Electroanalgesia in urologic surgery

Transcutaneous electrical nerve stimulation (TENS) was employed to reduce postoperative pain in 40 patients who had either radical nephrectomy, radical prostatectomy, or implantation of an inflatable penile prosthesis. These patients used 68 per cent less pain medication and made 84 per cent fewer requests for meperidine hydrochloride (Demerol) injections than did 40 control patients who had similar surgical procedures. The TENS units were easy to use, and there were no complications to electroanalgesia. The TENS program also was costeffective. TENS provided a simple, safe method of reducing postoperative pain in the three surgical procedures tested. Electroanalgesia may have application in other types of urologic surgery, and TENS should be particularly useful in patients who have outpatient surgery.     

Anticoagulation in urologic surgery

The present report describes a pilot project to apply the principle of minidose heparinization to patients undergoing prostatectomy, comparing a control group of 50 prostatectomies treated in conventional fashion to a study group of 43 prostatectomies treated with minidose heparinization. Results of the study indicate that perioperative minidose heparinization in patients undergoing prostatectomy is associated with longer hospitalization, greater need for blood transfusion, greater degree of immediate and delayed postoperative bleeding, and a higher incidence of “rebound” pulmonary embolization after cessation of heparin, than in patients treated in conventional fashion.     

Ambulatory urologic surgery

Since November 1st, 1988, an outpatient clinic has been set up in our department of Urology. Patients come to the clinic on the morning of the procedure and leave in the evening after a few hours of monitoring. Eligibility for outpatient surgery is determined using strict social, surgical and medical criteria. A visit with the anesthesiologist is scheduled one week before the operation. On the day of the procedure, the patient arrives at 7 a.m., is shaved, prepared and operated on by a senior surgeon before impatient operations begin. Postoperative monitoring is carried out as usual and around 6 p.m. the surgeon and the anesthesiologist decide whether the patient can be discharged. Most patients are interviewed by telephone within one week of the procedure. From November 1988 through December 1989, 172 adults were admitted to the outpatient clinic for endoscopic surgery (85 cases), open surgery (42 cases) or other procedures including diagnostic investigations, instillations, and removal or replacement of stents (44 cases). Twenty-three patients were discharged only on the day following the procedure. One patient was readmitted for clotting in the bladder. These preliminary results show that, as compared to inpatient surgery, outpatient surgery is cost-saving, easier to cope with psychologically and less apt to be followed by nosocomial infection, without greater risk to the patient provided inclusion criteria are stringently applied.     

Complications of lymphadenectomy in urologic surgery

Lymphadenectomy in urologic surgery provides accurate staging and may be therapeutic in some patients with lymph node metastases. In addition to the associated cost, pelvic lymph node dissection (PLND) has the potential for morbidity. This article focuses on the complications associated with PLND, including lymphocele, thromboembolic events, ureteral injury, nerve injury, vascular injury, and lymphedema. With improvements in surgical technique and perioperative care, the morbidity associated with lymphadenectomy may be minimized.     

Simulation training in video-assisted urologic surgery

The current system of surgical education is facing many challenges in terms of time ef.ciency, costs, and patient safety. Training using simulation is an emerging area, mostly based on the experience of other high-risk professions like aviation. The goal of simulation-based training in surgery is to develop not only technical but team skills. This learning environment is stress-free and safe, allows standardization and tailoring of training, and also objectively evaluate performances. The development of simulation training is straightforward in endourology, since these procedures are video-assisted and the low degree of freedom of the instruments is easily replicated. On the other hand, these interventions necessitate a long learning curve, training in the operative room is especially costly and risky. Many models are already in use or under development in all fields of video-assisted urologic surgery: ureteroscopy, percutaneous surgery, transurethral resection of the prostate, and laparoscopy. Although bench models are essential, simulation increasingly benefits from the achievements and development of computer technology. Still in its infancy, virtual reality simulation will certainly belong to tomorrow’s teaching tools.     

Current trends in urologic laparoscopic surgery

PURPOSE: We examined the status of laparoscopy in urology and the impact of residency and fellowship training on the performance of laparoscopy as primary surgeon. We also examined whether performing nonsurgical tasks requiring two-handed dexterity had any link to the adoption of laparoscopic techniques by urologists. MATERIALS AND METHODS: A total of 8760 laparoscopy questionnaires containing 135 queries were mailed to urologists listed on the American Urological Association practicing urologists mailing list. The questions sought information on area of practice, time in practice, fellowship training, ambidexterity, laparoscopic experience, and experience with robotics. The response rate was 1.8% (155 of 8760). RESULTS: There appeared to be no significant correlation between the performance of laparoscopic surgery and participation in activities requiring bimanual dexterity. However, a correlation of strong statistical significance did exist between laparoscopic residency training and performance of laparoscopy after residency (p=0.003. There also was a correlation between fellowship training in laparoscopy/endourology and doing laparoscopy as primary surgeon. CONCLUSIONS: Participation in laparoscopic surgery during residency training is a major determining factor in performance of laparoscopy as a primary surgeon in practice. Younger surgeons trained in laparoscopy during residency are performing more laparoscopy post residency than those without laparoscopic training during residency. At present, there is a need to train more urologists in laparoscopy at the postgraduate level.