RESUMO
To ensure accurate targeting and repeatability, 3D TRUS-guided biopsies require registration to determine coordinate transformations to (1) incorporate pre-procedure biopsy plans and (2) compensate for inter-session prostate motion and deformation between repeat biopsy sessions. We evaluated prostate surface- and image-based 3D-to-3D TRUS registration by measuring the TRE of manually marked, corresponding, intrinsic fiducials in the whole gland and peripheral zone, and also evaluated the error anisotropy. The image-based rigid and non-rigid methods yielded the best results with mean TREs of 2.26 mm and 1.96 mm, respectively. These results compare favorably with a clinical need for an error of less than 2.5 mm.
Assuntos
Biópsia/métodos , Próstata/diagnóstico por imagem , Próstata/patologia , Técnica de Subtração , Cirurgia Assistida por Computador/métodos , Ultrassonografia de Intervenção/métodos , Ultrassonografia/métodos , Algoritmos , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
The effect of adding a calcium channel antagonist to kidney allograft perfusate solution was assessed. All renal transplants in which both kidneys from the same donor used for transplantation were studied between November, 2003 and August, 2005 (n=46). The first renal allograft was perfused on the backtable with 1 L of histidine-tryptophan-ketoglurate solution and the second with 1 L of histidine-tryptophan-ketoglurate with 5 mg/L of verapamil. Both organs were transplanted in the usual manner. Baseline demographic parameters were similar between first and second kidney recipients other than BMI and cold ischemic time. At 6 and 12 months, renal function was significantly improved in the verapamil versus control cohort (creatinine clearance 73.8+/-23.5 mL/min vs. 55.8+/-17.0 mL/min, P<0.05 and 87.5+/-28.4 mL/min vs. 59.7+/-21.3 mL/min, P<0.05 respectively). Additionally, rates of hypotension during graft reperfusion and other adverse reactions were similar in both groups. In conclusion, verapamil supplemented perfusate significantly improved renal function posttransplantation.
Assuntos
Sobrevivência de Enxerto/efeitos dos fármacos , Transplante de Rim/fisiologia , Verapamil/uso terapêutico , Sistema ABO de Grupos Sanguíneos , Adulto , Bloqueadores dos Canais de Cálcio/uso terapêutico , Estudos de Coortes , Creatinina/metabolismo , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/fisiopatologia , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Perfusão/métodos , Estudos Prospectivos , Estudos Retrospectivos , Transplante Homólogo/fisiologiaRESUMO
We describe laparoscopic partial nephrectomy in a patient with autosomal dominant polycystic kidney disease. Reconstruction was accomplished despite the abnormal quality of the renal tissue. In this patient, with borderline renal function, the warm-ischemia time (50 minutes) was longer than the normally accepted time and was poorly tolerated. In order to avoid the damaging effects of warm ischemia, alternatives to hilar clamping should be employed, and open partial nephrectomy should be considered.
Assuntos
Laparoscopia/métodos , Nefrectomia/métodos , Rim Policístico Autossômico Dominante/cirurgia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Cuidados Pós-Operatórios , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: To highlight the use of intraoperative laparoscopic ultrasonography (ILUS) in complex renal surgery, as well its impact on management. ILUS has been used to facilitate advanced laparoscopic surgery, but only limited descriptions of the indications for its use have been published. METHODS: All patients undergoing laparoscopic renal procedures requiring ILUS from October 2001 to March 2005 were reviewed. A total of 50 cases, including 35 partial nephrectomies, cryoablation of 6 renal tumors, 6 radical nephrectomies, 2 perinephric explorations, and 1 resection of a renal artery aneurysm were assessed by ILUS. RESULTS: The average tumor size in the patients undergoing laparoscopic partial nephrectomy was 3.1 cm (range 1.4 to 8.0), and all margins were negative. Also, a previously unidentified satellite lesion was found in 1 patient. ILUS was essential in assessing iceball formation during laparoscopic renal cryotherapy. ILUS also proved useful in defining the anatomy during laparoscopic perinephric exploration, assessing renal vein thrombi during laparoscopic nephrectomy, and evaluating renal perfusion during laparoscopic renal artery aneurysm repair. CONCLUSIONS: ILUS can be extremely useful in advanced laparoscopic renal surgery. In a number of situations, it is an essential surgical tool. With expanding indications for laparoscopic surgery, the indications for ILUS continue to grow.
