RESUMEN
Metastatic renal cell carcinoma (mRCC) has been one of the most treatment-resistant cancers because of its unpredictable clinical course, resistance to chemo- and radiotherapy, and the limited response to immunotherapy and targeted agents. We present a case of long-term survival, that is, 28 years, after primary diagnosis (longest survival in the literature up to our knowledge) with mRCC after several metastasectomies (from local site recurrence, liver, and lung) and eight lines of systemic targeted therapy. This case report shows how crucial is the regular follow-up of patients with RCC after primary management and positive impact of early metastasectomy and systemic targeted therapy in case of mRCC on patients' condition and overall survival.
RESUMEN
PURPOSE: To evaluate functional outcomes and morbidity rates after laparoscopic adenomectomy (LA) and Eraser laser enucleation of the prostate (ELEP). MATERIALS AND METHODS: Forty patients with lower urinary tract symptoms suggesting bladder outlet obstruction, with a prostate heavier than 70 g on transrectal ultrasound, were selected to undergo laparoscopic adenomectomy or Eraser laser enucleation of the prostate. All patients were consecutively enrolled without randomization and assessed preoperatively, 3 and 6 months postoperatively. Baseline characteristics, perioperative data, and postoperative outcomes were compared. RESULTS: The total operating time was significantly longer in the LA group (138.8 ± 11.4 vs. 78.4 ± 10.0 min, p < 0.000001). Catheter removal was performed earlier (61.2 ± 21.3 vs. 174.0 ± 13.2 h, p < 0.000001) and the hospital stay was significantly shorter (62.4 ± 21.2 vs. 187.2 ± 12.6 h, p < 0.000001) in the ELEP group. The latter group experienced significantly less perioperative hemoglobin (Hb) loss (0.71 ± 0.25 vs. 2.15 ± 1.08 g/dl, p < 0.000001), and their postoperative Hb levels (14.1 ± 1.21 vs. 11.7 ± 1.31 g/dl, p < 0.000001) were significantly higher. The resected tissue was significantly greater in the LA group (58.5 ± 23.3 vs. 87.9 ± 22.4 g, p = 0.0002). Significant improvements in Qmax, Qol, and symptom scores from baseline to each follow-up time point were noted in both groups. No statistically significant difference in symptom scores or Qmax was registered between the LA and the ELEP group throughout the follow-up period. CONCLUSION: Laparoscopic adenomectomy and ELEP were equally effective for relieving bladder outflow obstruction and lower urinary tract symptoms. The advantages of ELEP include less blood loss, shorter catheterization times, and shorter hospital stays.
Asunto(s)
Laparoscopía/métodos , Terapia por Láser/métodos , Próstata/cirugía , Prostatectomía/métodos , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/cirugía , Anciano , Pérdida de Sangre Quirúrgica , Estudios de Seguimiento , Humanos , Tiempo de Internación , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/prevención & control , Masculino , Persona de Mediana Edad , Tempo Operativo , Próstata/patología , Hiperplasia Prostática/patología , Resultado del Tratamiento , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/prevención & controlRESUMEN
UNLABELLED: BACKGROUND/AIMS/OBJECTIVES: To describe the depth of the laser coagulation zone in vivo based on histological examinations and the functional outcome of a 1,318-nm diode laser for enucleation in benign prostatic enlargement (BPE). METHODS: A total of 20 patients with BPE were treated by laser Eraser® enucleation of the prostate (ELEP). Prostatic tissue wedges were evaluated to assess the depth of the ELEP coagulation zones. Additionally, patients were assessed preoperatively and 12 months postoperatively. RESULTS: The coagulation zones were 0.36 ± 0.17 mm in epithelial tissue, 0.28 ± 0.15 mm in stromal tissue, and 0.25 ± 0.12 mm in mixed tissue. The coagulation area at the cutting edge completely sealed capillary vessels, reaching a depth of 0.35 ± 0.15 mm. The diameter of the coagulated vessels measured 1.75 ± 0.83 mm. Mean blood loss was 115.54 ± 93.12 ml, catheter time 1.35 ± 0.33 days, and hospital stay 1.89 ± 0.52 days. The International Prostate Symptom Score, maximal flow rate, and quality of life significantly improved 12 months after the procedure. CONCLUSIONS: ELEP is safe and effective for BPE treatment and yields good results at a follow-up of 1 year. Because of the limited penetration depth, damage to the urinary sphincter is not expected.
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Terapia por Láser/instrumentación , Próstata/cirugía , Obstrucción del Cuello de la Vejiga Urinaria/cirugía , Anciano , Biopsia , Coagulación Sanguínea , Estudios de Seguimiento , Hemostasis , Humanos , Terapia por Láser/métodos , Rayos Láser , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/cirugía , Calidad de Vida , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/psicologíaRESUMEN
PURPOSE: Animal studies have shown the potential benefits of mannitol as renoprotective during warm ischemia; it may have antioxidant and anti-inflammatory properties and is sometimes used during partial nephrectomy (PN) and live donor nephrectomy (LDN). Despite this, a prospective study on mannitol has never been performed. The aim of this study is to document patterns of mannitol use during PN and LDN. MATERIALS AND METHODS: A survey on the use of mannitol during PN and LDN was sent to 92 high surgical volume urological centers. Questions included use of mannitol, indications for use, physician responsible for administration, dosage, timing and other renoprotective measures. RESULTS: Mannitol was used in 78 and 64 % of centers performing PN and LDN, respectively. The indication for use was as antioxidant (21 %), as diuretic (5 %) and as a combination of the two (74 %). For PN, the most common dosages were 12.5 g (30 %) and 25 g (49 %). For LDN, the most common doses were 12.5 g (36.3 %) and 25 g (63.7 %). Overall, 83 % of centers utilized mannitol, and two (percent or centers??) utilized furosemide for renoprotection. CONCLUSIONS: A large majority of high-volume centers performing PN and LDN use mannitol for renoprotection. Since there are no data proving its value nor standardized indication and usage, this survey may provide information for a randomized prospective study.
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Trasplante de Riñón/métodos , Riñón/cirugía , Donadores Vivos , Manitol/uso terapéutico , Nefrectomía/métodos , Antiinflamatorios/administración & dosificación , Antiinflamatorios/farmacología , Antiinflamatorios/uso terapéutico , Antioxidantes/administración & dosificación , Antioxidantes/farmacología , Antioxidantes/uso terapéutico , Relación Dosis-Respuesta a Droga , Encuestas de Atención de la Salud , Humanos , Internacionalidad , Riñón/efectos de los fármacos , Manitol/administración & dosificación , Manitol/farmacología , Estudios Prospectivos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Partial nephrectomy has become the most frequently used surgical procedure in the treatment of renal cell cancer. The current role of laparoscopy for this indication has to be defined.The technique of laparoscopic partial nephrectomy has undergone a continuous development to become mature. Once the learning curve of the individual surgeon has been overcome the results are comparable to those of open surgery. This is true for ischemia time, complication rate and oncologic outcome. In addition there is the advantage of the minimally invasive approach in laparoscopy sparing a painful flank incision. Laparoscopic partial nephrectomy is not yet a standard of care but yields excellent results in the hands of experts. There are no conclusive studies comparing standard and da Vinci®-assisted laparoscopy. No clear advantages become obvious, but the costs of the robot are substantial.
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Laparoscopía/tendencias , Procedimientos Quirúrgicos Mínimamente Invasivos/tendencias , Nefrectomía/tendencias , Procedimientos de Cirugía Plástica/tendencias , Robótica/tendencias , Cirugía Asistida por Computador/tendencias , HumanosRESUMEN
The functional and oncological results of laparoscopic retroperitoneal lymphadenectomy (L-RPLND) have proven to be as efficacious as open series (O-RPLND) after 5 year follow-up. In the most recent publication series from high-volume laparoscopy centres, there was a trend towards fewer complications in L-RPLND compared to O-RPLND. Up to now only two case series of four treated patients have been reported adopting a robotic-assisted retroperitoneal lymphadenectomy for testicular cancer so that it is not yet possible to judge whether it is useful tool or not.
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Laparoscopía/tendencias , Escisión del Ganglio Linfático/tendencias , Procedimientos Quirúrgicos Mínimamente Invasivos/tendencias , Robótica/tendencias , Cirugía Asistida por Computador/tendencias , Neoplasias Testiculares/secundario , Neoplasias Testiculares/cirugía , Humanos , Metástasis Linfática , Masculino , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/cirugía , Neoplasias Testiculares/patologíaRESUMEN
AIM: The aim of this paper was to compare the diagnostic performance of positron emission tomography/computed tomography (PET/CT) with fluorocholine (18F) (FCH) or fluoride(18F) (FNa) for the detection of bone metastasis in patients with prostate cancer complaining from osteoarticular pain, taking into account whether they were referred for initial staging or recurrence localization. The initial hypothesis was that FCH site-based specificity would be superior to that of F Na, with no loss in sensitivity. METHODS: Forty-two patients were enrolled in this prospective study, underwent both PET/CTs and were then followed-up for at least 6 months. The standard of truth (SOT) about the presence/absence and location of bone metastasis could be determined in 40 patients, by 2 independent medical assessors, blinded to the results of both PET/CTs. The comparison was performed according to the guideline of the European Medicines Agency, i.e. based on the results of blind reading with SOT as reference. RESULTS: Bone extension was present in 22 patients and absent in 18. Patient-based performance for FCH vs. FNa was 91% vs. 91% for sensitivity, 89% vs. 83% for specificity and 90% vs. 88% for accuracy (no significant difference). Of 360 skeletal sites, 68 were malignant and 292 non-invaded. There was no significant difference in site-based performance in the group of patients referred at initial staging, but in the group of patients referred for suspicion of recurrence, FCH was significantly more specific than FNa (96% vs. 91%, P=0.033 with Obuchowski's correction) while sensitivity was the same, 89%. CONCLUSION: Both radiopharmaceuticals, based on a very different metabolic approach, showed good diagnostic performance. If FCH is available, it should be preferred in patients after initial treatment.
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Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Colina/análogos & derivados , Tomografía de Emisión de Positrones/métodos , Neoplasias de la Próstata/diagnóstico por imagen , Fluoruro de Sodio , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Radioisótopos de Flúor , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias de la Próstata/patología , Radiofármacos , Sensibilidad y EspecificidadRESUMEN
In the era of early detection of organ-confined prostate cancer, guidelines support the fact that many patients will not need an aggressive staging work-up, to avoid unnecessary investigations. This strategy may lead to serious repercussions in rare incidences. We present a rare case of urinary extravasation following laparoscopic radical prostatectomy caused by injury of the upper pole ectopic ureter of an undetected duplex system on 1 side, an injury which is the first of its kind in laparoscopic urology.
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Laparoscopía/efectos adversos , Prostatectomía , Neoplasias de la Próstata/cirugía , Uréter/anomalías , Uréter/lesiones , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Enfermedades Renales Quísticas/cirugía , Neoplasias Renales/cirugía , Laparoscopía , Nefrectomía/métodos , Humanos , Consentimiento Informado , Enfermedades Renales Quísticas/diagnóstico , Enfermedades Renales Quísticas/diagnóstico por imagen , Neoplasias Renales/diagnóstico por imagen , Cuidados Posoperatorios , Cuidados Preoperatorios , Radiografía Abdominal , Radiografía Torácica , Tomografía Computarizada por Rayos X , UrografíaRESUMEN
Proper assessment of lymph node status is of crucial importance in the management of newly diagnosed prostate cancer. Early stage metastatic disease takes the form of microscopic tumor-cell deposits rather than grossly enlarged nodes. So far there is no imaging technique, however, which allows detecting small metastases in the range of a few millimetres. Therefore pelvic lymph node dissection (PLND) is the only reliable method of staging for clinically localized prostate cancer. The cornerstone of radioguided prostate surgery is a radiopharmaceutical--a carrier molecule labeled by radionuclide. After injection to at the prostate, the radiopharmaceutical crosses the lymphatic pores and migrates into the lymph vessels and from there to the first echelon of lymph nodes. We were the first to show that sentinel PLND can be performed by means of laparoscopy preceding laparoscopic radical prostatectomy. Our most recent publication presents data of 140 patients with clinically localized prostate cancer in which laparoscopic sentinel PLND was performed preceding radical prostatectomy from November 2001 to January 2005. On the preoperative scintigraphy SLNs were detected bilaterally,unilaterally, not on the pelvic-walls in 113 (80.7%), 20 (14.2%) and 6 (4.2%) patients and intraoperatively in 96 (68.6%), 36 (25.7%), 8 (5.7%) patients respectively. In 99 out of 140 patients (70.7%) intraoperatively SLN was detected in the same position as on preoperative scan. At least one SLN was detected in 133 patients (95.3%). Whenever PLND is indicated it should not be limited to lymph node sampling as provided by standard limited PLND but has to be performed in the template of extended PLND. There is only limited experience with sentinel PLND, but all the data collected so far indicate that this method has the potential to become an alternative to extended PLND since it allows for reduction of the extent of PLND without compromising diagnostic accuracy.
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Adenocarcinoma/secundario , Metástasis Linfática/diagnóstico , Neoplasias de la Próstata/patología , Biopsia del Ganglio Linfático Centinela , Adenocarcinoma/diagnóstico , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/cirugía , Ensayos Clínicos como Asunto , Humanos , Laparoscopía , Escisión del Ganglio Linfático , Masculino , Estadificación de Neoplasias/métodos , Prostatectomía/métodos , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/cirugía , Radiología Intervencionista , Cintigrafía , Radiofármacos/administración & dosificación , Radiofármacos/farmacocinéticaRESUMEN
PURPOSE: Open partial nephrectomy has emerged as the standard of care in the management of renal tumors smaller than 4 cm. While laparoscopic radical nephrectomy has been shown to be comparable to open radical nephrectomy with respect to long-term outcomes, important questions remain unanswered regarding the oncological efficacy of laparoscopic partial nephrectomy. We examined the practice patterns and pathological outcomes following laparoscopic partial nephrectomy. MATERIALS AND METHODS: A survey was sent to academic medical centers in the United States and in Europe performing laparoscopic partial nephrectomy. The total number of laparoscopic partial nephrectomies, positive margins, indications for intraoperative frozen biopsy as well as tumor size and position were queried. RESULTS: Surveys suitable for analysis were received from 17 centers with a total of 855 laparoscopic partial nephrectomy cases. Mean tumor size was 2.7 cm (+/-0.6). There were 21 cases with positive margins on final pathology, giving an overall positive margin rate of 2.4%. Intraoperative frozen sections were performed selectively at 10 centers based on clinical suspicion of positive margins on excised tumor. Random biopsies were routinely performed on the resection bed at 5 centers. Frozen sections were never performed at 2 centers. Of the 21 cases with positive margins 14 underwent immediate radical nephrectomy based on the frozen section and 7 were followed expectantly. CONCLUSIONS: Early experience with laparoscopic partial nephrectomy in this multicenter study demonstrates oncological efficacy comparable to that of open partial nephrectomy with respect to the incidence of positive margins. The practice of intraoperative frozen sections varied among centers and is not definitive in guiding the optimal surgical treatment.
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Carcinoma de Células Renales/patología , Neoplasias Renales/patología , Nefrectomía , Pautas de la Práctica en Medicina , Carcinoma de Células Renales/cirugía , Europa (Continente) , Encuestas Epidemiológicas , Humanos , Periodo Intraoperatorio , Neoplasias Renales/cirugía , Laparoscopía , Resultado del Tratamiento , Estados UnidosRESUMEN
La correcta valoración de la afectación ganglionar es de gran importancia en el manejo de los nuevos casos de cáncer de próstata. El estadio precoz de la enfermedad metastásica se manifiesta como pequeños focos microscópicos más que como ganglios linfáticos engrosados. Sin embargo, hasta ahora no hay ninguna técnica de imagen que permita detectar metástasis cuyo diámetro alcance unos pocos milímetros. Por tanto, la linfadenectomía pélvica (LNDP) es el único método fiable para el estadiaje del cáncer de próstata organoconfinado (CPO). El pilar de la cirugía prostática radioguiada es el uso de un radiofármaco, una molécula transportadora marcada con radionúclido. Tras la inyección en la glándula prostática, el radiofármaco alcanza el territorio linfático y migra al primer escalón linfático, el ganglio centinela (GC). Fuimos los primeros en demostrar que la LDNP del GC se podía llevar a cabo mediante abordaje laparoscópico previo a la prostatectomía radical (PTR) laparoscópica. En nuestra publicación más reciente se presentan los datos de 140 pacientes diagnosticados de CPO entre noviembre de 2001 a enero 2005 en los que se realizó LDNP laparoscópica del GC previa a la PTR, también laparoscópica14. En la gammagrafía preoperatoria, se detectaron GC de forma bilateral en 113 pacientes (80,7%), de forma unilateral en 20 (14,2%) y no se detectaron en 6 (4,2%), mientras que en la realizada durante la cirugía se detectaron en 96 pacientes (68,6%), 36 (25,7%), 8 (5,7%) respectivamente. Los GC se hallaron en la misma localización con ambos procedimientos en 99 de 140 pacientes (70,7%). Al menos se objetivó un GC en 133 pacientes (95,3%). Cuando la LDNP está indicada, ésta no debería restringirse a la exéresis de adenopatías, según la técnica de LDNP limitada o estándar, sino que tiene que realizarse siguiendo el patrón de la LDNP extendida. Hay poca experiencia con la LDNP del GC, pero todos los datos publicados hasta ahora indican que este procedimiento puede ser una alternativa a la LDNP extendida, ya que permite reducir la extensión de la LDNP sin comprometer la exactitud diagnóstica
Proper assessment of lymph node status is of crucial importance in the management of newly diagnosed prostate cancer. Early stage metastatic disease takes the form of microscopic tumor-cell deposits rather than grossly enlarged nodes. So far there is no imaging technique, however, which allows detecting small metastases in the range of a few millimetres. Therefore pelvic lymph node dissection (PLND) is the only reliable method of staging for clinically localized prostate cancer. The cornerstone of radioguided prostate surgery is a radiopharmaceutical - a carrier molecule labeled by radionuclide. After injection to at the prostate, the radiopharmaceutical crosses the lymphatic pores and migrates into the lymph vessels and from there to the first echelon of lymph nodes. We were the first to show that sentinel PLND can be performed by means of laparoscopy preceding laparoscopic radical prostatectomy. Our most recent publication presents data of 140 patients with clinically localized prostate cancer in which laparoscopic sentinel PLND was performed preceding radical prostatectomy from November 2001 to January 200514. On the preoperative scintigraphy SLNs were detected bilaterally, unilaterally, not on the pelvic-walls in 113 (80.7%), 20 (14.2%) and 6 (4.2%) patients and intraoperatively in 96 (68.6%), 36 (25.7%), 8 (5.7%) patients respectively. In 99 out of 140 patients (70.7%) intraoperatively SLN was detected in the same position as on preoperative scan. At least one SLN was detected in 133 patients (95.3%). Whenever PLND is indicated it should not be limited to lymph node sampling as provided by standard limited PLND but has to be performed in the template of extended PLND. There is only limited experience with sentinel PLND, but all the data collected so far indicate that this method has the potential to become an alternative to extended PLND since it allows for reduction of the extent of PLND without compromising diagnostic accuracy
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Masculino , Humanos , Biopsia del Ganglio Linfático Centinela , Neoplasias de la Próstata/patología , Prostatectomía , Antígeno Prostático Específico/análisis , Escisión del Ganglio LinfáticoRESUMEN
After initial scepticism laparoscopic radical nephrectomy has rapidly been developed to a standard of care which should be offered to all patients as an alternative to open surgery. This procedure is indicated for all renal tumours clinical stage 1-2 which are not considered for partial nephrectomy. Many studies now show that the oncologic outcome is good and comparable to open surgery. Follow-up, however, is limited to about 10 years. Laparoscopic radical nephrectomy has become a standardized procedure. Removal of the kidney by morcellation, favoured by the majority some time ago, has been abandoned to a great extent. Also the controversy about the advantages and disadvantages of the respective approach has been settled. Several prospective randomized studies proved that both the transperitoneal and retroperitoneal approaches are equally effective. Excluding the bias of the learning curve the complication rate of laparoscopy is not higher than that of open surgery, but morbidity is clearly lower. Since the rate of elective partial nephrectomy is increasing rapidly, laparoscopy may be a good choice for this indication as well. When performed during ischaemia all principles of open surgery--excision of the tumour with clear margins, haemostasis using sutures, closure of the collecting system, suture repair of the renal parenchyma--can be duplicated. The problem of long warm ischaemia time can be managed by the evolution of the surgical technique, but also by induction of hypothermia. Complication rates are comparable to open surgery. Oncologic results, with limited follow-up however, are promising.
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Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Laparoscopía/métodos , Nefrectomía/métodos , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Humanos , Hipotermia Inducida , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Escisión del Ganglio Linfático/métodos , Estadificación de Neoplasias , Complicaciones Posoperatorias/etiología , Tasa de SupervivenciaRESUMEN
The introduction of laparoscopic pyeloplasty was the first step towards the development of suturing and knotting techniques. The final breakthrough came with the development of radical prostatectomy since the performance of the urethrovesical anastomosis required highly developed skills in reconstructive surgery. For most laparoscopic surgeons suturing and knot tying became quite familiar henceforth. As a consequence, the interest for other reconstructive procedures has increased tremendously since. Within a very short time pyeloplasty was developed to a surgical standard, and the results compare very favorably with open surgery. A very attractive method is the ureteral reimplantation according to the psoas hitch technique, which, however, does not completely duplicate the open surgical operation. Many patients can potentially be attracted by sacrocolpopexy to treat genital prolapse. The long-term success rate is 92% which is excellent for this indication. Urinary diversion following cystectomy is usually not performed completely intracorporeally, but laparoscopically assisted.
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Enfermedades Urogenitales Femeninas/cirugía , Laparoscopía/métodos , Enfermedades Urogenitales Masculinas/cirugía , Técnicas de Sutura , Neoplasias Urogenitales/cirugía , Anastomosis Quirúrgica/métodos , Femenino , Estudios de Seguimiento , Humanos , Pelvis Renal/cirugía , Masculino , Uréter/cirugía , Obstrucción Ureteral/cirugía , Ureterostomía/métodos , Derivación Urinaria/métodos , Incontinencia Urinaria/cirugía , Reservorios Urinarios Continentes , Reflujo Vesicoureteral/cirugíaRESUMEN
Ureteropelvic junction (UPJ) obstruction in adults is usually symptomatic, secondary, and it tends to progress. Surgical correction of obstructed UPJ is necessary to preserve the renal function of the affected kidney. Pyeloplasty as a surgical management for UPJ obstruction in adults has proven its efficacy with high success rates on long-term results. Laparoscopic pyeloplasty in the management of primary or secondary UPJ obstruction in adults technically duplicate the open surgical technique. Laparoscopic pyeloplasty has developed to match success, morbidity and complication rates of open surgical pyeloplasty. However it was shown that laparoscopy had consistently a shorter convalescence than open surgery. Endopyelotomy is utilized to manage UPJ obstruction. Early results for endopyelotomy were promising but long-term results were not encouraging. In the management of UPJ obstruction in adults, long-term success rates for laparoscopic pyeloplasty were found to be superior to those of endopyelotomy. Therefore we believe that laparoscopic pyeloplasty will become as a standard management for UPJ obstruction in adults.
Asunto(s)
Pelvis Renal/cirugía , Laparoscopía , Obstrucción Ureteral/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Humanos , Masculino , Resultado del TratamientoRESUMEN
OBJECTIVE: The European Society of Uro-Technology (ESUT) conducted a survey in order to assess the application of laparoscopy and the facilitation of training programs within Europe. METHODS: A total of 430 urologists and residents from European countries answered the ESUT survey during the XVIIIth Annual EAU Meeting in Madrid in 2003. The survey constituted of 11 questions of which nine with dual response (Y/N) options. Two questions, evaluating the importance of different training methods and different reasons not to be involved in laparoscopy, were assessed by means of a Likert type scale. RESULTS: Laparoscopy was performed in 71% of urological departments. The majority (85%) of departments where no laparoscopy was performed, intended to establish it in the future. Two thirds of respondents believed laparoscopy would replace open surgery in the next 5 to 10 years. The access to training facilities was insufficient for 44%. Different methods of training were considered to be of equal importance. Among the reasons for not being involved in laparoscopic surgery a high variability was identified. CONCLUSIONS: Laparoscopy is performed in the majority of urological departments in Europe. While there is a strong believe in the prominent role of laparoscopy in the mid-long future, access to training is still needed.
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Laparoscopía/estadística & datos numéricos , Procedimientos Quirúrgicos Urológicos/educación , Procedimientos Quirúrgicos Urológicos/estadística & datos numéricos , Urología/educación , Urología/estadística & datos numéricos , Competencia Clínica/estadística & datos numéricos , Educación Médica Continua/estadística & datos numéricos , Europa (Continente) , Encuestas de Atención de la Salud , Humanos , Motivación , Evaluación de NecesidadesRESUMEN
The concept of organ- and function-preserving surgery without compromising the primary goal of complete tumour removal has been recently applied in adrenal surgery. This has been accomplished by open surgery in the past. With recent advancements in minimally invasive surgery, partial adrenalectomy by laparoscopic approach has become feasible. The indications, contraindications and worldwide experience have been reviewed for this article.
RESUMEN
INTRODUCTION: Laparoscopic nephroureterectomy reduces the morbidity of surgical management of urinary tract transitional cell carcinoma (TCC), but a potentially increased risk for local tumour spreading was reported. We evaluated results obtained from patients undergoing a modified laparoscopic approach and open procedures in this respect. PATIENTS AND METHODS: Between January 2000 and March 2002 we performed 19 modified laparoscopic nephroureterectomies (LNU) with open intact specimen retrieval in conjunction with open distal ureter and bladder cuff removal and 15 open standard nephroureterectomies (ONU). Staging lymphadenectomy was performed in 14/19 (73.7%) patients with LNU and in 6/15 (40.0%) with ONU. In all patients operating time, blood loss, complications, pain score (VAS) and data in respect to tumour recurrence were analysed. Mean follow-up was 22.1+/-9.2 (range 14-34) months for LNU and 23.1+/-8.8 (14-36) for ONU respectively. RESULTS: In LNU and ONU pathological features were 12 pT1 vs. 10 pT1, 2 pT2 vs. 2 pT2 and 5 pT3 vs. 3 pT3, respectively. All patients had TCC and were R0 at final histology. Four patients with LNU had lymph node involvement, one in ONU. LNU had decreased operating times (p=0.057), blood loss (p=0.018), complications (p=0.001) and VAS scores (p=0.001). One tumour recurrence occurred in LNU, associated with a pT3b pN2 G3 TCC at final histology. One patient with ONU had local tumour recurrence at the site of the bladder cuff. No port-site metastasis occurred during follow-up with LNU. CONCLUSION: Improved peri-operative results and same cancer control as compared to open surgery by this modified LNU was not associated with an increased risk for tumour recurrence, since strict "non-touch" preparation, avoiding of urine spillage and intact specimen retrieval prevents tumour seeding. However, results from long term studies are still warranted to clarify this issue.