A census of laparoscopic and robotic urological practice: a survey of minimally invasive surgery department of the Brazilian Society of Urology

ABSTRACT Minimally invasive urologic surgery has been developing in Brazil and now is a routine part of care in many regions and patients with different conditions benefit from it. Training in laparoscopic and robotic surgery has evolved and concerns exist both over the quality of surgical training and the practical effect on results of the urological training. This is an unprecedented study which undertook a census to determinate the current state of laparoscopic and robotic urological practice and to know the mains barriers to adequate practice in Brazil. In august 2017, surveys, consisting of an anonymous questionnaire with 15 questions, were sent via internet to the mailing list of the Brazilian Society of Urology (SBU). With these data, activities related to laparoscopy and robotic surgery of our urologists and the mains difficulties and barriers to practice laparoscopy and robotic surgery were evaluated. In our survey, 413 questionnaires were completed. Majority of the responders were currently working in the southeast region of Brazil (52.1%) and 75.5% of the surgeons performed laparoscopic surgery while, only 12.8%, robotic surgery. The lack of experience on the technique and the lack of equipment were the mains barriers and difficulties for not executing laparoscopic and robotic surgeries, respectively. Proper longitudinal training and access to good equipment in minimally invasive surgery are still barriers for urologists in our country.

Total and partial laparoscopic adrenalectomy

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Laparoscopic renal biopsy

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Cistectomia radical laparoscópica com reservatório ileal / Laparoscopic radical cystectomy with ileal reservoir

Worldwide experience with laparoscopic radical cystectomy is increasing in the last few years. We describe a 29-year-old female who underwent a laparoscopic radical cystectomy with ileal reservoir for a bladder sarcoma. Operative time was 405 minutes and estimated blood loss was 500 mL. She had an uneventful postoperative course and was discharged in the fifth postoperative day. Key-words: bladder, cystectomy, laparoscopy, urinary diversion, bladder neoplasms.

A comparison of hand-assisted and pure laparoscopic techniques in live donor nephrectomy

PURPOSE: To compare hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy techniques in live donor nephrectomy. METHODS: In this retrospective study, we included all patients submitted to hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy between May 2002 and December 2007. The operative data and post-operative courses were reviewed. Information was collected on the operative time, warm ischemia time, estimated blood loss, intra-operative complications, time to first oral intake, length of hospital stay, and post-operative complications. The data were analyzed using Student's t -tests and Fisher exact tests as appropriate, with statistical significance defined as p < 0.05. RESULTS: The means of the operative duration, warm ischemia time and intra-operative bleeding were 83 min, 3.6 min and 130.9 cc, respectively, for hand-assisted laparoscopic donor nephrectomy, and 78.4 min, 2.5 min and 98.9 cc, respectively, for pure laparoscopic live donor nephrectomy (p=0.29, p<0.0001 and p=0.08, respectively). Intra-operative complications occurred in 6 percent of patients submitted to hand-assisted laparoscopic donor nephrectomy and in 4.5 percent of those submitted to pure laparoscopic live donor nephrectomy (p=0.68). Only one patient from each group required conversion to open surgery; one person receiving hand-assisted laparoscopic donor nephrectomy had bleeding and one person receiving pure laparoscopic live donor nephrectomy had low carbon dioxide levels during the warm ischemia period. Compared with patients receiving hand-assisted laparoscopic donor nephrectomy, patients submitted to pure laparoscopic live donor nephrectomy were able to take their first meal earlier (12.5 vs. 9.2 hours, p=0.046), were discharged home sooner (2.8 vs. 1.4 days, p<0.0001) and had fewer post-operative complications (7.5 percent vs. 0.6 percent, p=0.04). CONCLUSIONS: Pure laparoscopic live...

Controle dos vasos renais usando clips vasculares e fio cirúrgico em nefrectomias vídeo-assistidas de doadores vivos / Control of renal vessels using titanium clips and cotton suture in hand-assisted laparoscopic live donor nephrectomy

OBJETIVO: A nefrectomia laparoscópica em doadores vivos para transplante renal vem assumindo um papel importante na era das cirurgias minimamente invasivas, acarretando menor morbidade aos doadores, e resultados semelhantes à técnica aberta no que se refere ao enxerto renal. O objetivo do presente artigo é relatar a experiência do nosso serviço utilizando a técnica de controle dos vasos renais usando fio cirúrgico e clips vasculares. MÉTODO: Foram realizadas 45 nefrectomias utilizando a técnica vídeo-assistida, com ligadura dos vasos renais com clips de titânio (LT-300) e fio cirúrgico. As variáveis analisadas foram tempo cirúrgico, perda sangüínea, tempo de isquemia quente, permanência hospitalar, necessidade de conversão e complicações. RESULTADOS: O procedimento foi realizado com sucesso em todos os casos. O tempo cirúrgico médio foi de 118 minutos, com perda sangüínea estimada em 84ml e tempo de isquemia quente de 4,3 minutos. Dois casos de íleo prolongado, uma lesão de veia gonadal, um escape de artéria renal e uma necrose de ureter foram observados. A permanência hospitalar média foi de 3,7 dias. O uso de clips vasculares e fio cirúrgico reduziu a perda de tecido venoso comparado à técnica com staplers e gerou redução de custos. CONCLUSÕES: A nefrectomia vídeo-assistida com a técnica descrita é factível e mostrou ser efetiva na contenção de gastos e na redução de tecido venoso perdido.

BACKGROUND: Laparoscopic live donor nephrectomy has acquired an important role in the minimally invasive surgery era, decreasing morbidity to kidney donors, with an equivalent renal graft outcome compared with open surgery. The aim of this article is report our experience using the technique of renal vessels control with metallic clips and cotton suture. METHODS: Fourty-five nephrectomies were performed following the hand-assisted technique and using titanium clips (LT-300) and cotton suture for renal vessels ligatures. Operative data and postoperative courses were reviewed, including surgical time, estimated blood loss, warm ischemia time, length of hospital stay, conversion to laparotomy, and complications. RESULTS: The procedure was performed successfully in all cases, including 18 right nephrectomies and 27 left nephrectomies. The mean operative time in our series was 118 minutes, with an estimated blood loss of 84ml and warm ischemia time of 4.3 minutes. Two cases of postoperative ileus, one gonadal vein lesion, one metallic clip displacement and one ureteral necrosis were observed. The mean postoperative hospital stay was 3.7 days. The use of titanium clips and cotton suture reduced the loss of venous tissue compared to the technique using the Endo-GIA stapling device (4 to 6 mm vs. 10 to 15 mm) and showed to be associated with a cost reduction, saving about 700 US dollars per stapler. CONCLUSION: Hand-assisted nephrectomy using the above described technique is technically feasible and showed to be effective in reducing costs and decreasing the loss of vascular length.

Quilotórax traumático por ferimento penetrante do tórax / Traumatic chylothorax by Gunshot wound of thorax

The authors report two cases of traumatic chylothorax. They were caused by gunshot wounds producing thorax transfixing injuries and the chilothorax was subsequently diagnosed during the thoracic drainage follow-up, a chilous color was noticed in the drainage output. This was confirmed with a Sudam III stain. Both cases were treated conservatively with Total Parenteral Nutrition according to the current literature. One of the cases, in its evolution, required surgical treatment due to a persistent high output fistulae

Clampeamento da aorta torácica: experiência de um Hospital de Emergência / Aortic cross-clamping: experience in an emergency hospital

A oclusäo temporária da aorta descendente, tanto antes quanto depois do procedimento cirúrgico pelas lesöes traumáticas, visa a redistribuiçäo do fluxo sanguíneo para o coraçäo e para o cérebro e também minimizar a perda sanguínea. Este estudo descreve a experiência dos autores na realizaçäo da toracotomia antero-lateral esquerda com oclusäo temporária da aorta descendente no manejo de pacientes com perda sanguínea maciça. Analisou-se retrospectivamente onze pacientes vítimas de trauma torácico e abdominal fechado e/ou penetrante, admitidos no Hospital Universitário Cajurú, da Pontifícia Universidade Católica do Paraná, de fevereiro à novembro de 1996. Todos os pacientes foram submetidos ao clampeamento da aorta torácica. Os onze pacientes eram do sexo masculino, com idade média de 22,2 anos. A causa mais comum de trauma foi ferida por arma de fogo, representando 72,7 por cento de todos os casos. ORTs era 4,11 + - 1,97. O local mais frequentemente envolvido foi o abdome (63,6 por cento) e 81,8 por cento pacientes apresentavam lesöes nos grandes vasos tóraco-abdominais. O clampeamento aórtico foi realizado antes da abordagem das lesöes traumáticas em sete pacientes. O índice de mortalidade no pós-operatório imediato foi 63,6 por cento. Somente dois pacientes sobreviveram na amostra global e um deles desenvolveu uma acidose metabólica. O clampeamento da aorta representa um risco imediato de morte devido às severas lesöes hemorrágicas que o precedem. Em relaçäo à literatura, retardamos o clampeamento da aorta torácica, visto que näo há uma hora oportuna para proceder com o clampeamento da aorta. O clampeamento aórtico apresenta-se como um procedimento desafiador, sendo raramente realizado e está associado a um elevado índice de mortalidade, devido a gravidade das lesöes associadas(AB)