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Resumen: Introducción: el dolor agudo postoperatorio demora la recuperación funcional del paciente. Objetivo: evaluar utilidad de la ketamina asociada a morfina administrados en bolos intravenosos en el control del dolor agudo postoperatorio de pacientes sometidos a cirugía renal electiva. Material y métodos: realizamos estudio doble ciego en pacientes con dolor postoperatorio moderado-severo sometidos a cirugía renal electiva. Se conformaron dos grupos: grupo MK administramos morfina 0.05 mg/kg más ketamina 0.2 mg/kg y grupo M morfina 0.05 mg/kg más solución salina a 0.9%. Pacientes con dolor de intensidad moderada-severa según escala analógica visual recibieron dosis de morfina cada 20 minutos hasta lograr dolor ligero, registrándose el consumo total de morfina por paciente. La tensión arterial, frecuencia cardíaca y respiratoria, saturación de oxígeno y efectos adversos fueron evaluados con la misma periodicidad. Resultados: el grupo MK mostró menor intensidad del dolor con disminución significativa del consumo de morfina. Ambos grupos resultaron ser similares en cuanto a cifras de tensión arterial, frecuencia cardíaca, frecuencia respiratoria y saturación de oxígeno. Las náuseas y vómitos fueron los efectos adversos de mayor prevalencia, siendo superiores en el grupo morfina. Conclusiones: la asociación morfina-ketamina resultó útil en el control del dolor moderado-severo en pacientes sometidos a cirugía renal electiva.
Abstract: Introduction: acute postoperative pain delays the patient's functional recovery. Objective: to evaluate the utility of ketamine associated with morphine administered in intravenous boluses in the control of acute postoperative pain in patients undergoing elective renal surgery. Material and methods: we conducted a double-blind study in patients with moderate-severe postoperative pain undergoing elective renal surgery. Two groups were formed: group MK administered 0.05 mg/kg morphine plus 0.2 mg/kg ketamine and group M 0.05 mg/kg morphine plus 0.9% saline solution. Patients with pain of moderate-severe intensity according to the visual analogue scale received doses of morphine every 20 minutes until achieving light pain, recording the total consumption of morphine per patient. Blood pressure, heart and respiratory rates, oxygen saturation, and adverse effects were evaluated with the same periodicity. Results: MK group showed lower pain intensity with a significant decrease in morphine consumption. Both groups turned out to be similar in terms of blood pressure, heart rate, respiratory rate and oxygen saturation Figures. Nausea and vomiting were the most prevalent adverse effects, being higher in the morphine group. Conclusions: the morphine-ketamine association was useful in the control of moderate-severe pain in patients undergoing elective renal surgery.
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Objective:To assess the safety and feasibility of complete lateral position endoscopic combined intra-renal surgery (ECIRS) in treatment of staghorn kidney calculi.Methods:The clinical data of 105 patients with staghorn kidney calculi from March 2016 to July 2022 in the First Hospital of Shanxi Medical University were retrospectively analyzed. Among them, 55 patients were treated with lateral position percutaneous nephrolithotomy (PCNL) (PCNL group), and 50 patients were treated with complete lateral position ECIRS (ECIRS group). The operative time, removal time of double J-tube, postoperative hospital stay, postoperative hemoglobin decrease value, operative complications (using Clavien-Dindo grading criteria), additional postoperative intervention and calculi free rate were compared between two groups.Results:Both groups of patients were successfully operated. The operative time, postoperative hemoglobin decrease value and rate of additional postoperative intervention in ECIRS group were significantly lower than those in PCNL group: (98.3 ± 19.1) min vs. (103.4 ± 16.5) min, (9.34 ± 3.04) g/L vs. (12.55 ± 4.75) g/L and 8.00% (4/50) vs. 21.82% (12/55), the calculi free rate was significantly higher than that in PCNL group: 90.00% (45/50) vs. 74.55% (41/55), and there were no statistical differences ( P<0.05 or <0.01); there were no statistical differences in the removal time of double J-tube, postoperative hospital stay, incidence of Clavien-Dindo≥ grade Ⅱ operative complications between two groups ( P>0.05). Conclusion:The complete lateral position ECIRS is a safe and effective treatment for staghorn kidney calculi, and is a good complement to the ECIRS technique because of its high stone free rate in phase Ⅰ, low complication incidence and easy dissemination.
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Objective:To explore the feasibility of deep learning technology for renal artery recognition in retroperitoneal laparoscopic renal surgery videos.Methods:From January 2020 to July 2021, the video data of 87 cases of laparoscopic retroperitoneal nephrectomy, including radical nephrectomy, partial nephrectomy, and hemiurorectomy, were retrospectively analyzed. Two urological surgeons screened video clips containing renal arteries. After frame extraction, annotation, review, and proofreading, the labeled targets were divided into training set and test set by the random number table in a ratio of 4∶1. The training set was used to train the neural network model. The test set was used to test the ability of the neural network to identify the renal artery in scenes with different difficulties, which was uniformly transmitted to the YOLOv3 convolutional neural network model for training. According to the opinion of two senior doctors, the test set was divided into high, medium, and low discrimination of renal artery and surrounding tissue. High identification means a clean renal artery and a large exposed area. For middle recognition degree, the renal artery had a certain degree of blood immersion, and the exposed area was medium. Low identification means that the exposed area of the renal artery was small, often located at the edge of the lens, and the blood immersion was severe, which may lead to lens blurring. In the surgical video, the annotator annotated the renal artery truth box frame by frame. After normalization and preprocessing, all images were input into the neural network model for training. The neural network output the renal artery prediction box, and if the overlap ratio (IOU) with the true value box was higher than the set threshold, it was judged that the prediction was correct. The neural network test results of the test set were recorded, and the sensitivity and accuracy were calculated according to IOU.Results:In the training set, 1 149 targets of 13 videos had high recognition degree, 1 891 targets of 17 videos had medium recognition degree, and 349 targets of 18 videos had low recognition degree. In the test set, 267 targets in 9 videos had high recognition degree, 519 targets in 11 videos had medium recognition degree, and 349 targets in 18 videos had low recognition degree. When the IOU threshold was 0.1, the sensitivity and accuracy were 52.78% and 82.50%, respectively. When the IOU threshold was 0.5, the sensitivity and accuracy were 37.80% and 59.10%, respectively. When the IOU threshold was 0.1, the sensitivity and accuracy of high, medium and low recognition groups were 89.14% and 87.82%, 45.86% and 78.03%, 32.95%, and 76.67%, respectively. The frame rate of the YOLOv3 algorithm in real-time surgery video was ≥15 frames/second. The false detection rate and missed detection rate of neural network for renal artery identification in laparoscopic renal surgery video were 47.22% and 17.49%, respectively (IOU=0.1). The leading causes of false detection were similar tissue and reflective light. The main reasons for missed detection were image blurring, blood dipping, dark light, fascia interference, or instrument occlusion, etc.Conclusions:Deep learning-based renal artery recognition technology is feasible. It may assist the surgeon in quickly identifying and protecting the renal artery during the operation and improving the safety of surgery.
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Objective To explore the best minimal invasive method in treating renal pelvic stones less than 1.5 cm.Methods A total of 90 patients with renal pelvic stone less than 1.5 cm were enrolled, including 47 cases of retrograde intrarenal surgery(RIRS)by rigid and flexible ureteroscopy with holmium laser lithotripsy,and 43 cases of percutaneous nephrolithotomy(PCNL)by holmium laser lithotripsy.Opera-tion time,stonefree rate(SFR),hospitalization,and complications were analyzed for comparison.Results The average sizes of stone in the RIRS group and PCNL group were 1.2 cm(range 1.0 ~1.5 cm)and 1.3 cm (1.0 ~1.5 cm),respectively.In the RIRS group,45(95.74%)patients out of 47 had complete clearance and 32 patients needed combination of flexible ureteroscopy to fragmentate the stones falling into the renal calices.The operation time was 44 min(range 27 ~70 min)with postoperative fever in 2 cases.The decrea-sing in hemoglobin and hematocrit was(0.18 ±0.06)g/L and 0.11%,respectively.No major complication was recorded.In PCNL group,the mean operation time was 70min(range 45 ~90 min)with a stone-free rate of 95.35%(41 /43).The decreasing in hemoglobin and hematocrit was(17.25 ±6.70)g/L and 5. 62%,respectively.The complications in PCNL group were postoperative fever in two cases and bleeding in two cases.Conclusion RIRS has the advantages of natural orifice endoscopic surgery in shortening opera-tion time,reducing blood transfusion requirements,and decreasing postoperative complications.For renal pelvic stone less than 1.5 cm,RIRS can be the primary choice.
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PURPOSE: To investigate surgical outcomes between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups for a main stone sized 15 to 30 mm and located in the lower-pole calyx. MATERIALS AND METHODS: Patients who underwent PNL or RIRS for a main stone sized 15 to 30 mm and located in the lower-pole calyx were retrospectively reviewed. Each patient in the RIRS group was matched to one in the PNL group on the basis of calculated propensity scores by use of age, sex, body mass index, previous treatment history, stone site, maximum stone size, and stone volume. We compared perioperative outcomes between the unmatched and matched groups. RESULTS: Patients underwent PNL (n=87, 66.4%) or RIRS (n=44, 33.6%). After matching, 44 patients in each group were included. Mean patient age was 54.4+/-13.7 years. Perioperative hemoglobin drop was significantly higher and the hospital stay was longer in the PNL group than in the RIRS group. The operative time was significantly longer in the RIRS group than in the PNL group. Stone-free rates were higher and complications rates were lower in the RIRS group than in the PNL group without statistical significance. The presence of a stone located in the lower-anterior minor calyx was a predictor of stone-free status. CONCLUSIONS: RIRS and single-session PNL for patients with a main stone of 15 to 30 mm located in the lower-pole calyx showed comparable surgical results. However, RIRS can be performed more safely than PNL with less bleeding. Stones in the lower-anterior minor calyx should be carefully removed during these procedures.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Hemoglobins/metabolism , Kidney Calculi/pathology , Length of Stay/statistics & numerical data , Nephrectomy/adverse effects , Nephrostomy, Percutaneous/adverse effects , Prognosis , Propensity Score , Retrospective Studies , Treatment OutcomeABSTRACT
Background: The segmental arteries of the kidney supply the organ in such away that, each renal pole receives its own arterywhile, the anterior portion between the poles is supplied by an upper and lower segmental vessel. These two arteries also include in their territory the lateral edge of the kidney and adjacent to the strip of parenchyma on the dorsal or posterior aspect of the organ. The knowledge of inferior segmental branch of renal artery is very important for surgeries in its distribution area in kidney. Materials and Methods: 100 kidneys (Fifty pairs) intact with abdominal aorta were collected from department of Forensic medicine, JSS Medical College and Mysore Medical College. For study of segmental variation Corrosion cast technique method was used. The variations of inferior segmental branch of renal artery were observed and recorded. Results: In present study type I inferior segmental branch of renal artery were found in - 59% cases, type II in - 6% cases, type III in - 28% cases, type IV in - 2% cases. Conclusion: The inferior segmental artery from the anterior division of the renal artery is the commonest event –arising in 59%. This is Type I, the normal type. It arises from the renal artery (28%) or from the posterior division (6%) or from the aorta (2%). The knowledge of inferior segmental branch of renal artery helpful in kidney transplantation and renal surgery because these type of surgeries success mainly depends on arterial ligations.
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Background: The kidneys are paired solid organs that lie in the retro peritoneum along the borders of psoas muscle. Each kidney is positioned obliquely and awareness of the relationship of the kidneys to the surrounding organs is paramount. Each kidney is supplied by a renal artery, which is a branch of the abdominal aorta, the branching pattern of renal artery shows very much variations , the knowledge of individual segmental artery variation are very helpful for clinical practices of renal surgeries. Materials andMethods: Fifty pairs of kidneys with intact abdominal aorta and renal artery were collected from the dead bodies obtained from themortuary of Forensic department, JSSMedical College andMysore Medical College and studied in JSS Medical College. For study of segmental variation Corrosion cast technique method was used. Results: In present study type I anterior inferior segmental artery were found in 47%, type II in 16%, type III in 24%, type IV 10%, type V in 0% o and type VI 1% of cases. Conclusion: The variation of the anterior inferior segmental artery has not been given importance in previous works and they have been typed (6 types) in the present work. The knowledge of anterior inferior segmental artery variations are helpful in renal surgeries in particular with anterior inferior segmental artery distribution area.
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PURPOSE: Although laparoscopy is considered the mainstay for most renal procedures in adults, its role in the pediatric population is still controversial, especially for smaller children. We reviewed our experience in pediatric renal laparoscopic surgery in three pediatric age groups in an attempt to identify if age has an impact on feasibility and surgical outcomes. MATERIALS AND METHODS: From November 1995 to May 2006, 144 pediatric laparoscopic renal procedures were performed at our institution. The charts of these patients were reviewed for demographic data, urologic pathology and surgical procedure, as well as perioperative complications and post-operative outcomes. The findings were stratified into 3 groups, according to patient age (A: < 1 year, B: 1 to 5 years and C: 6-18 years). RESULTS: Median age of the patients was 4.2 years (42 days - 18 years). We performed 54 nephrectomies, 33 nephroureterectomies, 19 upper pole nephrectomies, 11 radical nephrectomies, 22 pyeloplasties and 4 miscellaneous procedures. The 3 age groups were comparable in terms of the procedures performed. Conversion rates were 0 percent, 1.4 percent and 1.9 percent for groups A, B and C, respectively (p = 0.72). Incidence of perioperative complications was 5 percent, 8.2 percent and 7.8 percent for age groups A to C, respectively (p = 0.88). CONCLUSIONS: Most renal procedures can be performed safely by laparoscopy in the pediatric population, with excellent aesthetic and functional outcomes. The morbidity related to the procedure was minimal irrespective of the age group.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Kidney Diseases/surgery , Laparoscopy , Age Factors , Feasibility Studies , Intraoperative Complications , Laparoscopy/adverse effects , Laparoscopy/methods , Postoperative Complications , Time Factors , Treatment OutcomeABSTRACT
Laparoscopic surgery is presently assuming an important role in pediatric urology. It offers minimally invasive surgery to benign real conditions. We report our experience with laparoscopic renal surgery in the pediatric age group and evaluate our series to establish the safety and efficacy of it. Between August 2003 and June 2004,4 girls with ages ranging from 8 months to 8 years old, averaging 44 months, underwent laparoscopic renal surgeries. Our series consistent of 1 Nephrectomy, 1 Nephroureterectomy (retroperitoneal approach) and 2 Heminephroureterectomies. Operating time ranged from 125 to 340 minutes averaging 185 minutes. Blood loss was minimal. No early or late postoperative complications were noted. Our series also showed that patients experience minimal postoperative discomfort, improved cosmesis and shorter hospital stay with the laparoscopic approach. As we gain more experience refinements in our surgical technique are expected and with the advent of new technology such as Ultrasonic SonoSurg, laparoscopy will be an important facet in the surgical armamentarium of pediatric urologists. (Author)
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The most serious complications of renal surgery, such as nephrotomy or partial nephrectomy, are intraoperative bleeding, urine leakage or secondary hemorrhage. To avoid such complication, meticulous parenchymal sutures are necessary with traumatizing loss of renal functioning parenchyma. Fibrin sealant is a newly developed substance for hemostasis, tissue sealing and wound healing. We made the experimental study on the effect of fibrin sealant in renal surgery to minimize to above complications without sutures. The following results were obtained: 1. The fibrin sealant was useful for joining the wound surfaces in nephrotomy or partial nephrectomy. 2. The serious complications, such as hemorrhage or urine leakage could be reduced. 3. The significant parenchymal loss caused by sutures was eliminated by its applications. 4. There was no foreign body reaction with its applications. Judging from the results of this experiments, it may be expected that by the use of the fibrin sealant the surgical complications can be markedly reducible in urologic surgical fields.
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Fibrin Tissue Adhesive , Fibrin , Foreign-Body Reaction , Hemorrhage , Hemostasis , Nephrectomy , Sutures , Wound Healing , Wounds and InjuriesABSTRACT
Temporary occlusion of the renal artery may be necessary for the extensive kidney operation. Performance of kidney operation requires an understanding of renal responses to warm ischemia and available methods of protecting the kidney while arterial occlusion. To minimize the loss of kidney function cooling of the organ is mandatory. The cooling can be accomplished either by perfusion with cold solution or by in situ surface cooling During the last 41 months, we performed renal surgery using hypothermia technique with good results in l5 patients.
Subject(s)
Humans , Hypothermia , Kidney , Perfusion , Renal Artery , Warm IschemiaABSTRACT
An in situ hypothermia technique allows ample exposure for a precise and bloodless dissection as well as ample protection against ischemia and blood loss in the surgical management of renal parenchyma. The saline slush method is simple and requires material that is readily available in standard operating rooms. Renal parenchymal surgery using in situ hypothermia was performed on 23 patients, 18 with renal calculi and 5 with renal injury, during 4 years period from June, 1976 to Mar, 1980. Partial nephrectomy was done in 12 patients, extended pyelolithotomy with nephrotomy in 5, nephrolithotomy in 3 and bivalve nephrolithotomy in 3. There was no morbidity related particularly to this hypothermia technique, however, in 4 out of 18 renal calculous patients remnant calculi were detected on postoperative study.