Predictors of surgical outcomes of retroperitoneal laparoscopic partial nephrectomy.

OBJECTIVES: To evaluate surgical outcomes in a series of laparoscopic retroperitoneal partial nephrectomies. METHODS: A total of 147 patients who underwent laparoscopic retroperitoneal partial nephrectomy by a single surgeon were evaluated. Pre-operative parameters (body mass index, ASA score, tumour size, cTNM stage, PADUA score risk, surgeon experience) and intraoperative and postoperative outcomes (operative mean time, warm ischemia time, blood loss, transfusion rate, length of hospitalization, and margin-ischaemiacomplications [MIC] success rate) were considered. RESULTS: For 134 patients (91.1%) the success of the treatment, defined by a MIC = 3, was obtained. When the statistical significance of each of the independent variables was tested, surgeon's experience added statistical significance to the prediction of operative time (p = 0.000), warm ischemia time (p = 0.000) and blood loss (p = 0.000); tumour size (p = 0.046) to the prediction MIC (p = 0.010), operative time (p = 0.000), warm ischemia time (p = 0.003) and blood loss (p = 0.010); ASA score to the length of hospitalization (p = 0.009). CONCLUSIONS: Laparoscopic retroperitoneal partial nephrectomy represents an adequate and safe technique for the treatment of T1 renal cancer. Optimal MIC success rate can be achieved, although intraoperative outcomes tend to be related to the learning curve even in a very experienced laparoscopic surgeon. Length of hospitalization depends on general health condition of patients.

The impact of previous prostate surgery on the outcomes of laparoscopic radical prostatectomy.

BACKGROUND: The aim of this study was to evaluate the outcomes in laparoscopic radical prostatectomy (LRP) in patients who had undergone prior prostate surgery (PPS). METHODS: In this study 946 consecutive LR P patients were included and a retrospective comparison between those patients who had received PPS (group A) and those who had not received PPS (group B) was carried out. The preoperative, intraoperative and postoperative data was collected in a prospectively-maintained database. All complications occurring ≤30 days after surgery were recorded and defined according to the Dindo-modification of the Clavien system. RESULTS: Longer operative time, greater blood loss, longer catheterization time, higher incidence of lymphocele, rectal injury and anastomotic stricture were found to be more frequent in group A. No statistically significant difference was noted between the two groups in terms of positive surgical margin rate and Biochemical recurrence free survival (BCRFS). Complete urinary continence rate resulted significantly higher in group B patients at both 1-year and 2-year follow-up. Potency rate resulted better in group B patients even if a statistically significant difference for both unilateral and bilateral nerve sparing techniques was not reached. CONCLUSIONS: LRP procedure can be safely performed on patients who have previously undergone PPS without compromising oncologic safety whereas a negative impact on functional outcome in terms of achieving a complete urinary continence rate and sexual potency should be expected.

Long-term oncological and functional results of extraperitoneal laparoscopic radical prostatectomy: one surgical team's experience on 1,600 consecutive cases.

PURPOSE: To determine the oncologic and functional outcomes of ELRP on a single surgical team's series. METHODS: A total of 1,600 consecutive ELRP patients were recorded with a 2-year follow-up. In 778 patients, a 5-year follow-up was available. RESULTS: The mean operative time was 125,6 min (PLND not included) and 150,9 min (PLND included). Postoperative stage was pT2a in 282 patients (17.6 %), pT2b in 877 (54.8 %), pT2c in 18 (1.1 %), pT3a in 241 (15 %), and pT3b in 182 (11.3 %). Positive margins were detected in 7.4 and 13.4 % of pT2 and pT3 tumors, respectively. Overall complication rate was 4 %. PSA levels resulted in <0.2 ng/mL in 96.4, 94.9, 92, 90.9, and 81.5 % of the cases at 3, 12, 24, 36, and 60 months after surgery, respectively. BCRFS rates 5 years after ELRP were 88.7 % for patients staged as pT2, 73.9 % for pT3a, and 62.4 % for pT3b. Complete urinary continence rate resulted in 39 and 92 % after 1 and 12 months, respectively, with a further increase from 92 to 98.4 % at 24-month follow-up. A nerve-sparing procedure was performed in 45 % of patients. The overall potency rate at 12-month follow-up was 38.67 % for UNSS patients and 75 % for BNSS patients. Potency recovery was age-dependent, with patients aged <55 years who resulted potent in 46.8 % of UNSS and 95.8 % of BNSS after 24 months. CONCLUSIONS: ELRP is a standardized and safe procedure that implies advantages of both minimally invasive and extraperitoneal approaches with elevated standards for oncologic and functional outcomes obtained at long-term follow-up.

A single institute's experience in retroperitoneal laparoscopic dismembered pyeloplasty: results with 86 consecutive patients.

PURPOSE: To report our institute's retroperitoneal technique of laparoscopic pyeloplasty (LP) and present results of 86 consecutive patients. PATIENTS AND METHODS: From January 2004 to January 2009, 86 patients who were affected with ureteropelvic junction obstruction (UPJO) underwent retroperitoneal LP. In all operations, a four-port, balloon-dissecting, retroperitoneal approach was used and a simple "personalized" modification of the conventional Anderson-Hynes technique consisting of an approaching and stabilizing stitch made between the renal pelvis and proximal ureter. A needle introductor at the level of the surgical assistant's trocar was used as well to facilitate the Double-J stent introduction. Follow-up studies were performed postoperatively with intravenous urography and renal ultrasonography at 6, 12, and 18 months. RESULTS: All operations were completed laparoscopically, and no open conversions were needed. The mean operative time was 79.3 minutes (range 65-125 min). The mean blood loss was 10 mL (range 5-40 mL), and the mean postoperative hospitalization stay was 5.7 days (range 3-14 d). No intraoperative complications occurred. Aberrant crossing vessel and primary stricture as the cause of UPJO were noted in 31 and 55 patients, respectively. Transient anastomotic leakage occurred in six patients and was successfully treated by conservative management. A persistent UPJO was detected at first follow-up visit in three patients and was treated by conservative management in two cases and by performing an open pyeloplasty in one case. A mean follow-up of 29 months (range 18 to 48 mos) was performed and showed a 96.6% success rate after the first operation. CONCLUSIONS: Our experience with LP in accordance with the Anderson-Hynes procedure has demonstrated that this technique is an effective treatment for UPJO, with a high overall success rate, a short hospital stay, and a negligible incidence of early complications.

[Transrectal ultrasound assessment of anastomosis after videolaparoscopic radical prostatectomy: our experience]. / Il controllo ecografico transrettale dell'anastomosi dopo VLRP. La nostra esperienza.

BACKGROUND: Trans-Rectal UltraSound (TRUS) has proved to be an accurate procedure comparable to that of Fluoro-cystography (FC) to assess vesicourethral anastomosis after radical prostatectomy, with the advantages of lower costs, no radiation exposure and no dependence on the radiology department. METHODS: 60 Video Laparoscopic Radical Prostactomies (VLRP) were performed at our institution between September 2008 and January 2010. All patients underwent anatomosis assessment on postoperative day 6 with TRUS (Aloka A7 US machine with endorectal end-fire probe). 200 ml of sterile saline was manually instilled into the bladder by an assistant, while TRUS visualization of anastomosis was carried out by an urologist. The test was considered positive if any expanding anechoic shadow developed beside the anastomosis. In case of negative test the catheter was removed. In case of positive test the catheter was left in place and reassessment was performed every 5-7 days with both TRUS and FC, until negative result. RESULTS: At the initial TRUS assessment we had 4 positive and 56 negative tests. Three out of the four patients with a positive test had a second assessment on p.o. day 14, which gave a negative result. The 4th positive case had a positive second assessment on p.o. day 14 and a third negative one on p.o. day 21. In a total of 20 assessments both TRUS and FC were performed. The results of the two procedures were always in accordance. CONCLUSIONS: We have introduced TRUS assessment of vescicourethral anastomosis after laparoscopic radical prostatectomy as a routine procedure in our department. We are planning a comparative study, using FC as the gold standard, for validation purposes.