Long-term experience on laparoscopic incontinent urinary diversion unrelated to cystectomy in radiated or recurrent pelvic malignancies.

BACKGROUND: There are few reports describing series of cases about development on laparoscopic urinary diversions no related to cystectomy. The aim of this paper is to show the experience of our reference institutions for treatment of pelvic malignancies when laparoscopic techniques were applied to perform only urinary diversion without cystectomy or pelvic exenteration. MATERIALS AND METHODS: We included retrospectively 12 cases of cutaneous ureterostomy and 21 cases with a reservoir (16 ileal conduits, 2 colonic conduits and 3 wet colostomies) treated in our institute from 2004 to 2010. It was evaluated operative time, blood loss, intraoperative complications, conversion rate, length of large incision, post operative complications, analgesic consumption, time to food intake, hospital stay, time to recovery to normal activities. Mean time to follow-up was 3(2-7) years. RESULTS: All procedures were completed without conversions. In the cutaneous ureterostomy group the mean surgical time.

Laparoscopic radical prostatectomy for high risk localized and locally advanced disease.

PURPOSE: The indication for surgery in locally advanced prostate cancer is growing considering and long-term follow-up shows that 60-80% of patients can be free of clinical recurrence. The aim of this video is demonstrate the modifications in traditional laparoscopic surgery that permit to observe the oncological principles reproducing open surgery. MATERIALS AND METHODS: A 55 years-old male presented with an initial PSA = 25ng/dL, the digital rectal examination found a prostate with hardened nodules bilaterally (clinical stage T2c). Prostate biopsy showed an adenocarcinoma Gleason 7, the patient's disease was classified as a localized high-risk prostate cancer. Surgery was offered as initial therapeutic option and the critical technical points were: transperitoneal approach to evaluate if separation of rectum from prostate and seminal vesicles was possible, extended pelvic lymphadenectomy, opening of endopelvic fascia lateral to the prostate, bladder neck section without preservation, pedicle control without neurovascular bundle preservation, meticulous dissection of apical region, reconstruction of posterior bladder neck before the anastomosis. RESULTS: The operative time was 240 minutes without conversion to open surgery and an estimated blood loss around 520 mL. Neither intraoperative nor postoperative complications occurred and the hospital stay was about 36 hours. Pathological report confirmed a prostate adenocarcinoma Gleason 4+4, negative margins and stage pT3a pN0 pMx. CONCLUSIONS: Laparoscopic surgery adopting oncological principles can be utilized with efficacy to selected patients with high risk localized and locally advanced prostate cancer maintaining the advantages of minimally invasive surgical approach.

LESS sacrocolpopexy: step by step of a simplified knotless technique.

INTRODUCTION: Pelvic organ prolapse is an ordinary disease with around 200.000 surgeries performed annually in the US to treat this condition. The surgical treatment for complete vaginal vault prolapse after hysterectomy involves abdominal or vaginal sacrocolpopexy. The purpose of this video is to demonstrate the steps of a laparoendoscopic single-site surgery (LESS) sacrocolpopexy performed by a simplified knotless technique. MATERIALS AND METHODS: A 52 year-old female submitted a total hysterectomy five years ago due to miomatosis who developed vault prolapse and urinary incontinence after surgery. She was treated by transumbilical LESS cutaneous retractor and a surgical glove attached to three trocars through a 3.5 cm umbilical incision. Patient was positioned in lithotomy, the Y-shape polypropylene mesh was passed through the trocar. Only conventional laparoscopic instruments were used for intrabdominal dissection of vagina and peritoneum. The mesh was fixed to the vaginal fornix using 3 continuous sutures held in extremities by polymeric clips. The last helical suture was fixed by polymeric clips to the sacral periosteum from the promontory to achieve good vaginal positioning without tension. The posterior peritoneum was closed over the mesh. RESULTS: The operative time was 150 minutes, blood loss of approximately 100 mL and the patient was discharged after 18 hours with no immediate complications and a 3 months follow-up free of vault prolapse and urinary incontinence until now. CONCLUSIONS: LESS sacrocolpopexy performed with conventional instruments is feasible and a safe procedure reproducing surgical steps of conventional laparoscopic or robotic surgery.

Single-site video endoscopic inguinal lymphadenectomy: initial report.

Techniques that attempt to further reduce the morbidity and improve cosmesis of laparoscopic surgery have particularly generated interest. Since its initial urologic description in 2007, there has been a surge of interest in laparoendoscopic single-site surgery, which is now an emerging technique within the field of minimally invasive urologic surgery. This report describes a preliminary experience with single-site video endoscopic inguinal lymphadenectomy (SSVEIL) compared with conventional video endoscopic inguinal lymphadenectomy (VEIL) on inguinal nodes management in a 45-year-old man with pT(2) grade 2 squamous cell penile carcinoma and impalpable inguinal nodes. VEIL with saphenous vein preservation in the left leg and SSVEIL on the other side presented no difference concerning operative time (100 vs 120 min), blood loss (50 mL), drainage volume, number of nodes retrieved (8), pain, and oncologic outcome. The patient had an uneventful postoperative course, was discharged 12 hours after the procedure, and preferred the aesthetic result of SSVEIL. Further refinements in technology will likely alleviate many of the persistent technical problems. Additional rigorous comparison studies are needed to evaluate the true benefits of the technique and the extent of its clinical application, mainly oncologic results, before the widespread adoption of SSVEIL. Ultimately, advance breakthroughs in fields of in-vivo instrumentation, robotics, and purpose-built robotic platforms will bring its potential to full clinical realization.

Video-assisted double-barreled wet colostomy: a new minimally invasive simultaneous diversion to patients after pelvic radiation therapy.

INTRODUCTION: A wet colostomy can be done when the simultaneous diversion of fecal and urine streams are necessary. Laparoscopic access is gaining space in urinary diversion procedures. The aim of the present study was to present the technique and results of the first case reported of a video-assisted double-barreled wet colostomy. PATIENT AND METHODS: In this article, we report a case of a 50-year-old woman with actinic complex urinary and fecal fistula, treated through a retroperitoneoscopic double-barreled wet colostomy. Only the left kidney had function, so she was treated by video endoscopic retroperitoneal dissection of the left ureter, preplanned transverse 5-cm incision for exteriorization of left colon and ureter, extracorporeal section of the left colon with a linear stapler, extracorporeal antireflux ureterocolonic anastomosis, and maturation of the stoma 10 cm proximal to the end of the proximal colonic loop. RESULTS: Operative time was 135 minutes. No transfusion was required nor had intraoperative complications occurred. Oral intake was initiated in postoperative day 2, and the patient was discharged postoperative day 6 without complications. Normal activities were recovered after 21 days. In a 3-month follow-up, there were no infectious complications, and good urinary drainage was observed. She was satisfied and adapted to the stoma. CONCLUSIONS: Video-assisted double-barreled wet colostomy is a feasible procedure. The same goals of the open procedure were achieved, offering the advantages of the laparoscopic approach.