RESUMEN
Intraoperative cell salvage (IOCS) has been used in urologic surgery for over 20 years to manage intraoperative blood loss and effectively minimize the need for allogenic blood transfusion. Concerns about viability of transfused erythrocytes and potential dissemination of malignant cells have been addressed in the urologic literature. We present a comprehensive review of the use of IOCS in urologic oncologic surgery. IOCS has been shown to preserve the integrity of erythrocytes during processing and effectively provides cell filtration to mitigate the risk of tumor dissemination. Its use is associated with reduction in the overall need for allogenic blood transfusion, which clinically reduces the risk of hypersensitivity reactions and disease transmission, and may have important implications on overall oncologic outcomes. In the context of a variety of urologic malignancies, including prostate, urothelial, and renal cancer, the use of IOCS appears to be safe, without risk of tumor spread leading to metastatic disease or differences in cancer-specific and overall survival. IOCS has been shown to be an effective intraoperative blood management strategy that appears safe for use in urologic oncology surgery. The ability to reduce the need for additional allogenic blood transfusion may have significant impact on immune-mediated oncologic outcomes.
RESUMEN
Purpose: The robot-assisted approach to distal ureteral reconstruction is increasingly utilized. Traditionally, the robot is docked between the legs in lithotomy position resulting in limited bladder access for stent placement. We examined the use of side docking of the daVinci robot® to perform distal ureteral reconstruction. Materials and Methods: A retrospective review of distal ureteral reconstruction (ureteral reimplantation and uretero-ureterostomy) executed robotically was performed at a single institution by a single surgeon. The daVinci robotic® Si surgical platform was positioned at the right side of the patient facing towards the head of the patient, i.e. side docking. Results: A total of 14 cases were identified from 2011–2013. Nine patients underwent ureteral reimplantation for ureteral injury, two for vesicoureteral reflux, one for ureteral stricture, and one for megaureter. One patient had an uretero-ureterostomy for a distal stricture. Three patients required a Boari flap due to extensive ureteral injury. Mean operative time was 286 minutes (189–364), mean estimated blood loss was 40cc (10–200), and mean length of stay was 2.3 days (1–4). Follow-up renal ultrasound was available for review in 10/14 patients and revealed no long-term complications in any patient. Mean follow-up was 20.7 months (0.1–59.3). Conclusion: Robot-assisted laparoscopic distal ureteral reconstruction is safe and effective. Side docking of the robot allows ready access to the perineum and acceptable placement of the robot to successfully complete ureteral repair.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Posicionamiento del Paciente/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Uréter/cirugía , Creatinina/sangre , Complicaciones Intraoperatorias , Tiempo de Internación , Tempo Operativo , Periodo Perioperatorio , Complicaciones Posoperatorias , Reproducibilidad de los Resultados , Estudios Retrospectivos , Reimplantación/instrumentación , Reimplantación/métodos , Procedimientos Quirúrgicos Robotizados/instrumentación , Stents , Resultado del Tratamiento , Ureterostomía/instrumentación , Ureterostomía/métodosRESUMEN
PURPOSE: The robot-assisted approach to distal ureteral reconstruction is increasingly utilized. Traditionally, the robot is docked between the legs in lithotomy position resulting in limited bladder access for stent placement. We examined the use of side docking of the daVinci robot® to perform distal ureteral reconstruction. MATERIALS AND METHODS: A retrospective review of distal ureteral reconstruction (ureteral reimplantation and uretero-ureterostomy) executed robotically was performed at a single institution by a single surgeon. The daVinci robotic® Si surgical platform was positioned at the right side of the patient facing towards the head of the patient, i.e. side docking. RESULTS: A total of 14 cases were identified from 2011-2013. Nine patients underwent ureteral reimplantation for ureteral injury, two for vesicoureteral reflux, one for ureteral stricture, and one for megaureter. One patient had an uretero-ureterostomy for a distal stricture. Three patients required a Boari flap due to extensive ureteral injury. Mean operative time was 286 minutes (189-364), mean estimated blood loss was 40cc (10-200), and mean length of stay was 2.3 days (1-4). Follow-up renal ultrasound was available for review in 10/14 patients and revealed no long-term complications in any patient. Mean follow-up was 20.7 months (0.1-59.3). CONCLUSION: Robot-assisted laparoscopic distal ureteral reconstruction is safe and effective. Side docking of the robot allows ready access to the perineum and acceptable placement of the robot to successfully complete ureteral repair.