Descending laparoscopic radical nephrectomy and proven advantages in long term. / Nefrectomía radical laparoscópica descendente. Ventajas a largo plazo demostradas.

OBJECTIVES: We aim to present and analyze the long term results of descending transperitoneal laparoscopic nephrectomy (TLN) technique (Tunc technique). METHODS: A total of 308 patients that underwent descending TLN were included to the study between January 2011 and March 2018. Mean operation time, mean estimated blood loss, duration of hospital stay, complications, mean tumor size, and pathologic margin status were analyzed. RESULTS: A total of 308 patients underwent the descending TLN technique. Mean tumor size was 6.5±1.83 (range 3.5-12 cm). Mean intraoperative estimated blood loss was 38±6.91mL. Mean operation time was 24.97±6.8 minutes. Duration of hospital stay was1.85±0.69 days. Only one patient received postoperative blood transfusion for chronic anemia. Two of the patients had endoGIA stapler malfunction. None of the patients required conversion to open surgery intraoperative. There was no positive margin status. CONCLUSIONS: We could prove the safety and effectiveness of descending TLN technique. The main advantages of descending TLN over traditional ascending nephrectomy technique are shorter operation time and hospital stay.

OBJETIVOS: El objetivo fue presentar y analizar los resultados a largo plazo de la técnica de nefrectomía laparoscópica transperitoneal (TLN) descendente (técnica Tunc).MÉTODOS: Un total de 308 pacientes sometidos a TLN descendente se incluyeron en el estudio entre enero de 2011 y marzo de 2018. Se analizaron el tiempo medio de operación, la pérdida sanguínea estimada media, la duración de la estancia hospitalaria, las complicaciones, el tamaño tumoral medio y el estado del margen patológico. RESULTADOS: Un total de 308 pacientes se sometieron a la técnica de TLN descendente. El tamaño promedio del tumor fue de 6,5 ± 1,83 (rango de 3,5-12 cm). La pérdida de sangre estimada intraoperatoria media fue de 38 ± 6,91 ml. El tiempo medio de operación se calculó en 24,97 ± 6,8 minutos. La duración de la estadía hospitalaria fue de 1,85 ± 0,69 días. Solo un paciente recibió transfusión de sangre postoperatoria por anemia crónica. Dos de los pacientes tenían mal funcionamiento de la engrapadora endoGIA. Ninguno de los pacientes requirió conversión a cirugía abierta intraoperatoria. No hubo un estado de margen positivo. CONCLUSIONES: Podríamos demostrar la seguridad y efectividad de la técnica de TLN descendente. Las principales ventajas de la TLN descendente sobre la técnica tradicional de nefrectomía ascendente son el tiempo de operación más corto y la estancia hospitalaria.

Nefrectomía radical laparoscópica descendente. Ventajas a largo plazo demostradas / Descending laparoscopic radical nephrectomy and proven advantages in long term

Objetivos: El objetivo fue presentar y analizar los resultados a largo plazo de la técnica de nefrectomía laparoscópica transperitoneal (TLN) descendente (técnica Tunc). Métodos: Un total de 308 pacientes sometidos a TLN descendente se incluyeron en el estudio entre enero de 2011 y marzo de 2018. Se analizaron el tiempo medio de operación, la pérdida sanguínea estimada media, la duración de la estancia hospitalaria, las complicaciones, el tamaño tumoral medio y el estado del margen patológico. Resultados: Un total de 308 pacientes se sometieron a la técnica de TLN descendente. El tamaño promedio del tumor fue de 6,5 ± 1,83 (rango de 3,5-12 cm). La pérdida de sangre estimada intraoperatoria media fue de 38 ± 6,91 ml. El tiempo medio de operación se calculó en 24,97 ± 6,8 minutos. La duración de la estadía hospitalaria fue de 1,85 ± 0,69 días. Solo un paciente recibió transfusión de sangre postoperatoria por anemia crónica. Dos de los pacientes tenían mal funcionamiento de la engrapadora endoGIA. Ninguno de los pacientes requirió conversión a cirugía abierta intraoperatoria. No hubo un estado de margen positivo. Conclusiones: Podríamos demostrar la seguridad y efectividad de la técnica de TLN descendente. Las principales ventajas de la TLN descendente sobre la técnica tradicional de nefrectomía ascendente son el tiempo de operación más corto y la estancia hospitalaria

Objectives: We aim to present and analyze the long term results of descending transperitoneal laparoscopic nephrectomy (TLN) technique (Tunc technique). Methods: A total of 308 patients that underwent descending TLN were included to the study between January 2011 and March 2018. Mean operation time, mean estimated blood loss, duration of hospital stay, complications, mean tumor size, and pathologic margin status were analyzed. Results: A total of 308 patients underwent the descending TLN technique. Mean tumor size was 6.5 ± 1.83 (range 3.5-12 cm). Mean intraoperative estimated blood loss was 38 ± 6.91 mL. Mean operation time was 24.97 ± 6.8 minutes. Duration of hospital stay was1.85 ± 0.69 days. Only one patient received postoperative blood transfusion for chronic anemia. Two of the patients had endoGIA stapler malfunction. None of the patients required conversion to open surgery intraoperative. There was no positive margin status. Conclusions: We could prove the safety and effectiveness of descending TLN technique. The main advantages of descending TLN over traditional ascending nephrectomy technique are shorter operation time and hospital stay

Detailed Surgical Anatomy of Prostate: Relationship between Urethra and Dorsal Vein Complex with Apex.

AIM: To describe our surgical technique for dissecting the apex of prostate during robotic-assisted laparoscopic radical prostatectomy (RALP) and detailed surgical anatomy of prostate including relationship between urethra and dorsal vein complex with apex. MATERIALS AND METHODS: In retrospective view of prospective collected data, 73 patients underwent RALP between December 2012 and September 2014. Surgical anatomy of prostate was revealed in all procedures. Quality of life (QoL) scores were assessed before, immediately after catheter removal, and 1 month after surgery. We divided urinary continence into 3 groups, as very early continence; continence at time of urethral catheter removal, early continent; and continence 1 month after surgery. The rest of the patients were accepted as continence. RESULTS: The mean follow-up was 10.2 ± 5.4 months and mean age was 61.5 ± 6.6. Maximum protection of urethra could be provided in all. Mean catheter removal was 8.9 ± 1.7 days, and all patients were continent at the time of catheter removal. QoL scores before RALP could be protected after surgery (p = 0.2). Neither conversion to open/conventional laparoscopic surgery nor complications related with bladder neck were detected. CONCLUSIONS: Our surgical technique can be a strong candidate for being a surgical technique for preserving urethra and very early continence could be provided after surgery.

Subureteral Injection with Small-Size Dextranomer/Hyaluronic Acid Copolymer: Is It Really Efficient?

The aim of this study was to evaluate the clinical results of patients with vesicoureteral reflux, which were treated with subureteral injection of small-size (80-120 µm) dextranomer/hyaluronic acid copolymer (Dx/HA). Data of 75 children (105 renal units) who underwent STING procedure with small-size Dx/HA for the treatment of vesicoureteral reflux (VUR) in our clinic between 2008 and 2012 were retrospectively analyzed. Preoperative reflux grade and side, injection indication, postoperative urinary infections and urinary symptoms, voiding cystourethrogram, and renal scintigraphy results were evaluated. The success rate of the procedure was 100% in patients with grades 1 and 2 reflux, 91% in patients with grade 3 reflux, and 82.6% in patients with grade 4. Overall success rate of the treated patients was 97%. Endoscopic subureteric injection with Dx/HA procedure has become a reasonable minimally invasive alternative technique to open surgery, long-term antibiotic prophylaxis, and surveillance modalities in treatment of VUR in terms of easy application, low costs and complication rates, and high success rates. Injection material composed of small-size dextranomer microspheres seems superior to normal size Dx/HA, together with offering similar success with low cost.

A novel surgical technique for preserving the bladder neck during robot-assisted laparoscopic radical prostatectomy: preliminary results.

PURPOSE: To describe our new surgical technique for preserving the bladder neck during robot-assisted laparoscopic prostatectomy (RALP) and to present the anatomy between the bladder neck and prostate. METHODS: Between December 2012 and May 2014, 52 RALPs were performed at our institute. Demographic, perioperative, and postoperative data were recorded. Quality of life (QoL) scores were assessed before RALP, after urethral catheter removal, and at the first month after RALP. Fatty connective tissue between bladder neck and prostate was introduced, and circular muscle fibers of the internal sphincter were seen in all patients. Complications were classified according to the Clavien-Dindo classification. Statistical analyses were performed. RESULTS: Mean follow-up was 9.6±5.2 months; mean age was 61.1±6.5 years. Our novel surgical technique for preserving the bladder neck was performed in 52 patients, and they were continent after catheter removal; mean duration of the catheter was 9.4±1.4 days. There was a significant difference in QoL before RALP and after catheter removal, however, but there was no statistical difference between before and 1 month after RALP (respectively; P<0.001, P=0.5). Furthermore, there was no complication related to the bladder neck such as bladder neck stricture, acute/chronic urinary retention, as well as no Clavien III, IV, and V complications. In addition, conventional laparoscopy and/or open surgery was not needed in any of the RALP cases. CONCLUSION: Our novel technique provided very early continence at the time of catheter removal after RALP within short-term follow-up. This can help early recovery and develop QoL scores after RALP.