Bilateral subgaleal hematoma after a robot-assisted radical prostatectomy: an uncommon complication.

Robot-assisted radical prostatectomy is a relatively recent technique. Its advantages include less invasiveness and better pain management, but has specific anesthesia requirements, such as steep Trendelenburg position and pneumoperitoneum. Mild complications are common, e.g., transient hypotension or soft tissue edema. We present a case of a 62-year old male who developed subgaleal hematoma associated with transient neurologic impairment after surgery. Jugular vein insufficiency was suspected as the most likely cause. The patient recovered fully. Robot-assisted radical prostatectomy can be a challenging procedure due to the anesthesia requirements, but most complications are mild and transient. However, patients should be carefully assessed before surgery. We identified potential factors that may have led to this complication: the abnormal prolonged surgical time, the steep Trendelenburg, a non-assessed jugular vein insufficiency, and/or patient`s obesity.

Bilateral subgaleal hematoma after a robot-assisted radical prostatectomy: an uncommon complication / Hematoma subgaleal bilateral tras prostatectomía radical robótica: una complicación infrecuente

Robotassisted radical prostatectomy is a relatively recent technique. Its advantages include less invasiveness and better pain management, but has specific anesthesia requirements, such as steep Trendelenburg position and pneumoperitoneum. Mild complications are common, e.g., transient hypotension or soft tissue edema. We present a case of a 62 year old male who developed subgaleal hematoma associated with transient neurologic impairment after surgery. Jugular vein insufficiency was suspected as the most likely cause. The patient recovered fully.Robotassisted radical prostatectomy can be a challenging procedure due to the anesthesia requirements, but most complications are mild and transient. However, patients should be carefully assessed before surgery. We identified potential factors that may have led to this complication: the abnormal prolonged surgical time, the steep Trendelenburg, a nonassessed jugular vein insufficiency, and/or patient’s obesity.(AU)

La prostatectomía robótica radical es una técnica relativamente reciente. Sus ventajas son una menor invasividad y mejor control del dolor. Tiene algunas peculiaridades anestésicas, como Trendelenburg extremo y neumoperitoneo. Son frecuentes las complicaciones leves, como la hipotensión transitoria o el edema de partes blandas. Presentamos el caso de un varón de 62 años que desarrolló un hematoma subgaleal asociado a deterioro neurológico transitorio tras la intervención. Se sospechó como causa más probable una incompetencia venosa yugular. El paciente se recuperó completamente.La prostatectomía robótica radical puede ser un reto debido a los requisitos anestésicos, pero la mayoría de las complicaciones son leves y transitorias. No obstante, los pacientes deben ser estudiados cuidadosamente antes de la intervención. En este caso podemos encontrar varios factores que pueden haber influido, como el tiempo quirúrgico anormalmente prolongado, el Trendelenburg extremo, una insuficiencia de la vena yugular no evaluada y/o la obesidad del paciente.(AU)

Renal autotransplant for subsequent endovascular exclusion of the thoracoabdominal aorta.

In the last 20 years, endovascular procedures have radically altered the treatment of diseases of the aorta. The objective of endovascular treatment of dissections is to close the entry point to redirect blood flow toward the true lumen, thereby achieving thrombosis of the false lumen. In extensive chronic dissections that have evolved with the formation of a large aneurysm, the dissection is maintained from the end of the endoprosthesis due to multiple orifices, or reentries, that communicate with the lumens. In addition, one of the primary limitations of this technique is when the visceral arteries have disease involvement. In this report we present a case where, despite having treated the entire length of the descending thoracic aorta, the dissection was maintained distally, leading to progression of the diameter of the aneurysm. After reviewing the literature, and to the best of our knowledge, we describe the first case in which renal autotransplant was performed to allow for subsequent exclusion of the aorta at the thoracoabdominal level using a fenestrated endoprosthesis for the celiac trunk and the superior mesenteric artery.

Surgical treatment of aortobronchial fistula after thoracic endograft failure.

Endovascular stent grafting has been recently considered as a less invasive alternative to either medical therapy or open surgical treatment for many patients with descending thoracic aortic disease. Late complications are rarely described in literature. Herein, we described the occurrence of an aorto-bronchial fistula and a retro-A dissection in a 73-year-old man after stent-grafting for a penetrating atherosclerotic ulcer (PAU) of the descending thoracic aorta and the successful surgical technique adopted in order to remove the stent-graft.