Percutaneous cystostomy drainage for early removing urethral catheter in robotic-assisted laparoscopic radical prostatectomy: Improving on patients' discomfort

ObjectiveUrethral catheterization is often a major source of discomfort and pain to a patient after a surgical procedure. To better understand the safety and feasibility of the early removal of urethral Foley catheter after robotic-assisted laparoscopic radical prostatectomy by using percutaneous cystostomy drainage, we collected the related data and present our experience.Patients and methodsThis study involved 20 patients. In the study group (10 patients), we used the percutaneous cystostomy device (PCD) and an 18 French urethral catheter together. The urethral catheter was removed at postoperative day (POD) 3 and the PCD was removed at POD 7. In the control group (10 patients), they had standard urethral catheterization with an 18 French catheter and the catheter was removed at POD 7. Demographic and outcome data were measured and analyzed. Urethral pain was recorded using the visual analog scale.ResultsThe two groups were comparable in terms of age, serum prostate specific antigen level, body mass index, clinical tumor stage, surgical duration, estimated blood loss, and surgical times. The study group had significantly less penile pain in POD 3 and POD 7 (mean visual analog scale: 0.9 vs. 2.2, p < 0.001 at POD 3; 0.1 vs. 1.4, p = 0.002 at POD 7). All patients had good urinary continence within 30 days and no urethra stricture was found during the follow up period.ConclusionThe use of a percutaneous cystostomy device is feasible and safe for the early removal of urethral Foley catheter in robotic-assisted laparoscopic radical prostatectomy to decrease penile pain and patient discomfort.     

Minimal incisions for laparoscopic radical cystectomy with extracorporeal-assisted urinary diversion

ObjectiveLaparoscopic radical cystectomy (LRC) had been used for >10 years. However, longer wound incisions for extracorporeal-assisted urinary diversion decrease the benefits of a laparoscopic approach. In this study, we describe our experience of modified LRC with extracorporeal-assisted urinary diversion using minimal wound incisions.Materials and methodsFrom January 2011 to January 2013, 22 consecutive patients underwent radical cystectomy by a single surgeon. Seven patients underwent open radical cystectomy (ORC), and 15 patients underwent LRC with four-port incisions.ResultsThe LRC group had a significantly lower estimated blood loss (p = 0.005), lower blood transfusion rate (p = 0.004), and lower ileus rate (p = 0.031) than the ORC group. No significant differences were noted in operative time, time to flatus, pain score, overall complication rate, pathological stage, positive surgical margin rate, or lymph node yield (27.6 for LRC and 29.1 for ORC). The 1-year disease free survival rate was 86.7% in the LRC group and 71.4% in the ORC group, and the 1-year overall survival rates were both 100%.ConclusionOur experience shows that LRC with extracorporeal-assisted urinary diversion using minimal incisions is a safe and feasible surgical technique with less blood loss. Further reports with a longer follow-up period and large number of cases are necessary to validate our findings.     

Clinical evaluation of a novel commercial single port in laparoendoscopic single-site surgery

IntroductionEndoscopic total extraperitoneal herniorrhaphy (TEP) has emerged as a recognized surgical method for adult inguinal hernia. To reduce port-site-related morbidity and improve postoperative convalescence, a novel surgical approach known as laparoendoscopic single-site surgery (LESS) TEP repair has been developed.AimTo compare the clinical efficiency of a novel commercial single port with a homemade single port in TEP groin hernia repair.MethodsSixty consecutive patients undergoing LESS TEP repair were enrolled in this trial with 31 in the homemade port group and 29 in the commercial single-port group. Preoperative, intraoperative, and postoperative factors were recorded. The patients were interviewed postoperatively at outpatient clinics.ResultsThe demographic data were comparable between the two groups. The median operative time was longer in the homemade port group than in the commercial port group (59.4 vs. 51.4 minutes, respectively, p = 0.04). The homemade port group was significantly associated with more port-related malfunctions than the commercial port group (19% vs. 0, respectively, p = 0.02). The postoperative results were comparable between the groups in pain scores, analgesic requirements, complications, and postoperative convalescence.ConclusionThe novel commercial single port studied is associated with less intraoperative malfunctions and improved the procedural efficiency of LESS TEP for groin hernia repair. Thus, a well-designed commercial port will be of significant benefit in overcoming the existing procedural inefficiencies of single-port surgery performed using a homemade port, which requires relatively time-consuming procedures and significant experience of the surgeon.     

Efficacy of the intracorporeal one-hand tie technique for renal pedicle control during hand-assisted retroperitoneoscopic nephroureterectomy

ObjectiveThis study examined the efficacy of the intracorporeal one-hand tie technique for renal pedicle control during hand-assisted retroperitoneoscopic nephroureterectomy (HARN).MethodsThe intracorporeal one-hand tie technique was conducted in 32 consecutive patients with upper tract urothelial cancer that underwent HARN and open bladder cuff excision.ResultsAll suture ligatures were successful in securing the renal vessels, except one minor venous bleeding that occurred during vessel transection, which was then controlled by additional clips. The process of controlling the renal pedicle took an average of 12.4 minutes (range, 8–30 minutes). No pedicle control related morbidities were noted. By sparing the usage of endovascular clips and staplers, operative costs were reduced and associated malfunctions eliminated.ConclusionThe intracorporeal one-hand tie technique is an easy, reliable, and cost-effective method in controlling the renal pedicle during HARN. Its efficacy in pedicle control is beyond doubt.     

腹腔镜手术和开放手术治疗泌尿外科疾病效果对比研究

目的：对比后腹腔镜手术和传统开放手术中在泌尿外科疾病治疗方面的临床效果。方法选取该院2011年4月—2013年4月收治的泌尿外科疾病患者140例，根据治疗方法的不同分为观察组72例，对照组68例，观察组采取后腹腔镜手术方式，对照组采取传统开放手术方式，对比两组患者治疗效果、平均手术时间、术中平均出血量、术后下床活动时间、住院时间、并发症发生率等指标。结果观察组痊愈71例（98.6%），出现并发症8例（11.1%），平均手术时间（113.6±19.7）min，术中平均出血量（41.9±10.4）mL，术后下床活动时间（1.6±0.4）d、住院时间（5.8±1.4）d，对照组痊愈53例（77.9%），出现并发症16例（23.5%），平均手术时间（136.8±20.6）min，术中平均出血量（69.5±11.2）mL，术后下床活动时间（3.3±1.9）d、住院时间（8.7±3.9）d，观察组各项指标均显著优于对照组（P＜0.05）。结论后腹腔镜手术与传统开放手术相比，治疗效果较为显著，并发症发生率有明显下降，安全性较高，且恢复较快，值得临床推广应用。     

Small renal mass management in the elderly and the calibration of risk

Due to the increased utilization of cross-sectional imaging and prolonged life expectancy, the incidence of incidentally diagnosed renal tumors continues to rise. While partial nephrectomy is currently recommended as the gold standard treatment of cT1a small renal mass whenever technically feasible, the perceived benefits of partial nephrectomy may not be applicable to all patient groups. Selecting between treatment options in elderly and the infirm can present a significant challenge. Informed and thoughtful small renal mass management decisions require consideration and balance of patient, tumor, and procedural risks to maintain oncological efficacy while minimizing treatment associated morbidity. Herein we review the comparative effectiveness of partial versus radical nephrectomy in the elderly and the role of standardized tools to quantify risk.     

Nefrectomía parcial laparoscópica off-clamp tras la embolización del tumor en sala híbrida frente a nefrectomía parcial convencional: un análisis de pares emparejados por puntuación de propensión

ObjectiveOff-clamp laparoscopic partial nephrectomy in a hybrid operating room after superselective arterial embolization (hLPN) is a promising minimally invasive approach. In this study, we compared the perioperative surgical outcomes of this innovative technique with the conventional standard of care laparoscopic partial nephrectomy (cLPN) technique.Patients and methodsOverall, 86 and 127 patients treated with hLPN and cLPN, respectively, were included. These two techniques were compared in terms of surgical complications, estimated blood loss (EBL), operative time, length of stay (LOS), surgical margins, and Trifecta achievement rate (defined as warm ischemia duration < 25 min, negative surgical margins and absence of complications). A propensity score based on age, gender, BMI, preoperative eGFR and tumor size was used for a 1:1 matching of patients of each group. After matching, two groups of 67 patients with similar characteristics were obtained.ResultsConversion rate to open surgery, complications and EBL were similar in both groups. Conversely, operative time, LOS and Trifecta rates favored hLPN. The multivariate analysis showed that hLPN had a 70% higher chance of Trifecta achievement than cLPN in all age groups and for all tumor size across the study population.ConclusionCompared to a conventional approach, off-clamp laparoscopic partial nephrectomy in a hybrid room after superselective arterial embolization showed satisfying immediate surgical outcomes and reached a higher rate of Trifecta achievement. Mid and long-term functional and oncological results are needed to establish this minimally invasive surgical alternative.     

腹腔镜修补术治疗急性胃穿孔患者的效果

目的观察腹腔镜修补术治疗急性胃穿孔患者的临床效果。方法选取单县海吉亚医院收治的56例胃穿孔患者作为研究对象,按照入院时间先后顺序分成观察组(n=28)和对照组(n=28),两组患者均行急诊手术,对照组行传统开腹修补术,观察组行腹腔镜修补术,比较两组手术情况、临床疗效及术后并发症发生情况。结果观察组手术时间、排气时间、下床活动时间和住院时间均明显短于对照组,术中出血量明显少于对照组,差异均有统计学意义(P<0.05);观察组治疗有效率为96.43%,明显高于对照组的67.86%,差异有统计学意义(P<0.05);观察组并发症发生率为3.57%,明显低于对照组的28.57%,差异有统计学意义(P<0.05)。结论腹腔镜修补术治疗急性胃穿孔患者可明显提高治疗有效率,改善手术指标水平,降低并发症发生率的效果优于传统开腹修补术治疗效果。