologic score, respectively r = -0.205 (P = 0.037) and r = -0.209 (P = 0.031), but not with endocrine function. The correlation between morphology and PABA recovery or pancreatic polypeptide secretion was observed in the subgroup with alcohol-induced chronic pancreatitis but not in those with idiopathic chronic pancreatitis. Pain is a prominent symptom of chronic pancreatitis. Pain was more frequent and more severe in patients suffering from chronic pancreatitis caused by alcohol or idiopathy. CONCLUSIONS: Morphology and exocrine function correlate in patients with alcohol-induced chronic pancreatitis but not in patients with chronic pancreatitis. When compared to patients with chronic pancreatitis of idiopathic origin, patients with alcoholic origin show differences in presentation and morphology but not in function.
Asunto(s)
Páncreas/fisiología , Pruebas de Función Pancreática/métodos , Pancreatitis/fisiopatología , Ácido 4-Aminobenzoico/orina , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Persona de Mediana Edad , Páncreas/anatomía & histología , Polipéptido Pancreático/metabolismo , Pancreatitis/diagnóstico , Pancreatitis/metabolismo , Estudios RetrospectivosRESUMEN
BACKGROUND: This study was performed to evaluate the (long-term) morbidity associated with hand-assisted laparoscopic surgery (HALS) for various indications. METHODS: HALS procedures for various indications were evaluated prospectively from 1995 to 2002. The primary outcome parameters were postsurgical complications and the development of incisional hernias. RESULTS: Twenty-six splenectomies, 51 hand-assisted laparoscopic donor nephrectomies (HLDN), 34 segmental bowel resections, 29 proctocolectomies, and 10 emergency colectomies were evaluated. A Küstner or Pfannenstiel incision was used for handport placement. Minor complications (i.e., wound complications, urinary tract infection) occurred in 15%, 12%, 26%, 7%, and 33% of the patients after, respectively, splenectomy, HLDN, bowel resection, proctocolectomy, and emergency colectomy. Major complications (i.e., hemorrhage, anastomotic leakage) occurred in 15% and 12% of the patients after, respectively, bowel resection and proctocolectomy. Incisional hernias occurred in six patients (4%), all after a wound complication in the Küstner incision. CONCLUSION: HALS is fast, safe, and feasible for various indications, especially HLDN and (procto-)colectomies. Little advantage can be expected when HALS is applied in splenectomy and segmental bowel (sigmoid) resection.
Asunto(s)
Laparoscopía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Colectomía/métodos , Urgencias Médicas , Femenino , Mano , Humanos , Ileostomía/métodos , Intestino Grueso/cirugía , Aprendizaje , Masculino , Persona de Mediana Edad , Nefrectomía/métodos , Países Bajos/epidemiología , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Esplenectomía/métodos , Recolección de Tejidos y Órganos/métodosRESUMEN
BACKGROUND/AIMS: Postoperative mortality after colon surgery is relatively infrequent. In order to evaluate the quality of colon surgery, post-mortem evaluation is useful. This study was performed to determine the value of a mortality register used at the Department of Surgery of the Red Cross Hospital. METHODS: From 1991 to 2000, 882 colon resections were performed for both malignant and benign disorders, including elective and emergency surgery. Permission for autopsy was asked routinely. All cases were reviewed and categorized in a multidisciplinary meeting. Any discrepancy between the clinical and post-mortem diagnosis was determined by a pathologist. RESULTS: The mortality rate of colon surgery was 8.0% (n = 71), 23% for emergency surgery and 6% for elective surgery (p < 0.001). For patients under 70 years of age the mortality rate was 4.3%, for patients over 70 years of age 11.2% (p < 0.001). Autopsy was performed in 62% (n = 44) of the patients. Discrepancy between clinical and post-mortem findings was documented in 14%. CONCLUSION: Postoperative mortality after colon surgery is influenced by the timing of surgery (elective or emergency procedure) and the age of the patient. A discrepancy of 14% between clinical cause of death and post-mortem cause of death justifies the need for obtaining autopsy in this type of surgery.
Asunto(s)
Colectomía/mortalidad , Mortalidad Hospitalaria , Sistema de Registros/estadística & datos numéricos , Factores de Edad , Anciano , Colectomía/estadística & datos numéricos , Urgencias Médicas , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
The main reason for conversion in laparoscopic donor nephrectomy (LDN) is peroperative bleeding. One of the advantages of hand-assisted laparoscopic donor nephrectomy (HDLN) is facilitated control in case of bleeding. This report describes two methods to avert conversion in HLDN in the case of abrupt major arterial bleeding. In the first case, during left HLDN the clips placed on the renal artery dislodged, and the surgeon managed to control the bleeding by compressing the focus of the bleeding with his finger. A balloon occlusion catheter was inserted through a groin incision in the aorta and advanced to the origo of the renal artery. Due to control of the hemorrhage, it was possible to close the renal artery stump by laparoscopic suturing, and a conversion was averted. The patient was discharged after 5 days, without signs of damage to the remaining kidney. In the second case, during right HLDN, the clips on the renal artery dislodged during stapling of the renal vein. The bleeding was controlled by finger compression and new clips were placed. The cuff of the artery was long enough to be clipped again. The patient was discharged after 5 days. Graft function was excellent in both cases. Major arterial bleeding can be controlled and managed in hand-assisted laparoscopic surgery. The use of a balloon occlusion catheter is an elegant way to avert conversion.
Asunto(s)
Pérdida de Sangre Quirúrgica , Hemostasis Quirúrgica/métodos , Laparoscopía/métodos , Donadores Vivos , Nefrectomía/métodos , Arteria Renal/cirugía , Instrumentos Quirúrgicos , Recolección de Tejidos y Órganos/métodos , Adulto , Cateterismo , Constricción , Embolectomía , Embolia/etiología , Embolia/cirugía , Falla de Equipo , Femenino , Arteria Femoral , Mano , Humanos , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Nefrectomía/instrumentación , Complicaciones Posoperatorias , PresiónRESUMEN
BACKGROUND: Several methods for skin closure are used, i.e. sutures, adhesive papertape and tissue adhesives. Little is known about the efficacy of these techniques in laparoscopic surgery. This study was performed to analyse the efficacy of octylcyanoacrylate, a new tissue adhesive, adhesive papertape and poliglecaprone for wound closure in laparoscopy. METHODS: From May 2000 to September 2001, 140 patients were included in a prospective randomized trial. Wounds were closed with octylcyanoacrylate (n = 48), adhesive papertape (n = 42) or poliglecaprone (n = 50). Closing time, wound infection, cosmetic results and costs were evaluated. A time-motion analysis was also performed. RESULTS: The patients in the three groups were well matched for age, gender and body mass index. Closing times per wound were 26, 33 and 65 s respectively for adhesive papertape, octylcyanoacrylate and poliglecaprone (P < 0.001). Cosmetic results, as scored by the patients, were no different. The number of actions required to close each wound was 5.7, 8.3 and 21.0 for octylcyanoacrylate, adhesive papertape (P = 0.05 versus octylcyanoacrylate) and poliglecaprone (P < 0.01 versus octylcyanoacrylate and adhesive papertape) respectively. Octylcyanoacrylate was significantly more expensive than poliglecaprone and adhesive papertape. CONCLUSION: Closure with adhesive papertape was the fastest method. The smallest number of actions required to close a wound was with octylcyanoacrylate. Adhesive papertape was the most cost-effective.
Asunto(s)
Cianoacrilatos/uso terapéutico , Laparoscopía/métodos , Adhesivos Tisulares/uso terapéutico , Análisis de Varianza , Análisis Costo-Beneficio , Cianoacrilatos/economía , Femenino , Humanos , Laparoscopía/economía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infección de la Herida Quirúrgica/etiología , Adhesivos Tisulares/economía , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
This study was performed to determine the long-term results of radiotherapy in localized prostate cancer. The frequency and severity of late gastrointestinal and genitourinary toxicities were also investigated. Between 1980 and 1991, 206 men with localized prostate cancer were treated with radiotherapy alone at our hospital. Biopsy, transurethral resection of the prostate, or both, confirmed the diagnosis. Overall survival, cancer-specific survival, disease-free survival, local recurrence-free survival and metastasis-free survival were determined and compared with age, stage, grade and diagnostic intervention. A change in treatment policy occurred in 1987. The treatment results of the two periods are compared. Late toxicity was registered according to the Radiation Therapy Oncology Group scale. The 8-year overall survival rates were 60%, 44% and 29% for Stages T1, T2 and T3 respectively (P=0.028). The 8-year cancer-specific survival rates were 86%, 66% and 34% for Stages T1, T2 and T3 respectively (P=0.002). Transurethral resection of the prostate had a negative influence on cancer-free and disease-free survivals, owing especially to an increased incidence of metastases. In the bladder and rectum, late toxicity of grade 2 or more occurred in 26 (13%) of the 199 patients who were alive at 6 months after radiotherapy. One of these patients developed late toxicity 5 years after the radiotherapy. Radiation dose and field size had no detectable influence on the development of late toxicity. The difference between overall survival and cancer-specific survival confirms that many of these patients die without any clinical signs of prostate cancer or metastases. This observation puts a question mark over whether a biochemical endpoint alone is of clinical relevance. Although not statistically significant, local recurrence-free, disease-free and cancer-specific free survivals from 1987 onwards improved for larger tumours, which was most likely due to the administration of higher doses of radiation.