Current management of stage I testicular germ cell tumors in a French cancer institute. A practice analysis over the 10 past years.

BACKGROUND: Testicular Germ Cell Tumors (TGCTs) represent the most frequent malignant tumour among young male adults. Orchiectomy alone cure 80% of stage I. Standard options after orchiectomy include radiotherapy (RT), chemotherapy (CT) by 1 cycle of carboplatin AUC 7 or active surveillance (SV) for seminomatous GCTs (SGCT) and retroperitoneal lymphadenectomy (RPLND), CT by 1 or 2 cycles of Bleomycine Etoposide Cisplatine (BEP) or active surveillance for nonseminomatous GCTs (NSGCT). Adjuvant treatments decrease the relapse rate after orchiectomy with substantial toxicities without any benefit on overall survival. Recent guidelines accorded utmost importance on SV rather than adjuvants strategies. The main objective of this study was to describe our current practice over the 10 past years in regard of these recommendations. METHODS: Data of 50 patients with stage I GCT treated in our institute were collected between 2006 and 2016. Demographic and anatomopathologic data were reported. Clinical practice in our center was analyzed during two periods [2006-2011] and [2012-2016] according to the European Association of Urology Guidelines in 2011. RESULTS: Patient's median age was 35.3 years. The analysis of clinical practice during the last 10 years showed that in SGCT, main treatment was RT than SV and CT. This option declined over the years (89% between 2006-2010 versus 53% between 2011-2016) whereas SV was more often employed (27% between 2011-2016 versus none between 2006-2010). Surveillance was used for 64% of NSGCT. CONCLUSIONS: In our center, RT was less used over the years for the benefit of SV which is recommended by guidelines.

[Laparoscopic treatment of an isolated ureteropelvic junction disruption following blunt abdominal trauma]. / Traitement d'une rupture traumatique isolée de la jonction pyélo-urétérale par laparoscopie rétro-péritoneale.

Isolated disruption of the ureteropelvic junction following blunt abdominal trauma is rare, although not exceptional. The diagnosis may be delayed. CT-scan with excretory phase imaging is the usual mode of diagnosis. The urinary tract can be repaired by an ureteropyelic anastomosis over a stent. The authors report the first case of an isolated disruption of the ureteropelvic junction following blunt abdominal trauma repaired by retroperitoneal laparoscopy.

[Retroperitoneal laparoscopic pyeloplasty: retrospective study of 45 consecutive adult cases]. / La résection de jonction pyélo-urétérale par laparoscopie rétropéritonéale: etude rétrospective de 45 cas consécutifs chez l'adulte.

OBJECTIVE: To evaluate the results of retroperitoneal laparoscopic surgical repair of ureteropelvic junction (UPJ) syndrome. MATERIAL AND METHODS: Retrospective study of 45 consecutive Küss-Anderson-Hynes laparoscopic pyeloplasties performed over a 4-year period (December 1998-November 2002) in adults (26 women, 19 men) with a mean age of 44.8 years (range: 16-83 years). RESULTS: The mean operating time was 138 minutes (range: 75-250 minutes). Open conversion was necessary in 3 cases: necrotic pyelitis, ectopic renal artery, posterior pelvic tear. The mean hospital stay was 6.1 days. With a mean follow-up of 19 months (range: 3-58 months), the clinical success rate was 97.6% and the success rate on IVU or scintigraphy was 83.3%. CONCLUSION: This series confirms that laparoscopic pyeloplasty is a minimally invasive technique that gives better results than those of the various endopyelotomy techniques and equivalent results to those of open pyeloplasty with decreased morbidity.

[Design of a prototype operating seat with SESAM (Ergonomic System of Mobile Forearm Rests) mobile armrests designed to optimize the surgeon's ergonomy during pelvic laparoscopy]. / Conception d'un prototype de siège opératoire avec appui-bras mobiles SESAM (Système Ergonomique de Support d'Avant-bras Mobiles) destiné à optimiser l'ergonomie du chirurgien en coelioscopie pelvienne.

INTRODUCTION: Pelvic laparoscopic surgery offers multiple advantages for patients, but requires uncomfortable, non-ergonomic positions for the surgeon. Only a remote operator (Robot "slave" reproducing the surgeon's movements performed on a "master" console situated away from the patient), like Da-Vinci or Zeus (Intuitive Surgical) can improve the laparoscopic surgeon's working conditions. The objective of this study, based on an ergonomic analysis and recording of a laparoscopic surgeon's movements, was to define the specifications for the manufacture of an operating seat with armrests, based on the surgeon's position using a remote operator. MATERIAL AND METHODS: Movements of the centre of pressure and upper limbs of 12 urologists and gynaecologists with various levels of experience, were recorded using a force platform and a SAGA 3 RT movement analysis system (Biogesta), during 4 exercises performed on a pelvi-trainer, with the surgeon positioned to the left (introduction of a needle, unravelling of a cord, dissection, suture). Ergonomic analysis of the laparoscopic surgeon's movements was based on video recordings of a surgeon under real operating conditions. The specifications were defined from all of these data. RESULTS AND DISCUSSION: The small amplitude of movements of the surgeon 's centre of pressure (< 45 cm2) confirmed that surgeons can be seated during laparoscopy. Recordings of the upper defined the elbow working zones and the need for 3D mobile armrests. Ergonomic analysis of posture defined the characteristics of the prototype. On the basis of these specifications, a prototype operating seat was developed. This prototype now needs to be validated or invalidated clinically.