Forest buffer-strips mitigate the negative impact of oil palm plantations on stream communities.

The global area cultivated with oil palm has doubled in the past two decades, causing deforestation, land-use change, freshwater pollution, and species loss in tropical ecosystems worldwide. Despite the palm-oil industry been linked to severe deterioration of freshwater ecosystems, most studies have focused on terrestrial environments, while freshwaters have been significantly less studied. We evaluated these impacts by contrasting freshwater macroinvertebrate communities and habitat conditions in 19 streams from primary forests (7), grazing lands (6), and oil palm plantations (6). In each stream, we measured environmental characteristics, e.g., habitat composition, canopy cover, substrate, water temperature, and water quality; and we identified and quantified the assemblage of macroinvertebrates. Streams in oil palm plantations lacking riparian forest strips showed warmer and more variable temperatures, higher turbidity, lower silica content, and poorer macroinvertebrate taxon richness than primary forests. Grazing lands showed higher conductivity and temperature, and lower dissolved oxygen and macroinvertebrate taxon richness than primary forests. In contrast, streams in oil palm plantations that conserved a riparian forest, showed a substrate composition, temperature, and canopy cover more similar to the ones in primary forests. These habitat improvements by riparian forests in the plantations increased macroinvertebrate taxon richness and maintained a community resembling more the one in primary forests. Therefore, the conversion of grazing lands (instead of primary forests) to oil palm plantations can increase freshwater taxon richness only if riparian native forests are safeguarded.

Robot-assisted partial nephrectomy in 95 consecutive patients: Oncological and functional outcomes at 3 years of follow-up. / Nefrectomía parcial robótica en 95 pacientes consecutivos: resultados oncológicos y funcionales a 3 años de seguimiento.

BACKGROUND: We present the oncological and functional results from a series of 43 patients with renal tumours, treated consecutively with robot-assisted partial nephrectomy (RPN). MATERIALS AND METHOD: Between 2010 and 2014, we performed 95 RPNs. To assess the results, we included only those patients (n=43) who had a minimum follow-up of 2 years. A descriptive analysis was conducted of the demographic characteristics and perioperative variables. We employed Kaplan-Meier curves to assess overall survival, cancer-specific survival and recurrence-free survival. RESULTS: The patients' mean age was 53.1±13.5 years. The mean preoperative tumour size was 3.7±2.3cm. The mean surgical time was 102.2±37.1min. The mean ischemia time was 21.27±7.74minutes, with a median intraoperative bleeding volume of 150mL (IQR, 87.5-425). There was a 7% rate of postoperative complications (Clavien≥III). There was no mortality. The average Fürhman grade was 2.5±0.56. There were no positive surgical margins or local recurrences. The median follow-up was 38±8 months, with an overal survival, recurrence-free survival and cancer-specific survival of 100% at 3 years of follow-up. The recurrence-free survival was 92,3% at 48 months of follow-up. The mean preoperative glomerular filtration rate was 91.04±28.17mL/min/1.73m(2), and the postoperative rate was 89.9±27.69mL/min/1.73m(2), with a nonsignificant reduction (P=.74). CONCLUSIONS: The functional and oncological results of our series confirm the safety and efficacy of RPN. RPN offers optimal preservation of renal function and oncological control in the medium term.

Indiana continent catheterizable urinary reservoir.

INTRODUCTION: Radical pelvic surgery requires continent or incontinent urinary diversion. There are many techniques, but the orthotopic neobladder is the most used. A continent catheterizable urinary reservoir is sometimes a good alternative when this derivation is not possible or not indicated. This paper has aimed to present our experience with the Indiana pouch continent urinary reservoir. MATERIAL AND METHODS: The series is made up of 85 patients, 66 women and 19 men, with a mean age of 56 years (31-77 years). Variables analyzed were operating time, estimated blood loss, transfusion rate, hospital stay and peri-operatory complications. RESULTS: The main indication in 49 cases was resolution of complications related to the treatment of cervical cancer. Average operation time was 110.5 minutes (range 80-130 minutes). Mean blood loss was 450 cc (100-1000 cc). Immediate postoperative complications, all of which were treated medically, occurred in 16 patients (18.85%). One patient suffered anastomotic leakage. Hospital stay was 19 days (range 5-60 days) and there was no mortality in the series. Late complications occurred in 26 patients (32%), these being ureteral anastomotic stenosis in 11 cases, cutaneous stoma stenosis in 9 cases and reservoir stones in 6 cases. CONCLUSION: The Indiana continent catheterizable urinary reservoir is a valid option for the treatment of both urological and gynecological malignancies as well as for the management of pelvic morbidity related to the treatment of pelvic cancers.

Complications associated with laparoscopic adrenalectomy: Description and standardized assessment.

OBJECTIVE: Laparoscopic adrenalectomy (LA) is the procedure of choice for surgical management of the adrenal masses. Our objective is to show a standardized assessment of perioperative complications in one LA series. MATERIAL AND METHODS: 322 LA were performed consecutively between June of 1993 and September of 2012 in patients diagnosed with suprarenal tumour. In order to evaluate perioperative complications, data were collected prospectively and analysed retrospectively. Intraoperative complications were defined using Satava classification and Clavien-Dindo classification of postoperative complications. RESULTS: Twenty five LA showed perioperative complications (7.3%); 11 (3.2%) were intraoperative complications, most of them vascular diaphragmatic lesions (Satava Grade 2); and 14 (4.1%) were postoperative complications. Six patients showed complications requiring surgery (Clavien IIIa/IIIb) and/or support in Intensive Care Unit (Clavien IV). Conversion to open surgery was necessary in one case (.3%). Despite all appropriate preoperative endocrine measures were taken, an uncontrolled hypertensive crisis and cardio-respiratory arrest recovered were developed during surgery in one patient carrier of pheochromocytoma who died from massive cerebral infarction at 5 days (Clavien V). CONCLUSIONS: Standardized criteria of surgical complications are necessary. Standardization is possible by combined application of two tools. We believe that this evaluation concept of the surgery morbidity must be used systematically in order to achieve a new standard refined, concise and comparative for reports of adverse perioperative events.

Laparoscopic partial nephrectomy: An experience in 227 cases.

OBJECTIVE: To evaluate our long-term experience with laparoscopic partial nephrectomy (LPN) and to review the literature. MATERIAL AND METHODS: We performed a retrospective chart review, evaluating 227 consecutives laparoscopic partial nephrectomies performed between June 1995 and June 2010. Perioperative were recorded along with clinical a oncological outcomes. RESULTS: Mean age was 56.4 years (18-87) and clinical stages were T1a, T1b and T2 in 90.74% (206/227), 7.48% (17/227) and 1.76% (4/227), respectively. Median blood loss was 250 mL (10-1800). The mean operative time was 108.42 minutes (30-240) and median warm ischemia time was 25 minutes (10-60). The intraoperative complication rate was 2.64% (6/227), 5 (2.2%) secondary to bleeding. The postoperative complication rate was 5.72% (13/227) and bleeding is also the most frequent in 3% (7/227) of the cases. According to the Clavien classification, 1.32% (3/227), 0.88% (2/227) and 3.52% (8/227) were grade I, II and IIIb, respectively. The mean hospital stay was 3.66 days (1-12). Clear cell carcinoma was the most common histological finding in 74.6% (150 patients). TNM clasification was T1a, T1b y T2 in 90.74% (206/227), 7.48% (17/227) and 1,76% (4/227), respectively. No conversion or mortality was reported. Positive surgical margins were found in 4 patients (2.7%), with no local recurrence after long-term follow-up. At a mean follow up of 27 months, one patient had port site and peritoneal recurrence. CONCLUSION: Laparoscopic partial nephrectomy is a safe and viable alternative to open partial nephrectomy, providing equivalent oncologic outcomes and comparable morbidity to the traditional approach in experienced centers.

Laparoscopic pyeloplasty: technique and results in 80 consecutive patients.

OBJECTIVE: To present our long-term results with the Anderson-Hynes laparoscopic pyeloplasty, performed by a single surgeon. MATERIAL AND METHODS: Between August 1999 and December 2009, 79 patients (80 procedures) were operated for primary ureteropelvic junction obstruction. We use the Anderson-Hynes technique by a transperitoneal approach. Patients were evaluated with Ultrasound, Excretory urography and dynamic renal scintigraphy (Mag-3). The perioperative characteristics, complications and results were reviewed. RESULTS: We performed 80 laparoscopic pyeloplasties in 79 patients. Mean operative time was 93.2 minutes (60-180). Crossing vessels were found in 38 of 82 (46.3%) renal units. Kidney abnormalities occurred in 4 patients (1 double ureteropelvic system, one associated retrocaval ureter, 1 horseshoe kidney and one pelvic kidney). Complications occurred in 5 procedures (6.5%): an immediately postoperative bleeding (Clavien 3b), 1 cecal volvulus (Clavien 3b), 1 urosepsis (Clavien 4th) and 1 urinary fistula (Clavien 3a). In this series there was neither mortality nor conversion to open surgery There was recurrence in 3 out of 80 patients (3.7%). They were resolved as follows: 1 percutaneous antegrade endopyelotomy, 1 secondary laparoscopic pyeloplasty and 1 robotic pyeloplasty. There was a 96.3%. of primary overall success rate. CONCLUSIONS: Our results show that laparoscopic pyeloplasty compares favorably with the result achieved by open surgery. We believe that laparoscopic pyeloplasty is a good surgical alternative for the management of primary ureteropelvic junction obstruction.

Laparoscopic cystectomy and intracorporeal continent urinary diversion (Mainz II) in treatment for interstitial cystitis.

INTRODUCTION: Interstitial cystitis (IC) is a difficult-to-manage chronic and insidious condition. We present a series of patients with IC who failed to respond to conservative treatment. The patients underwent total cystectomy with completely intracorporeally performed continent urinary diversion (Mainz II rectosigmoid pouch) as a radical alternative to the treatment of this condition. MATERIAL AND METHODS: Eight patients who fulfilled the clinical criteria for IC according to the National Institute of Health and in whom all previous conservative treatments had failed between January 2001 and April 2009 were operated on. A descriptive analysis was made with the following variables: age, surgical risk according to the American Society of Anesthesiology (ASA), total surgical time (ST), ST of the cystectomy, ST of the urinary diversion, early and late complications, time of hospital stay, bleeding and need of transfusion, specimen extraction pathway and uterine sparing. RESULTS: Mean age was 54.25 (±17.8) years, total mean ST 286.4 (±44.8) minutes, mean ST of the cystectomy 86.2 (±25.6) minutes, mean ST of the diversion 123.7 (±28.6) minutes, mean bleeding 321.4 (±242.9) cc, mean time of hospital stay 8.3 (±1.3) days. Fifty percent were ASA I, 37.5% ASA II and 12.5% ASA III. A hysterectomy was made in 50% of the cases. In 5 cases (62.5%) the bladder was extracted through the rectum and in 3 cases (37.5%) through the vagina. The only early complication was urinary sepsis in one patient. There was no conversion in the series. CONCLUSIONS: Total cystectomy with urethrectomy and intracorporeal continent urinary diversion is an effective and definitive alternative for the treatment of treatment resistant IC. Their technical difficulty and its learning curve limit their application to centers with an extensive experience in laparoscopy.

Reemplazo ureteral con colgajo de Boari laparoscópico: experiencia multi-institucional en 30 casos / Laparoscopic ureteral replacement by Boari flap: Multi-institutional experience in 30 cases

Introducción: El colgajo vesical tipo Boari es una excelente técnica para el reemplazo de lesiones del uréter distal. Existen pocas comunicaciones con el uso de la vía laparoscópica, sobre todo con resultados a largo plazo. Nuestro objetivo es presentar los resultados de un estudio multi-institucional en 30 casos. Material y método: Se analizan 30 pacientes tratados entre diciembre de 2001 y enero de 2009, en quienes se realizó un colgajo de Boari laparoscópico intracorpóreo en 3 centros latinoamericanos. En todos los casos se empleó la misma técnica quirúrgica. La base de datos fue registrada de forma prospectiva y analizada retrospectivamente. Resultados: La edad media fue de 43,2 años (rango de 9 a 71 años). La mayoría fueron mujeres (22 de 30) con un ligero predominio del lado izquierdo (17 de 30). Las causa más frecuente de lesión ureteral fue la histerectomía en 14 pacientes (46,6%) y la ureterolitotomía endoscópica en 9 pacientes (30%). La longitud ureteral media resecada fue de 7 cm (5 a 20 cm). El tiempo medio operatorio fue de 161,16 min (90 a 280 min). El sangrado intraoperatorio estimado promedio fue de 123 ml (0 a 500 ml) y la estancia hospitalaria de 4,86 días (2 a 10 días). No hubo complicaciones intraoperatorias ni conversión a cirugía abierta. Ocurrieron complicaciones postoperatorias en 5 pacientes (16,6%), Clavien 1 en 2 pacientes (6,6%) y Clavien 3 en 3 pacientes (10%). La tasa de éxito de la cirugía fue del 96,6% (29 pacientes), con un tiempo medio de seguimiento de 32 meses (5 a 60 meses). Conclusiones: Nuestros resultados con la técnica de colgajo de Boari laparoscópico confirman los buenos resultados de esta técnica a corto y largo plazo (AU)

Introduction: The Boari flap is an excellent technique for replacement of distal ureteral injuries. There are few reports with the use of laparoscopic surgery, especially with long term results. Our goal is to present the results of a multi-institutional study of 30 cases. Materials and methods: We analyzed 30 patients treated between December 2001 and January 2009 who underwent a laparoscopic intracorporeal Boari flap, in three Latin American centers. In all cases the same surgical technique was employed. The database was recorded prospectively and analyzed retrospectively. Results: The mean age was 43.2 years (range 9–71 years). Most were women (22 of 30) with a slight predominance of left-side lesions (17 of 30). The most common cause of ureteral injury was hysterectomy in 14 patients (46.6%) and endoscopic ureterolithotomy in 9 patients (30%). The mean length of ureteral resection was 7 cm (5–20 cm). The average operative time was 161.16 min (90–280 min). The average estimated blood loss was 123 mL (0–500 mL), and hospital stay was 4.86 days (2–10 days). There were no intraoperative complications or conversion to open surgery. Postoperative complications occurred in 5 patients (16.6%), Clavien 1 in 2 patients (6.6%) and Clavien 3 in three patients (10%). The success rate was 96.6% (29 patients) with a mean follow up of 32 months (5–60 months). Conclusions: Laparoscopic Boari flap in our hands had good short and long term results (AU)

Linfadenectomía lumboaórtica laparoscópica en tumor residual posquimioterapia en el cáncer testicular / Laparoscopic lumbar-aortic lymphadenectomy in residual post-chemotherapy tumours in testicular cancer

Introducción: La linfadenectomía lumboaórtica abierta (LALA) es el estándar de oro en el manejo de masas retroperitoneales posquimioterapia. La LALA laparoscópica (LALA-L) ha surgido los últimos años como una alternativa para el manejo de estos pacientes, con los eventuales potenciales beneficios de la mínima invasión. Objetivo: Exponer nuestra experiencia en el manejo laparoscópico (LALA-L) de las masas residuales posquimioterapia en pacientes con cáncer testicular avanzado. Material y métodos: Entre los años 1993 y 2009 43 pacientes fueron sometidos a LALA-L posquimioterapia. Se utilizó una técnica transperitoneal en todos los pacientes. Se evaluaron variables demográficas, perioperatorias y patológicas, así como también las complicaciones y el seguimiento. Resultados: En 17 pacientes se realizó una disección unilateral, mientras que 26 pacientes fueron sometidos a una disección retroperitoneal bilateral. Del primer grupo 4 pacientes recidivaron; el segundo grupo no presenta recidivas. Tras un seguimiento promedio de 21 meses la tasa de sobrevida global alcanza un 95%. Solo se registró un 9,3% de complicaciones perioperatorias. Conclusiones: La LALA-L es una alternativa quirúrgica técnicamente factible, en manos experimentadas, en el tratamiento de pacientes portadores de un cáncer testicular avanzado con masas residuales posquimioterapia. La disección realizada debe ser bilateral en pro de evitar las recidivas tumorales y prolongar la tasa de sobrevida de estos pacientes (AU)

Introduction: Open lumbar-aortic lymphadenectomy (OLAL) is the gold standard for treating post-chemotherapy retroperitoneal masses. Laparoscopic OLAL (L-OLAL) has emerged in recent years as an alternative for the handling of patients with these masses, with the additional potential benefits of minimal invasion. Objective: To present our experience with the laparoscopic handling (L-OLAL) of residual post-chemotherapy masses in patients with advanced testicular cancer. Material and methods: Between 1993 and 2009, 43 patients underwent post-chemotherapy L-OLAL. A transperitoneal technique was employed in all patients. We assessed demographic, perioperational and pathological variables, as well as complications and follow-up. Results: A unilateral dissection was performed in 17 patients, while 26 patients underwent a bilateral retroperitoneal dissection. In the first group, 4 patients relapsed. In the second group, there were no relapses. After an average follow-up of 21 months, the overall survival rate reached 95%. We recorded a rate of perioperative complications of only 9.3%. Conclusions: In experienced hands, L-OLAL is a technically feasible surgical alternative for the treatment of patients who are carriers of advanced testicular cancer with residual post-chemotherapy masses. The dissection performed should be bilateral to avoid tumour relapses and increase the survival rate of these patients (AU)

Laparoscopic surgery of vesicoureteral reflux: an experience in 42 patients with the Lich-Gregoir extravesical technique.

INTRODUCTION: Vesico-ureteral reflux (VUR) is a common congenital anomaly of the urinary tract in the pediatric population, existing controversy regarding its management. Patients selected for treatment options are offered, from endoscopic injection of substances sub-ureteral to ureteral reimplantation surgery. OBJECTIVE: To evaluate the use of the laparoscopic surgical technique for the treatment of vesico-ureteral reflux, with an analysis of the procedure, results and complications. MATERIAL AND METHODS: We evaluated a series of 50 ureteral units in 42 patients, who undergoing laparoscopic transperitoneal ureteral reimplant, using the classic technique of Lich-Gregoir detrusorrafia. RESULTS: The mean operative time was 74 min. There were no intraoperative nor immediate postoperative. At longer follow-up VUR was cured in all cases. CONCLUSIONS: Laparoscopic surgery is an effective alternative in the surgical treatment of vesico-ureteral reflux, with results comparable to open surgery techniques and over sub-ureteral injection techniques.

Laparoscopic ureteral replacement by Boari flap: multi-institutional experience in 30 cases.

INTRODUCTION: The Boari flap is an excellent technique for replacement of distal ureteral injuries. There are few reports with the use of laparoscopic surgery, especially with long term results. Our goal is to present the results of a multi-institutional study of 30 cases. MATERIAL AND METHODS: We analyzed 30 patients treated between December 2001 and January 2009 who underwent a laparoscopic intracorporeal Boari flap, in three Latin American centers. In all cases the same surgical technique was employed. The database was recorded prospectively and analyzed retrospectively. RESULTS: The mean age was 43.2 years (range 9 to 71 years). Most were women (22 of 30) with a slight predominance of left-side lesions (17 of 30). The most common cause of ureteral injury was hysterectomy in 14 patients (46.6%) and endoscopic ureterolithotomy in 9 patients (30%). The mean length of ureteral resection was 7 cm. (5 to 20 cm). The average operative time was 161.16 min (90 to 280 min). The average estimated blood loss was 123 mL. (0 to 500 mL), and hospital stay was 4.86 days (2 to 10 days). There were no intraoperative complications or conversion to open surgery. Postoperative complications occurred in 5 patients (16.6%), Clavien 1 in 2 patients (6.6%) and Clavien 3 in three patients (10%). The success rate was 96.6% (29 patients) with a mean follow up of 32 months (5 to 60 months). CONCLUSIONS: Laparoscopic Boari flap in our hands had good short and long term results.

Nefrectomía parcial robótica con compresión selectiva del parénquima (pinza de Simon) / Robotic Partial Nephrectomy With Selective Parenchymal Compression (Simon Clamp)

Objetivo: Presentar nuestra experiencia inicial en nefrectomía parcial robótica (NPR) realizando compresión selectiva del parénquima renal, sin pinzamiento del hilio renal. Material y métodos: Se realizó NPR utilizando el sistema robótico da Vinci S HD con abordaje transperitoneal y compresión selectiva del parénquima renal a 4 pacientes con masa tumoral exofítica de localización polar. Se utilizó la pinza de Simon laparoscópica (Simon's clamp Aesculap®) sin control vascular del hilio renal. La reconstrucción renal fue la utilizada regularmente. Resultados: La edad promedio fue de 49,6 años (42-59) con una relación hombre/mujer 3:1. El tiempo operatorio promedio fue de 71,6 min (40-120). El sangrado estimado promedio fue de 250 ml (50-400). El tamaño tumoral promedio fue de 3,25 cm (1,5-5,3). No hubo complicaciones perioperatorias ni postoperatorias. La estancia media hospitalaria fue de 3,5 días (1-7). No hubo complicaciones hemorrágicas intra ni postoperatorias. El examen patológico de las lesiones reveló carcinoma renal en 3 casos y quiste hemorrágico en un caso. No hubo márgenes quirúrgicos positivos. Conclusiones: Nuestros resultados preliminares muestran que la NPR con compresión regional del parénquima renal es una alternativa quirúrgica factible en pacientes seleccionados y tumores de localización polar, proporcionando un campo quirúrgico adecuado para la resección tumoral (AU)

Objective: To present our initial experience using selective renal parenchymal ischemia, without hilar clamping, in robotic-assisted partial nephrectomy. Material and methods: In four patients with T1a renal tumor we performed robotic-assisted partial nephrectomy, using the Simon's clamp (Aesculap®). It provides selective parenchymal compression without the need of vascular clamping. All patients had exofitic renal tumors in polar location. Renal parenchymal reconstruction was done as the standard technique. Results: The median age was 49.6 years (42-59), 3 male and 1 female patient. Median operative time was 71,6 minutes (40-120). Mean stimated bleeding was 250 ml (50-400). Average tumor size was 3,25 cm (1,5-5,3). There were no complications and the average hospital stay was 3,5 days (1-7). The pathology was informed as renal cell carcinoma in three patients and one hemorrhagic cyst. The surgical margins were negative. Conclusion: Our preliminary results shows that selective renal parenchymal compression, with the Simon's clamp, provides an alternative to vascular control in selected patients with polar renal tumors (AU)

Laparoscopic lumbar-aortic lymphadenectomy in residual post-chemotherapy tumours in testicular cancer.

INTRODUCTION: Open lumbar-aortic lymphadenectomy (OLAL) is the gold standard for treating post-chemotherapy retroperitoneal masses. Laparoscopic OLAL (L-OLAL) has emerged in recent years as an alternative for the handling of patients with these masses, with the additional potential benefits of minimal invasion. OBJECTIVE: To present our experience with the laparoscopic handling (L-OLAL) of residual post-chemotherapy masses in patients with advanced testicular cancer. MATERIAL AND METHODS: Between 1993 and 2009, 43 patients underwent post-chemotherapy L-OLAL. A transperitoneal technique was employed in all patients. We assessed demographic, perioperational and pathological variables, as well as complications and follow-up. RESULTS: A unilateral dissection was performed in 17 patients, while 26 patients underwent a bilateral retroperitoneal dissection. In the first group, 4 patients relapsed. In the second group, there were no relapses. After an average follow-up of 21 months, the overall survival rate reached 95%. We recorded a rate of perioperative complications of only 9.3%. CONCLUSIONS: In experienced hands, L-OLAL is a technically feasible surgical alternative for the treatment of patients who are carriers of advanced testicular cancer with residual post-chemotherapy masses. The dissection performed should be bilateral to avoid tumour relapses and increase the survival rate of these patients.

Robotic partial nephrectomy with selective parenchymal compression (Simon clamp).

OBJECTIVE: To present our initial experience using selective renal parenchymal ischemia, without hilar clamping, in robotic-assisted partial nephrectomy. MATERIAL AND METHODS: In four patients with T1a renal tumor we performed robotic-assisted partial nephrectomy, using the Simon's clamp (Aesculap). It provides selective parenchymal compression without the need of vascular clamping. All patients had exofitic renal tumors in polar location. Renal parenchymal reconstruction was done as the standard technique. RESULTS: The median age was 49.6 years (42-59), 3 male and 1 female patient. Median operative time was 71,6 minutes (40-120). Mean stimated bleeding was 250 ml (50-400). Average tumor size was 3,25 cm (1,5-5,3). There were no complications and the average hospital stay was 3,5 days (1-7). The pathology was informed as renal cell carcinoma in three patients and one hemorrhagic cyst. The surgical margins were negative. CONCLUSION: Our preliminary results shows that selective renal parenchymal compression, with the Simon's clamp, provides an alternative to vascular control in selected patients with polar renal tumors.

Nefrectomía parcial robótica: experiencia inicial en 25 casos consecutivos / Robotic Partial nephrectomy: An initial experience in 25 consecutive cases

Objetivo: Presentar nuestra experiencia inicial en nefrectomía parcial robótica (NPR) en una serie de 25 pacientes operados de forma consecutiva. Material y métodos: Se trata de una serie de 25 pacientes consecutivos sometidos a NPR desde abril de 2010 a febrero de 2011. Se utilizó el sistema robótico da Vinci S HD, con abordaje transperitoneal. En 22 casos se utilizó control vascular total del hilio renal y en tres casos se realizó compresión selectiva del parénquima renal con un dispositivo ad hoc. Resultados: La edad promedio fue de 55,8 años (26-77), con una relación hombre/mujer 2:1. El tiempo operatorio promedio fue de 117,6 minutos (54-205) y el tiempo de isquemia caliente fue de 20,2 minutos (9-34). El sangrado estimado promedio fue de 440 ml (20-2.000). El tamaño tumoral promedio fue de 3,25 cm (1-5,3). Cinco pacientes (20%) presentaron complicaciones, siendo la hemorragia intraoperatoria la más frecuente (Clavien II). No hubo conversión a cirugía abierta o laparoscópica. La estancia media hospitalaria fue de 3,5 días (1-7). El examen patológico de las lesiones reveló carcinoma renal en 19 casos y lesiones benignas en 6 pacientes. No hubo márgenes quirúrgicos positivos ni mortalidad. Conclusiones: Nuestros resultados preliminares muestran que la NPR es una alternativa quirúrgica factible de realizar en pacientes con tumores renales de pequeño tamaño (AU)

Objective: To report our initial experience with robotic partial nephrectomy (RPN) in a series of 25 consecutively-operated patients. Material and methods: A series of 25 consecutive patients who underwent RPN from April 2010 to February 2011 were studied. We used the da Vinci S HD robotic system with transperitoneal approach. Total renal hilum control was used 22 cases and 3 patients underwent selective renal parenchymal compression with an adhoc device. Results: Mean age was 55.8 years (26-77) with a male/female ratio of 2:1. Mean operative time was 117.6 minutes (54-205) and the warm ischemia time was 20.2 minutes (9-34). Mean estimated blood loss was 440 ml (20-2000) and the mean tumor size was 3.25 cm (1-5.3). Five patients (20%) had complications, the most frequent being intraoperative bleeding (Clavien II). There was no conversion to open or laparoscopic surgery. Mean hospital stay was 3.5 days (1-7). The pathological study revealed renal cell carcinoma in 19 cases and benign lesions in6 patients. There were no positive surgical margins and no mortality. Conclusions: Our preliminary results show that RPN is a feasible surgical approach in small-size drenal tumors (AU)

[Robotic partial nephrectomy: an initial experience in 25 consecutive cases]. / Nefrectomía parcial robótica: experiencia inicial en 25 casos consecutivos.

OBJECTIVE: To report our initial experience with robotic partial nephrectomy (RPN) in a series of 25 consecutively-operated patients. MATERIAL AND METHODS: A series of 25 consecutive patients who underwent RPN from April 2010 to February 2011 were studied. We used the da Vinci S HD robotic system with transperitoneal approach. Total renal hilum control was used 22 cases and 3 patients underwent selective renal parenchymal compression with an ad-hoc device. RESULTS: Mean age was 55.8 years (26-77) with a male/female ratio of 2:1. Mean operative time was 117.6 minutes (54-205) and the warm ischemia time was 20.2 minutes (9-34). Mean estimated blood loss was 440 ml (20-2000) and the mean tumor size was 3.25 cm (1-5.3). Five patients (20%) had complications, the most frequent being intraoperative bleeding (Clavien II). There was no conversion to open or laparoscopic surgery. Mean hospital stay was 3.5 days (1-7). The pathological study revealed renal cell carcinoma in 19 cases and benign lesions in 6 patients. There were no positive surgical margins and no mortality. CONCLUSIONS: Our preliminary results show that RPN is a feasible surgical approach in small-sized renal tumors.

Prostatectomía simple (adenomectomía) por vía laparoscópica: experiencia en 59 pacientes consecutivos / Laparoscopic Simple Prostatectomy (Adenomectomy): Experience in 59 Consecutive Patients

Objetivo: La adenomectomía laparoscópica es una alternativa mínimamente invasiva a la cirugía abierta en próstatas de gran volumen. Nuestro objetivo es dar a conocer nuestra serie de 59 pacientes tratados mediante adenomectomía laparoscópica con control vascular preciso. Material y métodos: Entre junio de 2003 y junio de 2006 un total de 59 pacientes con una edad promedio de 65,5 años (51 a 82) fueron sometidos a adenomectomía laparoscópica extraperitoneal. Todos los pacientes tenían un historial de síntomas del tracto urinario inferior (STUI) y de hiperplasia benigna de próstata (HPB). La mediana del International Prostate Symptom Score (IPSS) fue de 20 puntos (16-22). La información fue recogida de forma prospectiva en una base de datos. El análisis fue realizado a posteriori. Resultados: Todos los 59 adenomas fueron extirpados en su totalidad por vía laparoscópica sin conversión a cirugía abierta. La mediana de volumen prostático preoperatorio medida por ultrasonidos fue de 108,5 cc (75-150). El tiempo operatorio promedio fue de 123 minutos (90-180). La pérdida de sangre promedio fue 415ml (50-1500) y 4 pacientes (14,8%) requirieron transfusión de sangre. Dos (7,4%) de los pacientes presentaron complicaciones perioperatorias. La mediana de estancia hospitalaria y el tiempo de sonda vesical fueron de 3,5 (2-7) y 4,2 (3-7) días respectivamente. Conclusiones: La prostatectomía laparoscópica simple extraperitoneal es un procedimiento efectivo para el tratamiento de grandes adenomas prostáticos. Parece haber menos morbilidad perioperatoria y en nuestra experiencia esta técnica parece factible y reproducible; sin embargo, su curva de aprendizaje es un tema complicado de abordar (AU)

Objective: Laparoscopic adenomectomy 150 is a minimally invasive alternative to open surgery in large prostates. Our aim is to discuss our series of 59 patients treated by means of laparoscopic adenomectomy with precise vascular control. Materials and methods: Between June 2003 and June 2006, a total of 59 patients with a mean age of 65.5years (51 to 82), underwent laparoscopic extraperitoneal adenomectomy. All the patients had a history of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). The mean International Prostate Symptom Score (IPSS) was 20 points (16-22). The information was collected prospectively in a database. The analysis was performed subsequently. Results: All 59 adenomas were completely removed laparoscopically without conversion to open surgery. The mean preoperative prostate volume by ultrasound was 108.5 cc (75-150). The average operating time was 123minutes (90-180). The mean loss of blood was 415ml (50-1500) and 4 patients (14.8%) required a blood transfusion. Two (7.4%) of the patients presented perioperative complications. The mean hospital stay and the bladder catheterization time were 3.5 (2-7) and 4.2 (3-7) days respectively. Conclusions: Laparoscopic extraperitoneal simple prostatectomy is an effective procedure for the treatment of large prostatic adenomas. There seems to be less perioperative morbidity and, in our experience, this technique seems to be feasible and reproducible; however, its learning curve is a complicated matter to deal with (AU)

Cistectomía radical laparoscópica con confección extracorpórea de neovejiga ortotópica ileal en forma de ‘‘Y’’ usando sutura mecánica no reabsorbible (Fontana) / Laparoscopic radical cystectomy with extracorporeal creation of a ‘‘Y’’ shaped orthotopic ileal neobladder using non-reabsorbable mechanical suture (Fontana)

Introducción: se describe la técnica y se presentan los resultados preliminares de la técnica decistectomía radical laparoscópica con confección extracorpórea de neovejiga ortotópica ileal en forma de ‘‘Y’’, usando una sutura mecánica no reabsorbible (Fontana). Material y método: se describe paso a paso la técnica y se presenta una serie de 15 pacientes sometidos a esta cirugía entre noviembre de 2005 y agosto de 2009, con especial énfasis en el tiempo de cirugía, tiempo de derivación urinaria, las complicaciones intraoperatorias y postoperatorias, la continencia diurna y nocturna y la frecuencia miccional postoperatoria. Resultados: la mediana de seguimiento de la serie es de 24 meses (6-32). El tiempo quirúrgico medio fue 280 (rango: 210-345) minutos y el tiempo medio de la derivación urinaria fue 54,5 (rango: 40-75) minutos. No se presentaron complicaciones intraoperatorias y el tiempo promedio de hospitalización fue de 7 días (rango: 5-15). Durante el seguimiento se presentaron 5complicaciones postoperatorias tardías, dos cuadros de infección urinaria con buena respuesta al tratamiento antibiótico y tres estenosis de la anastomosis uretero-neovesical, que se han manejado con una dilatación percutánea con balón con un buen resultado funcional. No se han encontrado litiasis en la neovejiga. Se obtuvo continencia diurna completa en 13 de 14 pacientes (92,9%) y nocturna completa en 6 de 14 (42,9%). Un paciente (6,7%) precisa autosondaje limpio intermitente por no presentar micción espontánea. Conclusiones: la neovejiga ortotópica ileal en forma de ‘‘Y’’ usando una sutura mecánica no reabsorbible es una técnica factible, rápida, segura y que permite resultados funcionales prometedores. Se necesita mayor seguimiento para determinar sus resultados a largo plazo (AU)

Introduction: We describe the technique and present the preliminary results of the laparoscopic radical cystectomy technique with the extracorporeal creation of a ‘‘y’’ shaped ileal orthotopicneo bladder using non-absorbable mechanical suture (Fontana). Materials and method: We describe the technique step by step and we present a series of 15 patients that underwent this surgery between November 2005 and August 2009, with special emphasis on the duration of the surgery, urinary diversion time, intraoperative and postoperative complications, daytime and night time continence and the frequency of postoperative micturition. Results: The mean follow-up of the series was 24 months (6-32). The mean duration of surgery was 280 (range 210-345) minutes and the mean urinary diversion time was 54.5 (range 40-75) minutes. There were no intraoperative complications and the average hospitalization time was 7 (range 5-15) days. During the follow-up, there were 5 late postoperative complications, 2cases of urinary infection with good response to antibiotic treatment and 3 uretero-neovesical anastomosis strictures, which were treated with percutaneous balloon dilation, with a good functional result. No lithiasis was found in the neobladder. Complete daytime continence wa sobtained in 13/14 patients (92.9%) and complete night time continence in 6/14 (42.9%). One patient (6.7%) required clean intermittent self-catheterization as the patient did not micturate spontaneously. Conclusions: The creation of a ‘‘Y’’ shaped ileal orthotopic neobladder using non-absorbable mechanical suture is a feasible, fast and safe technique and it provides promising functional results. Further follow-up is required to determine its long-term results (AU)

[Laparoscopic simple prostatectomy (adenomectomy): experience in 59 consecutive patients]. / Prostatectomía simple (adenomectomía) por vía laparoscópica: experiencia en 59 pacientes consecutivos.

OBJECTIVE: Laparoscopic adenomectomy 150 is a minimally invasive alternative to open surgery in large prostates. Our aim is to discuss our series of 59 patients treated by means of laparoscopic adenomectomy with precise vascular control. MATERIALS AND METHODS: Between June 2003 and June 2006, a total of 59 patients with a mean age of 65.5 years (51 to 82), underwent laparoscopic extraperitoneal adenomectomy. All the patients had a history of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). The mean International Prostate Symptom Score (IPSS) was 20 points (16-22). The information was collected prospectively in a database. The analysis was performed subsequently. RESULTS: All 59 adenomas were completely removed laparoscopically without conversion to open surgery. The mean preoperative prostate volume by ultrasound was 108.5 cc (75-150). The average operating time was 123 minutes (90-180). The mean loss of blood was 415 ml (50-1500) and 4 patients (14.8%) required a blood transfusion. Two (7.4%) of the patients presented perioperative complications. The mean hospital stay and the bladder catheterization time were 3.5 (2-7) and 4.2 (3-7) days respectively. CONCLUSIONS: Laparoscopic extraperitoneal simple prostatectomy is an effective procedure for the treatment of large prostatic adenomas. There seems to be less perioperative morbidity and, in our experience, this technique seems to be feasible and reproducible; however, its learning curve is a complicated matter to deal with.

Nefrectomía laparoscópica en niños / Laparoscopic nephrectomy in children

Introducción: la nefrectomía laparoscópica en niños, a diferencia de la población adulta, ha tenido una evolución más lenta debido al erróneo concepto de que los niños requieren incisiones pequeñas y se recuperan con mayor rapidez. El objetivo de este artículo es presentar nuestra experiencia en cirugía renal laparoscópica en una población pediátrica. Material y métodos: se revisaron las historias clínicas de los niños que fueron sometidos a cirugía renal laparoscópica en nuestra institución entre mayo de 1993 y septiembre de 2010. Los datos fueron registrados prospectivamente y analizados de forma retrospectiva. Las variables analizadas fueron la indicación quirúrgica, edad, sexo, procedimiento y abordaje, tiempo de quirófano, estancia hospitalaria, sangrado intraoperatorio, complicaciones perioperatorias, conversión a cirugía abierta, reintervención y tasas de transfusión de sangre. Resultados: entre mayo de 1993 y septiembre de 2010 un total de 72 pacientes fueron operados; se practicaron 45 nefrectomías (62,5%), 13 nefroureterectomías (18%) y 14 heminefrectomías(19,4%). La edad media fue de 68 meses (rango: 3-168). El tiempo medio operatorio (OR) fue de 80,4 minutos (rango: 25-270 min) con una pérdida estimada sanguínea promedio de 37,5 ml (rango: 0 -1.000 ml). Hubo tres (4,1%) conversiones a cirugía abierta. Una fue debido a un sangrado intraoperatorio y las otras dos secundarias a una difícil disección debido a presentar cirugías renales previas. La estancia media hospitalaria fue de 3,17 días (rango: 1-30 días) y hubo 7 (9,72%) complicaciones postoperatorias. No hubo mortalidad. Conclusiones: consideramos que el abordaje laparoscópico para la cirugía renal en pacientes pediátricos es un procedimiento factible, seguro y eficaz que debe ser considerado como la primera opción para el tratamiento de la patología benigna en este grupo de población (AU)

Introduction: Laparoscopic nephrectomy in children, not as in the adult population, has evolved more slowly due to the misleading concept that children require small incisions and recover faster. The aim of this article is to present our experience in laparoscopic renal surgery in a paediatric population. Material and methods: We checked the clinical records of children that were subjected to laparoscopic renal surgery at our institution between May 1993 and September 2010. We recorded the data prospectively and analysed it retrospectively. The variables we studied were surgical indication, age, sex, procedure and approach, surgery time, hospital stay, intraoperative bleeding, perioperative complications, conversion to open surgery, reintervention and blood transfusion rates. Results: Between May 1993 and September 2010, we operated a total of 72 patients, 45 nephrectomies (62.5%), 13 nephroureterectomies (18%) and 14 heminephrectomies (19.4%). The mean age was 68 months (range 3-168). The mean surgery time was 80.4 min. (range: 25-270 min.) with a estimated mean blood loss of 37.5 ml (range: 0 -1.000 ml). There were 3 (4.1%) conversions to open surgery. One was due to intraoperative bleeding and the other two were secondary to a difficult dissection due to a history of prior renal surgical interventions. The mean hospital stay was 3.17 days (range: 1-30 days) and there were 7 (9.72%) postoperative complications. There were no deaths. Conclusions: We consider the laparoscopic approach for renal surgery in paediatric patients to be a feasible, safe and effective procedure that must be considered as the first option for the treatment of benign pathology in this population group (AU)