Laparoscopic and robotic urology surgery during global pandemic COVID-19

ABSTRACT Known laparoscopic and robotic assisted approaches and techniques for the surgical management of urological malignant and benign diseases are commonly used around the World. During the global pandemic COVID-19, urology surgeons had to reorganize their daily surgical practice. A concern with the use of minimally invasive techniques arose due to a proposed risk of viral transmission of the coronavirus disease with the creation of pneumoperitoneum. Due to this, we reviewed the literature to evaluate the use of laparoscopy and robotics during the pandemic COVID-19. A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID-19 virus was performed up to April 30, 2020. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. Few studies have been performed on viral transmission during surgery. No study has been made regarding this area during minimally invasive urology cases. To date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open, laparoscopic or robotic. There is no society consensus on restricting laparoscopic or robotic surgery. However, there is expert consensus on modification of standard practices to minimize any risk of transmission. During the pandemic COVID-19 we recommend the use of specific personal protective equipment for the surgeon, anesthesiologist and nursing staff in the operating room. Modifications of standard practices during minimally invasive surgery such as using lowest intra-abdominal pressures possible, controlled smoke evacuation systems, and minimizing energy device usage are recommended.

Vias de acesso para tratamento de cálculos urinários: influência da introdução da videolaparoscopia / Access way for treatment of urinary calculi: impact of the introduction of laparoscopy

Avaliar a influência da laparoscopia na rotina cirúrgica do Serviço de Urologia do HC-UFMG. Métodos: Foi feita uma análise retrospectiva de todas as cirurgias, para tratamento de cálculos, realizadas no HC-UFMG entre janeiro de 2004 e outubro de 2008. Resultados: No total foram realizados 613 procedimentos e 4.850 litotripsias extracorpóreas (LECOs). Ao estratificarmos o tipo de procedimento cirúrgico realizado em função do tempo, temos que: no período inicial do estudo (2004), houve apenas seis (4,7%) casos de litíase tratados pela via laparoscópica, já no ano de 2008, os procedimentos laparoscópicos corresponderam a 17 (15,2%) casos. Conclusões: As principais modalidades no tratamento de cálculos urinários são os procedimentos endoscópicos e a LECO. A laparoscopia, apesar de ter indicações limitadas, vem ganhando espaço frente à cirurgia aberta, principalmente nos casos refratários a tratamentos menos invasivos.

This paper aims to determine the influence of the laparoscopy in the treatment of urinary stones in a tertiary hospital (HC-UFMG). Methods: We reviewed our data from January 2004 to October 2008. All patients, who underwent surgery in our institution for the treatment of urinary calculi, were enrolled. Results: Six hundred and thirteen procedures and 4,850 shock wave lithotripsy (SWL) were performed. In the first year of the study (2004), only six (4.7%) cases were done by laparoscopic approach, whereas in the last year (2008) a total of 17 (15.2%) cases were performed using the laparoscopic technique. Conclusion: The SWL and the endoscopic surgery remained as the first line treatment of urinary stones, during the whole period studied. The laparoscopic technique, despite its limitations, is getting acceptance (over the traditional open procedure) and is indicated in those cases where minimally invasive techniques have failed.

New trends in minimally invasive urological surgery

Purpose: The perceived benefits of minimally-invasive surgery include less postoperative pain, shorter hospitalization, reduced morbidity and better cosmesis while maintaining diagnostic accuracy and therapeutic outcome. We review the new trends in minimally-invasive urological surgery. Materials and method: We reviewed the English language literature using the National Library of Medicine database to identify the latest technological advances in minimally-invasive surgery with particular reference to urology. Results: Amongst other advances, studies incorporating needlescopic surgery, laparoendoscopic single-site surgery , magnetic anchoring and guidance systems, natural orifice transluminal endoscopic surgery and flexible robots were considered of interest. The results from initial animal and human studies are also outlined. Conclusion: Minimally-invasive surgery continues to evolve to meet the demands of the operators and patients. Many novel technologies are still in the testing phase, whilst others have entered clinical practice. Further evaluation is required to confirm the safety and efficacy of these techniques and validate the published reports.

Cateter en doble J / Double J urethral catheter

Usamos el Catéter Ureteral en Doble J en varios casos de patología urología tales como, trauma, lesión iatrogénica y procedimientos quirúrgicos (pieloplastia, derivación urinaria, pelvis intrasinusal friable con infección y cálculos, etc.). La técnica endoscópica fue usada para tratar fístulas urinarias altas del uréter o la pelvis renal y uremia producida por cáncer pélvico avanzado que ocasionaba obstrucción. Somos especialmente entusiastas del uso del catéter en doble J para evitar obstrucciones severas del sistema urinario producidas por lesiones tuberculosas. Se comenta la mínima incrustación, la excelente tolerancia y la seguridad en los procedimientos quirúrgicos sin la utilización de catéteres externos

Uretroplastia transpubica / Transpubic Urethroplasty

Se operaron veinte pacientes, 2 niños y 18 adultos, por vía transpúbica para reparar lesiones de la uretra membranosa, asociadas a traumas severos de la pelvis ósea. Se utilizó en la mayoría de los casos una incisión adaptada por nosotros, que facilita tanto el abordaje de la pubectomía como el de la reparación uretral. Los resultados fueron altamente satisfactorios