Experiencia inicial con la nueva plataforma de puerto único da Vinci robótico / Initial experience with the new da Vinci single-port robot-assisted platform

Objetivo: Describir nuestra experiencia en los primeros casos de cirugías urológicas realizadas mediante el puerto único robótico da Vinci. Material y métodos: Se realizaron 5 cirugías robóticas por puerto único (R-LESS) entre mayo y octubre de 2014. Se realizaron 3 reimplantes ureterales, una ureteropieloplastia en un riñón invertido y una nefrectomía parcial. Se recogieron los resultados peri- y postoperatorios así como un informe de las complicaciones según la clasificación de Clavien. Resultados: De los 5 procedimientos, 4 se realizaron completamente por LESS, mientras que uno se reconvirtió a cirugía robótica multipuerto. No hubo complicaciones intraoperatorias. Se observaron complicaciones perioperatorias en 4 pacientes, siendo todas de grado 1 o 2. El tiempo operatorio medio fue de 262 min (rango 230-300). Discusión: En nuestra experiencia inicial con el dispositivo da Vinci, la cirugía R-LESS es factible y segura. Persisten algunas limitaciones en su uso, que requieren de nuevas plataformas R-LESS mejoradas

Objective: To describe our experience in the first cases of urological surgeries performed with the da Vinci single-port robot-assisted platform. Material and methods: We performed 5 single-port robot-assisted surgeries (R-LESS) between May and October 2014. We performed 3 ureteral reimplant surgeries, one ureteropyeloplasty in an inverted kidney and 1 partial nephrectomy. The perioperative and postoperative results were collected, as well as a report of the complications according to the Clavien classification system. Results: Of the 5 procedures, 4 were performed completely by LESS, while 1 procedure was reconverted to multiport robot-assisted surgery. There were no intraoperative complications. We observed perioperative complications in 4 patients, all of which were grade 1 or 2. The mean surgical time was 262 minutes (range, 230-300). Discussion: In our initial experience with the da Vinci device, R-LESS surgery was feasible and safe. There are still a number of limitations in its use, which require new and improved R-LESS platforms

Initial experience with the new da Vinci single-port robot-assisted platform. / Experiencia inicial con la nueva plataforma de puerto único da Vinci robótico.

OBJECTIVE: To describe our experience in the first cases of urological surgeries performed with the da Vinci single-port robot-assisted platform. MATERIAL AND METHODS: We performed 5 single-port robot-assisted surgeries (R-LESS) between May and October 2014. We performed 3 ureteral reimplant surgeries, one ureteropyeloplasty in an inverted kidney and 1 partial nephrectomy. The perioperative and postoperative results were collected, as well as a report of the complications according to the Clavien classification system. RESULTS: Of the 5 procedures, 4 were performed completely by LESS, while 1 procedure was reconverted to multiport robot-assisted surgery. There were no intraoperative complications. We observed perioperative complications in 4 patients, all of which were grade 1 or 2. The mean surgical time was 262minutes (range, 230-300). DISCUSSION: In our initial experience with the da Vinci device, R-LESS surgery was feasible and safe. There are still a number of limitations in its use, which require new and improved R-LESS platforms.

La formación del residente de urología en cirugía laparoscópica. Elaboración de un modelo de realidad virtual / Urology residents training in laparoscopic surgery. Develoment of a virtual reality model

Introducción: El entrenamiento y aprendizaje de los residentes en la cirugía laparoscópica tiene limitaciones legales, económicas y tecnológicas. La simulación es una herramienta imprescindible en la formación de los mismos como complemento a su formación en la cirugía laparoscópica. Dicha formación debe estar estructurada en un ambiente adecuado, con objetivos claros determinados previamente, tutelada por profesionales con experiencia en clínica y docencia en simulación y con modelos realísticos, usando tanto animales como tejidos ex-vivo de los mismos. Es imprescindible incorporar mecanismos de evaluación objetivos en el progreso formativo del residente. Objetivo: Presentamos el modelo de entrenamiento en cirugía laparoscópica para los resientes de urología en el Hospital Universitario Valdecilla, que se realiza en el Hospital Virtual Valdecilla, centro asociado al Center for Medical Simulation de Boston y acreditado por el Colegio Americano de Cirujanos. Material y método: El modelo está diseñado en 3 bloques, básico para R1, intermedio para R2-3 y avanzado para R4-5, con 9 módulos a entrenar. El entrenamiento se realiza en programas de 4 h en 4 tardes, a razón de 3 semanas por año de residencia, lo que conlleva que al final de la misma hayan realizado 240 h de formación laparoscópica en simulación. Para cada módulo utilizamos como medida de progresión formativa del residente evaluaciones objetivas estructuradas. Resultados: Desde 2003 se han formado 9 residentes de urología más los 5 que están actualmente en formación. El modelo se ha ido modificando y adecuando según las necesidades que el feedback con los alumnos nos trasmitía. La adquisición de las habilidades en un modelo de realidad virtual ha permitido la transferencia a la práctica real con seguridad. Conclusiones: El diseño de un programa formativo en cirugía laparoscópica, en bloques estructurados y de progresiva complejidad, permite alcanzar una formación adecuada para transferir las habilidades adquiridas mediante este modelo a un escenario real con seguridad para el paciente

Introduction: The training and learning of residents in laparoscopic surgery has legal, financial and technological limitations. Simulation is an essential tool in the training of residents as a supplement to their training in laparoscopic surgery. The training should be structured in an appropriate environment, with previously established and clear objectives, taught by professionals with clinical and teaching experience in simulation. The training should be conducted with realistic models using animals and ex-vivo tissue from animals. It is essential to incorporate mechanisms to assess the objectives during the residents’ training progress. Objective: We present the training model for laparoscopic surgery for urology residents at the University Hospital Valdecilla. The training is conducted at the Virtual Hospital Valdecilla, which is associated with the Center for Medical Simulation in Boston and is accredited by the American College of Surgeons. Material and method: The model is designed in 3 blocks, basic for R1, intermediate for R2-3 and advanced for R4-5, with 9 training modules. The training is conducted in 4-hour sessions for 4 afternoons, for 3 weeks per year of residence. Residents therefore perform 240 hours of simulated laparoscopic training by the end of the course. For each module, we use structured objective assessments to measure each resident's training progress. Results: Since 2003, 9 urology residents have been trained, in addition to the 5 who are currently in training. The model has undergone changes according to the needs expressed in the student feedback. The acquisition of skills in a virtual reality model has enabled the safe transfer of those skills to actual practice. Conclusions: A laparoscopic surgery training program designed in structured blocks and with progressive complexity provides appropriate training for transferring the skills acquired using this model to an actual scenario while maintaining patient safety

Carcinoma urotelial vesical variedad en nidos: presentación de 12 casos y revisión de la literatura / The nested variant of bladder transitional cell carcinoma: Review of 12 cases and review of the literature

Objetivos: El carcinoma urotelial vesical variedad en nidos es extremadamente infrecuente, y tiene un comportamiento más agresivo que el resto de tumores de vejiga. El objetivo principal de este estudio es analizar si su comportamiento en nuestro medio es tan agresivo como lo descrito en la literatura. Material y método: Revisión de 12 casos diagnosticados de carcinoma urotelial vesical variedad en nidos y análisis de las características tumorales, opciones de tratamiento, análisis de recurrencia y supervivencia de la enfermedad entre enero de 1997 y diciembre del 2010 en nuestra institución. Resultados: El 50% de los casos tuvo un estadio tumoral ≥ T2, siendo el grado de diferenciación G2 (50%) o G3 (50%). Tras el resultado anatomopatológico de la primera resección transuretral (RTU) vesical en 5 pacientes se practicó cistoprostatectomía radical, 3 una segunda RTU y 4 pacientes solo con tratamiento quimioterápico (QT) posterior y/o radioterapia (RT). De los 12 casos 5 (41,7%) fallecieron por causa tumoral y 3 (25%) por otras causas (sepsis urinaria, insuficiencia respiratoria, insuficiencia renal). Con una mediana de seguimiento de 40 meses la supervivencia global fue del 50% y la supervivencia cáncer específica del 65,6%. Conclusiones: El carcinoma urotelial vesical variedad en nidos es un tumor que se presenta en estadios avanzados, con altas tasas de recurrencias y mortalidad a pesar del uso de diferentes herramientas de tratamiento. No existe hasta la fecha una guía de práctica clínica para esta variedad de tumor urotelial

Objectives: The nested variant of bladder transitional cell carcinoma is extremely rare and has a different biological behavior to other bladder tumors. The aim of this study is to analize if their behavior is as aggressive as has been described in the literature. Material and method: Review of 12 diagnosed cases with nested variant of bladder transitional cell carcinoma and analysis of demographic characteristics, clinical presentation, tumor characteristics, treatment options, analysis of recurrence and cancer-specific survival between January 1997 and December 2010 in our hospital. Results: 50% of the cases had a pathologic stage ≥ T2, with grade of differentiation G2 (50%) or G3 (50%). After the pathological result of the TUR (transurethral resection) Bladder, 5 cases underwent radical cystoprostatectomy, 3 a second TUR bladder and 4 cases with treatment chemotherapy and/or radiotherapy (RT). Five out of 12 cases (41.7%) died due to bladder cancer and 3 died (25%) of other causes (urinary sepsis, respiratory failure, renal failure). With a median follow up of 40 months, the overall survival was 50% and cancer-specific survival of 65.6%. Conclusions: The nested variant of bladder transitional cell carcinoma is a disease with an advanced-stage presentation, with high recurrence and mortality rates despite the use of different treatments. So far there is not a clinical practice guideline for this variety of urothelial tumor

Urology residents training in laparoscopic surgery. Development of a virtual reality model.

INTRODUCTION: The training and learning of residents in laparoscopic surgery has legal, financial and technological limitations. Simulation is an essential tool in the training of residents as a supplement to their training in laparoscopic surgery. The training should be structured in an appropriate environment, with previously established and clear objectives, taught by professionals with clinical and teaching experience in simulation. The training should be conducted with realistic models using animals and ex-vivo tissue from animals. It is essential to incorporate mechanisms to assess the objectives during the residents' training progress. OBJECTIVE: We present the training model for laparoscopic surgery for urology residents at the University Hospital Valdecilla. The training is conducted at the Virtual Hospital Valdecilla, which is associated with the Center for Medical Simulation in Boston and is accredited by the American College of Surgeons. MATERIAL AND METHOD: The model is designed in 3 blocks, basic for R1, intermediate for R2-3 and advanced for R4-5, with 9 training modules. The training is conducted in 4-hour sessions for 4 afternoons, for 3 weeks per year of residence. Residents therefore perform 240 hours of simulated laparoscopic training by the end of the course. For each module, we use structured objective assessments to measure each resident's training progress. RESULTS: Since 2003, 9 urology residents have been trained, in addition to the 5 who are currently in training. The model has undergone changes according to the needs expressed in the student feedback. The acquisition of skills in a virtual reality model has enabled the safe transfer of those skills to actual practice. CONCLUSIONS: A laparoscopic surgery training program designed in structured blocks and with progressive complexity provides appropriate training for transferring the skills acquired using this model to an actual scenario while maintaining patient safety.

The nested variant of bladder transitional cell carcinoma: Review of 12 cases and review of the literature.

OBJECTIVES: The nested variant of bladder transitional cell carcinoma is extremely rare and has a different biological behavior to other bladder tumors. The aim of this study is to analize if their behavior is as aggressive as has been described in the literature. MATERIAL AND METHOD: Review of 12 diagnosed cases with nested variant of bladder transitional cell carcinoma and analysis of demographic characteristics, clinical presentation, tumor characteristics, treatment options, analysis of recurrence and cancer-specific survival between January 1997 and December 2010 in our hospital. RESULTS: 50% of the cases had a pathologic stage ≥T2, with grade of differentiation G2 (50%) or G3 (50%). After the pathological result of the TUR (transurethral resection) Bladder, 5 cases underwent radical cystoprostatectomy, 3 a second TUR bladder and 4 cases with treatment chemotherapy and/or radiotherapy (RT). Five out of 12 cases (41.7%) died due to bladder cancer and 3 died (25%) of other causes (urinary sepsis, respiratory failure, renal failure). With a median follow up of 40 months, the overall survival was 50% and cancer-specific survival of 65.6%. CONCLUSIONS: The nested variant of bladder transitional cell carcinoma is a disease with an advanced-stage presentation, with high recurrence and mortality rates despite the use of different treatments. So far there is not a clinical practice guideline for this variety of urothelial tumor.

Leiomioma vesical / Leiomyoma of the bladder

Presentamos un nuevo caso de leiomioma vesical en una paciente con clínica inespecífica, y en la que las pruebas de imagen preoperatorias no lo orientaron. El diagnóstico definitivo lo dio el estudio anatomopatológico de la pieza quirúrgica (AU)

[Bladder leiomyoma]. / Leiomioma vesical.

A new case of leiomyoma of the bladder is presented in a patient with unspecific symptoms and the preoperatives patterns don't give to a certainty diagnosis. The conclusive diagnosis was obtained with pathoanatomical study of the quirurgic piece.