Laparoendoscopic single-site nephroureterectomy for morbid obese patients

Since the first laparoendoscopic single-site (LESS) surgery report in urology in 2007 (1) (Rane A e Cadeddu JA), the few reports of LESS extraperitoneal access in the literature were mainly described for less complex cases. The aim of this video is to demonstrate the feasibility of LESS extraperitoneal access in a morbid obese patient presenting a malignant tumor in the renal pelvis. The patient is positioned in 90-degree lateral decubitus. An incision is made below the abdominal skin crease on the left side of the patient and the anterior rectus fascia is vertically incised with manual dissection of the extra/retroperitoneal space. We use an Alexis® retractor to retract the skin maximizing the incision orifice. Three trocars (12, 10 and 5 mm) are inserted through a sigle-port. The pedicle was controlled “en bloc” with a vascular stapler and the bladder cuff treated by the conventional open approach through the same incision. Operative time was 126 minutes with minimal blood loss. The pathology reported high grade papillary urothelial carcinoma in the pelvis (pT3N0M0) and in the ureter (pTa). LESS extraperitoneal nephroureterectomy is feasible and safe, even in more complex cases. It is a good alternative for morbid obese patients and for patients with synchronous distal ureteral tumors for whom an open approach to the bladder cuff is proposed to avoid incisions in two compartments of the abdominal wall.

Expanded criteria for Video Endoscopic Inguinal Lymphadenectomy (VEIL) in penile cancer: palpable lymph nodes

Introduction Open inguinal lymphadenectomy is the gold standard for the treatment of inguinal metastasis in patients with penile cancer (PC). Recently the Video Endoscopic Inguinal Lymphadenectomy (VEIL) was proposed as an option to reduce the morbidity of the procedure in patients without palpable inguinal lymph nodes (PILN), however the oncological equivalency in patients with PILN remains poorly studied. The aims of this video are the demonstration of VEIL in patients with PILN and present the preliminary experience comparing patients with and without PILN. Materials and Methods The video illustrates the procedure performed in two cases that were previously underwent partial penectomy for PC with PILN. Data from the series of 15 patients (22 limbs operated) with PILN underwent VEIL were compared with our series of VEIL in 25 clinically N0 patients (35 limbs operated). Results The comparison between the groups with and without PILN found, respectively, these outcomes: age 52,45 × 53,2 years, operative time 126,8 × 95,5 minutes, hospital stay 5. × 3.1 days, drainage time 6.7 × 5.7 days, 9 resected lymph nodes on average in both groups, global complications 32% × 26%, cellulitis 4.5% × 0%, lymphocele 23% in both groups, skin necrosis 0% × 3%, myocutaneous necrosis 4.5% × 0%, pN+ 33% × 32%, cancer specific mortality 7% × 5% and mean follow-up 17.3 × 35.3 months. None of the variables presented p < 0.05. Conclusions VEIL is a safe complementary procedure for treatment of PC, even in patients with PILN. Oncological results in patients with PILN seem to be appropriate but are still very premature. Prospective multicenter studies with larger samples and long-term follow-up should be conducted to determine the oncological equivalence of VEIL compared with open surgery in patients with PILN. .

Insuficiência renal aguda induzida pelo contraste em pacientes submetidos à cineangiocoronariografia: análise dos métodos de prevenção / Radiocontrast: induced nephropathy in patients undergoing coronary angiography: analysis of protective methods

A insuficiência renal aguda induzida por contraste (IRAIC) é considerada, atualmente, uma importante causa de disfunção renal em pacientes hospitalizados submetidos à cinecorioangiografia (CAG). Este achado adquire maior importância quando se verifica que a IRAIC é responsável por um aumento significativo dos índices de morbidade e mortalidade hospitalar / Radiocontrast-induced nephropathy (RIN) is considered an importante cause of renal failure in patients undergoing coronary. This data becomes more relevant when it presents a positive correlation with higher morbidity and mortality rates...