Uso de vaina asistida por vacío en mininefrolitotomía percutánea (mini-NLPC) en decúbito supino / Vacuum-assisted access sheath in supine mini-percutaneous nephrolithotomy (mini-PCNL)

Introducción La vaina de acceso asistida por vacío es un nuevo dispositivo para el tratamiento de los cálculos renales mediante nefrolitotomía percutánea (NLPC). Objetivo Nuestro objetivo fue comparar la tasa libre de litiasis (TLL) y las complicaciones entre la mini-NLPC estándar y la asistida por vacío (VaNLPC). Método Estudio retrospectivo de pacientes intervenidos mediante mini-NLPC y VaNLPC desde enero de 2018 hasta junio de 2022. La VaNLPC se realizó con una vaina desechable (ClearPetra®) que permite la conexión de aspiración por un canal lateral facilitando la extracción de fragmentos. Se recogieron las características basales de los pacientes, los resultados quirúrgicos y los datos perioperatorios y postoperatorios. Se compararon en cuanto a las complicaciones y la TLL. Resultados Identificamos 136 pacientes, 57 (41,9%) intervenidos con VaNLPC y 79 (58,15%) con mini-NLPC. El tiempo quirúrgico medio fue significativamente menor en el grupo VaNLPC (95 min) que en el mini-NLPC (146 min; p = 0,001). La técnica tubeless se realizó con mayor frecuencia en el grupo VaNLPC (61,4 vs. 34,2%; p = 0,002). No se observaron diferencias en las complicaciones postoperatorias. El tiempo medio de hospitalización fue significativamente inferior en el grupo VaNLPC con 1,7 días por paciente frente a 2,7 días en el grupo mini-NLPC (p = 0,001). No hubo diferencias en la TLL a los tres meses entre VaNLPC (71,9%) y mini-NLPC (71,8%; p = 0,848). Conclusiones Los pacientes tratados con VaNLPC obtuvieron resultados comparables a la mini-NLPC, mostrando una TLL igual con similares complicaciones infecciosas. Como potenciales beneficios de la VaNLPC, se postulan menor tiempo quirúrgico y estancia postoperatoria. (AU)

Introduction The vacuum-assisted access sheath is a new device for the treatment of kidney stones with percutaneous nephrolithotomy (PCNL). Objective Our aim was to compare the stone-free rate (SFR) and complications between standard mini percutaneous nephrolithotomy (mini-PCNL) and vacuum-assisted PCNL (Va-PCNL). Methods Retrospective study of patients undergoing mini-PCNL and Va-PCNL from January 2018 to June 2022. Va-PCNL was performed with a disposable sheath (ClearPetra) with continuous high-flow irrigation and vacuum fluid dynamics for easier stone fragment removal. Baseline patient characteristics, surgical outcomes, perioperative and postoperative data were collected. We compared SFR and complications. Results A total of 136 patients were identified, 57 (41,9%) underwent Va-PCNL and 79 (58,15%) mini-PCNL. Mean operative time was significantly shorter in the Va-PCNL group (95 min.) than in mini-PCNL (146 min.; P = .001) group. The tubeless technique was performed more frequently in Va-PCNL group (61,4% vs. 34,2%; P = .002). We did not observe any differences in postoperative complications. The mean hospital stay was significantly lower in Va-PCNL with 1,7 ± 1,9 days per patient compared with 2,7 ± 1,5 days in the mini-PCNL group (P = .001). There were no differences in SFR at 3 months between Va-PCNL (71,9%) and mini-PCNL (71,8%; P = .848). Conclusion Patients treated with Va-PCNL had comparable results to mini-PCNL, showing equal SFR with similar infectious complications rates. Potential benefits of Va-PCNL include shorter operative time and postoperative stay. (AU)

Vacuum-assisted access sheath in supine mini-percutaneous nephrolithotomy (mini-PCNL).

INTRODUCTION: The vacuum-assisted access sheath is a new device for the treatment of kidney stones with percutaneous nephrolithotomy (PCNL). OBJECTIVE: Our aim was to compare the stone-free rate (SFR) and complications between standard mini percutaneous nephrolithotomy (Mini-PCNL) and vacuum-assisted PCNL (Va-PCNL). METHODS: Retrospective study of patients undergoing Mini-PCNL and Va-PCNL from January 2018 to June 2022. Va-PCNL was performed with a disposable sheath (ClearPetra®) with continuous high-flow irrigation and vacuum fluid dynamics for easier stone fragment removal. Baseline patient characteristics, surgical outcomes, perioperative and postoperative data were collected. We compared SFR and complications. RESULTS: A total of 136 patients were identified, 57 (41,9%) underwent Va-PCNL and 79 (58,15%) Mini-PCNL. Mean operative time was significantly shorter in the Va-PCNL group (95 min.) than in Mini-PCNL (146 min; P = ,001) group. The tubeless technique was performed more frequently in Va-PCNL group (61,4% vs. 34,2%; P = ,002). We did not observe any differences in postoperative complications. The mean hospital stay was significantly lower in Va-PCNL with 1,7 ± 1,9 days per patient compared with 2,7 ± 1,5 days in the Mini-PCNL group (P = ,001). There were no differences in SFR at 3 months between Va-PCNL (71,9%) and Mini-PCNL (71,8%; P =v ,848). CONCLUSION: Patients treated with Va-PCNL had comparable results to Mini-PCNL, showing equal SFR with similar infectious complications rates. Potential benefits of Va-PCNL include shorter operative time and postoperative stay.

Resultados funcionales y supervivencia a ocho años de la artroscopia de cadera en pacientes con patología degenerativa de cadera / Functional outcomes and 8-year survival after hip arthroscopy in patients with degenerative hip disease

ANTECEDENTES Y OBJETIVOS: El objetivo de este estudio es evaluar qué factores pueden influir en la supervivencia de la artroscopia de cadera a medio plazo en el contexto de patología degenerativa. MATERIAL Y MÉTODOS: Llevamos a cabo un estudio retrospectivo de 40 casos de una serie de 102 pacientes intervenidos de artroscopia de cadera en nuestro centro, desde agosto de 2007 a octubre de 2011. Al final del seguimiento, todos los pacientes cumplimentaron tres escalas funcionales: Hip Outcome Score-Activites of Daily Life (HOS-ADL), Hip Outcome Score-Sport (HOS-S) y Harris Hip Score modificado (HHSm). RESULTADOS: Finalmente se incluyó un total de 39 pacientes (40 caderas), con una edad media de 43,1 años y un tiempo de seguimiento medio de 6 años (43-130 meses). Los pacientes intervenidos con una edad inferior a 50 años obtuvieron mejor puntuación en las escalas HOS-S (25,2 puntos) y HHS-m (84,1 puntos) en comparación con aquellos intervenidos a partir de dicha edad (HOS-S [25,2 puntos]; HHS-m [84,1 puntos]). El tiempo de evolución también influyó significativamente en el resultado de nuestros pacientes, siendo mejor en aquellos en los que éste era menor a 12 meses (26,6 meses), en comparación con aquellos en los que era mayor (21,3 meses). Por otro lado, aquellos que presentaban una intervención quirúrgica lumbar previa obtuvieron peores resultados de HOS-ADL (49,3 puntos), respecto a aquellos que no presentaban este antecedente (56,5 puntos). El Patient acceptable symptom state (PASS) fue superado por 23 pacientes (57,5%), 22 pacientes (55%) y 25 pacientes (62,5%) en las escalas HHSm, HOS-ADL y HOS-S respectivamente. Ningún paciente presentó ninguna complicación mayor. Cuatro pacientes presentaron complicaciones menores. La supervivencia media obtenida fue de 97,1 meses (IC 95%, 85,1-109,1 meses), asociado con un 81% de pacientes (IC 95%, 69%-93%) que no precisó rescate quirúrgico a los 10 años. CONCLUSIONES: Creemos que los datos obtenidos en nuestra serie sugieren que la artroscopia de cadera en el contexto de patología degenerativa es una intervención quirúrgica segura con un resultado funcional fiable a corto-medio plazo. Por otro lado, dicha indicación debería hacerse con mayor precaución en pacientes sometidos previamente a cirugía lumbar. NIVEL DE EVIDENCIA: Nivel IV. Serie de casos

BACKGROUND AND PURPOSE: The purpose of this study is to identify which variables may have a significant impact in mid-term survivorship following hip arthroscopy. METHODS: This a single-centre single-surgeon retrospective study including 102 patients who underwent a hip arthroscopy procedure between August 2007 and October 2011. Each subject completed three questionnaires at final follow- up: Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport (HOS-S) and Modified Harris Hip Score (m-HHS). RESULTS: Thirty-nine patients (40 hips) were finally included in our study. Mean age was 43.1 ± 9.9 years with a three-year minimum follow-up (75.43 ± 25.2 months). Younger patients and those with a shorter duration of symptoms obtained significantly higher HOS-S and m-HSS scores. Patients who had undergone previous lumbar spinal surgery obtained significantly worse HOS-ADL scores. Patient acceptable symptom state (PASS) was achieved in 23 patients (57.5%) for m-HHS, 22 patients (55%) for HOS-ADL and 25 patients for HOS-S scores. No major complication was observed. Only four patients had minor complications. Mean survival time was 97.1 months (95% CI, 85.1 to 109.1 months), with a survival at 8 years of 69% (95% CI, 53% to 85%). CONCLUSIONS: Our findings suggest that hip arthroscopy is a safe procedure with acceptable functional outcomes after a long follow-up. Care should be taken when treating patients with prior lumbar surgery. LEVEL OF EVIDENCE: Level IV. Case series

Functional outcomes and 8-year survival after hip arthroscopy in patients with degenerative hip disease. / Resultados funcionales y supervivencia a ocho años de la artroscopia de cadera en pacientes con patología degenerativa de cadera.

BACKGROUND AND PURPOSE: The purpose of this study is to identify which variables may have a significant impact in mid-term survivorship following hip arthroscopy. METHODS: This a single-centre single-surgeon retrospective study including 102 patients who underwent a hip arthroscopy procedure between August 2007 and October 2011. Each subject completed three questionnaires at final follow- up: Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport (HOS-S) and Modified Harris Hip Score (m-HHS). RESULTS: Thirty-nine patients (40 hips) were finally included in our study. Mean age was 43.1 ± 9.9 years with a three-year minimum follow-up (75.43 ± 25.2 months). Younger patients and those with a shorter duration of symptoms obtained significantly higher HOS-S and m-HSS scores. Patients who had undergone previous lumbar spinal surgery obtained significantly worse HOS-ADL scores. Patient acceptable symptom state (PASS) was achieved in 23 patients (57.5%) for m-HHS, 22 patients (55%) for HOS-ADL and 25 patients for HOS-S scores. No major complication was observed. Only four patients had minor complications. Mean survival time was 97.1 months (95% CI, 85.1 to 109.1 months), with a survival at 8 years of 69% (95% CI, 53% to 85%). CONCLUSIONS: Our findings suggest that hip arthroscopy is a safe procedure with acceptable functional outcomes after a long follow-up. Care should be taken when treating patients with prior lumbar surgery. LEVEL OF EVIDENCE: Level IV.