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1.
Urology ; 135: 57-65, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31618656

RESUMO

OBJECTIVE: To evaluate differences in the incidence of benign ureteroenteric stricture, we compared stricture rates of robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using Surveillance, Epidemiology, and End Results-Medicare data. METHODS: We identified 332 RARC and 1449 ORC performed between 2009 and 2014 to determine stricture rates at 6, 12, and 24 months following surgery. We defined ureteroenteric stricture as the need for procedural intervention. Additionally, we compared the incidence of stricture diagnosis. Multivariable proportional hazards regression was performed to determine factors associated with stricture development. RESULTS: The incidence of ureteroenteric stricture at 6 and 12 months was higher for RARC vs ORC at 12.1% vs 7.0% (P < .01) and 15.0% vs 9.5% (P = .01), respectively. RARC vs ORC stricture incidence at 2 years did not differ significantly at 14.6% vs 11.4% (P = .29). Similarly, the stricture diagnosis rates were significantly lower following ORC at 6, 12, and 24 months (P < .05). In adjusted analysis, RARC (HR 1.64, 95%CI 1.23-2.19) and preoperative hydronephrosis (HR 1.51, 95% CI 1.17-1.94) were associated with the development of stricture. Higher hospital volume was associated with a lower risk of stricture (HR 0.40, 95%CI 0.26-0.63). CONCLUSION: RARC is associated with a higher rate of ureteroenteric stricture diagnosis and intervention on a population-based level that is mitigated by higher hospital volume. A significant study limitation is inability to differentiate extracorporeal vs intracorporeal diversion. However, a stricture complication compounds the financial burden of care and efforts must be pursued to improve this surgical outcome.


Assuntos
Cistectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Obstrução Ureteral/epidemiologia , Derivação Urinária/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Carcinoma de Células de Transição/cirurgia , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Cistectomia/métodos , Feminino , Humanos , Incidência , Intestinos/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos
2.
Int Braz J Urol ; 45(6): 1136-1143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808401

RESUMO

PURPOSE: To prospectively evaluate the association of adherent perinephric fat (APF) on perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of the surgical learning curve. MATERIALS AND METHODS: 305 consecutive RAPNs performed by a single experienced surgeon were analyzed. The fi rst 100 RAPNs were considered the learning curve and therefore excluded. APF was defined as the necessity of subcapsular renal dissection to mobilize the tumor from surrounding perinephric fat. Perioperative outcomes were evaluated including operative time, warm ischemia time (WIT), postoperative complications, length of stay, margins, ischemia, and complications score (MIC), estimated blood loss (EBL), and change in pre-operative to postoperative day 1 (POD 1) laboratory values. After correction for multiple comparisons, P values ≤0.0045 were considered statistically signifi cant but associations with P values ≤0.05 were also mentioned in the study results. RESULTS: Fifty-eight (28.3%) patients had APF. Patients with APF had longer operative times compared to those without APF (median, 213 vs. 192 minutes, P <0.001). There was some evidence of higher increase in change in creatinine from preoperative to POD 1 among those with APF compared to those without APF, although this was not statistically signifi cant (median, 0.2 vs. 0.1mg/dL, P=0.03). There were no other statistically significant associations between presence of APF and perioperative outcomes. CONCLUSIONS: APF is associated with increased operative time but no change in other perioperative outcomes. Surgeon experience does not affect perioperative outcomes associated with APF.


Assuntos
Tecido Adiposo Branco/cirurgia , Competência Clínica , Curva de Aprendizado , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Duração da Cirurgia , Período Perioperatório , Complicações Pós-Operatórias , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto Jovem
3.
Anticancer Res ; 39(11): 6339-6346, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704865

RESUMO

BACKGROUND/AIM: To evaluate the chronological changes in health-related quality of life and treatment satisfaction after robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: A total of 196 patients were included, and treatment satisfaction was evaluated using the Expanded Prostate Cancer Index Composite (EPIC) score before and at 1, 3, 6, and 12 months after RARP. RESULTS: At 12 months after RARP, 64.8% of patients were satisfied. On the contrary, 4.6% of patients were dissatisfied at 12 months after RARP. In a multivariate analysis, only urinary bother of EPIC was significantly associated with satisfaction at 12 months after RARP (p=0.025, odds ratio=1.029). CONCLUSION: Treatment satisfaction with RARP was generally acceptable from 1 to 12 months after surgery and did not change over time. Urinary bother was associated with satisfaction at 12 months after RARP. Compared with the objective 24-hour pad test, questionnaires answered subjectively were more associated with satisfaction.


Assuntos
Satisfação do Paciente/estatística & dados numéricos , Prostatectomia/psicologia , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/psicologia , Idoso , Disfunção Erétil/etiologia , Disfunção Erétil/psicologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Antígeno Prostático Específico/sangue , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Terapia de Salvação/métodos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia
4.
Medicine (Baltimore) ; 98(46): e18011, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725673

RESUMO

RATIONALE: Robot-assisted laparoscopic prostatectomy (RALP) is the most frequent strategy used for the surgical remedy of patients with localized prostate cancer. Although there is awareness about potential patient positioning nerve injuries, iatrogenic nerve lesions are less described in the literature. Here, we report 3 cases of patients who presented with neuropathic painful complications due to RALP-associated nerve lesions. PATIENT CONCERNS: A 62-year-old patient (case 1), a 72-year-old male (case 2), and a 57-year-old patient (case 3) presented at the clinic with symptoms of neuropathic pain after RALP surgery. DIAGNOSIS: Patients were diagnosed with a potential injury of different branches of the pudendal nerve (cases 1 and 2), and left obturator nerve (case 3). INTERVENTIONS: Patients underwent multimodal pharmacologic treatment through pregabalin, weak opioids, strong opioid, paracetamol, and adjuvants. In cases 2 and 3, a multidisciplinary approach was needed. As the patients responded to conservative treatment, invasive approaches were not necessary. OUTCOMES: After treatment, the patients of case 1 showed pain relief after 4 days, paresthesia resolved in 15 days, whereas the anal crushing sensation lasted for approximately 1 month. In case 2, after 4 weeks of treatment, the patient experienced a considerable decrement in pain intensity with complete response after 4 months. In case 3, pain relief was achieved after 2 days, motor symptoms recovery after 2 weeks, and neuropathic features resolved completely after 5 weeks although the obturator sign resolved within 2 months. LESSONS: The RALP-associated neurologic injuries may occur even when performed by highly experienced surgeons. A better understanding of the potential iatrogenic nerve lesions can surely allow an improvement in the surgical technique. A multidisciplinary approach and early multimodal pain strategy are mandatory for managing these complications.


Assuntos
Neuralgia/etiologia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Idoso , Analgésicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/tratamento farmacológico , Nervo Obturador/lesões , Prostatectomia/métodos , Nervo Pudendo/lesões , Procedimentos Cirúrgicos Robóticos/métodos
5.
Am Surg ; 85(9): 978-984, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638510

RESUMO

Only a small percentage of patients fail laparoscopic fundoplications undertaken for gastroesophageal reflux disease. But because many laparoscopic fundoplications have been undertaken, surgeons frequently encounter patients in need of "redo" operations. This study was undertaken to evaluate the robotic approach versus laparoendoscopic single-site (LESS) approach for redo fundoplications. With an Institutional Review Board approval, 64 patients undergoing LESS (n = 32) or robotic (n = 32) redo antireflux operations were prospectively followed up. Data are presented as median (mean + SD). For LESS versus robotic redo operations, the operative duration was 145 (143 ± 33.5) versus 196 (208 ± 76.7) minutes (P < 0.01), estimated blood loss was 50 (80 ± 92.1) versus 20 (43 ± 57.1) mL (P = 0.07), and length of stay was 1 (3 ± 5.4) versus 1 (2 ± 1.9) day (P = 0.57); 1 LESS operation was converted to "open." Operative duration was longer for men (P = 0.01). Postoperative complications were not more frequent after Nissen (n = 36) or Toupet (n = 28) fundoplication, regardless of the approach. When matched by BMI, operative duration was prolonged by a large Type I to IV hiatal hernia (P = 0.01). Symptoms improved dramatically and were similar with both approaches, and patient satisfaction was high. Robotic redo antireflux operations take longer than LESS operations. LESS and robotic redo antireflux operations are both safe and offer significant and similar amelioration of symptoms after failed fundoplications.


Assuntos
Fundoplicatura/métodos , Hérnia Hiatal/cirurgia , Laparoscopia/métodos , Reoperação , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Perda Sanguínea Cirúrgica , Conversão para Cirurgia Aberta , Feminino , Seguimentos , Fundoplicatura/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
6.
Am Surg ; 85(9): 1061-1065, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638525

RESUMO

As minimally invasive operations evolve, it is imperative to evaluate the advantages and risks involved. The aim of our study was to evaluate our institution's experience in incorporating a robotic platform for transhiatal esophagectomy (THE). Patients undergoing robotic THE were prospectively followed. Data are presented as median (mean ± SD). Forty-five patients were of 67 (67 ± 6.9) years and BMI 26 (27 ± 5.5) kg/m². Nine per cent of operations were converted to "open," but none in the last 25 operations. Operative duration of robotic THE was 334 (364 ± 108.8) minutes and estimated blood loss was 200 (217 ± 144.0) mL, which decreased with time (P = 0.017). Length of stay was 8 (12 ± 11.1) days. Twenty per cent had respiratory failure requiring intubation that resolved, 4 per cent developed pneumonia, 11 per cent developed a surgical site infection, 2 per cent developed renal insufficiency, and 2 per cent developed a UTI. Two per cent (one patient) died within 30 days postoperatively, because of cardiac arrest. Our experience with robotic THE promotes robotic application because we endeavor to achieve high-level proficiency. With experience, we improved estimated blood loss and converted fewer transhiatal esophagectomies to "open." Our length of hospital stay seems long but reflects the ill-health of patients, as does the variety of complications. Our data support the evolving future of THE, which will integrally include a robotic approach.


Assuntos
Esofagectomia/efeitos adversos , Esofagectomia/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Perda Sanguínea Cirúrgica , Índice de Massa Corporal , Conversão para Cirurgia Aberta , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Intubação Intratraqueal , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonia/diagnóstico , Complicações Pós-Operatórias , Estudos Prospectivos , Insuficiência Respiratória/terapia , Infecção da Ferida Cirúrgica , Infecções Urinárias
7.
Medicine (Baltimore) ; 98(39): e17089, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574808

RESUMO

To determine if there are advantages to transitioning to Da Vinci robotics by a surgeon compared to the video-assisted thoracic surgical lobectomy.A systematic electronic search of online electronic databases: PubMed, Embase, and Cochrane library updated on December 2017. Publications on comparison Da Vinci-robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for non-small cell lung cancer were collected. Meta-analysis RevMan 5.3 software (The Cochrane collaboration, Oxford, UK) was used to analyze the combined pooled HRs using fixed or random-effects models according to the heterogeneity.Fourteen retrospective cohort studies were included. No statistical difference was found between the 2 groups with respect to conversion to open, dissected lymph nodes number, hospitalization time after surgery, duration of surgery, drainage volume after surgery, prolonged air leak, and morbidity (P > .05).Da Vinci-RATS lobectomy is a feasible and safe technique and can achieve an equivalent surgical efficacy when compared with VATS. There does not seem to be a significant advantage for an established VATS lobectomy surgeon to transition to robotics based on clinical outcomes.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Torácica Vídeoassistida/métodos , Conversão para Cirurgia Aberta , Humanos , Tempo de Internação , Excisão de Linfonodo , Duração da Cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Resultado do Tratamento
8.
Bone Joint J ; 101-B(10): 1230-1237, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564152

RESUMO

AIMS: The aim of this study was to assess the effect of posterior cruciate ligament (PCL) resection on flexion-extension gaps, mediolateral soft-tissue laxity, fixed flexion deformity (FFD), and limb alignment during posterior-stabilized (PS) total knee arthroplasty (TKA). PATIENTS AND METHODS: This prospective study included 110 patients with symptomatic osteoarthritis of the knee undergoing primary robot-assisted PS TKA. All operations were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess gaps before and after PCL resection in extension and 90° knee flexion. Measurements were made after excision of the anterior cruciate ligament and prior to bone resection. There were 54 men (49.1%) and 56 women (50.9%) with a mean age of 68 years (sd 6.2) at the time of surgery. The mean preoperative hip-knee-ankle deformity was 4.1° varus (sd 3.4). RESULTS: PCL resection increased the mean flexion gap significantly more than the extension gap in the medial (2.4 mm (sd 1.5) vs 1.3 mm (sd 1.0); p < 0.001) and lateral (3.3 mm (sd 1.6) vs 1.2 mm (sd 0.9); p < 0.01) compartments. The mean gap differences after PCL resection created significant mediolateral laxity in flexion (gap difference: 1.1 mm (sd 2.5); p < 0.001) but not in extension (gap difference: 0.1 mm (sd 2.1); p = 0.51). PCL resection significantly improved the mean FFD (6.3° (sd 4.4) preoperatively vs 3.1° (sd 1.5) postoperatively; p < 0.001). There was a strong positive correlation between the preoperative FFD and change in FFD following PCL resection (Pearson's correlation coefficient = 0.81; p < 0.001). PCL resection did not significantly affect limb alignment (mean change in alignment: 0.2° valgus (sd 1.2); p = 0.60). CONCLUSION: PCL resection creates flexion-extension mismatch by increasing the flexion gap more than the extension gap. The increase in the lateral flexion gap is greater than the increase in the medial flexion gap, which creates mediolateral laxity in flexion. Improvements in FFD following PCL resection are dependent on the degree of deformity before PCL resection. Cite this article: Bone Joint J 2019;101-B:1230-1237.


Assuntos
Artroplastia do Joelho/métodos , Instabilidade Articular/prevenção & controle , Osteoartrite do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Amplitude de Movimento Articular/fisiologia , Procedimentos Cirúrgicos Robóticos/métodos , Fatores Etários , Idoso , Análise de Variância , Artroplastia do Joelho/efeitos adversos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Melhoria de Qualidade , Medição de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Fatores Sexuais , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(41): e17222, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593079

RESUMO

RATIONALE: Radical cystectomy and urinary diversion remains the definite management for muscle invasive bladder urothelial cancer. Internal herniation caused by ureteral adhesion is an extremely rare complication after the procedure. To the best of our knowledge, this is the first case report of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after robot-assisted radical cystectomy (RARC). PATIENT CONCERNS: A 64-year-old woman presented with symptom of small bowel obstruction such as nausea, vomiting, and abdominal fullness after RARC and Indiana pouch. Another 61-year-old man presented with left obstructive hydronephrosis and recurrent pyelonephritis after RARC and ileal conduit. DIAGNOSIS: Both patients received computed tomography scans and the results were suggestive of small bowel herniation between bilateral ureters and urinary diversion. INTERVENTIONS: The 2 patients underwent open ureterolysis and internal hernia reduction. During the operation, bowel loop herniation between the interureteral spaces were found. OUTCOMES: Both patients recovered smoothly after second operation. LESSONS: The incidence of internal herniation may increase by the growing use of RARC. Suitable stoma position, appropriate length of ureter dissection, and retroperitonealization can help prevent this complication.


Assuntos
Cistectomia/efeitos adversos , Hérnia/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Doenças Ureterais/etiologia , Derivação Urinária/efeitos adversos , Cistectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/métodos , Derivação Urinária/métodos
10.
Urology ; 134: 90-96, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31560917

RESUMO

OBJECTIVE: To describe a rare complication in 5 women who had vaginal prolapse, dehiscence, and/or evisceration after having undergone robotic-assisted radical cystectomy with creation of ileal conduit urinary diversion. Radical cystectomy is the standard of care in the extirpative treatment for muscle invasive urothelial carcinoma. Anterior exenteration in the female patient requires removal of the anterior vaginal wall, urethra, uterus, and adnexa which results in significant changes to the pelvic floor. METHODS: Retrospective identification of all women having undergone robotic-assisted radical cystectomy for urothelial carcinoma who ultimately represented with vaginal prolapse, dehiscence, and/or evisceration between January 2012 and April 2019. We identified patient characteristics detailing their presentation. A review of the available literature highlighted the lack of available information in this uncommon cohort. RESULTS: Five women with vaginal dehiscence and/or evisceration who had previously undergone robotic-assisted radical cystectomy, anterior vaginectomy with urethrectomy, pelvic lymph node dissection, and creation of ileal conduit by 4 surgeons were identified. Mean interval time to initial presentation of prolapse or dehiscence was 44.4 weeks (range 11-120). In the 2 patients that eviscerated prior to repair, this occurred at 5 and 25 weeks after initial outpatient consultation. All reconstructive efforts were approached transvaginally. Two patients underwent 2 or more repairs. Management options included expectant management, pessary, and immediate vs delayed transvaginal surgical repair. CONCLUSION: Our case series describes the unique and potentially devastating complication of vaginal dehiscence and bowel evisceration in women with history of robotic-assisted radical cystectomy.


Assuntos
Carcinoma/cirurgia , Doenças do Colo , Cistectomia , Herniorrafia/métodos , Distúrbios do Assoalho Pélvico , Complicações Pós-Operatórias/cirurgia , Deiscência da Ferida Operatória , Neoplasias da Bexiga Urinária/cirurgia , Prolapso Uterino , Idoso , Carcinoma/patologia , Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Cistectomia/efeitos adversos , Cistectomia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/etiologia , Distúrbios do Assoalho Pélvico/cirurgia , Reoperação/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos , Prolapso Uterino/etiologia , Prolapso Uterino/cirurgia
11.
Urology ; 134: 116-123, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31563536

RESUMO

OBJECTIVE: To compare robot assisted to laparoscopic sacrocolpopexy, in terms of efficacy, in the treatment of high-stage pelvic organ prolapse. METHODS: This was a noninferiority prospective randomized trial conducted in a tertiary Urology unit, comparing robot assisted and laparoscopic sacrocolpopexy in patients with symptomatic prolapse stage III and IV, according to the Pelvic Organ Prolapse quantification. All participants provided written informed consent at enrolment. The primary outcome was prolapse objective cure rate. Secondary outcomes included prevalence of urinary, anorectal and sexual symptoms, UDI-6, IIQ7 and FSFI scores, and maximum flow rate. Operative times, intraoperative blood loss, length of hospital stay, postsurgery pain, patient satisfaction as well as surgical and mesh complications were assessed. The Mann-Whitney and Wilcoxon tests for unpaired and paired data, respectively, were used to compare ordinal and nonnormally distributed continuous variables. Categorical data were analyzed by the McNemar, chi-square or Fisher exact test. Two-tailed P <.05 was considered significant. RESULTS: One hundred patients were randomized. At a mean follow-up of 24.06 months the cure rate for the apical compartment was 100% with both approaches. There were no significant between-group differences in any of the secondary outcomes with the only exception of C/D point values, where results were significantly better in the robot-assisted group. Overall surgical procedure time was longer in the robot-assisted group. The main limitation of our study is the single-centre design and the inclusion of docking time in robotic-procedure surgical time calculations. CONCLUSION: Robot-assisted sacrocolpopexy provides outcomes comparable to those of laparoscopic with 100% anatomic correction of the apical compartment.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Laparoscopia , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Duração da Cirurgia , Preferência do Paciente , Prolapso de Órgão Pélvico/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/psicologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Índice de Gravidade de Doença
12.
J Laparoendosc Adv Surg Tech A ; 29(11): 1451-1455, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31433257

RESUMO

Background: Laparoscopic sigmoid resection is the surgical standard for the treatment of diverticulitis. Robotic sigmoid resection with the da Vinci Xi® platform may offer advantages over the laparoscopic approach. Materials and Methods: One hundred and six patients with uncomplicated, complicated, or recurrent diverticular disease underwent robotic (n = 60) or laparoscopic (n = 46) sigmoid resection at our institution between 2013 and 2018. Patient demographics and characteristics, perioperative measures, and complications were retrospectively analyzed. Results: There were no statistically significant differences between the robotic and laparoscopic group with regard to operative time (130 versus 118 minutes; P = .23), anastomotic leakage (6.7% versus 6.5%; P = 1.0), need for stoma (6.7% versus 4.3%; P = 1.0), conversion rate (1.7% versus 0%; P = .36), reoperation (8.3% versus 15.2%; P = .27), overall complications according to the Clavien-Dindo classification (30.0% versus 30.4%; P = .8), mortality (1.7% versus 0%; P = 1.0), and need for intravenous analgesics (3.0 versus 2.1 days; P = .21). The duration of postoperative ileus was significantly shorter in the robotic group (2.2 versus 2.8 days; P = .01). Conclusion: Robotic sigmoid resection for uncomplicated, complicated, or recurrent diverticular disease is a safe and feasible procedure. However, robotic sigmoid resection for diverticulitis is not associated with relevant clinical benefits for patients compared to laparoscopic resection except for a slightly shorter duration of postoperative ileus.


Assuntos
Colectomia/métodos , Doença Diverticular do Colo/cirurgia , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Idoso , Fístula Anastomótica/etiologia , Colectomia/efeitos adversos , Colo Sigmoide/cirurgia , Conversão para Cirurgia Aberta , Enterostomia , Feminino , Humanos , Íleus/etiologia , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Reoperação , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
13.
Medicine (Baltimore) ; 98(35): e16968, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464939

RESUMO

BACKGROUND: Robotic arm-assisted unicompartmental knee arthroplasty (UKA) has been recommended for treatment of unicompartmental knee osteoarthritis. However, its effectiveness and safeness remain controversial compared with conventional UKA. Therefore, the goal of this study was to perform a meta-analysis to re-evaluate the effects of robotic arm-assisted UKA on clinical functional outcomes. METHODS: PubMed, Embase, and Cochrane Library databases were searched to screen the relevant studies. Continuous data (surgical time, knee excursion during weight acceptance, American knee society score [AKSS], Oxford knee score [OKS], forgotten joint score [FJS], visual analog scale [VAS], and range of motion [ROM]) were pooled using a standardized mean difference (SMD) with their corresponding 95% confidence intervals (CIs) to estimate the effect size, while dichotomous data (complication rate, revision rate) were pooled to obtain the relative risk (RR) with a 95% CI by STATA 13.0 software. RESULTS: Eleven studies involving 498 patients undergoing robotic-assisted UKA and 589 patients receiving conventional UKA were included. Our pooled results demonstrated that robotic-assisted could significantly reduce the complication rate (RR: 0.62, 95% CI: 0.45-0.85; P = .0041) and improve the knee excursion during weight acceptance (SMD: 0.62, 95% CI: 0.25-1.00; P = .001), but prolonged the surgical time (SMD: 0.74, 95% CI: 0.40-1.08; P < .001). No significant difference in the revision rate, AKSS, OKS, FJS, VAS, and ROM between robotic-assisted and conventional UKA groups. CONCLUSION: This meta-analysis demonstrates robotic-assisted UKA may be an effective and safe surgical procedure for treatment of unicompartmental knee osteoarthritis.


Assuntos
Artroplastia do Joelho/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Artroplastia do Joelho/efeitos adversos , Humanos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Amplitude de Movimento Articular , Reoperação/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
15.
Curr Pain Headache Rep ; 23(7): 51, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31263977

RESUMO

PURPOSE OF REVIEW: Robotic surgery has been shown to have a significant benefit in obese gynecologic patients over open surgery. However, robotic surgery in these patients requires a thorough understanding of the physiologic adaptations caused by obesity, adequate preoperative optimization, specialized equipment and techniques, and careful attention to intra- and postoperative management in order to minimize complications. This article reviews the benefits of a minimally invasive approach in obese patients and provides a thorough guide to perioperative management of obese patients undergoing robotic gynecologic surgery. A useful set of tips and tricks to overcome many of the technical challenges in performing robotic surgery in the obese patients is included. RECENT FINDINGS: In the USA, obesity has risen to affect 39.8% of the population, which leads to increased incidence of mortality, hypertension, diabetes, heart disease, and stroke. Moreover, obese patients are at greater risk of perioperative complications during gynecologic surgery. With the use of laparoscopy, many of the perioperative risks of surgery in obese patients can be ameliorated. However, minimally invasive surgery in obese patients is technically challenging. Robotic-assisted laparoscopy addresses several of these challenges, allowing surgeons to offer minimally invasive approaches to patients with extreme BMIs while reducing perioperative risk. Obese patients undergoing gynecologic surgery receive a greater benefit than their non-obese counterparts from a laparoscopic approach, and current data support the safety and feasibility of robotic surgery in the obese population. Therefore, every effort to offer a minimally invasive surgery to obese patients should be made.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Incidência , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
16.
Fertil Steril ; 112(1): 11-18, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277761

RESUMO

Uterus transplantation (UTx) is the first available treatment for absolute uterine factor infertility, a condition due to absence of the uterus or presence of a non-functional uterus. The proof-of-concept of UTx as an infertility treatment for this group of patients occurred in 2014 in Sweden by the first birth after human UTx. That and subsequent cases of the Swedish trial were live-donor UTx procedures with laparotomy of both donor and recipient. Although results of the initial Swedish clinical UTx trial were very favorable in terms of take-home-baby rate, the drawback was the long duration (>10 h) of donor surgeries and associated long recovery periods. There exist three later publications, with uterus procurements from live donors by laparotomy with a range of surgical durations of 5.3 hours to 13 hours. Our collaborative Swedish-French team has initiated efforts to introduce minimal invasive surgery in one trial in Sweden and one in France. The principle of these UTx trials is to use modern concepts of robotic-assisted laparoscopy primarily in the live donor. There also exists a small number of published UTx procedures with donor surgery by partial conventional laparoscopy and one published case with total robotic-assisted laparoscopy procedure. This review discusses open versus minimal invasive surgery in relation to the accumulated knowledge in the field. Moreover, we propose some future directions for the development of this surgery in UTx.


Assuntos
Infertilidade Feminina/cirurgia , Laparoscopia , Laparotomia , Procedimentos Cirúrgicos Robóticos , Doadores de Tecidos/provisão & distribução , Útero/transplante , Feminino , Fertilidade , Sobrevivência de Enxerto , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Nascimento Vivo , Doadores Vivos/provisão & distribução , Gravidez , Taxa de Gravidez , Técnicas de Reprodução Assistida , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
17.
J Laparoendosc Adv Surg Tech A ; 29(9): 1180-1184, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31355700

RESUMO

Purpose: To compare the surgical outcomes of children submitted to robot-assisted reconstruction with or without drainage placement performed by a single surgeon in a tertiary referral center. Materials and Methods: Patients submitted to robot-assisted reconstruction, including pyeloplasty for ureteral pelvic junction obstruction, end-to-end anastomosis for retrocaval ureter, and reimplantation for vesical ureter reflux (VUR) from January 2016 to November 2018, were included. Patients with ureteral pelvic junction obstruction or retrocaval ureter were selected for surgery according to the presence of symptoms and/or evidence of obstruction on diagnostic imaging. The criteria for reimplantation included breakthrough urinary tract infections, progressive renal scarring, and persistent VUR despite watchful waiting. Results: Overall, 31 children composed the no drain placement (DP) group and 29 the DP group. Preoperative feature of the two groups were comparable. Overall, only 1 (3.3%) postoperative complication occurred in no DP group and 2 (6.9%) in the placement group (P = .512). Length of stay was 3 (interquartile range [IQR]: 3-4) and 4 (IQR: 4-4) days, respectively (P = .651). At last follow-up, overall success rate was 100% in the no DP group and 96.6% in the DP group (P = .297). Conclusions: Robot-assisted reconstruction represents a safe minimally invasive approach with optimal surgical outcomes for the treatment of upper urinary tract. Expert robotic surgeons could avoid drainage placement after surgery as this does not undermine perioperative outcomes and postoperative success rate. Our study, first in literature, proves the interest in assessing the safety of no drainage placement also in the pediatric field.


Assuntos
Drenagem/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Centros de Atenção Terciária , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Refluxo Vesicoureteral/cirurgia , Anastomose Cirúrgica/métodos , Pré-Escolar , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reimplante/métodos , Estudos Retrospectivos , Resultado do Tratamento , Refluxo Vesicoureteral/etiologia
18.
Surg Laparosc Endosc Percutan Tech ; 29(4): 255-260, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31162298

RESUMO

BACKGROUND: This retrospective study compared postoperative pain between patients undergoing open thyroidectomy (OT) and bilateral axillo-breast approach (BABA) robotic thyroidectomy (RT). MATERIALS AND METHODS: We analyzed the electronic medical records of 1269 patients who underwent OT or RT at Chung-Ang University Hospital between January 1, 2010 and April 30, 2016. On the basis of the surgical procedure performed, patients were categorized into an OT (n=1128) and a BABA RT (BRT) group (n=141). On the basis of covariates, patients in these groups were matched using propensity score matching (n=86 in each group). RESULTS: After propensity score matching, no intergroup differences were observed in the covariates. The visual analogue scale scores for pain on postoperative day 0 were lower in the BRT than in the OT group (2.57±0.95 vs. 2.28±0.95, P=0.040). However, no statistically significant differences were observed in the use of rescue analgesics, the numerical rating scale score for nausea, and the use of rescue antiemetics. CONCLUSIONS: Pain on postoperative day 0 was lesser in the BRT than in the OT group. Similarly, the severity of nausea was lesser in the BRT group, despite longer operation time and broad dissection performed for docking the robotic arms.


Assuntos
Dor Pós-Operatória/fisiopatologia , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Bases de Dados Factuais , Feminino , Seguimentos , Hospitais Universitários , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Medição da Dor , Pontuação de Propensão , República da Coreia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Estatísticas não Paramétricas , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/efeitos adversos , Resultado do Tratamento
19.
Cir Esp ; 97(6): 305-313, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31151741

RESUMO

Minimally invasive approaches for endocrine surgery of the neck are the result of efforts by several surgeons to extrapolate to neck surgery the proven benefits of minimally invasive techniques from other regions of the body, including less pain, morbidity and hospital stay. However, the main argument that led to the introduction of these techniques was the improvement of esthetic results. Endoscopic and robotic remote-access endocrine neck approaches through small incisions have been developed over the last 25 years and are constantly being refined. The objective of this review is to determine the current state of the literature through a systematic evaluation of the different techniques available in minimally invasive endocrine surgery of the neck, either with or without remote access, by describing their main characteristics and evaluating their advantages, disadvantages and controversies, while discussing their role and future in neck surgery.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Pescoço/cirurgia , Procedimentos Cirúrgicos Robóticos , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Plástica/métodos , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Resultado do Tratamento
20.
J Urol ; 202(5): 913-919, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31219762

RESUMO

PURPOSE: To our knowledge the reliability of administrative claims codes to report postoperative radical cystectomy complications has not been examined. We compared complications identified by claims data to those abstracted from clinical chart review following radical cystectomy. METHODS: We manually reviewed the charts of 268 patients treated with radical cystectomy between 2014 and 2016 for 30-day complications and queried administrative complication coding using 805 ICD-9/10 codes. Complications were categorized. Using Cohen κ statistics we assessed agreement between the 2 methods of complication reporting for 1 or more postoperative complications overall, categorical complications and complications stratified by the top quartile length of hospital stay and patients who were readmitted. RESULTS: At least 1 or more complications were recorded in 122 patients (45.5%) through manual chart review and 80 (29.9%) were recorded via claim coding data with a concordance rate of κ=0.16, indicating weak agreement. Concordance was generally weak for categorical complication rates (range 0.05 to 0.36). However, when examining only the top length of stay quartile, 1 or more complications were reported in 32 patients (65%) by the manual chart review and in 12 (25%) via coding data with a concordance rate of κ=-0.2. Agreement was weak, similar to the total cohort. CONCLUSIONS: Manual chart review and claim code identification of complications are not highly concordant even when stratified by patients with an extended length of stay, who are known to have more frequent complications. Researchers and administrators should be aware of these differences and exercise caution when interpreting complication reports.


Assuntos
Cistectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Neoplasias da Bexiga Urinária/diagnóstico
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