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1.
Eur Radiol ; 33(2): 1040-1049, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36066733

RESUMO

OBJECTIVES: Percutaneous radiofrequency ablation (RFA) is stated as a treatment option for renal cell carcinoma (RCC) smaller than 4 cm (T1a). Microwave ablation (MWA) is a newer technique and is still considered experimental in some guidelines. The objective of this study was to compare the safety and efficacy of RFA and MWA for the treatment of RCC. METHODS: Patients with T1a RCC treated by RFA or MWA in two referral centers were retrospectively analyzed. Patient records were evaluated to generate mRENAL nephrometry scores. Local tumor progression (LTP) was considered when new (recurrence) or residual tumor enhancement within/adjacent to the ablation zone was objectified. Differences in LTP-free interval (residual + recurrence) between ablation techniques were assessed with Cox proportional hazards models and propensity score (PS) methods. RESULTS: In 164 patients, 87 RFAs and 101 MWAs were performed for 188 RCCs. The primary efficacy rate was 92% (80/87) for RFA and 91% (92/101) for MWA. Sixteen patients had residual disease (RFA (n = 7), MWA (n = 9)) and 9 patients developed recurrence (RFA (n = 7), MWA (n = 2)). LTP-free interval was significantly worse for higher mRENAL nephrometry scores. No difference in LTP-free interval was found between RFA and MWA in a model with inverse probability weighting using PS (HR = 0.99, 95% CI 0.35-2.81, p = 0.98) and in a PS-matched dataset with 110 observations (HR = 0.82, 95% CI 0.16-4.31, p = 0.82). Twenty-eight (14.9%) complications (Clavien-Dindo grade I-IVa) occurred (RFA n = 14, MWA n = 14). CONCLUSION: Primary efficacy for ablation of RCC is high for both RFA and MWA. No differences in efficacy and safety were observed between RFA and MWA. KEY POINTS: • Both RFA and MWA are safe and effective ablation techniques in the treatment of T1a renal cell carcinomas. • High modified RENAL nephrometry scores are associated with shorter local tumor progression-free interval. • MWA can be used as heat-based ablation technique comparable to RFA for the treatment of T1a renal cell carcinomas.


Assuntos
Carcinoma de Células Renais , Ablação por Cateter , Neoplasias Renais , Neoplasias Hepáticas , Ablação por Radiofrequência , Humanos , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Renais/patologia , Estudos Retrospectivos , Pontuação de Propensão , Resultado do Tratamento , Micro-Ondas , Ablação por Radiofrequência/métodos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Ablação por Cateter/métodos , Neoplasias Hepáticas/patologia
2.
Br J Anaesth ; 126(2): 377-385, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33092803

RESUMO

BACKGROUND: Deep neuromuscular block is associated with improved working conditions during laparoscopic surgery when propofol is used as a general anaesthetic. However, whether deep neuromuscular block yields similar beneficial effects when anaesthesia is maintained using volatile inhalation anaesthesia has not been systematically investigated. Volatile anaesthetics, as opposed to intravenous agents, potentiate muscle relaxation, which potentially reduces the need for deep neuromuscular block to obtain optimal surgical conditions. We examined whether deep neuromuscular block improves surgical conditions over moderate neuromuscular block during sevoflurane anaesthesia. METHODS: In this single-centre, prospective, randomised, double-blind study, 98 patients scheduled for elective renal surgery were randomised to receive deep (post-tetanic count 1-2 twitches) or a moderate neuromuscular block (train-of-four 1-2 twitches). Anaesthesia was maintained with sevoflurane and titrated to bispectral index values between 40 and 50. Pneumoperitoneum pressure was maintained at 12 mm Hg. The primary outcome was the difference in surgical conditions, scored at 15 min intervals by one of eight blinded surgeons using a 5-point Leiden-Surgical Rating Scale (L-SRS) that scores the quality of the surgical field from extremely poor1 to optimal5. RESULTS: Deep neuromuscular block did not improve surgical conditions compared with moderate neuromuscular block: mean (standard deviation) L-SRS 4.8 (0.3) vs 4.8 (0.4), respectively (P=0.94). Secondary outcomes, including unplanned postoperative readmissions and prolonged hospital admission, were not significantly different. CONCLUSIONS: During sevoflurane anaesthesia, deep neuromuscular block did not improve surgical conditions over moderate neuromuscular block in normal-pressure laparoscopic renal surgery. CLINICAL TRIAL REGISTRATION: NL7844 (www.trialregister.nl).


Assuntos
Anestésicos Inalatórios/administração & dosagem , Rim/cirurgia , Laparoscopia , Nefrectomia , Bloqueio Neuromuscular , Sevoflurano/administração & dosagem , Cirurgiões , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Monitorização Neurofisiológica Intraoperatória , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Países Baixos , Bloqueio Neuromuscular/efeitos adversos , Monitoração Neuromuscular , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
3.
Nat Commun ; 10(1): 3118, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311922

RESUMO

Iatrogenic injury of the ureters is a feared complication of abdominal surgery. Zwitterionic near-infrared fluorophores are molecules with geometrically-balanced, electrically-neutral surface charge, which leads to renal-exclusive clearance and ultralow non-specific background binding. Such molecules could solve the ureter mapping problem by providing real-time anatomic and functional imaging, even through intact peritoneum. Here we present the first-in-human experience of this chemical class, as well as the efficacy study in patients undergoing laparoscopic abdominopelvic surgery. The zwitterionic near-infrared fluorophore ZW800-1 is safe, has pharmacokinetic properties consistent with an ideal blood pool agent, and rapid elimination into urine after a single low-dose intravenous injection. Visualization of structure and function of the ureters starts within minutes after ZW800-1 injection and lasts several hours. Zwitterionic near-infrared fluorophores add value during laparoscopic abdominopelvic surgeries and could potentially decrease iatrogenic urethral injury. Moreover, ZW800-1 is engineered for one-step covalent conjugatability, creating possibilities for developing novel targeted ligands.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Laparoscopia/efeitos adversos , Compostos de Amônio Quaternário/administração & dosagem , Ácidos Sulfônicos/administração & dosagem , Ureter/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Corantes Fluorescentes/administração & dosagem , Corantes Fluorescentes/efeitos adversos , Corantes Fluorescentes/farmacocinética , Voluntários Saudáveis , Humanos , Infusões Intravenosas , Complicações Intraoperatórias/etiologia , Ionóforos/administração & dosagem , Ionóforos/efeitos adversos , Ionóforos/farmacocinética , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Imagem Óptica/métodos , Compostos de Amônio Quaternário/efeitos adversos , Compostos de Amônio Quaternário/farmacocinética , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Ácidos Sulfônicos/efeitos adversos , Ácidos Sulfônicos/farmacocinética , Ureter/lesões , Adulto Jovem
6.
Neurourol Urodyn ; 34(2): 144-50, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24249542

RESUMO

AIMS: Laparoscopic radical prostatectomy (LARP) may cause stress urinary incontinence (SUI). This study reports the effects of preoperative pelvic floor muscle therapy (PFMT) on SUI and quality of life (QoL) in men undergoing LARP. MATERIALS AND METHODS: In this single-center randomized controlled trial, 122 patients undergoing LARP were assigned to an intervention group of PFMT with biofeedback once a week preoperatively, with 4 weeks' follow-up or to a control group receiving standard care. Randomization and allocation to the trial group were carried out by a central computer system. The primary analysis was based on 121 (n = 65; n = 56), comparing SUI rates and QoL in the two groups in a 1-year follow-up. Validated questionnaires, the Pelvic Floor Inventories (PeLFls), the King's Health Questionnaire (KHQ), the International Prostate Symptom Score (IPSS), a bladder diary, a 24-hr pad test and pelvic floor examination were used. Continence was defined as no leakage at all. All analyses were performed according to intention-to-treat. RESULTS: One hundred twenty-two patients were randomized, 19 patients were excluded from analysis because of early drop-out. There were no significant differences between both groups in the incidence of SUI and QoL based on the KHQ, IPSS, and pad tests (P ≥ 0.05). In all patients continence was achieved in 77.2% at 1 year postoperatively. CONCLUSIONS: Preoperative PFMT does not appear to be effective in the prevention of SUI and QoL following LARP.


Assuntos
Biorretroalimentação Psicológica/fisiologia , Diafragma da Pelve/fisiologia , Modalidades de Fisioterapia , Cuidados Pré-Operatórios/métodos , Prostatectomia/efeitos adversos , Qualidade de Vida/psicologia , Incontinência Urinária por Estresse/psicologia , Incontinência Urinária por Estresse/terapia , Idoso , Terapia por Exercício/métodos , Seguimentos , Humanos , Incidência , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Força Muscular/fisiologia , Músculos/fisiologia , Neoplasias da Próstata/cirurgia , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária por Estresse/epidemiologia
7.
PLoS One ; 9(9): e108464, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25247809

RESUMO

Low survival rates of metastatic cancers emphasize the need for a drug that can prevent and/or treat metastatic cancer. αv integrins are involved in essential processes for tumor growth and metastasis and targeting of αv integrins has been shown to decrease angiogenesis, tumor growth and metastasis. In this study, the role of αv integrin and its potential as a drug target in bladder cancer was investigated. Treatment with an αv integrin antagonist as well as knockdown of αv integrin in the bladder carcinoma cell lines, resulted in reduced malignancy in vitro, as illustrated by decreased proliferative, migratory and clonogenic capacity. The CDH1/CDH2 ratio increased, indicating a shift towards a more epithelial phenotype. This shift appeared to be associated with downregulation of EMT-inducing transcription factors including SNAI2. The expression levels of the self-renewal genes NANOG and BMI1 decreased as well as the number of cells with high Aldehyde Dehydrogenase activity. In addition, self-renewal ability decreased as measured with the urosphere assay. In line with these observations, knockdown or treatment of αv integrins resulted in decreased metastatic growth in preclinical in vivo models as assessed by bioluminescence imaging. In conclusion, we show that αv integrins are involved in migration, EMT and maintenance of Aldehyde Dehydrogenase activity in bladder cancer cells. Targeting of αv integrins might be a promising approach for treatment and/or prevention of metastatic bladder cancer.


Assuntos
Carcinoma de Células de Transição/patologia , Vetores Genéticos/farmacologia , Integrina alfaV/efeitos dos fármacos , Terapia de Alvo Molecular , Proteínas de Neoplasias/antagonistas & inibidores , Interferência de RNA , RNA Interferente Pequeno/farmacologia , Receptores de Vitronectina/antagonistas & inibidores , Neoplasias da Bexiga Urinária/patologia , Aldeído Desidrogenase/biossíntese , Aldeído Desidrogenase/genética , Animais , Adesão Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Autorrenovação Celular/efeitos dos fármacos , Transição Epitelial-Mesenquimal/efeitos dos fármacos , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Coração , Humanos , Integrina alfaV/fisiologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Invasividade Neoplásica , Proteínas de Neoplasias/biossíntese , Proteínas de Neoplasias/genética , Transplante de Neoplasias/métodos , Papiloma/patologia , Receptores de Vitronectina/fisiologia , Tíbia , Fatores de Transcrição/biossíntese , Fatores de Transcrição/genética , Transdução Genética , Ensaio Tumoral de Célula-Tronco , Ensaios Antitumorais Modelo de Xenoenxerto
8.
Trials ; 14: 63, 2013 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-23452344

RESUMO

BACKGROUND: Surgical conditions in laparoscopic surgery are largely determined by the depth of neuromuscular relaxation. Especially in procedures that are confined to a narrow working field, such as retroperitoneal laparoscopic surgery, deep neuromuscular relaxation may be beneficial. Until recently, though, deep neuromuscular block (NMB) came at the expense of a variety of issues that conflicted with its use. However, with the introduction of sugammadex, rapid reversal of a deep NMB is feasible. In the current protocol, the association between the depth of NMB and rating of surgical conditions by the surgeon and anesthesiologist is studied. METHODS/DESIGN: This is a single-center, prospective, randomized, blinded, parallel group and controlled trial. Eligible patients are randomly assigned to one of two groups: (1) deep NMB (post-tetanic count, one or two twitches; n = 12) and (2) moderate NMB (train-of-four, 1 to 2 twitches, n = 12) by administration of high-dose rocuronium in Group 1 and a combination of atracurium and mivacurium in Group 2. The NMB in Group 1 is reversed by 4 mg/kg sugammadex; the NMB in Group 2 by 1 mg neostigmine and 0.5 mg atropine. Patients are eligible if they are over 18 years, willing to sign the informed consent form, and are scheduled to undergo an elective laparoscopic renal procedure or laparoscopic prostatectomy. A single surgeon performs the surgeries and rates the surgical conditions on a five-point surgical rating scale (SRS) ranging from 1 (poor surgical conditions) to 5 (excellent surgical conditions). The intra-abdominal part of the surgeries is captured on video and a group of five anesthesiologists and ten surgical experts will rate the videos using the same SRS. The primary analysis will be an intention-to-treat analysis. Evaluation will include the association between the level of NMB and SRS, as obtained by the surgeon performing the procedure and the agreement between the scoring of the images by anesthesiologists and surgeons. DISCUSSION: We aim to show that under the right conditions the perceived opposing goals of surgeons and anesthesiologists (optimal surgical conditions vs. optimal postoperative conditions) may be met without compromise to either. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01631149.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Rim/cirurgia , Laparoscopia , Corpo Clínico Hospitalar/psicologia , Bloqueio Neuromuscular/métodos , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Prostatectomia/métodos , Projetos de Pesquisa , Centro Cirúrgico Hospitalar , Centros Médicos Acadêmicos , Androstanóis/administração & dosagem , Serviço Hospitalar de Anestesia , Atracúrio/administração & dosagem , Atropina/administração & dosagem , Protocolos Clínicos , Feminino , Humanos , Análise de Intenção de Tratamento , Isoquinolinas/administração & dosagem , Laparoscopia/efeitos adversos , Masculino , Mivacúrio , Neostigmina/administração & dosagem , Países Baixos , Bloqueio Neuromuscular/efeitos adversos , Fármacos Neuromusculares não Despolarizantes/efeitos adversos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Percepção , Estudos Prospectivos , Prostatectomia/efeitos adversos , Rocurônio , Sugammadex , Análise e Desempenho de Tarefas , Resultado do Tratamento , Gravação em Vídeo , gama-Ciclodextrinas/administração & dosagem
9.
Eur Urol ; 60(2): 337-43, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21616583

RESUMO

BACKGROUND: Bladder cancer is the fifth most common malignancy in the Western world and the second most frequently diagnosed genitourinary tumor. In the majority of cases, death from bladder cancer results from metastatic disease. Understanding the multistep process of carcinogenesis and metastasis in urothelial cancers is pivotal to the development of new therapeutic strategies. Molecular imaging of cancer growth and metastasis in preclinical models provides the essential link between cell-based experiments and clinical translation. OBJECTIVE: Develop preclinical models for sensitive bladder cancer cell tracking during tumor progression and metastasis. DESIGN, SETTING, AND PARTICIPANTS: A human transitional cell carcinoma UM-UC-3 cell line was generated that stably expresses luciferase 2 (UM-UC-3luc2), a mammalian codon-optimized firefly luciferase with superior expression. Preclinical models were developed with human UM-UC-3luc2 cells xenografted into the bladder (orthotopic model with metastases) or inoculated into the left cardiac ventricle (bone metastasis model) of immunocompromised mice. MEASUREMENTS: Noninvasive, sensitive bioluminescent imaging of human firefly luciferase 2-positive bladder cancer in mice using the IVIS100 imaging system. RESULTS AND LIMITATIONS: In the orthotopic model (intravesical inoculation), tumor growth could be followed directly after inoculation of UM-UC-3luc2 cells. Importantly, micrometastatic lesions originating from orthotopically implanted cancer cells could be detected in the locoregional lymph nodes and in distant organs. In addition, the superior bioluminescent indicator firefly luciferase 2 allows the detection and monitoring of micrometastatic lesions in real time after intracardiac inoculation of human bladder cancer cells in mice. The main disadvantage is the lack of T-cell immunity in the preclinical models. CONCLUSIONS: The new bioluminescence-based preclinical bladder cancer models enable superior, noninvasive, and real-time tracking of cancer cells, tumor progression, and micrometastasis. Because of the significant improvement in detection of small cell numbers, the presented models are ideally suited for functional studies dealing with minimal residual disease as well as real-time imaging of drug response.


Assuntos
Neoplasias Ósseas/secundário , Carcinoma de Células de Transição/secundário , Rastreamento de Células/métodos , Luciferases de Vaga-Lume/biossíntese , Medições Luminescentes , Neoplasias Pulmonares/secundário , Neoplasias da Bexiga Urinária/patologia , Animais , Neoplasias Ósseas/genética , Neoplasias Ósseas/metabolismo , Carcinoma de Células de Transição/genética , Carcinoma de Células de Transição/metabolismo , Linhagem Celular Tumoral , Feminino , Humanos , Luciferases de Vaga-Lume/genética , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/metabolismo , Metástase Linfática , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Fatores de Tempo , Transfecção , Carga Tumoral , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/metabolismo
10.
Ned Tijdschr Geneeskd ; 155: A2703, 2011.
Artigo em Holandês | MEDLINE | ID: mdl-21447215

RESUMO

OBJECTIVE: To gain insight into variations in treatment policy for patients with non-metastatic muscle-invasive bladder carcinoma. DESIGN: Retrospective observational cohort study. METHOD: A total of 232 patients with non-metastatic muscle-invasive bladder carcinoma in the region of the Comprehensive Cancer Centre the Netherlands, location Leiden in the Netherlands in the period 2003-2005, were examined to ascertain whether treatment guidelines had been adhered to and which factors contributed to variations in policy. Overall and progression-free survival was compared between curative-intent treatment with cystectomy and with radiotherapy. RESULTS: In total 91% of the patients younger than 75 years were treated with curative intent. In patients of 75 years and over, this proportion varied between 77% of those without comorbid disease to 37% of those with more than 1 comorbid conditions. Only 40% of all patients underwent cystectomy as standard treatment. Age was the most important motivation in deciding against surgery. The proportion of patients who underwent cystectomy in the hospitals studied varied between 17% and 54%. In one hospital, this proportion was significantly lower than the regional average. Neoadjuvant chemotherapy was used in only a few hospitals in selected patients. There was no demonstrable difference in overall and progression-free survival between patients who underwent cystectomy and those treated with curative-intent radiotherapy. CONCLUSION: Age was the deciding factor in the choice of treatment for patients with muscle-invasive bladder carcinoma. The percentage treated by cystectomy varied between hospitals. We recommend thorough documentation of the considerations taken into account when deviating from guidelines.


Assuntos
Quimioterapia Adjuvante , Cistectomia , Neoplasias da Bexiga Urinária/terapia , Fatores Etários , Idoso , Estudos de Coortes , Terapia Combinada , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Invasividade Neoplásica , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/mortalidade
11.
Int Urogynecol J ; 21(10): 1301-3, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20204325

RESUMO

Bladder perforation is a complication which can occur after a Prolift procedure and may enhance vesicovaginal fistula formation. Different methods of management of bladder perforation caused by mesh procedures are described in the literature, and most authors advise complete excision of the mesh. In the case described in this article, we propose a combined transurethral and suprapubical approach as the optimal method for maximal tape removal, being both minimally invasive and less damaging to the vesical wall. A suprapubical catheter can be removed shortly after surgery to enable optimal tissue healing of the vesical mucosa.


Assuntos
Telas Cirúrgicas/efeitos adversos , Bexiga Urinária/lesões , Bexiga Urinária/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/cirurgia , Uretra
12.
Ned Tijdschr Geneeskd ; 153: A956, 2009.
Artigo em Holandês | MEDLINE | ID: mdl-20051162

RESUMO

Urothelial carcinoma of the bladder is diagnosed predominantly in people over 60 years of age. The most common symptom is haematuria. Smoking is an important risk factor (relative risk 2.5 to 3). Cystoscopy is performed whenever bladder carcinoma is suspected. The recurrence rate of a non-muscle invasive urothelial carcinoma is high (31-78% within 5 years). A single intravesical instillation with a chemotherapeutic agent within 24 hours of transurethral resection (TUR) reduces the risk of recurrence. Carcinoma in situ (CIS) should be treated as high-grade urothelial carcinoma. Standard treatment for patients with non-metastasized muscle-invasive urothelial carcinoma is cystectomy in combination with extensive lymph node dissection. There are several possibilities for urinary diversion following cystectomy, none of which are any better than the others. Bladder-sparing brachytherapy may be used in patients with solitary T1 - T2 urothelial carcinoma < 5 cm. Neoadjuvant cisplatin-containing chemotherapy prior to cystectomy in muscle-invasive carcinoma only slightly improves survival. Cisplatin-containing combination chemotherapy is the standard treatment for metastasized urothelial carcinoma.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma in Situ/terapia , Carcinoma de Células de Transição/terapia , Padrões de Prática Médica , Neoplasias da Bexiga Urinária/terapia , Urologia/normas , Administração Intravesical , Braquiterapia , Carcinoma in Situ/complicações , Carcinoma de Células de Transição/complicações , Cisplatino/uso terapêutico , Terapia Combinada , Cistoscopia , Hematúria/diagnóstico , Hematúria/etiologia , Humanos , Excisão de Linfonodo , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Países Baixos , Neoplasias da Bexiga Urinária/complicações , Derivação Urinária
13.
J Endourol ; 22(5): 969-72, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18370612

RESUMO

PURPOSE: To assess the status of urologic laparoscopy in the Netherlands in 2005. MATERIALS AND METHODS: A personal e-mail survey was sent to all practicing Dutch urologists to assess the urologic laparoscopic practice patterns in the Netherlands in 2005. RESULTS: Data were gathered from 86.8% of all urologists receiving the survey. In 2005, 25.5% of Dutch urologists performed laparoscopic procedures. The median number of laparoscopic procedures per urologist was low: 23 per year. Of all non-laparoscopists, 28.5% indicated an intent to begin performing laparoscopic procedures within 1 year. CONCLUSION: All currently performed laparoscopic urologic procedures were performed in the Netherlands in 2005, but the number of such procedures performed per year is low.


Assuntos
Laparoscopia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Países Baixos , Inquéritos e Questionários
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