ABSTRACT
BACKGROUND AND PURPOSE: Bosniak III and IV renal cysts have low mortality potential, and little is reported regarding the feasibility and safety of managing such tumors by laparoscopy and its comparison with open surgery. We report on the experience with 37 complex renal cysts managed in the era of laparoscopy. PATIENTS AND METHODS: A retrospective analysis of a prospective database from all patients with renal tumors who were operated on at our institution was evaluated after Institutional Review Board approval. The database comprises information for demographic, clinical, imaging, preoperative, intraoperative, histologic, and follow-up data. A comparison among all performed approaches was done for demographic, American Society of Anesthesiologists classification, operative time, estimated blood loss, ischemia time, hospital stay, oncologic and survival rate. The cysts removed by laparoscopic partial nephrectomy were compared with the solid tumors removed by the same approach at the same period. RESULTS: The database included 407 patients with renal tumors who were operated on from 2000 to 2009 at our institution. In 36 patients of the total cohort, there were 37 complex renal cysts. No patients with preoperative Bosniak type I or II underwent surgery. Of the cysts, 60% were Bosniak IV, and 86% were confirmed as malignant; 40% were Bosniak III, and 44% were confirmed as malignant. Laparoscopic partial nephrectomy was performed in 67.5%. The tumor size and hospital stay were significantly different in the laparoscopic group. No cyst spillage occurred either by laparoscopy or by the open approach, and no tumor recurrence was found in a mean follow-up of 43.7 months with overall survival of 100%. CONCLUSION: Laparoscopic surgery for complex cysts is safe, feasible, and effective. Nevertheless, regardless of surgical approach, patients with complex renal cysts have excellent overall survival with short-term follow-up.
Subject(s)
Kidney Diseases, Cystic/surgery , Laparoscopy/adverse effects , Laparoscopy/methods , Adult , Aged , Aged, 80 and over , Databases, Factual , Demography , Female , Humans , Kidney Diseases, Cystic/diagnostic imaging , Kidney Diseases, Cystic/pathology , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Magnetic Resonance Imaging , Male , Middle Aged , Perioperative Care , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Spermatic vein thrombosis is a particularly rare entity which can be difficult to diagnose. Pulmonary embolism associated with spermatic vein thrombosis is rarely seen. We report the diagnosis and management of a case at our institution and recommend spermatic vein ligation as the definite treatment for thrombosed spermatic veins associated with pulmonary thromboembolism. We prefer laparoscopy as a minimally invasive approach because of its clear advantages over open surgery.
Subject(s)
Pulmonary Embolism/etiology , Testis/blood supply , Thrombosis/complications , Veins , Adult , Humans , MaleABSTRACT
OBJECTIVES: Percutaneous nephrolithotomy is a relatively safe technique. However, it is not exempt from complications, some of which can be severe and even fatal. Some complications may be plausible for laparoscopic management. We report our experience in the management of a rare complication by laparoscopic means. METHODS: We report the case of an Amplatz sheath that inadvertently migrated out of the renal parenchyma during a percutaneous nephrolithotomy. Patient data, procedure conditions, and laparoscopic retrieval of the sheath are detailed. RESULTS: The Amplatz sheath was successfully retrieved laparoscopically. Total operative time was 180 minutes. Operative bleeding was minimal. The postoperative period was uneventful, and the patient was discharged on postoperative day 3. CONCLUSIONS: Laparoscopy must be regarded as an option for the management of a surgical complication, especially if a minimally invasive approach is to be kept.
Subject(s)
Foreign-Body Migration/surgery , Kidney Calculi/surgery , Laparoscopy , Nephrostomy, Percutaneous/instrumentation , Abdomen , Adult , Humans , Lithotripsy , MaleABSTRACT
La pieloplastia asistida sigue siendo la técnica de elección del tratamiento de la estenosis pieloureteral en niños. Las técnicas laparoscópicas requieren un largo aprendizaje, sobre todo para realizar suturas intracorpóreas en un espacio de trabajo reducido. Presentamos una técnica que combina técnicas laparoscópicas y tradicionales, haciendo un híbrido que acorta los tiempos quirúrgicos y permite su aplicación por cirujanos con limitada experiencia laparoscópica. Nuestros resultados en 10 niños operados en forma consecutiva han sido excelentes.
Subject(s)
Male , Humans , Infant , Child, Preschool , Child , Ureteral Obstruction/surgery , Kidney Pelvis/surgery , Urologic Surgical Procedures/methods , Follow-Up Studies , Laparoscopy , Minimally Invasive Surgical Procedures , Recurrence , Treatment Outcome , Video-Assisted SurgeryABSTRACT
BACKGROUND: The Gleason histological score is an independent prognostic factor in prostate cancer that helps in therapeutic decisions. AIM: To analyze the concordance between the Gleason score of needle prostatic biopsy and the score from the study of the surgical piece obtained during radical prostatectomy. MATERIAL AND METHODS: Retrospective analysis of 212 cases of prostate cancer, diagnosed between February 1993 and March 2003. All had the Gleason histological scores from needle prostatic biopsies and in the surgical piece obtained during radical prostatectomy. All pathological studies were done by the same observer. RESULTS: There was an exact concordance of Gleason scores between needle biopsy and the surgical piece in 49% of cases and a concordance of +/- 1 unit in 89%. The concordance improved in the second half of the study period. No cases with a Gleason score of less than 5 were detected since 1999 in the surgical piece. CONCLUSIONS: The concordance of Gleason score of needle prostatic biopsies and surgical pieces is good. This concordance increases with the experience of the pathologist.
