[Hand-assisted laparoscopic nephroureterectomy for the treatment of upper urinary tract transitional cancer]. / Nefroureterectomía laparoscópica mediante laparoscopia asistida por la mano para el tratamiento del carcinoma transicional del tracto urinario superior.

OBJECTIVE: To report our series of patients undergoing hand-assisted laparoscopic nephroureterectomy (HALNU) using the pluck-off procedure. MATERIALS AND METHODS: Twenty patient undergoing HALMU for upper urinary tract urothelial tumors from November 2002 to December 2007 were assessed. Demographic, clinical, surgical, and oncological data were assessed. RESULTS: Mean patient age was 69 years. Mean operating time and mean intraoperative bleeding were 176 min and 381 mL respectively. Twenty percent of patients required transfusion of blood products. Conversion to open surgery was not required in any patient. Major and minor complications occurred in 25% and 30% of patients respectively.Mean time to oral intake was 48 hours, and mean hospital stay was 5 days.Pathological study revealed transitional cell carcinoma in all cases: grade I in 5%, grade II in 60%, and grade III in 35% of patients. Clinical stage was pTa in 5%, pT1 in 20%, pT2 in 25%, pT3 in 40%, and pT4 in 10% of patients. A bladder recurrence rate of 30% and a 49% overall survival were seen after a mean follow-up of 33 months (5-73). Six-year cancer-specific survival was 67%. No patient developed either peritoneal or surgical bed recurrence. CONCLUSIONS: HALMU using the pluck-off procedure is a feasible, safe, and effective surgery. Both surgical and oncological results are similar to those of open surgery and pure laparoscopy.

Nefroureterectomía laparoscópica mediante laparoscopia asistida por la mano para el tratamiento del carcinoma transicional del tracto urinario superior / Hand-assisted laparoscopic nephroureterectomy for the treatment of upper urinary tract transitional cancer

Objetivo: Describimos nuestra serie de pacientes sometidos a nefroureterectomía por vía laparoscópica asistida por la mano (NU-LAM), con escisión cistoscópica circunferencial del uréter distal intramural. Material y métodos: Evaluamos a 20 pacientes sometidos a NU-LAM por tumor urotelial detracto urinario superior, entre noviembre-2002 y diciembre-2007. Valoramos datos demográficos y clínicos, quirúrgicos y datos oncológicos. Resultados: La media de edad de los pacientes fue de 69 años. La media del tiempo quirúrgico y el sangrado intraoperatorio fue de 176 min y 381 cc, respectivamente. El 20% de los pacientes requirió transfusión de hemoderivados. En ninguna ocasión fue necesaria la conversión a cirugía abierta y la tasa de complicaciones fue del 25% para las mayores y del 30% para las menores. Los pacientes iniciaron tolerancia oral a las 48 h de media, con una estancia media hospitalaria de 5 días. El estudio histológico catalogó al tumor urotelial en: grado I: 5% de los casos; grado II: 60%,y grado III: 35% de los casos; estadio clínico: Ta: 5%; T1: 20%; T2: 25%; T3: 40%, y T4: 10%. Con un seguimiento medio de 33 meses (5-73) se objetivó una tasa de recidiva vesical del 30%, una supervivencia global del 49% y una supervivencia cáncer específica del 67%, a los 6 años de seguimiento. Ningún paciente presentó cuadro de recidiva en el peritoneo ni en el lecho quirúrgico. Conclusiones: La NU-LAM con escisión cistoscópica del uréter distal es una técnica factible, segura y efectiva. Los resultados, tanto operatorios como oncológicos, son comparables con la cirugía abierta y con la laparoscopia pura (AU)

Objective: To report our series of patients undergoing hand-assisted laparoscopic nephroureterectomy (HALNU) using the pluck-off procedure. Materials and methods: Twenty patient undergoing HALMU for upper urinary tract urothelial tumors from November 2002 to December 2007 were assessed. Demographic, clinical, surgical, and oncological data were assessed. Results: Mean patient age was 69 years. Mean operating time and mean intraoperative bleeding were 176 min and 381 mL respectively. Twenty percent of patients required transfusion of blood products. Conversion to open surgery was not required in any patient. Major and minor complications occurred in 25% and 30% of patients respectively. Mean time to oral intake was 48 hours, and mean hospital stay was 5 days. Pathological study revealed transitional cell carcinoma in all cases: grade I in 5%, grade II in 60%, and grade III in 35% of patients. Clinical stage was pTa in 5%, pT1 in 20%, pT2 in25%, pT3 in 40%, and pT4 in 10% of patients. A bladder recurrence rate of 30% and a 49% overall survival were seen after a mean followup of 33 months (5-73). Six-year cancer-specific survival was 67%. No patient developed either peritoneal or surgical bed recurrence. Conclusions: HALMU using the pluck-off procedure is a feasible, safe, and effective surgery. Both surgical and oncological results are similar to those of open surgery and pure laparoscopy (AU)

[History of rachianesthesia and epidural anesthesia in Spain]. / Historia de la raquianestesia y de la anestesia epidural en España.

OBJECTIVES: To show the beginning of spinal and epidural anesthesia in our country and the contributions of Spanish urologists. METHODS: We reviewed books and writings of History of Medicine, Urology and Anesthesia and Doctoral thesis about spinal and epidural anesthesia. RESULTS: In the 20th century, surgeons also gave the anesthetic drugs to the patients. Spinal and epidural anesthesia were used for the first time in 1900. A lot of Spanish urologists like F Rusca Doménech, J.M. Batrina, M. Barragán Bonet, R. Lozano Monzón, L. Guedea Calvo, Gil Vernet, Fidel Pagés Miravé, V Sagarra Lascurain, Gómez Ulla, etc, did research, writings in scientific journals and Doctoral thesis about anesthesia.

Historia de la raquianestesia y de la anestesia epidural en España / History of rachianesthesia and epidural anesthesia in Spain

Objetivo: Conocer como se desarrollaron en nuestro país las técnicas de la raquianestesia y la anestesia epidural, y cuales fueron las aportaciones de los urólogos españoles. Métodos: Hemos revisado los libros de Historia de la Medicina, de la Urología y de Anestesia, las publicaciones periódicas y las Tesis Doctorales que sobre este tema se realizaron en la época. Resultados: En buena parte del siglo XX aquellos que se dedicaban a la cirugía administraban también la anestesia. Es a partir del año 1900 cuando comienzan a desarrollarse la raquianestesia y la anestesia epidural siendo numerosas y fundamentales las aportaciones de los urólogos españoles como F. Rusca Doménech, J.M. Batrina, M. Barragán Bonet, R. Lozano Monzón, L. Guedea Calvo, Gil Vernet, Fidel Pagés Miravé, V. Sagarra Lascuraín, Gómez Ulla, etc. realizando publicaciones en revistas de prestigio, comunicaciones en congresos y tesis doctorales sobre la anestesia raquídea y epidural (AU)

Objectives: To show the beginning of spinal and epidural anesthesia in our country and the contributions of Spanish urologists. Methods: We reviewed books and writings of History of Medicine, Urology and Anesthesia and Doctoral thesis about spinal and epidural anesthesia. Results: In the 20th century, surgeons also gave the anesthetic drugs to the patients. Spinal and epidural anesthesia were used for the first time in 1900. A lot of Spanish urologists like F. Rusca Doménech, J.M. Batrina, M. Barragán Bonet, R. Lozano Monzón, L. Guedea Calvo, Gil Vernet, Fidel Pagés Miravé, V. Sagarra Lascuraín, Gómez Ulla, etc, did research, writings in scientific journals and Doctoral thesis about anesthesia (AU)

[Hand-assisted laparoscopic radical nephrectomy vs. open nephrectomy in the treatment of clinically localized renal cell carcinoma. Comparative study]. / Nefrectomía radical laparoscópica asistida por la mano frente a nefrectomía abierta en el tratamiento del carcinoma de células renales clínicamente localizado. Estudio comparativo.

INTRODUCTION: The description of the first laparoscopic nephrectomy made a revolution in the managing of the benign and malignant renal diseases. Hand-assisted laparoscopy (HAL) was developed with the aim of offering advantages to both patients and surgeons. The aim of the present work is to compare, in our experience, the results offered in the radical nephrectomy by HAL and open surgery, by analysis of surgical time, estimated blood loss during surgery and hospital stay. METHODS: Eleven Hand-assisted laparoscopic (HAL) radical nephrectomies and eight open radical nephrectomies were carried out at our institution during the same period (June 2001 to December 2002). All patients underwent computed tomography and were found to have a clinically localised functioning renal mass in all cases. The size of this renal mass was 4-7 cm (average 5.5 cm) in the HAL group and 4.5-15 cm (average 7.8 cm) in the open group. Patient age, body mass index, and American Society of Anaesthesiologists' score showed no significant difference between groups. RESULTS: The average surgical time in the HAL group was 156.72 minutes, the average blood loss during surgery was of 83.6 ml and the average hospital stay was of 3.09 days. Conversion to open surgery was not necessary in any patient. Average surgical time in the open surgery group was 178.25 minutes, the estimated blood loss during surgery was of 337.75 ml (p < 0.05) and the hospital stay was of 5.37 days (p < 0.05). The comparison of the means by two-tailed student's t test revealed significant differences in estimated blood loss and hospital stay, favoring HAL, and no significant differences in surgical time. CONCLUSIONS: HAL nephrectomy is feasible in almost all nephrectomies and is a safe, reproducible, and minimally invasive technique to perform extirpable renal surgery. HAL offer clear advantages over traditional open surgery, including decreased blood loss and hospital stay.