Hemophagocytic syndrome in patients infected with the human immunodeficiency virus: A study of 15 consecutive patients.

OBJECTIVE: Hemophagocytic syndrome (HPS) is characterized by various clinical and biological data derived from cytokine hyperproduction and cell proliferation. The objectives of this study were to evaluate the epidemiological, etiological, clinical and evolutionary characteristics of patients diagnosed with hemophagocytic syndrome and HIV infection, as well as their comparison with data from the literature. METHODS: A retrospective descriptive observational study was performed, including all adult patients with a diagnosis of HPS and HIV infection treated in the Infectious Diseases and Tropical Medicine Unit of the Hospital Universitario Insular, Las Palmas, Gran Canaria from June 1, 1998 to December 31, 2018. RESULTS: An analysis of this series of case reports of 15 patients showed a higher percentage of males than females, with a mean age of 42 years. With respect to the diagnostic criteria for HPS, presence of fever, cytopenias and hyperferritinemia were a constant in all patients. Clinical neurological manifestations were frequent and clinical respiratory signs and symptoms absent. HPS was confirmed in some patients who were not severely immune-depressed and had undetectable viral loads. Furthermore, 40% of cases were not receiving ART. The most frequent triggering causes of HPS were viral, especially HHV-8. In addition, two new HPS triggers were identified: Blastocystis dermatitidis and Mycobacterium chelonae. CONCLUSIONS: Administration of treatment in HPS is arbitrary. This, together with the high mortality rate and the fact that it is underdiagnosed, indicates the importance of conducting future studies.

The best option: Umbilical LESS radical nephrectomy with vaginal extraction.

INTRODUCTION: Umbilical laparoendoscopic single-site (LESS) surgery represents an excellent alternative to laparoscopic or robotic multiport surgery. LESS surgery offers faster recovery, less postoperative pain and optimal cosmetic results. The reusable nature of its instruments also has significant economic advantages. PATIENT AND METHOD: We present a 34-year-old patient with a solid mesorenal lesion measuring 8 cm in the left kidney treated with pure LESS radical nephrectomy assisted by vaginal extraction of the specimen. The umbilical approach using a single-site multichannel KeyPort (Richard Wolf GmbH, Knittlingen, Germany) with DuoRotate curved instruments allows for minimum crushing and fewer spatial conflicts. Its perfect umbilical adaptation provides a hermetic system. The instrument's double rotation provides considerable movement precision. Vaginal extraction avoids damage to the abdominal wall and the need for widening the umbilical incision. RESULTS: After the placement of the device and triangulation of the clips, we proceeded to operate on posterior parietal peritoneum. The descending colon was mobilized to access the retroperitoneum and dissect the renal hilum. Hem-o-lok clips were placed on the artery and vein, which were subsequently sectioned. The specimen was inserted into a laparoscopic bag. Under direct vision, we placed a 15-mm trocar through the bottom of the vaginal posterior fornix to facilitate the extraction of the bag's thread. The incision was widened with the fingers, and the specimen was extracted, closing the vagina from the perineum with visualization from the navel. Abdominal drainage was not employed. The surgical time was 180 min. The patient was discharged the following day without needing analgesia. A year later, the patient was disease-free and had no complications. CONCLUSIONS: Umbilical LESS radical nephrectomy with vaginal extraction is feasible in selected cases. The procedure is oncologically safe, avoids scars and facilitates early recovery. From a practical point of view, this approach greatly simplifies natural orifice transluminal endoscopic surgery (NOTES) and enables a minimally invasive equivalent result.

Effects of resveratrol and other wine polyphenols on the proliferation, apoptosis and androgen receptor expression in LNCaP cells.

PURPOSE: To address the effect of resveratrol and other red wine polyphenols on cell proliferation, apoptosis and androgen receptor (AR) expression in human prostate cancer LNCaP cells. MATERIALS AND METHODS: LNCaP cells (5 × 102) were cultured in microtiter plate modules and treated with gallic acid, tannic acid and quercetin (1, 5 and 10 µM), rutin and morin (25, 50 and 75 µM) and resveratrol (5, 10 and 25 µM). To address the extent of proliferation at 24, 48, 72 and 96 hours, a colorimetric immunoassay method was used. An activity caspase 3/7 detection assay was used to disclose apoptosis at 24, 48 and 72 hours. AR mARN levels were determined by real time RT-PCR. RESULTS: All polyphenols studied significantly inhibited (P<.05) cell proliferation compared to control. However, there were moderate differences between them. Resveratrol was the strongest inhibitor at different times and doses. Also, caspase-3 and caspase-7 activity was significantly higher (P<.05) than control in the presence of all the compounds, but the earlier response was achieved by resveratrol. Resveratrol, quercetin and morin were the only nutrients that significantly inhibited AR mRNA expression. Again resveratrol produced the highest inhibition (90-250 times less than control), followed by morin (67-100 times) and quercetin (55-91 times). CONCLUSIONS: All polyphenols studied showed important antiproliferative effects and induced apoptosis when added to LNCaP cells culture. We confirm that resveratrol, morin and quercetin may achieve such effect through reduced expression of AR. The synergistic effects of these compounds and their potential to prevent progression of hormone-dependent prostate cancer merit further study.

Estado actual de la cirugía transumbilical por puerto único en urología: retos y aplicaciones / Current State of Single-Port Transumbilical Surgery in Urology: Challenges and Applications

Contexto: La cirugía laparoscópica en urología ha supuesto un avance importante, aunque no está exenta de cierta morbilidad asociada al empleo de múltiples trocares y de forma particular a la extracción del espécimen. Con intención de disminuir esta morbilidad y de mejorar la estética se están desarrollado otras técnicas, como la cirugía laparoendoscópica a través de orificios naturales (NOTES) y la cirugía laparoendoscópica a través de puerto único (LESS). Se pretende revisar el estado actual de la cirugía laparoendoscópica por puerto único en urología. Adquisición de evidencia: Se ha llevado a cabo una revisión no sistemática, a través de una búsqueda bibliográfica empleando los términos LESS y urología desde 2007 hasta 2012. Se describen la experiencia actual LESS en urología, sus principales indicaciones y los diferentes dispositivos de puerto único e instrumental disponibles en el mercado. Síntesis de evidencia: La cirugía LESS nace como un paso más en la evolución constante de la cirugía mínimamente invasiva en un intento por mejorar la estética, reducir el traumatismo quirúrgico y disminuir el dolor y las complicaciones postoperatorias asociadas a la laparoscopia convencional con múltiples trocares. Desde la primera descripción en 2007, la experiencia se ha incrementado exponencialmente y la técnica LESS, asistida o no por robot, se está consolidando para un gran espectro de indicaciones urológicas (tanto en cirugía oncológica como reconstructiva), a mucha mayor escala que la técnica NOTES. A pesar de que la mayoría de los datos existentes son no aleatorizados y en escasas ocasiones son comparativos, con el sesgo de selección que ello representa, parece evidente que el beneficio estético y de control analgésico asociado a la cirugía LESS es real y reproducible. Las complicaciones asociadas a la misma son mayores en casos de cirugía oncológica mayor y se deben más a la propia técnica que al abordaje. Conclusiones: Aunque el beneficio real de la cirugía LESS en urología aún no puede cuantificarse oportunamente, la mejora cosmética, el menor dolor y una mayor satisfacción del paciente con su herida resultan evidentes. El entrenamiento apropiado en este tipo de procedimientos en centros de gran volumen y las constantes mejoras técnicas en el desarrollo instrumental por parte de la industria biomédica permiten que la técnica LESS transumbilical en urología haya nacido para quedarse (AU)

Context: Laparoscopic surgery in urology is considered to be an important advance, although it is not exempt from some morbidity associated to the use of multiple trocars and specifically to the extraction of the specimen. In order to decrease this morbidity and improve esthetics, other techniques are being developed, such as natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). It is aimed to review the current status of laparoendoscopic single site surgery in urology. Acquisition of evidence: A nonsystematic review has been carried out by means of the bibliographic search using the terms LESS and Urology from 2007 to 2012. The current LESS experience in urology is described, and its principal indications and the different single site devices and instruments available on the market are described. Synthesis of evidence: LESS surgery arose as one more step in the constant evolution of minimally invasive surgery in an attempt to improve esthetics, reduce surgical trauma and decrease pain and the post-operative complications associated to the conventional laparoscopy with multiple trocars. Since it was first described in 2007, the experience has been increasing exponentially and the LESS technique, whether assisted or not by robot, is becoming consolidated for a large spectrum of urological indications (both in oncological and reconstructive surgery) on a much greater scale than the NOTES technique. Even though most of the existing data are not randomized and very rarely comparative, with the selection bias that this represents, it seems clear that the esthetic benefit and analgesic control associated to the LESS surgery is real and reproducible. The complications associated to it are greater in cases of major oncology surgery and are due more to the technique itself then to the approach. Conclusions: Although the real benefit of the LESS surgery in urology cannot be appropriately quantified, the cosmetic improvement, less pain and greater patient satisfaction with their wound are clear. Appropriate training in this type of procedures in centers having large volumes and the continuous technical improvements in the instrumental development by the biomedical industry has resulted in the fact that the transumbilical LESS technique in urology has been born to stay (AU)

[Current state of single-port transumbilical surgery in urology: challenges and applications]. / Estado actual de la cirugía transumbilical por puerto único en urología: retos y aplicaciones.

CONTEXT: Laparoscopic surgery in urology is considered to be an important advance, although it is not exempt from some morbidity associated to the use of multiple trocars and specifically to the extraction of the specimen. In order to decrease this morbidity and improve esthetics, other techniques are being developed, such as natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). It is aimed to review the current status of laparoendoscopic single site surgery in urology. ACQUISITION OF EVIDENCE: A nonsystematic review has been carried out by means of the bibliographic search using the terms LESS and Urology from 2007 to 2012. The current LESS experience in urology is described, and its principal indications and the different single site devices and instruments available on the market are described. SYNTHESIS OF EVIDENCE: LESS surgery arose as one more step in the constant evolution of minimally invasive surgery in an attempt to improve esthetics, reduce surgical trauma and decrease pain and the post-operative complications associated to the conventional laparoscopy with multiple trocars. Since it was first described in 2007, the experience has been increasing exponentially and the LESS technique, whether assisted or not by robot, is becoming consolidated for a large spectrum of urological indications (both in oncological and reconstructive surgery) on a much greater scale than the NOTES technique. Even though most of the existing data are not randomized and very rarely comparative, with the selection bias that this represents, it seems clear that the esthetic benefit and analgesic control associated to the LESS surgery is real and reproducible. The complications associated to it are greater in cases of major oncology surgery and are due more to the technique itself then to the approach. CONCLUSIONS: Although the real benefit of the LESS surgery in urology cannot be appropriately quantified, the cosmetic improvement, less pain and greater patient satisfaction with their wound are clear. Appropriate training in this type of procedures in centers having large volumes and the continuous technical improvements in the instrumental development by the biomedical industry has resulted in the fact that the transumbilical LESS technique in urology has been born to stay.

Cistectomía radical laparoendoscópica con neovejiga íleal ortotópica a través de puerto único umbilical / Laparoendoscopic Radical Cystectomy with Orthotopic Ileal Neobladder through Umbilical Single Port

Contexto: La cistectomía radical con derivación ortotópica es una de las técnicas urológicas más complejas, aunque la cirugía laparoscópica ha hecho posible que este procedimiento sea cada vez menos invasivo. Objetivo: Proporcionar una revisión actualizada acerca del abordaje a través de puerto único para llevar a cabo cirugía radical por cáncer de vejiga. Adquisición de evidencia: Se lleva a cabo una revisión exhaustiva de la literatura mediante Medline y Embase, para conocer la experiencia acumulada acerca de la viabilidad de llevar a cabo cistectomía radical laparoscópica, linfadenectomía pélvica y neovejiga ortotópica mediante abordaje laparoendoscopic single site surgery (LESS). Se presenta además nuestra experiencia con este abordaje y se describe la técnica empleada con sistema KeyPort® reutilizable, desarrollado por Richard Wolf. Síntesis de evidencia: Es posible llevar a cabo el tratamiento radical del cáncer de vejiga en hombres y en mujeres a través de puerto único, e incluso la realización de neovejiga ileal como procedimiento reconstructivo en estos pacientes. Se detalla la técnica quirúrgica, los cuidados postoperatorios y el resultado obtenido en nuestro centro. La experiencia acumulada a nivel mundial describe 25 casos de cistectomía radical realizados mediante diferentes sistemas de puerto único, 14 de ellos completados con neovejiga intestinal ortotópica. Conclusión: La cistectomía KeyPort® umbilical constituye en nuestro entorno la alternativa menos invasiva posible para tratar eficientemente el cáncer de vejiga músculo-invasivo, con excelente resultado estético, mínimo dolor postoperatorio y corta estancia hospitalaria. La cicatriz umbilical disminuye los requerimientos analgésicos y acaba siendo prácticamente invisible, por lo que supone un paso importante en el desarrollo de la cirugía mínimamente invasiva para el cáncer vesical (AU)

Context: Radical cystectomy with orthotopic derivation is one of the most complex urological techniques, although laparoscopic surgery has made this procedure increasingly less invasive. Objective: To provide an up-dated review of the single port approach to carry out radical surgery due to bladder cancer. Evidence Acquisition: A comprehensive review of the literature was performed using Medline and Embase to discover the accumulated experience of the viability of carrying out laparoendoscopic radical cystectomy, pelvic lymphadenectomy and orthotopic neobladder using the laparoendoscopic single site surgery (LESS) approach. Our experience with this approach is also presented and the technique used with the reusable KeyPort® system developed by Richard Wolf is described. Evidence Synthesis: Radical treatment of bladder cancer is possible in men and women using a single port and even performance of ileal neobladder, as reconstructive procedure in these patients. The surgical technique, post-operative cares and result obtained in our center are described. The accumulated experience worldwide describes 25 cases of radical cystectomy performed using different single port systems, 14 of them with orthotopic intestinal neobladder. Conclusion: The KeyPort® umbilical cystectomy constitutes in our setting the least possible invasive alternative to efficiently treat muscle-invasive bladder cancer, with excellent esthetic result, minimum post-operative pain and short hospital stay. The umbilical scar decreases the analgesic requirements and it ends up being practically invisible. This supposes an important step in the development of the minimally invasive surgery for bladder cancer (AU)

Puesta en marcha de un programa de entrenamiento para laparoscopia urológica por puerto único / Onset of a Training Program for Single-Port Laparoscopic Urology

Objetivos: Describir el inicio de un programa de laparoendoscopia a través de puerto único para llevar a cabo la cirugía oncológica de un Servicio de Urología. Presentamos la experiencia inicial en laboratorio y en animalario con instrumentos precurvados rígidos y elemento de acceso reutilizable tipo Key Port (Richard Wolf). Material y métodos: Dos cirujanos experimentados en cirugía laparoscópica, con la ayuda de4 ayudantes, llevaron a cabo un programa de entrenamiento mediante tareas predeterminadas en caja de simulación y en modelo suido, siguiendo los requisitos de la Comunidad Autónoma de Madrid para el manejo de animales de experimentación. Resultados: Los participantes en este programa inicialmente se dividieron en parejas compuestas por cirujano experimentado y ayudante para la realización de múltiples tareas predeterminadas en la caja de simulación, con intención de familiarizarse con los instrumentos. Seguidamente se llevaron a cabo 20 sesiones animales en las que se realizaron disecciones ganglionares (pélvica o retroperitoneal) (n = 20), nefrectomías (n = 40), cistorrafias con sutura (n = 20) y anastomosis uterino-vesicales (n = 20). Se registraron los tiempos necesarios para la realización de los ejercicios y los principales errores percibidos en la realización de cada una de las tareas. Las tareas de complejidad creciente fueron realizadas con el instrumental descrito cada vez en menor tiempo y con menos dificultad. Se precisó un trócar accesorio de 3,5 mm para la realización de las suturas in vivo. Conclusiones: El abordaje Key Port tiene aplicación potencial en diferentes aplicaciones urológicas. Un entrenamiento reglado permite la adquisición de destrezas y posibilita la implantación con éxito de un programa de cirugía laparoendoscópica en humanos (AU)

Objectives: To describe the onset of a single port laparoendoscopic program to carry out oncology surgery in a Urology Service. We present the initial experience in the laboratory and in the Animal Facility with rigid precurved instruments and Key Port reusable access element (Richard Wolf). Material and Methods: Two surgeons experienced in laparoscopic surgery and with the help of four assistants performed a training program based on predetermined tasks performed in simulation boxes (pelvitrainer) and porcine model following the requirements of the Regional Community of Madrid to handle experimental animals. Results: The participants in this program were initially divided into pairs made up of an experienced surgery and assistant for the predetermined multiple tasks in simulator box in order to become familiarized with the instruments. After, 20 animal sessions were conducted in which the following were performed: (retroperitoneal or pelvic) lymph node dissections (n = 20), nephrectomies (n = 40), cystorrhaphy with suture (n = 20) and uterine-vesical anastomosis (n = 20).Times needed to perform the exercises and the principal errors perceived during the performance of each one of the tasks were recorded. The tasks, of growing complexity, were performed with the instruments described in increasingly less time and with less difficulty. An accessory trocar of 3.5 mm was required to perform the in vivo sutures. Conclusions: The Key Port approach has potential application in different urological applications. Standardized training allows the acquirement of skills and makes the successful implementation possible of a laparoendoscopic surgery program in humans (AU)

[Laparoendoscopic radical cystectomy with orthotopic ileal neobladder through umbilical single port]. / Cistectomía radical laparoendoscópica con neovejiga íleal ortotópica a través de puerto único umbilical.

CONTEXT: Radical cystectomy with orthotopic derivation is one of the most complex urological techniques, although laparoscopic surgery has made this procedure increasingly less invasive. OBJECTIVE: To provide an up-dated review of the single port approach to carry out radical surgery due to bladder cancer. EVIDENCE ACQUISITION: A comprehensive review of the literature was performed using Medline and Embase to discover the accumulated experience of the viability of carrying out laparoendoscopic radical cystectomy, pelvic lymphadenectomy and orthotopic neobladder using the laparoendoscopic single site surgery (LESS) approach. Our experience with this approach is also presented and the technique used with the reusable KeyPort(®) system developed by Richard Wolf is described. EVIDENCE SYNTHESIS: Radical treatment of bladder cancer is possible in men and women using a single port and even performance of ileal neobladder, as reconstructive procedure in these patients. The surgical technique, post-operative cares and result obtained in our center are described. The accumulated experience worldwide describes 25 cases of radical cystectomy performed using different single port systems, 14 of them with orthotopic intestinal neobladder. CONCLUSION: The KeyPort(®) umbilical cystectomy constitutes in our setting the least possible invasive alternative to efficiently treat muscle-invasive bladder cancer, with excellent esthetic result, minimum post-operative pain and short hospital stay. The umbilical scar decreases the analgesic requirements and it ends up being practically invisible. This supposes an important step in the development of the minimally invasive surgery for bladder cancer.

[Onset of a training program for single-port laparoscopic urology]. / Puesta en marcha de un programa de entrenamiento para laparoscopia urológica por puerto único.

OBJECTIVES: To describe the onset of a single port laparoendoscopic program to carry out oncology surgery in a Urology Service. We present the initial experience in the laboratory and in the Animal Facility with rigid precurved instruments and KeyPort reusable access element (Richard Wolf). MATERIAL AND METHODS: Two surgeons experienced in laparoscopic surgery and with the help of four assistants performed a training program based on predetermined tasks performed in simulation boxes (pelvitrainer) and porcine model following the requirements of the Regional Community of Madrid to handle experimental animals. RESULTS: The participants in this program were initially divided into pairs made up of an experienced surgery and assistant for the predetermined multiple tasks in simulator box in order to become familiarized with the instruments. After, 20 animal sessions were conducted in which the following were performed: (retroperitoneal or pelvic) lymph node dissections (n = 20), nephrectomies (n = 40), cystorrhaphy with suture (n = 20) and uterine-vesical anastomosis (n = 20). Times needed to perform the exercises and the principal errors perceived during the performance of each one of the tasks were recorded. The tasks, of growing complexity, were performed with the instruments described in increasingly less time and with less difficulty. An accessory trocar of 3.5 mm was required to perform the in vivo sutures. CONCLUSIONS: The KeyPort approach has potential application in different urological applications. Standardized training allows the acquirement of skills and makes the successful implementation possible of a laparoendoscopic surgery program in humans.

Pielolitectomía por puerto único umbilical sobre riñón en herradura: una nueva indicación / Umbilical Single-Port Pyelolithectomy on Horseshoe Kidney: a New Indication

Introducción: La cirugía laparoscópica a través de puerto único es una evolución de la cirugía laparoscópica que resulta posible gracias al desarrollo tecnológico reciente de nuevos sistemas de acceso. Se trata de una técnica establecida en el campo de la cirugía mínimamente invasiva, pero sus indicaciones en el campo de la Urología están desarrollándose en la actualidad. Material y métodos: Presentamos la primera pielolitectomía sin incisión, a través de puerto único colocado en el ombligo, realizada en un paciente varón de 47 años (IMC: 38,2) con riñón en herradura portador de una litiasis piélica única de 4cm de diámetro. Se empleó una incisión umbilical de 2,5cm para la introducción del prototipo de puerto único reutilizable de Richard Wolf, sin necesidad de elemento auxiliar adicional alguno. Resultados: Tras colocación de doble-J izquierdo se llevó a cabo liberación del uréter proximal izquierdo y pelvis renal, pielolitectomía y pielorrafia con instrumentos-DuoRotate© (Richard Wolf). Se comprobó estanqueidad de la vía urinaria mediante instilación intravesical de azul de metileno y no se dejó drenaje. El procedimiento duró 280 minutos y el sangrado fue 30cc. El paciente fue dado de alta a las 24 horas sin dolor alguno. Conclusión: La pielolitectomía sin incisión es una opción factible y resolutiva para el tratamiento de la litiasis piélica. En centros con experiencia en cirugía a través de puerto único puede considerarse la opción más beneficiosa estéticamente hablando, sobre todo en casos especiales como el riñón en herradura (AU)

Introduction: Laparoscopic surgery through a single port is an evolution of laparoscopic surgery, possible after recent technological development of new access systems. It is an established minimally invasive technique, although its indications in the field of Urology are currently under development. Material and methods: We present the first case of incision-less pyelolithectomy, performed through a single-port placed in the umbilicus, performed in a 47 years-old male patient(38.2 BMI) with solitary 4 cm diameter lithiasis in a horseshoe kidney. An umbilical 2.5 cm incision was used for the introduction of a prototype of the reusable Richard Wolf single-port system, without any ancillary elements. Results: After placement of left double-J stent proximal left ureter and renal pelvis, pyelolithectomy and pyelorraphy were performed with Duo Rotate-Instruments© (Richard Wolf). Water-tightness was demostrated with methylene blue intravesical instillation and no drain was placed. The procedure lasted for 280 min and bleeding was 30 cc. The patient was discharged 24 hours later without pain. Conclusion: Incision-less pyelolithectomy is a feasible and resolutive option to treat pelviclithiasis. It can be considered the most beneficial option in aesthetical terms in experienced centers, especially in peculiar cases like horseshoe kidney (AU)

[Umbilical single-port pyelolithectomy on horseshoe kidney: a new indication]. / Pielolitectomía por puerto único umbilical sobre riñón en herradura: una nueva indicación.

INTRODUCTION: Laparoscopic surgery through a single port is an evolution of laparoscopic surgery, possible after recent technological development of new access systems. It is an established minimally invasive technique, although its indications in the field of Urology are currently under development. MATERIAL AND METHODS: We present the first case of incision-less pyelolithectomy, performed through a single-port placed in the umbilicus, performed in a 47 years-old male patient (38.2 BMI) with solitary 4 cm diameter lithiasis in a horseshoe kidney. An umbilical 2.5 cm incision was used for the introduction of a prototype of the reusable Richard Wolf single-port system, without any ancillary elements. RESULTS: After placement of left double-J stent proximal left ureter and renal pelvis, pyelolithectomy and pyelorraphy were performed with DuoRotate-Instruments© (Richard Wolf). Water-tightness was demostrated with methylene blue intravesical instillation and no drain was placed. The procedure lasted for 280 min and bleeding was 30 cc. The patient was discharged 24 hours later without pain. CONCLUSION: Incision-less pyelolithectomy is a feasible and resolutive option to treat pelvic lithiasis. It can be considered the most beneficial option in aesthetical terms in experienced centers, especially in peculiar cases like horseshoe kidney.

Nefrectomía parcial laparoscópica / Laparoscopic Partial Nephrectomy

Objetivo: Analizar el resultado quirúrgico y oncológico de una experiencia prospectiva con nefrectomía parcial laparoscópica. Se describe la técnica quirúrgica y los resultados oncológicos conseguidos a medio plazo. Material y métodos: Fueron intervenidos 60 pacientes mediante esta técnica entre junio de 2005 y junio de 2009. La edad media de los pacientes fue 58,9 (38-77 años), siendo 40 (66,7%) varones y 20 (33,3%) mujeres. El IMC medio fue 26,8 (18-40). La lateralidad fue 28 (46,7%) tumores derechos y 32 (53,3%) izquierdos, localizándose en el polo superior en 14 (23,3%) pacientes, en la zona media en 13 (21,7%), en el polo inferior en 22 (36,7%) y en la zona hiliar en 11 (18,3%). En 23 (38,3%) casos el tumor se localizó en la valva anterior, en 24 (40%) en la valva posterior, en 10 (16,7%) en el borde externo y en 3 (5%) en el borde interno. El tamaño medio tumoral en la TAC fue 3,3 (1-6,4) cm y en la pieza quirúrgica 3,1 (1,2-7) cm. Resultados: El tiempo medio quirúrgico fue 107,17 (50-185) minutos, con un tiempo de isquemia caliente de 33 (0-70) minutos. En 56 casos (93,3%) había una sola arteria y en 4 (6,7%) dos. Se realizó clampaje sólo de la arteria en 15 pacientes (25%), de la arteria y la vena en 44 (73,3%) y no se realizó clampaje en uno (1,7%). Se realizó reparación de la vía urinaria en 32 pacientes (53,3%), dejándose catéter ureteral en todos ellos. Precisaron transfusión el 20% de los pacientes (12). Se produjeron complicaciones intraoperatorias en 5 pacientes (8,7%). Estas fueron: una lesión esplénica que requirió esplenectomía (1,7%), un desgarro de la vena cava que se suturó laparoscópicamente (1,7%) y tres casos de sangrado por mal funcionamiento del «bulldog» (5%). Se produjeron complicaciones postquirúrgicas en 11 pacientes (18,7%) y estas fueron: un hematoma de pared que requirió reintervención (1,7%), una fístula urinaria que terminó en atrofia renal y posterior nefrectomía (1,7%), tres hematomas intracavitarios que se resolvieron de manera conservadora (5%), una fístula arteriovenosa que precisó embolización selectiva (1,7%), un urinoma que se solucionó con drenaje percutáneo (1,7%) y tres casos de fiebre postoperatoria (5%). Hubo márgenes positivos en un paciente (1,7%). En 49 casos (81,7%) la histología fue carcinoma renal, en 8 (13,3%) oncocitoma, en dos (3,3%) angiomiolipoma y en uno (1,7%) metástasis. La estancia media fue 5 (3-29) días. El seguimiento medio fue de 31 (12-61) meses. Se produjo una recidiva local a los 16 meses (tumor primario hiliar de 2,5 cm) y una metástasis en la suprarrenal ipsilateral a los 34 meses (tumor primario de 5,6 cm en el polo inferior izquierdo). Conclusiones: En esta serie de nefrectomía parcial laparoscópica se demuestra la baja tasa de complicaciones, los buenos resultados oncológicos y la baja tasa de recidiva a corto plazo. Se precisa mayor número de pacientes y seguimiento para afianzar los resultados oncológicos y funcionales de esta técnica quirúrgica (AU)

Objetives: To analyze the surgical and oncologic outcome of prospective experience with laparoscopic partial nephrectomy. We describe the surgical technique and mid term oncological results achieved. Material and methods: 60 patients were operated with this technique between June 2005 and June 2009. The mean age of patients was 58.9 [38-77] years, being 40 (66.7%) males and 20 (33.3%) women. The average BMI was 26.8 [18-40]. Laterality was 28 (46.7%) tumors rights and 32 (53.3%) left, being located in the upper pole in 14 (23.3%) patients, in the middle third in 13 (21.7%) in the lower pole in 22 (36.7%) and hiliar region in 11 (18.3%). In 23 cases (38.3%) tumors were located in the anterior valve, in 24 (40%) in posterior valve, in 10 (16.7%) at the outer edge and 3 (5%) at the inner edge. The average size tumor on CT was 3.3 [1-6.4] cm and in the surgical specimen 3.1 [1.2-7] cm. Results: The mean operative time was 107.17 [50-185] min, with a warm ischemia time of 33 [0-70] min. In 56 cases (93.3%) had a single artery and 4 (6.7%) cases had 2 arteries. The artery was clamped alone in 15 patients (25%), artery and vein in 44 (73.3%) and no clamping was performed in 1 (1.7%). We repaired the urinary tract in 32 patients (53.3%), leaving ureteral catheter in all patients. 20% of patients (12) required transfusion. Intraoperative complications occurred in 5 patients (8.7%). These were: 1 splenic injury requiring splenectomy (1.7%), 1 tear in the vena cava, sutured laparoscopically (1.7%) and 3 cases of bleeding due to bulldog malfunction (5%). Postoperative complications occurred in 11 patients (18.7%) and these were: 1 wall hematoma that required reoperation (1.7%), 1 urinary fistula ending in renal atrophy and subsequent nephrectomy (1.7%), 3 intracavitary hematomas hich resolved conservatively (5%), 1 arteriovenous fistula that needed embolization (1.7%), 1 urinoma that was resolved with percutaneous drainage (1.7%) and 3 cases of postoperative fever (5%). Margins were positive in 1 patient (1.7%). In 49 cases (81.7%) histology was renal cell carcinoma, in 8 (13.3%) oncocytoma, in 2 (3.3%) angiomyolipoma and 1 (1.7%) metastasis. The average stay was 5 [3-29] days. Median follow up was 31 [12-61] months. There was a local recurrence at 16 months (hiliar primary tumor 2.5 cm) and an ipsilateral adrenal metastasis at 34 months (primary tumor 5.6 cm in left lower pole). Conclusions: In this series of laparoscopic partial nephrectomy low rate of complications, good oncologic results and low recurrence rate in the short term are shown. More patients and further monitoring is required to strengthen the functional and oncological outcomes of this surgical technique (AU)

[Laparoscopic partial nephrectomy]. / Nefrectomía parcial laparoscópica.

OBJECTIVES: To analyze the surgical and oncologic outcome of prospective experience with laparoscopic partial nephrectomy. We describe the surgical technique and mid term oncological results achieved. MATERIAL AND METHODS: 60 patients were operated with this technique between June 2005 and June 2009. The mean age of patients was 58.9 [38-77] years, being 40 (66.7%) males and 20 (33.3%) women. The average BMI was 26.8 [18-40]. Laterality was 28 (46.7%) tumors rights and 32 (53.3%) left, being located in the upper pole in 14 (23.3%) patients, in the middle third in 13 (21.7%) in the lower pole in 22 (36.7%) and hiliar region in 11 (18.3%). In 23 cases (38.3%) tumors were located in the anterior valve, in 24 (40%) in posterior valve, in 10 (16.7%) at the outer edge and 3 (5%) at the inner edge. The average size tumor on CT was 3.3 [1-6.4] cm and in the surgical specimen 3.1 [1.2-7] cm. RESULTS: The mean operative time was 107.17 [50-185] min, with a warm ischemia time of 33 [0-70] min. In 56 cases (93.3%) had a single artery and 4 (6.7%) cases had 2 arteries. The artery was clamped alone in 15 patients (25%), artery and vein in 44 (73.3%) and no clamping was performed in 1 (1.7%). We repaired the urinary tract in 32 patients (53.3%), leaving ureteral catheter in all patients. 20% of patients (12) required transfusion. Intraoperative complications occurred in 5 patients (8.7%). These were: 1 splenic injury requiring splenectomy (1.7%), 1 tear in the vena cava, sutured laparoscopically (1.7%) and 3 cases of bleeding due to bulldog malfunction (5%). Postoperative complications occurred in 11 patients (18.7%) and these were: 1 wall hematoma that required reoperation (1.7%), 1 urinary fistula ending in renal atrophy and subsequent nephrectomy (1.7%), 3 intracavitary hematomas hich resolved conservatively (5%), 1 arteriovenous fistula that needed embolization (1.7%), 1 urinoma that was resolved with percutaneous drainage (1.7%) and 3 cases of postoperative fever (5%). Margins were positive in 1 patient (1.7%). In 49 cases (81.7%) histology was renal cell carcinoma, in 8 (13.3%) oncocytoma, in 2 (3.3%) angiomyolipoma and 1 (1.7%) metastasis. The average stay was 5 [3-29] days. Median follow up was 31 [12-61] months. There was a local recurrence at 16 months (hiliar primary tumor 2.5 cm) and an ipsilateral adrenal metastasis at 34 months (primary tumor 5.6 cm in left lower pole). CONCLUSIONS: In this series of laparoscopic partial nephrectomy low rate of complications, good oncologic results and low recurrence rate in the short term are shown. More patients and further monitoring is required to strengthen the functional and oncological outcomes of this surgical technique.

[Treatment of distal ureteral stricture by laparoscopic ureterovesical reimplantation]. / Tratamiento de la estenosis de uréter distal mediante reimplantación urétero-vesical laparoscópica.

INTRODUCTION: to analyse the results achieved to treat iliac or pelvic ureteric stricture using laparoscopic reimplantation of the ureter in a psoic bladder. MATERIAL AND METHOD: in a four-year period, we performed laparoscopic ureteral reimplantation in a psoic bladder in 6 patients (right/left 1:1; male/female 1:2; mean age 59.2 years, range 47-87). In 4 cases the lesion was iatrogenic and in 2 cases idiopathic. Ureteral resection with bladder cuff and cystorraphy followed by ipsilateral lymph node dissection was performed in idiopathic cases or those with history of previous urothelial tumour (4 cases in total) before ureteral reimplantation. Bladder was extensively mobilized and fixed to minor psoas tendon before performing ureteroneocystostomy. Mixed intra and extravesical technique with submucosal tunnel (Politano) was used in a case and in the remaining 5 cases extravesical technique with submucosal tunnel (Goodwin) was used. Mean follow-up was 26 months (range 18-34). RESULTS: there was no need to convert to open surgery. Time of surgery was 230 minutes in the case treated with Politano ureteroneocystostomy and 120 (range 75-150) in those treated purely extravesically. The mean hospital stay was 3.2 days (range 2-5). There were no intra or postoperative complications. Histologic assessment always revealed ureteral fibrosis and in 2 cases accompanying granulomatous inflammation and dysplasia. No patient suffered re-stricture or impairment in renal function during follow-up. CONCLUSIONS: laparoscopic ureteral reimplantation is an effective and safe minimally invasive technique to treat benign distal stricture of the ureter. Simplicity of extravesical reimplantation has an advantage over its intravesical counterpart.

Tratamiento de la estenosis de uréter distal mediante reimplantación urétero-vesical laparoscópica / Treatment of distal ureteral stricture by laparoscopic ureterovesical reimplantation

Introducción: analizar los resultados obtenidos para tratar la estenosis de uréter iliaco-pelviano sin tumor activo mediante reimplantación laparoscópica en vejiga psoica. Material y método: en un período de 4 años hemos practicado reimplantación ureteral laparoscópica en vejiga psoica a 6 pacientes (derecho/izquierdo 1:1; hombre/mujer 1:2; edad media 59,2 años, rango 47-85). En 4 casos la etiología fue iatrogénica y en 2 idiopática. En los pacientes con causa idiopática o antecedentes de tumor urotelial (4 casos en total) se realizó resección ureteral laparoscópica con rodete vesical, cistorrafia y linfadenectomía ipsilateral antes de la reimplantación. Se movilizó ampliamente la vejiga y se fijó al tendón del psoas. La reimplantación se realizó mediante técnica mixta intra-extravesical con túnel submucoso (Politano) en un caso, y mediante técnica extravesical con túnel submucoso (Goodwin) en el resto. El seguimiento medio fue 26 meses (rango 18-34). Resultados: no hubo reconversión a cirugía abierta y la duración fue 230 minutos en el caso de la reimplantación tipo Politano y 120 minutos (rango 75-150) para la reimplantación extravesical. La estancia postoperatoria fue 3,2 días (rango 2-5). No se produjeron complicaciones intra o postoperatorias. El estudio histológico mostró en todos los casos fibrosis ureteral sin signos de malignidad y ausencia de metástasis ganglionares. Ningún paciente ha presentado reestenosis ni deterioro de la función renal durante el seguimiento. Conclusiones: en casos seleccionados la reimplantación ureteral laparoscópica es una técnica mínimamente invasiva, eficaz y segura para el tratamiento de las estenosis ureterales distales sin tumor activo. Por su simplicidad de ejecución es preferible la reimplantación extravesical (AU)

Introduction: to analyse the results achieved to treat iliac or pelvic ureteric stricture using laparoscopic reimplantation of the ureter in a psoic bladder. Material and method: in a four-year period, we performed laparoscopic ureteral reimplantation in a psoic bladder in 6 patients (right/left 1:1; male/female 1:2; mean age 59.2 years, range 47-87). In 4 cases the lesion was iatrogenic and in 2 cases idiopathic. Ureteral resection with bladder cuff and cystorraphy followed by ipsilateral lymph node dissection was performed in idiopathic cases or those with history of previous urothelial tumour (4 cases in total) before ureteral reimplantation. Bladder was extensively mobilized and fixed to minor psoas tendon before performing ureteroneocystostomy. Mixed intra and extravesical technique with submucosal tunnel (Politano) was used in a case and in the remaining 5 cases extravesical technique with submucosal tunnel (Goodwin) was used. Mean follow-up was 26 months (range 18-34). Results: there was no need to convert to open surgery. Time of surgery was 230minutes in the case treated with Politano ureteroneocystostomy and 120 (range 75-150) in those treated purely extravesically. The mean hospital stay was 3.2 days (range 2-5). There were no intra or postoperative complications. Histologic assessment always revealed ureteral fibrosis and in 2 cases accompanying granulomatous inflammation and dysplasia. No patient suffered re-stricture or impairment in renal function during follow-up. Conclusions: laparoscopic ureteral reimplantation is an effective and safe minimally invasive technique to treat benign distal stricture of the ureter. Simplicity of extravesical reimplantation has an advantage over its intravesical counterpart (AU)

[Analysis of a laparoscopic radical prostatectomy program with 544 cases]. / Prostatectomía radical laparoscópica. Revisión de la literatura. Nuestra experiencia.

INTRODUCTION: This article reviews the latest publications that refer to Laparoscopic Radical Prostatectomy (LRP) up to 2005, and describes our series of patients for this type of surgery. MATERIALS AND METHODS: After a search of the Internet and consulting journals of renowned prestige, we selected articles that refer to this technique and we summarise the latest developments in LRP. We also present our series of patients. RESULTS: In view of the good oncologic and functional results obtained with LRP, and the possibility of performing hernioplasty as in open surgery, this technique provides a high quality service for patients. CONCLUSIONS: Due to the advances in the safety and quality of this technique, such as the use of robots, 3 CCD cameras, and the surgeon's experience, LRP should be offered to our patients, if it is within our means.