Analysis of surgical and histopathological results of robot-assisted partial nephrectomy with use of three or four robotic arms: an early series results

ABSTRACT Objectives: The aim of this study was to evaluate whether criteria exist to guide election between the use the three- or four-arm technique in robotic partial nephrectomy (RPN) instead of just the surgeon's preference. Material and Methods: We performed a retrospective review of 80 patients submitted to RPN from May 2016 to February 2020. The patients were divided into two groups of 40, the first submitted to the surgical procedure with use of three robotic arms and the second with four arms. The group division was performed independently of the complexity of the cases, age or gender of the patients and laterality of the renal lesions. Peri- and postoperative data were analyzed for comparison between the two groups. Results: Both techniques had similar oncological outcomes (positive tumor margins), renal function preservation (warm ischemia time) and hemorrhagic complications (estimated blood loss and renal artery pseudoaneurysm), with a small difference in the need for blood transfusion, favoring the technique with three arms. Conclusions: The two robotic partial nephrectomy techniques had similar oncological and postoperative outcomes, with minimal perioperative complications. The three-arm technique is safe and feasible regardless of the complexity and size of the tumor. Additionally, the use of the three-arm technique reduced surgery costs by US$ 413.00 per patient.

Analysis of surgical and histopathological results of robot-assisted partial nephrectomy with use of three or four robotic arms: an early series results.

OBJECTIVES: The aim of this study was to evaluate whether criteria exist to guide election between the use the three- or four-arm technique in robotic partial nephrectomy (RPN) instead of just the surgeon's preference. MATERIAL AND METHODS: We performed a retrospective review of 80 patients submitted to RPN from May 2016 to February 2020. The patients were divided into two groups of 40, the first submitted to the surgical procedure with use of three robotic arms and the second with four arms. The group division was performed independently of the complexity of the cases, age or gender of the patients and laterality of the renal lesions. Peri- and postoperative data were analyzed for comparison between the two groups. RESULTS: Both techniques had similar oncological outcomes (positive tumor margins), renal function preservation (warm ischemia time) and hemorrhagic complications (estimated blood loss and renal artery pseudoaneurysm), with a small difference in the need for blood transfusion, favoring the technique with three arms. CONCLUSIONS: The two robotic partial nephrectomy techniques had similar oncological and postoperative outcomes, with minimal perioperative complications. The three-arm technique is safe and feasible regardless of the complexity and size of the tumor. Additionally, the use of the three-arm technique reduced surgery costs by US$ 413.00 per patient.

Correction of severe stiff scoliosis through extrapleural interbody release and osteotomy (liepo) / Correção de escoliose rígida grave por liberação e osteotomia intersomática extrapleural (liepo) / Corrección de escoliosis rígida grave por liberación y osteotomía intersomática extrapleural (liepo)

ABSTRACT Objective: To report a new technique for extrapleural interbody release with transcorporal osteotomy of the inferior vertebral plateau (LIEPO) and to evaluate the correction potential of this technique and its complications. Method: We included patients with scoliosis with Cobb angle greater than 90° and flexibility less than 25% submitted to surgical treatment between 2012 and 2016 by the technique LIEPO at the National Institute of Traumatology and Orthopedics (INTO). Sagittal and coronal alignment, and the translation of the apical vertebra were measured and the degree of correction of the deformity was calculated through the pre and postoperative radiographs, and the complications were described. Results: Patients had an average bleed of 1,525 ml, 8.8 hours of surgical time, 123° of scoliosis in the preoperative period, and a mean correction of 66%. There was no case of permanent neurological damage and no surgical revision. Conclusion: The LIEPO technique proved to be effective and safe in the treatment of severe stiff scoliosis, reaching a correction potential close to the PEISR (Posterior extrapleural intervertebral space release) technique and superior to that of the pVCR (posterior Vertebral Column Resection) with no presence of infection and permanent neurological deficit. New studies are needed to validate this promising technique.

RESUMO Objetivo: Relatar uma nova técnica de liberação intersomática extrapleural associada a osteotomia transcorporal do platô vertebral inferior (LIEPO) e avaliar o potencial de correção dessa técnica e suas complicações. Método: Foram incluídos pacientes com escoliose com ângulo de Cobb maior que 90° e flexibilidade menor que 25%, submetidos ao tratamento cirúrgico entre 2012 e 2016 pela técnica LIEPO, no Instituto Nacional de Traumatologia e Ortopedia (INTO). Foram aferidos alinhamento sagital, coronal e a translação da vértebra apical e calculou-se o grau de correção da deformidade através das radiografias pré e pós-operatórias, sendo descritas as complicações encontradas. Resultado: Os pacientes tiveram média de sangramento de 1.525 ml, 8,8 horas de tempo cirúrgico, 123° de escoliose no pré-operatório e média de correção de 66%. Não houve caso de lesão neurológica permanente e nenhuma revisão cirúrgica. Conclusão: A técnica LIEPO mostrou-se eficaz e segura no tratamento de escoliose rígida grave, atingindo um potencial de correção próximo ao da técnica PEISR ("Posterior Extrapleural Intervertebral Space Release") e superior ao da RCVp (Ressecção de Coluna Vertebral via posterior) sem presença de infecção e déficit neurológico permanente. Novos estudos são necessários para a validação dessa técnica promissora.

RESUMEN Objetivo: Reportar una nueva técnica de liberación intersomática extrapleural asociada a la osteotomía transcorporal de la meseta vertebral inferior (LIEPO) y evaluar el potencial de corrección de esta técnica y sus complicaciones. Método: Se incluyeron pacientes con escoliosis con ángulo de Cobb superior a 90° y flexibilidad inferior al 25%, sometidos al tratamiento quirúrgico entre 2012 y 2016 por la técnica LIEPO, en el Instituto Nacional de Traumatología y Ortopedia (INTO). Se evaluaron la alineación sagital y coronal y la translación de la vértebra apical y se calculó el grado de corrección de la deformidad a través de las radiografías pre y postoperatorias, siendo descritas las complicaciones encontradas. Resultado: Los pacientes tuvieron media de sangrado de 1.525 ml, 8,8 horas de tiempo quirúrgico, 123° de escoliosis en el preoperatorio y promedio de corrección del 66%. No hubo casos de lesión neurológica permanente y ninguna revisión quirúrgica. Conclusión: La técnica LIEPO se mostró eficaz y segura en el tratamiento de la escoliosis rígida grave, alcanzando un potencial de corrección cercano al de la técnica PEISR ("Posterior extrapleural intervertebral space release") y superior al de la RCVp (Resección de columna vertebral vía posterior); sin presencia de infección y déficit neurológico permanente. Se necesitan nuevos estudios para validar esta técnica prometedora.

Minilaparoscopy in urology: initial results after 32 cases.

PURPOSE: The use of minilaparoscopic instruments has gained interest in recent years, permitting a less invasive treatment for many surgical procedures. Its application in urological surgeries has not been established yet. METHODS: Between November 2012 and December 2014, 32 patients underwent minilaparoscopic surgeries, using 3.5-mm instruments. The procedures performed included pyeloplasties (16 cases), radical nephrectomies (2), simple nephrectomies (4), renal cyst decortication (5), ureterolithotomy (2) ureteral reimplantation (2) and partial ureterectomy (1). RESULTS: All the procedures were performed minilaparoscopically, except for one simple nephrectomy and one renal cyst decortication that were converted to a standard laparoscopic approach, due to intensive perioperative bleeding. One pyeloplasty had to be reoperated for a urinary fistula repair. All the patients had good-to-excellent cosmetic outcomes, except for one patient who developed keloids at her scars. Functional results were comparable to the ones described in the literature. CONCLUSION: Minilaparoscopy is a feasible option for patients and physicians searching for a even less invasive procedure compared with the laparoscopic approach, with better cosmetic and the same functional and oncologic outcomes.