RESUMEN
OBJECTIVE: To determine feasibility and safety of robotic excision of local ipsilateral recurrences after nephrectomy for renal cell carcinoma (RCC). Surgical resection is an option for treatment of low burden locally recurrent RCC, potentially delaying the use of systemic therapy. This has historically been performed by open technique, which can impart significant morbidity. We present our experience with robotic excision. METHODS: We reviewed our institutional experience of patients with surgically excised RCC who underwent robotic excision of ipsilateral retroperitoneal recurrence in 2015-2018. Demographics and clinicopathological variables, including operative and postoperative outcomes, were examined. RESULTS: Twelve robotic excisions of ipsilateral local recurrences were performed in our hospital in 2015-2018. Mean age was 65.48 years (± standard deviation, SD: 9.51), 10 patients were male, and mean BMI 34.75 kg/m2 (± 6.71). Nine patients recurred after radical nephrectomy, and 3 after partial nephrectomy. Mean size of recurrence was 2.97 cm (±1.69). Mean anesthesia time, EBL, and LOS were 213 minutes (± 38.92), 152 mL (± 130.75), and 43 hours (± 12.64), respectively. All surgical margins were negative. No surgical complications were reported. Median follow-up was 19.0 months [interquartile range, IQR 12.7-30.0]. Five patients out of 12 recurred following robotic excision, these were treated with either systemic therapy, radiation, or palliative surgeries. Mean time for subsequent recurrence was 26.5 months. CONCLUSION: In this small case series, robotic excision of ipsilateral RCC retroperitoneal recurrence appears safe, technically feasible, and oncologically sound in expert hands and carefully selected patients.
Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Nefrectomía/efectos adversos , Neoplasias Retroperitoneales/cirugía , Procedimientos Quirúrgicos Robotizados/efectos adversos , Anciano , Carcinoma de Células Renales/secundario , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Renales/patología , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Selección de Paciente , Neoplasias Retroperitoneales/secundario , Espacio Retroperitoneal/patología , Espacio Retroperitoneal/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate whether the use of the physical surgical simulator may benefit the development of laparoscopic skills. METHODS: Ten medical students were divided into two groups: the first one performed ten weekly training sessions with a physical surgical simulator - ETX A2 LAP and, afterwards, one laparoscopic cholecystectomy in a porcine model, while the second group performed only a laparoscopic cholecystectomy. Both groups were compared regarding bleeding, total surgical time, time to perform each surgical step and qualitative parameters, based on a previously validated tool. RESULTS: There was no difference in any of the evaluated parameters. CONCLUSION: We did not find any evidence of benefit in the use of the physical simulator for surgical performance in medical students.
Asunto(s)
Educación de Pregrado en Medicina/métodos , Laparoscopía/educación , Entrenamiento Simulado/métodos , Adulto , Animales , Competencia Clínica , Evaluación Educacional , Diseño de Equipo , Femenino , Humanos , Laparoscopía/métodos , Masculino , Tempo Operativo , Reproducibilidad de los Resultados , Estadísticas no Paramétricas , Estudiantes de Medicina , Porcinos , Factores de Tiempo , Adulto JovenRESUMEN
Abstract Purpose: To evaluate whether the use of the physical surgical simulator may benefit the development of laparoscopic skills. Methods: Ten medical students were divided into two groups: the first one performed ten weekly training sessions with a physical surgical simulator - ETX A2 LAP and, afterwards, one laparoscopic cholecystectomy in a porcine model, while the second group performed only a laparoscopic cholecystectomy. Both groups were compared regarding bleeding, total surgical time, time to perform each surgical step and qualitative parameters, based on a previously validated tool. Results: There was no difference in any of the evaluated parameters. Conclusion: We did not find any evidence of benefit in the use of the physical simulator for surgical performance in medical students.