Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 11 de 11
Filter
Add filters








Type of study
Year range
1.
Int. braz. j. urol ; 48(2): 363-364, March-Apr. 2022.
Article in English | LILACS | ID: biblio-1364954

ABSTRACT

ABSTRACT Background: Reports in the literature describe lymphocele formation in up to half of patients following pelvic lymph node dissection (PLND) (1) in robotic-assisted radical prostatectomy (RARP), with 1-2% requiring intervention (2). The advantage of surgical approach is permanent excision of the lymphocele capsule and fewer days with pelvic drains compared to percutaneous drainage. This study aims to describe the step-by-step surgical management of symptomatic lymphoceles using a less invasive robotic platform, the Da Vinci® Single Port (SP). Material and Methods: We describe the technique of lymphocelectomy and marsupialization with the Da Vinci® SP for symptomatic lymphocele. For this study, several treatment modalities for symptomatic lymphoceles were available, including percutaneous drainage, sclerosing agents, and surgical marsupialization. All the data for this study were obtained through the procedure via Da Vinci® SP. Results: Operative time for the case was 84 minutes. Blood loss was 25ml. No intra- or post- operative complications were reported. The patient had his drain removed in under 24 hours after surgery. The mean follow-up period was 7.7 months. There were no complications or lymphocele recurrence. Conclusion: Da Vinci® SP lymphocelectomy is safe and feasible with satisfactory outcomes. The SP enables definitive treatment of the lymphocele sac (3), reducing the number of days with abdominal drains and allows further decrease in surgical invasiveness with fewer incisions and better cosmesis.


Subject(s)
Humans , Male , Robotics , Lymphocele/surgery , Lymphocele/etiology , Robotic Surgical Procedures/adverse effects , Prostatectomy/methods , Drainage/adverse effects , Drainage/methods , Lymph Node Excision/methods
2.
Int. braz. j. urol ; 48(2): 212-219, March-Apr. 2022. graf
Article in English | LILACS | ID: biblio-1364948

ABSTRACT

ABSTRACT Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.


Subject(s)
Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/complications , Robotic Surgical Procedures/methods , Erectile Dysfunction/etiology , Erectile Dysfunction/prevention & control , Prostate/surgery , Prostatectomy/adverse effects , Prostatectomy/methods , Treatment Outcome
3.
Int. braz. j. urol ; 48(2): 369-370, March-Apr. 2022.
Article in English | LILACS | ID: biblio-1364947

ABSTRACT

ABSTRACT Introduction: Over the years, since Binder and Kramer described the first Robotic-assisted Radical Prostatectomy (RARP) in 2000, different Nerve-sparing (NS) techniques have been proposed by several authors (1). However, even with the robotic surgery advantages, functional outcomes following RARP, especially erection recovery, still challenge surgeons and patients (2, 3). In this scenario, we have described different ways and grades of neurovascular bundle preservation (NVB) using the prostatic artery as a landmark until our most recent technique with lateral prostatic fascia preservation and modified apical dissection (4-6). In this video compilation, we have illustrated the anatomical and technical details of different grades of NVB preservation. Surgical technique: After the anterior and posterior bladder neck dissection, we lift the prostate by the seminal vesicles to access the posterior aspect of the prostate. Then, we incise the Denonvilliers layers and work between an avascular plane to release the posterior NVB from 5 to 1 and 7 to 11 o'clock positions on the right and left sides, respectively6. In sequence, we access the prostate anteriorly by incising the endopelvic fascia bilaterally (close to the prostate) until communicating the anterior and posterior planes. Finally, we control the prostatic pedicles with Hem-o-lok clips and then proceed for the apical dissection preserving the maximum amount of urethra length and periurethral tissues. Considerations: Potency recovery following radical prostatectomy remains a challenge due to its multifactorial etiology. However, basic concepts for nerve-sparing are crucial to achieving optimal outcomes, such as minimizing the amount of traction used on dissection, avoiding excessive cautery, and neural preservation based on anatomical landmarks (arteries and planes of dissection).


Subject(s)
Humans , Male , Prostatic Neoplasms/surgery , Robotic Surgical Procedures , Prostate/surgery , Prostatectomy/methods , Penile Erection
4.
Article | IMSEAR | ID: sea-207766

ABSTRACT

Background: Iron deficiency anemia during pregnancy is a serious global concern specially in developing country, which is preventable with effective measures. In women who cannot tolerate oral iron or have moderate to severe anemia, parenteral iron in the form of iron sucrose or ferric carboxymaltose can be very much useful. This study aimed to compare efficacy and safety of iron sucrose and ferric carboxymaltose in iron deficiency anemia during pregnancy.Methods: This prospective interventional comparative study was conducted during May 2016 to April 2018 at tertiary care hospital and total 100 antenatal women from 28 to 34 weeks of gestation having moderate to severe anemia were included in this study and all women were divided in to 2 groups randomly and were given either iron sucrose or ferric carboxymaltose according to iron requirement. Rise in haemoglobin and serum ferritin were noted and data analysed statistically.Results: The mean rise of haemoglobin with iron sucrose was 1.8 gm% and with ferric carboxymaltose was 2.6 gm%. The mean rise of serum ferritin with iron sucrose was 82.4 ng/ml and with ferric carboxymaltose was 100.9 ng/ml. Other than minimal local reaction one woman had developed severe anaphylactic reaction after receiving iron sucrose.Conclusions: Intravenous ferric carboxymaltose is better and safe molecule than iron sucrose and it has advantage of ability to administer large dose in single sitting which reduce overall cost of therapy.  Hence ferric carboxymaltose is a drug of choice as parenteral iron therapy in iron deficiency anemia during second trimester of pregnancy.

5.
Article | IMSEAR | ID: sea-212178

ABSTRACT

Background: Sepsis is a life-threatening medical condition triggered due to body's response to an infection. If empirical treatment for sepsis and bacteraemia is held up it will increase chances of mortality as well as duration of stay and cost. Hence, there is a need for risk stratification. So, we planned to study the clinicohematological profile of patients of sepsis admitted to this hospital in ICU.Methods: This was an observational study. A total of 50 patients of sepsis were included. All included participants were subject to CBC, RFT, LFT, RBS, Urine RM, ESR, chest X-ray, USG Abdomen.  Laboratory evaluations were performed in the institutional pathology and biochemistry labs. Data was analysed to assess the clinicohematological profile of the patients of sepsis to identify common factors which if taken care of in time can reduce development to sepsis and the morbidity and mortality related to it.Results: Most common presenting complaint was fever (72%), followed by altered sensorium (58%), vomiting (30%), jaundice (30%) and breathlessness (20%). Most noticed signs were pallor (36%), icterus (36%), edema (6%), reduced air entry (34%) and crepitations (26%). Most common source of the infection were abdomen (28%), urinary tract infection (26%) and community acquired pneumonia (24%).Conclusions: Most common presenting complaints were fever, breathlessness, altered sensorium. Most common source of sepsis were urinary tract infection, lung, and abdomen which if adequately treated in time would aid in reducing the number of sepsis patients and thus will control the morbidity, mortality and cost associated with sepsis.

6.
Article in English | IMSEAR | ID: sea-152211

ABSTRACT

Introduction: First year undergraduate medical students find it difficult to identify histology slides in the laboratory, even though they have a good theoretical knowledge about them. Aim: The present study was undertaken to improve histology slide identification skills of the students using a new innovative method and also to compare the same with traditional methods of teaching histology. Materials & Methods: 150 first year medical undergraduates (MBBS) from JIPMER, Pondicherry formed the subjects of the present study. Digital images from slides available at our department in JIPMER (Jawaharlal institute of post graduate medical education and research), Pondicherry were labeled and used in lecture classes as well as for subsequent student assessment. Results: 94% of the students identified all the slides correctly and mentioned important identifying points using the newer method whereas only 52% and 64% of the students identified all the slides correctly and mentioned important identifying points using pointers in the eye piece method and live/ real time demonstration (older/traditional methods ) respectively. Conclusion: The new method has been shown to be effective and makes efficient use of the available time and superior to older methods of teaching histology.

8.
Int. braz. j. urol ; 36(3): 259-272, May-June 2010. ilus, tab
Article in English | LILACS | ID: lil-555185

ABSTRACT

PURPOSE: Nerve sparing radical prostatectomy is the gold standard for the treatment of prostate cancer. Over the past decade, more and more surgeons and patients are opting for a robot-assisted procedure. The purpose of this paper is to briefly review different techniques and outcomes of nerve sparing robot assisted laparoscopic prostatectomy (RALP). MATERIALS AND METHODS: We performed a MEDLINE search from 2001 to 2009 using the keywords “robotic prostatectomy”, “cavernosal nerve”, “pelvic neuroanatomy”, “potency”, “outcomes” and “comparison”. Extended search was also performed using the references from these articles. RESULTS: Several techniques of nerve sparing are available in literature for RALP, which have been described in this manuscript. These include, “the veil of Aphrodite”, “athermal retrograde neurovascular release”, “clipless antegrade nerve sparing” and “clipless cautery free technique”. The comparative and the non comparative series showing outcomes of RALP have been described in the manuscript. CONCLUSIONS: The basic principles for nerve sparing revolve around minimal traction, athermal dissection, and approaching the correct planes. It has not been documented if any one technique is better than the other. Regardless of technique, patient selection, wise clinical judgment and a careful dissection are the keys to achieve optimal oncological outcomes following RALP.


Subject(s)
Humans , Male , Laparoscopy/methods , Penile Erection/physiology , Prostatectomy/methods , Prostatic Neoplasms/surgery , Robotics/methods , Erectile Dysfunction/prevention & control , Penis/innervation , Prostate/innervation , Treatment Outcome
9.
Int. braz. j. urol ; 35(3): 344-353, May-June 2009. ilus, tab
Article in English | LILACS | ID: lil-523160

ABSTRACT

OBJECTIVE: Optical coherence tomography (OCT) is a unique technology, developed to provide high resolution, cross sectional images of human tissue. The objective of this study was to explore the feasibility of OCT for the evaluation of positive surgical margins and extra capsular extension in robotic prostatectomy specimens and compare it to histopathology. MATERIAL AND METHODS: Radical prostatectomy was performed in 100 patients. Twenty OCT images of each specimen were taken from the base of the seminal vesicles (SV), apical and vesicle margins, peripheral and posterolateral area and any palpable nodule. Predictions were made regarding positive surgical margin, SV involvement, capsular invasion and compared with the final histopathology. RESULTS: A total of 2000 OCT images were taken and analyzed. Out of 100 specimens, 85 had T2 disease, 15 had T3 disease with a median Gleason's score of 7 (range 6 to 9) and 10 had positive surgical margins. We predicted 21 specimens to have positive margins based on OCT images out of which 7 were truly positive and 14 were falsely positive. Based on OCT images, 79 specimens were predicted to have negative margins out of which 76 were truly negative and 3 were falsely negative. We found the sensitivity, specificity, positive predictive value and negative predictive value to be 70 percent, 84 percent, 33 percent and 96 percent respectively. CONCLUSION: Our initial feasibility study established the template for the visual OCT characteristics of the prostate, SV and cancerous tissue. The negative predictive value of evaluating surgical margins was high.


Subject(s)
Humans , Male , Middle Aged , Image Enhancement/methods , Prostatectomy/methods , Prostatic Neoplasms/surgery , Robotics , Tomography, Optical Coherence/instrumentation , Feasibility Studies , Prostate/pathology , Prostate/surgery , Prostatic Neoplasms/pathology , Sensitivity and Specificity , Tomography, Optical Coherence/methods
11.
Indian J Pathol Microbiol ; 2003 Jul; 46(3): 482-3
Article in English | IMSEAR | ID: sea-74596

ABSTRACT

Von Hippel Lindau (VHL) disease is a rare autosomal dominant condition manifested by central nervous system hemangioblastoma, retinal angiomas, cysts of pancreas, kidney and epididymis, pheochromocytomas and renal cell carcinoma. We present such a case in a 45 years old male patient.


Subject(s)
Carcinoma, Renal Cell/pathology , Hemangioblastoma/pathology , Humans , Kidney Neoplasms/pathology , Male , Middle Aged , Supratentorial Neoplasms/pathology , von Hippel-Lindau Disease/pathology
SELECTION OF CITATIONS
SEARCH DETAIL