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1.
Chirurgia (Bucur) ; 115(6): 792-797, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378638

RESUMO

The treatment of primary psoas abscesses usually is performed by a combination of prolongued antiobiotic therapy and drainage with interventional radiology techniques. However, although this combination is usually adequate for the treatment of solitary extraperitoneal collections, the presence of multi-loculated complex abscesses requires usually multiple procedures and feruently mandates open surgery. Herein, we describe an alternative tehnique of percutaneous retroperitoneoscopic drainage of multiple extensive primary psoas abscesses using flexible endoscopy, which can enable treatment these cases as one-stop proedure in a minimally invasive manner.


Assuntos
Drenagem , Laparoscopia/métodos , Abscesso do Psoas , Drenagem/métodos , Endoscopia/métodos , Humanos , Assistência Perioperatória , Abscesso do Psoas/cirurgia , Espaço Retroperitoneal/cirurgia , Resultado do Tratamento
2.
Hinyokika Kiyo ; 66(9): 307-311, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32988168

RESUMO

A 32-year-old woman was referred to our hospital for consultation with a suspected left adrenal tumor detected by ultrasonography at a health check. Computed tomography and magnetic resonance imaging revealed a 3×1×4 cm multilocular cystic mass arising from the diaphragmatic crura, suggesting a retroperitoneal bronchogenic cyst. The patient underwent excision of the cyst and adjacent diaphragm using a retroperitoneoscopic approach. Retroperitoneal bronchogenic cysts are rare. We review the cases of 26 patients who underwent laparoscopic resection of a retroperitoneal bronchogenic cyst.


Assuntos
Neoplasias das Glândulas Suprarrenais , Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/cirurgia , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/cirurgia , Tomografia Computadorizada por Raios X
3.
Eur J Vasc Endovasc Surg ; 60(5): 752-763, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32741678

RESUMO

OBJECTIVE: Radical excision of retroperitoneal or intra-abdominal soft tissue sarcomas may necessitate vessel resection and reconstruction. The aim of this study was to assess surgical results of retroperitoneal or intra-abdominal sarcomas involving major blood vessels. METHODS: This was a retrospective single centre cohort study and a comprehensive review of literature. Patients with retroperitoneal or intra-abdominal sarcomas treated by the oncovascular team in Helsinki University Hospital from 2010 to 2018 were reviewed for vascular and oncological outcomes. A comprehensive literature review of vascular reconstructions in patients with retroperitoneal sarcoma was performed. RESULTS: Vascular reconstruction was performed in 17 patients, 11 of whom required arterial reconstructions. Sixteen of the operations were sarcoma resections; the post-operative diagnosis for one patient was thrombosis instead of the presumed recurrent leiomyosarcoma. Early graft thrombosis occurred in two venous and one arterial reconstruction. Late thrombosis was detected in three (18%). The median follow up was 27 (range 0-82) months. Of the patients with sarcoma resections 5 (31%) died of sarcoma and further 4 (25%) developed local recurrence or new distant metastases. The comprehensive review of literature identified 37 articles with 110 patients, 89 of whom had inferior vena cava reconstruction only. Eight arterial reconstructions were described. Late graft thrombosis occurred in 14%. The follow up was 0-181 months, during which 57% remained disease free and 7% died of sarcoma. CONCLUSION: Vascular reconstructions enable radical resection of retroperitoneal and intra-abdominal sarcomas in patients with advanced disease. The complex operations are associated with an acceptable rate of serious peri-operative complications and symptomatic thrombosis of the repaired vessel is rare. However, further studies are needed to assess the performance of the vascular reconstructions in the long term.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Oclusão de Enxerto Vascular/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retroperitoneais/cirurgia , Sarcoma/cirurgia , Trombose/epidemiologia , Adulto , Idoso , Artérias/cirurgia , Implante de Prótese Vascular/métodos , Feminino , Seguimentos , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/etiologia , Neoplasias Retroperitoneais/irrigação sanguínea , Neoplasias Retroperitoneais/patologia , Espaço Retroperitoneal/irrigação sanguínea , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Sarcoma/sangue , Sarcoma/patologia , Trombose/etiologia , Resultado do Tratamento , Grau de Desobstrução Vascular , Veia Cava Inferior/cirurgia
6.
Transplant Proc ; 52(6): 1655-1660, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32622519

RESUMO

INTRODUCTION: Living-donor kidney transplantation (LDKT) is the most realistic option for patients with end-stage kidney disease because of a severe shortage of deceased donors. Hand-assisted laparoscopic donor nephrectomy (HALDN) and hand-assisted retroperitoneoscopic donor nephrectomy (HARDN) have been undertaken at our institute. We compared these 2 surgical procedures with respect to donor outcome and the graft function of recipients. METHODS: We reviewed data from 840 consecutive live-donor kidney transplants from October 2003 to April 2019. Propensity scores were calculated for each patient using bivariate logistic regression. RESULTS: After propensity-score matching, the 2 groups each contained 205 patients. Donors in the HALDN group had a longer procedure time (217 minutes, P < .0001), less estimated blood loss (51 mL, P < .0001), lower serum levels of C-reactive protein at postoperative day (POD) 1 (7.9 mg/dL, P < .0001) than those in the HARDN group. There were 22 modified Clavien-classifiable complications among the study groups. A significantly higher conversion to open surgery was noted in the HARDN group (P = .0181) than in the HALDN group, but there was no significant difference in the prevalence of complications in either group. There was no significant difference in the estimated glomerular filtration rate of recipients at POD14 between the 2 groups. CONCLUSIONS: Safety and early graft function of HALDN in LDKT are comparable to or even better than that of HARDN.


Assuntos
Laparoscopia Assistida com a Mão/métodos , Laparoscopia/métodos , Nefrectomia/métodos , Coleta de Tecidos e Órgãos/métodos , Adulto , Conversão para Cirurgia Aberta , Feminino , Humanos , Transplante de Rim , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos
7.
J Urol ; 204(6): 1242-1248, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32717162

RESUMO

PURPOSE: Robotic assisted retroperitoneal lymph node dissection in patients with testicular cancer is controversial. Lately, unusual recurrence patterns with adverse outcomes after robotic assisted retroperitoneal lymph node dissection have been published. In this report we determine the feasibility, safety and early oncologic outcome of robotic assisted retroperitoneal lymph node dissection in patients with small volume metastatic testicular cancer. MATERIALS AND METHODS: We retrospectively evaluated 27 consecutive patients with small volume metastatic testicular cancer (October 2010 to November 2019) who underwent robotic assisted retroperitoneal lymph node dissection (unilateral modified template). Intraoperative and postoperative complications as well as early oncologic outcomes are reported. Surgery was performed in the primary metastatic setting in 22 (81%), post-chemotherapy in 4 (15%) and for late relapse in 1 patient (4%). Initial clinical stage was IIA for 14 (52%), IIB for 12 (43%) and III for 1 (4%) patient. RESULTS: Median operative time, blood loss and length of hospital stay were 175 minutes, 50 ml and 4 days, respectively. Expectedly, viable tumor was found in 21/27 patients (78%) and 6 patients (22%) showed fibrosis, necrosis or no tumor. Overall 3 (11%) patients experienced intraoperative (Satava II) and 1 (4%) postoperative (Clavien-Dindo IIIb) complications, respectively. Median followup was 16.5 months (3-69), and 3 (11%) patients experienced relapse outside of the surgical field after 12, 22 and 36 months. CONCLUSIONS: In highly selected patients with low volume metastatic testicular cancer robotic assisted retroperitoneal lymph node dissection may be indicated, and appears to be technically feasible and comparable with open surgery in terms of complications and early oncologic safety. Prospective data collection in larger series is necessary to clarify the role and specific indications of this approach.


Assuntos
Excisão de Linfonodo/efeitos adversos , Metástase Linfática/terapia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Seminoma/terapia , Neoplasias Testiculares/terapia , Adulto , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Quimioterapia Adjuvante , Estudos de Viabilidade , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Espaço Retroperitoneal/patologia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Seminoma/epidemiologia , Seminoma/secundário , Neoplasias Testiculares/epidemiologia , Neoplasias Testiculares/patologia , Resultado do Tratamento , Adulto Jovem
8.
Ann R Coll Surg Engl ; 102(8): e209-e212, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32538127

RESUMO

Idiopathic retroperitoneal haematoma is a rare clinical entity; resulting duodenal obstruction is even more occult. It can pose a diagnostic challenge due to variable presentations. Timely management requires a high index of suspicion and a multidisciplinary approach. Surgery is indicated in patients refractory to conservative treatment and failure of endoscopic or interventional radiology options. We report an interesting case illustrating the rarity and severity of this condition, with a review of the literature.


Assuntos
Obstrução Duodenal , Hematoma , Espaço Retroperitoneal , Obstrução Duodenal/diagnóstico por imagem , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/patologia , Espaço Retroperitoneal/cirurgia
10.
Transplant Proc ; 52(6): 1661-1664, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32446695

RESUMO

INTRODUCTION: Obese donors are increasingly accepted for living kidney donation. Obese individuals benefit the most from minimal access surgery; however, laparoscopic donor nephrectomy may be technically challenging in these individuals. Retroperitoneal laparoscopic donor nephrectomy (RLDN) in particular may be hampered by excessive perinephric fat. We performed a prospective nonrandomized controlled study comparing outcomes of RLDN in obese and nonobese kidney donors. AIM: To compare operative parameters, donor complications, and recipient outcomes in RLDN performed in obese and nonobese donors. MATERIALS AND METHODS: From June 2014 to April 2016, 200 donors underwent RLDN. Of these, 160 were nonobese (group I), and 40 were obese (group II). Preoperative parameters including body mass index, age, and sex, and operative parameters including total operative time, warm ischemia time, and estimated blood loss were recorded. Complications were compared using the Clavien-Dindo classification. Recipients' serum creatinine at day 7, 15, and 30 was compared between recipients who received grafts from obese and nonobese donors. RESULTS: There were 17.5% right-sided donors in group I and 15% in group II. Operative time, warm ischemia time, blood loss, length of hospital stay, and complications were similar in the 2 groups, and there were no statistically significant differences. Serum creatinine in the recipients was similar on follow-up. CONCLUSIONS: RLDN is safe and efficacious in obese donors. It gives all the benefits of minimal-access surgery without compromising on recipient outcomes.


Assuntos
Doadores Vivos , Nefrectomia/métodos , Obesidade/complicações , Coleta de Tecidos e Órgãos/métodos , Adulto , Feminino , Humanos , Transplante de Rim/mortalidade , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrectomia/mortalidade , Estudos Prospectivos , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/efeitos adversos
11.
Khirurgiia (Mosk) ; (3): 22-28, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271733

RESUMO

AIM: the assessment of the role of minimally invasive interventional procedures in the treatment of patients with infected pancreatic necrosis and their safety, as well as comparison of the results of the most common modern minimally invasive techniques among themselves. METHODS: The results of treatment of 310 patients are presented with infected destructive pancreatitis from 2013 to 2018 on the basis of the city clinical hospital named after I.V. Davydovsky. The patients were divided into three groups: in the first one (n=170) patients underwent puncture followed by drainage of necrotic foci under ultrasound and CT control, in the second (n=98) patients underwent sanation of foci completely by laparoscopic access, in the third (n=42) a series of retroperitoneoscopy was used for the same purpose. RESULTS: In 114 (67.1%) cases, patients from the first group did not require further surgical intervention. The results of percutaneous drainage were successful. The average length of hospital stay in the first group was 27 days, in the second and third groups - 31 days (the ratio in the 2nd and 3rd groups was 1.03 (95% CI 0.97-1.08; p<0.05)). In the course of treatment, complications were identified in 35 (35.7%) patients in the 2nd and 17 (40.4%) patients in the 3rd group (ratio 0.88 (95% CI 0.82-0.94)). There were 22 (7.1%) deaths. The causes of death were: 1 (0.3%) of the patient had arrosive bleeding, 2 (0.7%) had duodenal fistulas, 19 (6.1%) multiple organ failure against the background of widespread retroperitoneal phlegmon. CONCLUSION: The efficacy of treatment of infected pancreatic necrosis depends on the possibility of full drainage of the necrotic focus, regardless of approach. Minimally invasive techniques can reduce intraoperative trauma by reducing the wound surface, which contribute to develop systemic inflammatory response syndrome.


Assuntos
Desbridamento/métodos , Drenagem/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Necrose/terapia , Pancreatite Necrosante Aguda/diagnóstico por imagem , Pancreatite Necrosante Aguda/terapia , Humanos , Laparoscopia , Necrose/cirurgia , Pancreatite Necrosante Aguda/cirurgia , Espaço Retroperitoneal/cirurgia , Cirurgia Assistida por Computador , Resultado do Tratamento
12.
J Laparoendosc Adv Surg Tech A ; 30(5): 531-537, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32208049

RESUMO

Background: Considering the increase in a number of vascular complications, right laparoscopic donor nephrectomy is less preferred due to achieving not only shorter renal vein but also longer renal artery. However, recent studies have indicated that the side of the surgery would not affect the outcomes. Aim: The aim of this study is to evaluate the outcomes and strategies to increase the safety of pure retroperitoneoscopic donor nephrectomy (RDN). Methods: We analyzed the prospectively collected medical records of 158 kidney donors who underwent RDN from January 2010 to August 2018. The patients were divided into two groups based on their side of surgery. Right- and left-sided RDNs were compared in terms of demographics, intraoperative, and postoperative data, including the development of incisional hernia (IH). The outcomes of the recipients were also evaluated. Results: Right RDN was performed in 40 (25.3%) and left RDN was performed in 118 (74.7%) donors. Operation time (P = .593), warm ischemia time (P = .271), blood loss (P = .787), and length of hospital stay (P = .908) were statistically similar in right and left RDN groups. Intraoperative and postoperative complications were statistically showed no difference between right and left RDNs. No IH was observed in any group. One-year and five-year patient survival and graft survival rates were 100% versus 97% (P = .299) and 100% versus 95% (P = .126) on both sides, respectively. Conclusion: Right RDN is an effective and safe method as on the left side. RDN has an additional advantage in the absence of IH. Experience with other retroperitoneoscopic urological interventions may have had a positive effect on the outcomes of pure RDN.


Assuntos
Transplante de Rim , Nefrectomia/métodos , Coleta de Tecidos e Órgãos/métodos , Adulto , Perda Sanguínea Cirúrgica , Feminino , Sobrevivência de Enxerto , Humanos , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/efeitos adversos , Isquemia Quente
13.
J Robot Surg ; 14(6): 865-870, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32200542

RESUMO

The objective of this study is to determine recent trends in use of robotics and laparoscopy for pediatric retroperitoneal lymph-node dissection (RPLND) in pediatric and non-pediatric hospitals. We conducted a retrospective cohort study using data from 29 hospitals in the Pediatric Health Information System (PHIS), and data from 14 states in the State Inpatient Databases (SID), between 2008 and 2014. The study population was comprised of patients aged ≥ 10 years undergoing RPLND, with an inpatient diagnosis of testicular or paratesticular cancer, based on international classification of disease (ICD) codes. Robotic approach was identified by the presence of an ICD procedure code modifier. During the study period, a total of 90 RPLNDs were performed in pediatric hospitals (median patient age 16 years). Of these, 4 (4.4%) were performed robotically. A total of 3120 RPLNDs were performed in non-pediatric hospitals (median patient age: 32 years). Among these, 269 (8.6%) were performed robotically, with an increasing trend in the use of robotic RPLND (adjusted annual increase in probability of undergoing robotic vs. open procedure: 16%; 95% CI 8-24). Undergoing robotic RPLND was associated with a reduction in postoperative length of stay of 3.5 days (95% CI 2.9, 4.1). Open surgical approaches comprise the vast majority of RPLNDs performed at pediatric hospitals. This is in contrast with trends in non-pediatric hospitals where robotic RPLND is being increasingly utilized. Future research is necessary to investigate this discrepancy in adopting minimally invasive techniques for RPLND in pediatric centers.


Assuntos
Hospitais Pediátricos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Neoplasias Embrionárias de Células Germinativas/cirurgia , Espaço Retroperitoneal/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Testiculares/cirurgia , Adolescente , Adulto , Estudos de Coortes , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
14.
Int Braz J Urol ; 46(4): 538-544, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32213211

RESUMO

The indication for simultaneous bilateral native nephrectomy and the choice of surgical technique is of key importance, as these patients are burdened with a large comorbidity. The paper reports our experience of seven successful and completed simultaneous bilateral native nephrectomy procedures with retroperitoneal approach in the patient's flank position. Seven patients (mean age 34), were indicated for the removal of both kidneys before the planned transplant. Six patients underwent haemodialysis from 48 to 84 months, and one underwent peritoneal dialysis for 60 months. Two patients had undergone graftectomy. The indications were chronic infection or hypertension. The length of the kidneys ranged from 5.8 to 10cm. All procedures were performed by the laparoscopic technique with retroperitoneal approach, with the patient in the flank position. Three trocars were used on each side. The retroperitoneal space created did not require balloon dilatation. The kidneys were removed through the 10mm trocar hole after splitting. The duration of the procedure ranged from 150 to 240 minutes, average 139 minutes and blood loss ranged from100 to 250mL, average 142mL. There were no complications. In 6 patients, the postoperative dialysis was performed at zero-day. One patient continued peritoneal dialysis. Patients were discharged on the 2nd day, except one with peritoneal dialysis, who was discharged on the 3rd day. Retroperitoneal laparoscopic bilateral native nephrectomy is a safe and effective technique, and it can be considered as an ideal approach for native nephrectomy. It allows for the preservation of peritoneal integrity and vessels for future vascular access.


Assuntos
Nefrectomia , Adulto , Idoso , Feminino , Humanos , Transplante de Rim , Laparoscopia , Masculino , Diálise Peritoneal , Espaço Retroperitoneal/cirurgia
15.
Acta Vet Scand ; 62(1): 8, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32007092

RESUMO

BACKGROUND: Lymphatic vascular malformations are rare findings in canine patients with six reports available in veterinary literature. Retroperitoneal cystic lymphatic malformations have not been described previously in canine patients and neither has the use of immunohistochemistry to determine their origin, i.e. vascular versus lymphatic. CASE PRESENTATION: An 8-year-old neutered female Cocker spaniel was referred for pollakiuria, dysuria and a painful abdomen. Computed tomography scanning of the abdomen showed a fluid filled structure adjacent to the urinary bladder. During surgical exploration, a thin walled cystic structure with sero-haemorrhagic fluid was found, extending from the retroperitoneal space into the abdomen. The mass was excised and submitted for histopathology, revealing a cystic mass lined by a fibrovascular capsule within the retroperitoneal/mesenteric adipose tissue. The inner surface of the cyst was lined by a single layer of bland, flattened spindle cells. Intramural blood vessels were well differentiated, with perivascular haemorrhage. On recurrence 11 months later, the mass was excised for the second time and a PleuralPort (Norfolk Animal products) was placed. Fifteen months after initial presentation, progression occurred with haemorrhagic fluid in the cystic space, pleural- and abdominal cavities and the owners opted for euthanasia. Histopathology and positive immunohistochemistry for lymphatic markers lymphatic vessel endothelial hyaluronic acid receptor-1 (LYVE-1) and prospero homeobox protein-1 (PROX-1) confirmed a lymphatic vascular origin of the cystic structure. CONCLUSIONS: To our experience, a definitive diagnosis of retroperitoneal cystic malformation of lymphatic origin could be done only by combining the clinical presentation, advanced imaging, histopathology and LYVE-1 and PROX-1 immunohistochemistry. This is the first report of a vascular malformation in a dog where immunohistochemistry was used to make a final diagnosis. A lymphatic malformation, even if rare, should be added on the list of the differential diagnosis in a patient with a retroperitoneal cystic structure containing serohaemorrhagic fluid. Results of this case report can aid in diagnosis of future cases, however, further studies on therapy and management are needed to provide additional information about optimal treatment of these patients.


Assuntos
Doenças do Cão/patologia , Neoplasias Retroperitoneais/veterinária , Espaço Retroperitoneal/patologia , Animais , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/cirurgia , Cães , Eutanásia Animal , Feminino , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/cirurgia , Tomografia Computadorizada por Raios X/veterinária
16.
J Laparoendosc Adv Surg Tech A ; 30(5): 520-524, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32027216

RESUMO

Purpose: To investigate the feasibility of retroperitoneal laparoscopic ipsilateral nephrectomy of a benign nonfunctional kidney after percutaneous nephrostomy, and to compare this method with open surgery. Materials and Methods: Data from 70 patients who underwent simple nephrectomy from January 2014 to October 2018 at three large centers were retrospectively analyzed. All patients underwent percutaneous nephrostomy because of renal or ureteral calculi with severe hydronephrosis or pyonephrosis. Simple nephrectomy was performed via retroperitoneal laparoscopic surgery (retroperitoneal laparoscopic group; n = 33) or open surgery (open group; n = 37). The retroperitoneal laparoscopic and open groups were compared regarding preoperative variables (age, sex, location of surgery, hypertension, diabetes, BMI, preoperative serum creatinine level, American Society of Anesthesiologists (ASA) grade, fistula duration, fistula size, number of fistulae, and urinary tract infection), and perioperative variables (operation time, intraoperative blood loss, postoperative drainage volume, catheter indwelling time, gastrointestinal function recovery time, duration of bedrest, duration of postoperative hospitalization, postoperative hemoglobin decline, perioperative transfusion, and postoperative complications). Results: The retroperitoneal laparoscopic group included more patients with hydronephrosis, while the open group included more patients with pyonephrosis. There were no significant differences between the two groups in age (P = .813), sex (P = .729), location of surgery (P = .345), hypertension (P = .271), diabetes (P = .394), BMI (P = .798), preoperative serum creatinine level (P = .826), ASA grade (P = .820), fistula duration (P = .108), fistula size (P = .958), number of fistulae (P = .925), urinary tract infection (P = .111), or operative time (P = .851). The retroperitoneal laparoscopic group had significantly lesser intraoperative blood loss (P = .007), postoperative drainage volume (P = .008), shorter catheter indwelling time (P = .002), gastrointestinal function recovery time (P < .001), duration of bedrest (P < .001), and duration of postoperative hospitalization (P < .001), and lesser postoperative hemoglobin decline (P = .035) compared with the open group. Conclusions: Retroperitoneal laparoscopic ipsilateral nephrectomy is feasible for a benign nonfunctional kidney after percutaneous nephrostomy. The surgical method should be selected based on the surgeon's experience and the specific situation of the patient.


Assuntos
Nefrectomia/métodos , Espaço Retroperitoneal/cirurgia , Adulto , Repouso em Cama , Perda Sanguínea Cirúrgica , Estudos de Viabilidade , Feminino , Trato Gastrointestinal/fisiopatologia , Humanos , Hidronefrose/etiologia , Hidronefrose/cirurgia , Cálculos Renais/complicações , Cálculos Renais/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrostomia Percutânea , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Pionefrose/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Cálculos Ureterais/complicações , Cálculos Ureterais/cirurgia
17.
Medicine (Baltimore) ; 99(7): e19104, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049819

RESUMO

Hemodynamic stability is one of the most critical aspects of adrenal surgery for pheochromocytoma. Few articles have evaluated the hemodynamic status of patients undergoing posterior retroperitoneal adrenalectomy (PRA) for pheochromocytoma. The aim of this study is to compare the intraoperative hemodynamic parameters between lateral transperitoneal adrenalectomy (TPA) and PRA in this groups of patients.This report describes a retrospective study of 53 pheochromocytoma patients who underwent endoscopic adrenalectomy via transperitoneal (22 patients) or posterior retroperitoneal (31 patients) approaches from January 2008 to March 2015. Data from these patients were compared to investigate the differences in hemodynamic parameters between the 2 approaches.Clinical parameters at presentation were similar between the 2 groups, except for tumor size, which was larger in the TPA group. The PRA group is associated with reduced operative time, blood loss, and length of hospital stay compared to TPA even after adjusting for the tumor size. There was greater BP fluctuations and higher maximum systolic and diastolic blood pressure (BP) within the TPA group compared to PRA during univariate analysis. This was however not significant after adjusting for tumor size. There was no difference in the intraoperative inotropic support requirement between the 2 groups.PRA is associated with stable intraoperative hemodynamic status, as well as favorable perioperative outcomes compared to TPA in patients with small pheochromocytomas.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pressão Sanguínea , Estudos de Casos e Controles , Endoscopia , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Duração da Cirurgia , Feocromocitoma/patologia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos
18.
J Urol ; 204(1): 96-103, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32003612

RESUMO

PURPOSE: We analyzed the oncologic outcomes of men undergoing primary retroperitoneal lymph node dissection and characterized the use of adjuvant chemotherapy and template dissections. MATERIALS AND METHODS: Retrospective review of the Indiana University testis cancer database identified patients who underwent primary retroperitoneal lymph node dissection between January 2007 and December 2017. Patients and providers were contacted to obtain information regarding adjuvant therapy, recurrence and survival. The primary outcome was recurrence-free survival. Kaplan-Meier curves assessed survival differences stratified by pathological stage, template of dissection and use of adjuvant chemotherapy. RESULTS: A total of 274 patients were included in the study. Most men presented with clinical stage I disease (214, 78%). A modified unilateral template was performed in 257 (94%) and bilateral template in 17 (6%). Overall 148 (54%) and 126 (46%) men had pathological stage (PS) I and PS-II disease, respectively. Thirteen patients (10%) with PS-II disease were treated with adjuvant chemotherapy. With a median followup of 55 months only 33 (12%) patients had recurrence. Of the 113 patients with PS-II disease who did not receive chemotherapy 21 (19%) had disease relapse and 81% were cured with surgery alone and never had recurrence. No difference in recurrence-free survival was noted between modified and bilateral template dissections. CONCLUSIONS: The use of adjuvant chemotherapy has been minimal during the last decade. The majority (81%) of men with PS-II disease were cured with retroperitoneal lymph node dissection alone and were able to avoid chemotherapy. Modified unilateral template dissection provided excellent oncologic control while minimizing morbidity.


Assuntos
Quimioterapia Adjuvante/estatística & dados numéricos , Excisão de Linfonodo , Espaço Retroperitoneal/cirurgia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Adulto , Seguimentos , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias Embrionárias de Células Germinativas/mortalidade , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Espaço Retroperitoneal/patologia , Estudos Retrospectivos , Seminoma/mortalidade , Seminoma/patologia , Seminoma/terapia , Teratoma/mortalidade , Teratoma/patologia , Teratoma/terapia , Neoplasias Testiculares/mortalidade
19.
BMC Surg ; 20(1): 12, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931809

RESUMO

BACKGROUND: To compare the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy with those of retroperitoneal laparoscopic adrenalectomy for patients with pheochromocytoma. METHODS: We searched PubMed, EMBASE and the Cochrane Central Register for studies from 1999 to 2019 to assess the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy and the retroperitoneal approach for laparoscopic adrenalectomy in patients with pheochromocytoma. After data extraction and quality assessments, we used RevMan 5.2 to pool the data. RESULTS: Four retrospective studies were obtained in our meta-analysis. Patients who underwent retroperitoneal laparoscopic adrenalectomy were associated with shorter operative time (WMD: 34.91, 95% CI: 27.02 to 42.80, I2 = 15%; p < 0.01), less intraoperative blood loss (WMD: 139.32, 95% CI: 125.38 to 153.26, I2 = 0, p < 0.01), and a shorter hospital stay (WMD: 2, 95% CI: 1.18 to 2.82, I2 = 82%, p < 0.01) than patients who underwent transperitoneal laparoscopic adrenalectomy. No significant differences were found in the complication rate (OR: 1.58, 95% CI: 0.58 to 4.33, I2 = 0; p = 0.38) or in the incidence of hemodynamic crisis (OR: 0.74, 95% CI: 0.19 to 2.94, p = 0.67) between the two groups. CONCLUSION: Retroperitoneal laparoscopic adrenalectomy could achieve better perioperative outcomes than the transperitoneal approach for patients with pheochromocytoma.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Laparoscopia/métodos , Feocromocitoma/cirurgia , Perda Sanguínea Cirúrgica , Humanos , Tempo de Internação , Duração da Cirurgia , Espaço Retroperitoneal/cirurgia
20.
Int J Surg ; 74: 101-105, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31927032

RESUMO

OBJECTIVES: Posterior retroperitoneoscopic adrenalectomy (PRA) is used for removal of benign adrenal lesions. Though literature shows low complication rate in this procedure, there is no consensus about safety profile of PRA in high-risk patients. This study aimed to determine the feasibility and safety profile of PRA in high-risk patients. METHODS: This retrospective study recruited all patients who underwent PRA for benign adrenal lesions in the study center. Patients with an American Society of Anesthesiologists (ASA) score of ≥3, on anticoagulant therapy or a body mass index (BMI) over 30 were classified as high-risk patients. We analyzed patients' demographics, comorbidities, perioperative mean arterial pressure and operative time, postoperative complications and tumor characteristics. Mortality and morbidity rates and length of hospital stay of the high-risk and low-risk groups were compared. The chi-square and t tests were used to determine relationships between categorical variables between groups. RESULTS: Forty two PRA procedures were done on 21 men and 21 women; mean age of 50 years in low and 62 years in high risk groups. Twenty six (61.9%) patients had high-risk profile. We recorded 4 (9.5%) intra- and postoperative complications, while one (2.3%) PRA was converted to open due to intra-operative hemorrhage. Mean operative time of 86.45 and 108.19 min (p = 0.204), and postop hospital stay of 4.44 and 6.65 (p = 0.25) days were recorded for low and high risk groups, respectively. Intraoperative arterial pressure of ≥170 mmHg was noted for 6 low and 11 high risk patients (p = 885). CONCLUSION: Our results indicate that PRA for benign adrenal lesions is safe and feasible in patients with a high-risk profile without a risk of increased peri- and postoperative complications.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Adrenalectomia/efeitos adversos , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos
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