Robotic-assisted partial Nephrectomy: initial experience in South America

OBJECTIVE:To report the initial outcomes of robotic-assisted partial nephrectomy in a tertiary center in South America. MATERIAL AND METHODS: From 11/2008 to 12/2009, a total of 16 transperitoneal robotic-assisted partial nephrectomies were performed in 15 patients to treat 18 kidney tumors. One patient with bilateral tumor had two procedures, while two patients with two synchronous unilateral tumors had a single operation to remove them. Eleven (73 percent) patients were male and the right kidney was affected in 7 (46 percent) patients. The median patient age and tumor size were 57 years old and 30 mm, respectively. Five (28 percent) tumors were hilar and/or centrally located. RESULTS: The median operative time, warm ischemia time and estimated blood loss was 140 min, 27 min and 120 mL, respectively. Blood transfusion was required in one patient with bilateral tumor, and one additional pyelolithotomy was performed due to a 15mm stone located in the renal pelvis. The histopathology analysis showed 15 (83 percent) malignant tumors, which 10 (67 percent) were clear cell carcinoma. The median hospital stay was 72 hrs and no major complication was observed. CONCLUSION: Robotic-assisted partial nephrectomy is safe and represents a valuable option to perform minimally invasive nephron-sparing surgery.

Leiomyosarcoma of the renal vein

Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We presented a case of renal vein leiomyosarcoma detected in a routine study. The primary treatment was complete surgical removal of the mass. In cases where surgical removal is not possible the prognosis is poor, with high rates of local recurrence and distant spread

Tratamento atual dos cálculos localizados no ureter lombar / Modern treatment of lumbar ureteral calculi

No período de um ano, foram estudados 168 pacientes portadores de cálculos ureterais lombares. Os pacientes foram divididos em três grupos de acordo com o tratamento: grupo 1, 24 pacientes submetidos à ureterolitomia por lombotomia posterior; grupo 2, 100 pacientes tratados por método endourológico e grupo 3, 44 pacientes tratados por litotrícia extracorpórea por ondas de choque (L.E.O.C) com o LITHOSTAR da Siemens. O tempo de hospitalizaçäo e a taxa de complicaçöes foram menores no grupo 3. O sucesso foi considerado nos casos em que houve a completa eliminaçäo dos cálculos, sendo 100% no grupo submetido à lombotomia posterior, 92% no grupo tratado por endourologia e 97% por LEOC. A baixa morbidade, grande possibilidade de näo existir internaçäo e anestesia, associados ao alto índice de sucesso, permitem a conclusäo de que a LEOC é o método de eleiçäo no tratamento dos cálculos ureterais lombares