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1.
J Robot Surg ; 18(1): 24, 2024 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-38217830

RESUMO

In the era of robotic prostate surgery, various techniques have been developed to improve functional outcomes. Urinary continence has shown satisfactory results, but the preservation of lateral nerves to the periprostatic capsule is only achievable by sparing the pubovesical complex. This study aims to present the first cases of lateral-approach robot-assisted radical prostatectomy (LRRP) performed by a novice surgeon. We conducted a retrospective analysis of 70 prostate cancer patients who underwent LRRP between October 2019 and September 2021, analyzing the perioperative and functional outcomes. The median operative time and intraoperative blood loss were 102 (92-108) minutes and 150 (130-180) mL, respectively. Five minor postoperative complications were reported, and the median hospital stay was 2 (1-2) days. Eleven positive surgical margins occurred. Potency and urinary continence recovery were achieved in 59 (84%) and 66 (94%) patients, respectively, 12 months after surgery. Our analysis shows that LRRP is a safe and effective procedure for prostate cancer surgery. Continence and potency recovery required a short learning curve, with an acceptable recovery rate even in the initial cases.


Assuntos
Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Robótica , Cirurgiões , Incontinência Urinária , Masculino , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Próstata/cirurgia , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle , Estudos Retrospectivos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/complicações , Resultado do Tratamento
2.
Surg Endosc ; 37(7): 5708-5713, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37208481

RESUMO

OBJECTIVE: Pudendal Nerve Entrapment (PNE) may determine chronic pelvic pain associated with symptoms related to its innervation area. This study aimed to present the technique and report the outcomes of the first series of robot-assisted pudendal nerve release (RPNR). PATIENTS AND METHODS: 32 patients, who were treated with RPNR in our centre between January 2016 and July 2021, were recruited. Following the medial umbilical ligament identification, the space between this ligament and the ipsilateral external iliac pedicle is progressively dissected to identify the obturator nerve. The dissection medial to this nerve identifies the obturator vein and the arcus tendinous of the levator ani, which is cranially inserted into the ischial spine. Following the cold incision of the coccygeous muscle at the level of the spine, the sacrospinous ligament is identified and incised. The pudendal trunk (vessels and nerve) is visualized, freed from the ischial spine and medially transposed. RESULTS: The Median duration of symptoms was 7 (5, 5-9) years. The median operative time was 74 (65-83) minutes. The median length of stay was 1 (1-2) days. There was only a minor complication. At 3 and 6 months after surgery, a statistically significant pain reduction has been encountered. Furthermore, the Pearson correlation coefficient reported a negative relationship between the duration of pain and the improvement in NPRS score, - 0.81 (p = 0.01). CONCLUSIONS: RPNR is a safe and effective approach for the pain resolution caused by PNE. Timely nerve decompression is suggested to enhance outcomes.


Assuntos
Nervo Pudendo , Neuralgia do Pudendo , Robótica , Humanos , Nervo Pudendo/cirurgia , Neuralgia do Pudendo/etiologia , Neuralgia do Pudendo/cirurgia , Dor Pélvica/etiologia , Dor Pélvica/cirurgia , Diafragma da Pelve/inervação
3.
Can Urol Assoc J ; 15(1): E11-E16, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32701437

RESUMO

INTRODUCTION: High-resolution micro-ultrasound has the capability of imaging prostate cancer based on detecting alterations in ductal anatomy, analogous to multiparametric magnetic resonance imaging (mpMRI). This technology has the potential advantages of relatively low cost, simplicity, and accessibility compared to mpMRI. This multicenter, prospective registry aims to compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mpMRI with high-resolution micro-ultrasound imaging for the detection of clinically significant prostate cancer. METHODS: We included 1040 subjects at 11 sites in seven countries who had prior mpMRI and underwent ExactVu micro-ultrasound-guided biopsy. Biopsies were taken from both mpMRI targets (Prostate Imaging-Reporting and Data System [PI-RADS] >3 and micro-ultrasound targets (Prostate Risk Identification using Micro-ultrasound [PRIMUS] >3). Systematic biopsies (up to 14 cores) were also performed. Various strategies were used for mpMRI target sampling, including cognitive fusion with micro-ultrasound, separate software-fusion systems, and software-fusion using the micro-ultrasound FusionVu system. Clinically significant cancer was those with Gleason grade group ≥2. RESULTS: Overall, 39.5% were positive for clinically significant prostate cancer. Micro-ultrasound and mpMRI sensitivity was 94% vs. 90%, respectively (p=0.03), and NPV was 85% vs. 77%, respectively. Specificities of micro-ultrasound and MRI were both 22%, with similar PPV (44% vs. 43%). This represents the initial experience with the technology at most of the participating sites and, therefore, incorporates a learning curve. Number of cores, diagnostic strategy, blinding to MRI results, and experience varied between sites. CONCLUSIONS: In this initial multicenter registry, micro-ultrasound had comparable or higher sensitivity for clinically significant prostate cancer compared to mpMRI, with similar specificity. Micro-ultrasound is a low-cost, single-session option for prostate screening and targeted biopsy. Further larger-scale studies are required for validation of these findings.

4.
J Endourol Case Rep ; 3(1): 169-172, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29177195

RESUMO

To date, kidney transplant recipients have always undergone open surgery. The type and length of the wound vary, but most commonly, a modified Gibson's incision is made in the lower abdomen for the transplantation. Risk factors for wound complications are well defined in general surgery literature. The laparoscopic kidney transplantation (LKT) technique has been developed recently, and several teams have published studies on the intraperitoneal technique. In this case report, we present our technique of total preperitoneal LKT using the Da Vinci robotic surgical system.

5.
BMJ Case Rep ; 20152015 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-26224660

RESUMO

A 47-year-old man was admitted for preventive embolisation of a 10 cm angiomyolipoma (AML) of the right kidney. Three weeks after embolisation, he was readmitted at the emergency unit for a right renal colic. The CT scan confirmed the obstruction of the right ureter due to the presence of fatty tissue into the lumen. Understanding fatty tissue migration into the collecting system is not simple. We hypothesised that the use of alcohol during the embolisation procedure could have led to focal necrosis of the collecting system, thus enabling migration of fatty tissue into the renal calyces.


Assuntos
Angiomiolipoma/terapia , Embolização Terapêutica/efeitos adversos , Etanol/efeitos adversos , Neoplasias Renais/terapia , Cólica Renal/etiologia , Obstrução Ureteral/etiologia , Tecido Adiposo/diagnóstico por imagem , Etanol/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Obstrução Ureteral/diagnóstico por imagem
6.
Clin Genitourin Cancer ; 12(1): e19-27, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24210610

RESUMO

BACKGROUND: The purpose of this study was to evaluate morbidity, functional, and oncological outcomes after NSS in renal tumors > 7 cm. MATERIALS AND METHODS: We retrospectively analyzed data from 168 patients with tumors > 7 cm who were treated using NSS between 1998 and 2012. RESULTS: Imperative and elective indications accounted for 76 (45.2%) and 92 (54.8%) patients, respectively. Major perioperative complications and renal function deterioration occurred in 33 (19.6%) and 51 patients (30.4%), respectively. In multivariate analysis, age older than 60 years (P = .001; hazard ratio [HR], 5) and tumor malignancy (P = .014; HR, 6.7) were prognostic factors for renal function deterioration whereas imperative indication was a risk factor for major postoperative complications (P = .0019; HR, 2.7). In 126 (75%) patients with malignant tumors, after a median follow-up of 30 months (range, 1-254 months), 25 patients (20.2%) died. In multivariate analysis, imperative indication (P = .023; HR, 4.2), positive surgical margin (P = .021; HR, 3.3), and Fuhrman grade > II (P = .013; HR, 3.7) were prognostic indicators for cancer-free survival (CFS). Imperative indication (P = .04; HR, 8.5) and Fuhrman grade > II (P = .04; HR, 3.9) were predictive factors of cancer-specific survival (CSS). In case of elective indication, positive surgical margin, local recurrence, and cancer-related death occurred in 4 (7.6%), 1 (1.1%), and 1 (1.1%) cases, respectively. For elective indication, 5-year estimates of CFS, CSS, and overall survival rates were: 85.7%, 98%, and 93.9%, respectively. CONCLUSION: In this selected population, imperative vs. elective indication status seems to play a critical role in oncologic outcomes. Oncologic results for elective indications are close to those reported with radical nephrectomy.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/efeitos adversos , Néfrons/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Laparoscopia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Néfrons/fisiologia , Estudos Retrospectivos , Fatores de Risco , Robótica , Sobrevida , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
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