Transvaginal specimen removal in minimally invasive surgery.

The demand for urological surgical treatment associated with better cosmesis, lower morbidity rates and shorter hospitalization constantly grows. The transvaginal route has been proposed in an attempt to avoid long abdominal incisions for the removal of the large laparoscopic specimens. Moreover, the transvaginal NOTES approach represents a promising evolution of laparoscopic surgery to a more "minimally invasive" alternative. The current review summarizes the available experience in the literature in transvaginal conventional laparoscopy and NOTES in urology, gynecology and general surgery. The clinical outcome is presented. The most important issues associated with the transvaginal approach are the complications and the postoperative sexual function. These issues are presented.

Complications of percutaneous nephrolithotomy: classification, management, and prevention.

PURPOSE OF REVIEW: Percutaneous nephrolithotomy (PCNL) provides the highest stone-free rate after one session and low morbidity rates in cases of large or multiple renal calculi. The classification, management, and prevention of complications of PCNL are reviewed. RECENT FINDINGS: PCNL is a well tolerated and very effective procedure for the management of renal stones. Specific complications limit the surgical outcome of PCNL whereas the majority of the complications are resolving with conservative or minimally invasive management. Experience with the technique is important for minimizing complications. There is an ongoing effort to classify the complications and to achieve a consensus in reporting the complications and surgical outcome of the procedure. SUMMARY: The knowledge of risk factors, complications, and their management is important for every endourologist. Establishing of a PCNL-specific classification system for reporting outcomes and complications could set the basis for further improvement of the PCNL technique and outcomes.

Promotion of lactose isomerization to fructose and lactulose in one batch by immobilized enzymes on bacterial cellulose membranes.

The production of the sugars fructose and lactulose from lactose using the enzymes ß-galactosidase and glucose isomerase immobilized on bacterial cellulose (BC) membranes has been investigated. Lactose is hydrolyzed by ß-galactosidase at 30 °C to glucose and galactose at a high conversion rate, while at the same temperature, glucose isomerase is not effective in converting the produced glucose to fructose. The rate of the isomerization reaction of glucose to fructose at 70 °C has been studied. Two types of enzyme immobilization were investigated: immobilization in one stage and immobilization in two stages. The results showed that BC membrane increased three-fold the yield and the reaction rate of fructose and lactulose production from lactose. The noteworthy enhancement of BC membranes' impact on the isomerization reaction by immobilized enzymes grants permission for a novel research avenue within the context of white biotechnology development. Additionally, this effect amplifies the role of BC in sustainability and the circular economy.

Laparoscopic sacrocolpopexy using barbed sutures for mesh fixation and peritoneal closure: A safe option to reduce operational times.

INTRODUCTION: Laparoscopic sacrocolpopexy (LSC) has established itself as a safe method for the management of pelvic organ prolapse (POP). Laparoscopic suturing is a time-consuming intraoperative task during LSC. Self-retaining barbed sutures (SBSs) are known to reduce the operative time in laparoscopic cases. The current study aimed to evaluate the efficacy and safety of SBS during the performance of LSC. MATERIALS AND METHODS: Twenty female patients with symptomatic POP were treated with LSC by an expert surgeon. The preoperative evaluation included the International Continence Society POP-quantification (POP-Q) and the prolapse-specific quality-of-life questionnaire Mesh fixation was performed with SBS anteriorly on the anterior vaginal wall and posteriorly on the levator ani muscle. A 5-mm titanium tacking device was used for promontofixation. The peritoneum was also closed with an SBS. RESULTS: Mean patient's age was 63 years (range: 50-79 years). According to POP-Q, system 3 patients (15%) had Stage I, 12 patients (60%) had Stage II, 3 patients (15%) had Stage III, and 2 patients (10%) had Stage IV prolapse. Concomitant hysterectomy was performed in 14 patients, respectively. Mean operative time was 99.75 (range: 65-140) min, mean blood loss was 57.75 (range: 30-120) ml. One patient had a bladder perforation intraoperatively, and three patients developed transient fever postoperatively. One patient had a recurrent cystocele and three patients recurrent rectocele. CONCLUSIONS: The current study renders the use of SBS during LSC to be safe and efficient. Further comparative studies would elucidate the impact of the use of SBS in LSC.

Deep sedation in GreenLight laser prostatectomy.

INTRODUCTION: Evaluation of ketamine and propofol combination for the performance of photoselective vaporization of prostate (PVP). PATIENTS AND METHODS: Twenty-six patients undergoing PVP for benign prostatic hyperplasia were included in the study. Co-morbidities were present in 24 patients. Midazolam 2 mg intravenous was administered for the induction to anesthesia. Propofol (10 mg/ml) and ketamine (1 mg/ml) were administered with the use of two pumps. An initial bolus dose of 0.03 ml/kg of propofol and 5 mg of ketamine was administered intravenously. The anesthesia was maintained by continuous infusion of 0.01 ml/kg/min of propofol and 2 ml/min of ketamine. Fentanyl was administered when deemed necessary. The level of sedation, peri-operative parameters and side-effects were recorded. RESULTS: The average periods from the induction of anesthesia and intraoperative infusion were 12.38 ± 5.84 min and 59.5 ± 22.15 min, respectively. Average propofol and total ketamine dose were 85.5 ± 10.62 µg/kg/min and 144.9 ± 45.62 mg, respectively. The average dose of fentanyl administered was 29.81 ± 27.40 µcg. An average period between the end of the infusion and the discharge to the urology clinic was 34.62 ± 22.89 min. Ten patients experienced nausea and five eventually vomited. Hallucinations were observed in five cases while visual disturbances in two patients. CONCLUSION: The combined use of ketamine and propofol for the performance of PVP proved to be an efficient method for anesthesia. The "deep sedation" provided by these drugs was not associated with significant side-effects. Moreover, the use of the above method is indicated in patients with significant co-morbidities that should undergo PVP.

Modular training for percutaneous nephrolithotripsy: The safe way to go.

UNLABELLED: Objectives should be describe a modular training scheme (MTS) which aims to provide training in percutaneous nephrolithotripsy (PCNL) and ensure the safety of the patients. SUBJECTS AND METHODS: Two trainees with no experience in PCNL attended the MTS under the supervision of an experienced mentor. The MTS included five modules, comprising an initial animal laboratory course (using pigs), to acquire basic skills (Module 1), and Modules 2-5 included making the puncture, tract dilatation, single-stone and large-stone management in clinical cases, respectively. Each participant progressed from one module to the next under constant mentoring and evaluation by the mentor. When the trainees completed the MTS they proceeded to perform 60 PCNL procedures independently while the mentor performed 25 for comparison purposes. A global rating scale was used for the objective evaluation of the trainees. Peri-operative variables were recorded and statistically compared as appropriate. Statistical significance was defined as P < 0.05. RESULTS: One pig and 16 patients, and two pigs and 22 patients, were necessary to complete the MTS by each subject. There were no significant differences among the characteristics of the independently performed operations. The duration of surgery and fluoroscopy achieved a plateau similar to those of the mentor after ≈ 30 patients. The decrease in haemoglobin level, stone-free and complication rates in the patients were similar among the two trainees and the mentor. The complication rate of the trainees and the mentor never exceeded 13.3%. CONCLUSION: The MTS successfully combined animal and stepwise clinical training based on a standardised technique and objective evaluation.

Laparoscopic radical and partial nephrectomy: The clinical efficacy and acceptance of the techniques.

The laparoscopic approach has been established as the surgical procedure of choice for radical nephrectomy during the recent years. The advantages of the laparoscopic radical nephrectomy in comparison to the open approach are well-documented. The oncological results of the laparoscopic approach are similar to the open procedure while the post-operative morbidity is lower. Laparoscopic partial nephrectomy seems to gain ground to its open counterpart, as the accumulation of experience in the technique grows. In this review, a PubMed search in the latest literature on radical and partial laparoscopic nephrectomy took place and the outcome of the search is presented. Several issues about the surgical techniques and clinical efficacy are discussed. In addition, the preliminary experience in laparoscopic nephrectomy of one of the authoring institutions is also presented.