RESUMO
INTRODUCTION: To evaluate the effect of valveless trocar system (VTS) on intra-operative parameters, peri-operative outcomes, and 30-day postoperative complications in patients undergoing robotic-assisted laparoscopic prostatectomy. METHODS: A total of 200 consecutive patients undergoing Robot-assisted radical prostatectomy by a single surgeon were prospectively evaluated using either the valveless trocar (n = 100) or standard trocars (n = 100). Patient demographics, intra-operative parameters, length of stay, presence or absence of postoperative nausea and vomiting, analog pain score at 0-6 hours, 6-12 hours, 12-18 hours, and >24 hours, and 30-day postoperative complications were analyzed. RESULTS: There were no significant differences in estimated blood loss, intra-operative urine output, length of stay, or 30-day complication rates between the two groups. While the VTS group had higher Body Mass Index (BMI) (28.45 vs. 27.23; P = 0.049), the operative time was significantly shorter in the VTS group (146 minutes vs. 167 minutes; P < .005). The VTS group experienced fewer episodes of nausea (2% vs. 10%; P = 0.0172). The VTS group had less pain intensity compared to the control in the first 18 hours: 0-6 hours (1.9 vs. 2.5; P = 0.034), 6-12 hours (2.8 vs. 3.6; P = 0.044), and 12-18 hours (2.2 vs. 3.1; P = 0.049), respectively. CONCLUSION: The use of a valveless trocar system during robot-assisted robotic prostatectomy may shorten operative times, and reduce postoperative pain scores and nausea episodes without increasing the 30-day complication rate. Further prospective randomized trials should be performed to validate these findings.
Assuntos
Laparoscopia/instrumentação , Prostatectomia , Procedimentos Cirúrgicos Robóticos , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Neoplasias da Próstata/cirurgia , Escala Visual AnalógicaRESUMO
BACKGROUND: Urosepsis is a rare but life-threatening complication following transrectal ultrasound (TRUS) guided needle prostate biopsy. Despite the technological and pharmacological improvements, the problem of bacterial urosepsis after prostate biopsy remains. A strategy for preventing urosepsis following TRUS prostate biopsy in áreas with high prevalence of resistant strains or patients presenting risk factors is lacking. OBJECTIVES: The aim of this study was to assess the prevalence of urosepsis, as well its predictors, following TRUS guided needle biopsy of the prostate in a tertiary care medical center in Lebanon. MATERIALS AND METHODS: We carried out a retrospective study on all patients who underwent TRUS prostate biopsy at the American University of Beirut Medical Center between January 1, 2011 and June 31, 2013. Patients' hospital charts were reviewed. Data collected included demographic information, pre-procedure disease specific information, as well as post-procedure information. Predictors of urosepsis following TRUS were assessed. RESULTS: In total, 265 patients were included in this study, where the prevalence of urosepsis following TRUS prostate biopsy was found to be 9.4%. The significant independente predictors of urosepsis were found to be: age with an OR=0.93 (95% CI: 0.88-1.00, p-value=0.03), and hypertension comorbidity with an OR=3.25 (95% CI: 1.19-8.85, p-value=0.02). CONCLUSION: We found a high prevalence of urosepsis among patients who have undergone TRUS prostate biopsy, and identified two significant risk factors. The results of this study highlight the importance of implementing strategies for prevention of urosepsis following TRUS prostate biopsy.
Assuntos
Bacteriemia/epidemiologia , Bacteriemia/etiologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Próstata/patologia , Centros de Atenção Terciária/estatística & dados numéricos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Fatores Etários , Idoso , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Humanos , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
ABSTRACT Background Urosepsis is a rare but life-threatening complication following transrectal ultrasound (TRUS) guided needle prostate biopsy. Despite the technological and pharmacological improvements, the problem of bacterial urosepsis after prostate biopsy remains. A strategy for preventing urosepsis following TRUS prostate biopsy in areas with high prevalence of resistant strains or patients presenting risk factors is lacking. Objectives The aim of this study was to assess the prevalence of urosepsis, as well its predictors, following TRUS guided needle biopsy of the prostate in a tertiary care medical center in Lebanon. Materials and Methods We carried out a retrospective study on all patients who underwent TRUS prostate biopsy at the American University of Beirut Medical Center between January 1, 2011 and June 31, 2013. Patients’ hospital charts were reviewed. Data collected included demographic information, pre-procedure disease specific information, as well as post-procedure information. Predictors of urosepsis following TRUS were assessed. Results In total, 265 patients were included in this study, where the prevalence of urosepsis following TRUS prostate biopsy was found to be 9.4%. The significant independent predictors of urosepsis were found to be: age with an OR=0.93 (95% CI: 0.88–1.00, p-value=0.03), and hypertension comorbidity with an OR=3.25 (95% CI: 1.19–8.85, p-value=0.02). Conclusion We found a high prevalence of urosepsis among patients who have undergone TRUS prostate biopsy, and identified two significant risk factors. The results of this study highlight the importance of implementing strategies for prevention of urosepsis following TRUS prostate biopsy.