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1.
Mongolian Medical Sciences ; : 70-79, 2021.
Artigo em Inglês | WPRIM | ID: wpr-974462

RESUMO

@#However, the use of robots in medicine has only 30 years of history. The application of robots in surgery originates from the need of modern man to achieve two goals: the telepresence and the performance of repetitive and accurate tasks. The first ‘‘robot surgeon’’ used on a human patient was the PUMA 200 in 1985. In the 1990s, scientists developed the concept of ‘‘master–slave’’ robot, which consisted of a robot with remote manipulators controlled by a surgeon at a surgical workstation. Despite the lack of force and tactile feedback, technical advantages of robotic surgery, such as 3D vision, stable and magnified image, Endo Wrist instruments, physiologic tremor filtering, and motion scaling, have been considered fundamental to overcome many of the limitations of the laparoscopic surgery. Since the approval of the da Vinci robot by international agencies, American, European, and Asian surgeons have proved its factibility and safety for the performance of many different robot-assisted surgeries. </br> Comparative studies of robotic and laparoscopic surgical procedures in general surgery have shown similar results with regard to perioperative, oncological, and functional outcomes. However, higher costs and lack of haptic feedback represent the major limitations of current robotic technology to become the standard technique of minimally invasive surgery worldwide. Therefore, the future of robotic surgery involves cost reduction, development of new platforms and technologies, creation and validation of curriculum and virtual simulators, and conduction of randomized clinical trials to determine the best applications of robotics.

2.
Mongolian Medical Sciences ; : 10-16, 2020.
Artigo em Inglês | WPRIM | ID: wpr-974632

RESUMO

Background@#An aim of this study was to evaluate the long-term functional outcomes of laparoscopic ureteropyeloplasty compared to that of open surgery at the Urology and Andrology Center of the First Central Hospital of Mongolia. Ureteropelvic junction (UPJ) is the most common site for upper urinary tract obstruction occurring 1 in 750 - 1500 births. Laparoscopic pyeloplasty was first reported in 1993 by Schuessler WW and its technique was dismembered pyeloplasty.@*Material and Methods@#In the period from June 2018 to September 2019, we have operated 91 ureteropyeloplasty cases. Patients were randomized into Group I (45 laparoscopy) operated by the laparoscopic ureteropyeloplasty and Group II (46 open surgery) operated by the open ureteropyeloplasty. All the patients had ureteropelvic junction obstruction and ureteropyeloplasty was performed. Both groups were compared according to the operative time, and recovery duration. We studied restoration of renal function and causes of conditions. Demographic data including age, gender and complications were recorded. Renal diethylenetriamine penta-acetate scintigraphy was respectively performed 6 months after surgery. @*Results@#Mean age was 32±12.05 ranging 16-62 in all the study population. A total of 91 (55 men and 36 women) were participated. Ureteropelvic junction stricture was occurred 75.66% in laparoscopic cases and 84.78% in open cases which leads to hydronephrosis and it was statistically different (p<0.028). Compared to that of open surgery, wound size was 6 time smaller, blood loss and hospital stay less than 2 fold and wound healing is 5 days shorter than open surgery. There was statistical different (p<0.001) between parameters of 2 groups. In laparoscopic and open group respectively, renal function was 41.78±10.02ml/min, 42.15±11.34 ml/min (1.73м2). After intervention, renal function was increased by (46±10.17ml/min, 46.09±11.50ml/min) and there was difference between 2 groups (p<0.003). In laparoscopic group, renal function was more improved than open group (p=0.05).@*Conclusion@#Laparoscopic surgery had less blood, less analgesics usage, fewer hospital stays, and faster wound healing. Renal function was improved 6 months after surgery.

3.
Health Laboratory ; : 10-19, 2019.
Artigo em Inglês | WPRIM | ID: wpr-973026

RESUMO

Purpose@#Follow-up examinations in kidney donors is an essential yet necessary process in organ transplantation. In this study, we aimed to evaluate kidney function using biomarkers and biomarker based eGFR in kidney donors within 5 years of organ transplantation.@*Materials and method@#91 donors enrolled in our study. We measured body weight and blood and urine samples for laboratory tests. eGFR was calculated using 6 estimations.@*Result@#The mean serum creatinine in participants was 0.81±0.22 mg/dL, cystatin C was 1.11±0.19 mg/dL, urea was 31.44±8.02 mg/L. Systolic hypertension in subjects was 130.0±16.5 mmHg while diastolic hypertension was 78.4±10.8 mmHg. In all donors, 15.9% (n=14) had hematuria, 23.6% (n=21) had proteinuria, 24.7% (n=19) had albuminuria. Body weight, creatinine, cystatin C and urea measurements had gradually increased over the years. The average eGFR was 72.9±17.9 to 112.8±34.0 ml/min/1.73m<sup>2</sup> showing 0.15%-35.22% before donation. Follow – up rate was 28.3-59.2% of total donors.Having health insurance and living far from Ulaanbaatar city influenced follow – up rate. Donor registration data should be updated regularly. @*Conclusion@#</br> 1. Serum creatinine, cystatin C, urea was increasing in living kidney donors. Hypertension and microalbuminuria was greater than other donor study results. </br> 2. eGFR decreased 0.15-35.22% in donor. CKD EPI combined equation was best for donor. </br> 3. Health insurance and living far from Ulaanbaatar city were the influencing follow – up rate. Registration data is missing in 25.5%-82.4% of total donors suggesting enhancement in data collection.

4.
Mongolian Medical Sciences ; : 52-59, 2019.
Artigo em Inglês | WPRIM | ID: wpr-973308

RESUMO

@#There are many treatment options for the management of ureteropelvic junction obstruction (UPJO). Open pyeloplasty has a high success rate and has been considered as a gold standard. Minimally invasive surgical techniques are associated with reduced morbidity, improved cosmetic result and better convalescence than open pyeloplasty. For endopyelotomy, these advantages for minimally invasive surgery such as laparoscopic pyeloplasty and robot assisted pyeloplasty have superior success rate than open pyeloplasty. However, the success rate for laparoscopic surgery could potentially be improved by careful selection of patients, using the criteria of stricture <2 cm, renal function >25% and the absence of severe hydronephrosis. Laparoscopic pyeloplasty and robot-assisted pyeloplasty have similar success rates to open pyeloplasty (>90%) and the best outcomes have been reported for robot-assisted pyeloplasty although this treatment option is less readily available than laparoscopic pyeloplasty. Retrograde endopyelotomy is a simple, safe, and effective therapeutic option for primary and secondary symptomatic UPJO. </br> Retrograde endopyelotomy should be considered a viable first-line treatment option for the management of patients with UPJO. These include balloon dilation, antegrade endopyelotomy, retrograde endopyelotomy, Acucise endopyelotomy and laparoscopic pyeloplasty. During last decade, advances in endourological techniques have resulted in significant progress in the development of minimally invasive surgical procedures to treat UPJO. </br> Surgeons described their modification of Kusters dismembered procedure that involved anastomosis of the spatulated ureter to a projection of the lower aspect of the pelvis after a redundant portion was excised. Laparoscopic pyeloplasty was first reported in 1993 both by Schuessler and others and by Kavoussi and Peters, who utilized dismembered pyeloplasty technique. During last decade, advances in endourological techniques have resulted in significant progress in the development of minimally invasive surgical procedures to treat UPJO. The combination of less postoperative morbidity, improved cosmesis, shorter convalescence and comparable operative success rates has lured many patients away from gold standard of open pyeloplasty. Only few retrospective studies have been conducted regarding laparoscopic versus open pyeloplasty. Success rates are comparable for laparoscopic pyeloplasty.</br> The number of minimally invasive surgeries performed by us increased from year to year. Therefore the characteristics and performance of the surgeries should be studied in detail and based on the finding the evidence based medicine should be placed in.

5.
Mongolian Medical Sciences ; : 34-37, 2016.
Artigo em Inglês | WPRIM | ID: wpr-975613

RESUMO

Backgroundin 2009 we have been done the laparoscopic nephrectomy in the patient with left kidney cancer. In Urologyand Andrological center of State central hospital we have been done the urological laparoscopic surgerywhich is 0.32% of all surgery from 2010 to 2016. Following such increasing number of laparoscopicsurgery in urology we aimed to study surgical approach’s efficiency between open and laparoscopic forkidney cyst.Material and MethodsSince 2012 in surgery for kidney cysts studies case series models the center UNTE urology andandrology center based on clinical cases 34. Renal cysts with her open and laparoscopic surgicaladmissions bed days, wound size, surgery time, the average number of parameters such as size of thecyst value, standard deviation, median values, the high and low values expressed are compared.ResultIn our study includes 34 patients who was undergo the kidney cystectomy by open or laparoscopictechnique and ages between 18-68 (average age 48.1±12.07). 20 of them female and 14 of them malepatients. 18 of them were undergone laparoscopic cystectomy and 16 were undergone open surgery.Our study show that the cyst size is 2.5-10cm (average size 6±1.7) and there is no statistical correlationbetween cyst size and surgical types. The laparoscopic kidney cystectomy procedure lasts around 55-130min (average duration 93.1±23) which is 26 min longer than open cystectomy. The patient who wentto laparoscopic surgery their hospital staying duration is 2 fold less than the patient who went to opensurgery. Post operation surgical wound long is 4±0.8cm in laparoscopic surgery and 20.1±2.8 in opensurgery and therefore 5 times less in laparoscopic surgeryConclusionEven though the laparascopic kidney cystectomy’s procedure duration is longer than open technique, ithas less hospital staying duration, small surgical wound and fast rehabilation time.

6.
Journal of Surgery ; : 42-45, 2016.
Artigo em Inglês | WPRIM | ID: wpr-975568

RESUMO

Introduction: Extracorporeal shockwave lithotripsy (ESWL) revolutionizedthe treatment of urolithiasis and graduallybecame the favorite treatment option sothat today it is considered to be the first lineof treatment for patients with urolithiasis.The purpose of this study was assessment oftherapeutic efficacy, complications of ESWLin urolithiasis in Mongolia.Material and methods: A total of46 patients harboring renal and ureteralstones underwent ESWL between March2016 and September 2016 at First CentralHospital of Mongolia. Karl Storz ModulithSLK electromagnetic machines were usedto impart shock waves. All collected stonefragments sent for biochemical analysis.Results: A total of 46 patients 23 weremales (50%). Patients were mean age of34. The stone size distribution was 0.5cmto 3.1cm. The average treatment time wasranging from 75-110 minutes. The averagenumber of shock waves per treatmentwas 3172±378 (range 1500-4000). Theoverall success rate was 75.73%. All calculidisintegrated satisfactorily except for 3stones, which is located lower 1/3rd ofureter. Stone composition analysis proved tobe composed entirely or predominantly ofcalcium oxalate monohydrate. These patientsrequired to have ureterolithoextraction. Calculicomposition for remaining patients 12 werecalcium oxalate monohydrate, 17 calciumoxalate dehydrate, 6 uric acid and 1 struvite.Complications were mostly minor and rare.Most of the patients (90.7%) developedmacroscopic hematuria after treatment; fewpatients developed mild bruising at the entryand exit sites of the shockwaves on the bodywall. Severe complications such as renalhematoma and steinstrasse were diagnosedfor one patient each and their managementwas non-surgical.Conclusion: ESWL is therefore the firstline treatment for urolithiasis with stonesize smaller than 2cm. It has an efficiencyrate above 75, low procedure time, highsafety and good tolerability and minimalcomplication.

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