Search

Background: Laparoscopic nephroureterectomy (LNU) has become popular in treating upper urinary tract urothelial carcinoma (UTUC) and an emerging trend was observed in robotic approaches. Therefore, we compared robot-assisted radical nephroureterectomy (RANU) and LNU for the treatment of UTUC. Materials and Methods: This observational and retrospective case-series study included UTUC patients who underwent LNU or RANU. A pure laparoscopic approach was adopted in the LNU treatment group, and bladder cuff excision (BCE) was performed mostly with the open approach. Either the da Vinci Si or Xi surgical system was used for RANU. Extravesical BCE was performed, and bladder defects were closed intracorporeally. Perioperative and oncologic outcomes were compared between the LNU and RANU groups. Results: A total of 231 patients who underwent RANU ( n  = 87) or LNU ( n  = 144) were included. No significant differences were noted between the groups in terms of demographics, tumor characteristics, operative time, catheter time, or complications. Compared with LNU, RANU had a lower intraoperative blood loss (30 vs. 150 mL, p  < 0.001) and shorter postoperative hospital stay (8 vs. 9 days, p  = 0.009). The 5-year overall survival, cancer-specific survival, and bladder recurrence-free survival were comparable between the groups. Conclusion: Compared with LNU, RANU had similar perioperative and oncologic outcomes but was superior in terms of intraoperative blood loss and postoperative length of hospital stay. However, considering the potential biases owing to the heterogeneity of our cases, the interpretation of the results must be very cautious.

Background: Laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN) are accepted as alternatives of open partial nephrectomy for managing renal tumors. However, LPN and RPN are technically challenging procedures. This report analyzed, according to the Clavien classification, the complications after LPN and RPN., Methods: We analyzed consecutive LPN (n = 85) and RPN (n = 93) cases at our institution between April 1994 and December 2012. The data were retrospectively reviewed from a prospectively collected database. All complications that occurred within 3 months postoperatively were recorded and classified according to the modified Clavien classification system., Results: The mean tumor size was 3.90 ± 1.77 cm. The mean operative time was 255.0 ± 83.5 minutes, and the mean warm ischemia time was 31.6 ± 22.0 minutes. The overall complication rate was 18.5%. Clavien Grades I, II, IIIa, and IIIb complications accounted for 3.93%, 11.2%, 2.81%, and 1.69% of patients, respectively. The most common complication was perioperative hemorrhage that required blood transfusion. Delayed bleeding occurred in seven patients, and four patients underwent angiographic embolization. The proportions of intermediate and high PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) score (≥ 8) and RENAL (Radius/Exophytic/Nearness to collecting system/Anterior/Location) score (≥ 7) were 70.8% and 74.2%, respectively. A higher PADUA or RENAL score was associated with a significantly greater complication rate (p = 0.024 and p = 0.02, respectively)., Conclusion: The overall complication rate in the present study was comparable to that reported in previous studies, although our patients had a larger mean tumor size and higher-complexity procedures.

During the past few years, robotic surgical systems have been rapidly developed. The progress and advantages of these systems include three-dimensional vision and enhanced ergonomics. These advantages have helped a new generation of minimally invasive surgery to evolve. The da Vinci Surgical System seems to greatly resolve problems (e.g., wide exposure and retraction of peritoneal organs) that are confronted by traditional laparoscopic surgeries for retroperitoneal tumors that are near great vessels. There have been few reported cases concerning laparoscopic excision of retroperitoneal tumors situated between the inferior vena cava, the right renal vessel, and the kidney. We report the use of a robotic surgical system for this type of treatment. A 54-year-old female patient had a hypoechoic lesion near the inferior vena cava and superior to the right renal vessels. It was incidentally found by ultrasound during a health check-up examination. The computed tomography (CT) scan revealed a heterogeneous contrast-enhanced retroperitoneal mass approximately 4.4 cm medial to the right kidney with the inferior vena cava slightly deviated to the left. Robot-assisted laparoscopic excision of the retroperitoneal tumor was performed on October 15, 2010 with an operation time of 135 minutes and an estimated blood loss of less than 30 mL. The J-Vac drainage tube was removed on postoperative Day 3, and the patient was discharged in a stable condition the following day. The pathology of the tumor was retroperitoneal schwannoma. A re-evaluation was arranged postoperatively for the 15-month ambulatory visit. No local recurrence or distal metastasis was present., (Copyright © 2013. Published by Elsevier B.V.)

Background: Laparoscopic partial nephrectomy (LPN) is a definitive therapy in patients with a small renal tumor. The aim of this study was to present our interim results of LPN with its complications and outcomes., Methods: We conducted a retrospective chart review of 46 LPNs in 45 patients at Taipei Veterans General Hospital from April 2004 to September 2008. The perioperative data were prospectively collected. The follow-up data, including local recurrence, distant metastasis, and renal function, were recorded., Results: The mean age of these 45 patients was 54.8 years (range, 26-85 years). Three (6.5%) LPNs were converted to laparoscopic radical nephrectomy. The mean tumor diameter was 3.81 cm (range, 2.0-7.5 cm). The mean operative time was 319 minutes (range, 180-660 minutes). The mean blood loss was 501 mL (range, 20-3,300 mL). Pedicle clamping was performed in 37 (80.4%) cases and the mean warm ischemic time was 56 minutes (range, 24-100 minutes). There were 17 (40.0%) benign cases and 26 (56.5%) renal cell carcinomas, which were stage pT1a in 19 (73.1%) cases, pT1b in 5 (19.2%) cases, pT2 in 1 (3.8%) case, and pT3a in 1 (3.8%) case. The major complication rate was 4.3% (delayed bleeding in 1 case and urine leakage in 1 case). All margins were free for the malignant cases. Neither distant metastasis nor mortality was found. Local recurrence was found in 1 patient. The mean preoperative creatinine was 1.04 mg/dL (range, 0.6-2.4 mg/dL) and the mean elevated creatinine level was 0.10 mg/dL at 3 months (p < 0.05) and 0.13 mg/dL at 6 months (p < 0.05) postoperatively. The function of the operated kidney was reduced by a mean of 21.9% at 3 months (p < 0.05) and 27.7% at 6 months (p < 0.05) postoperatively., Conclusion: Although our warm ischemic time and operative time were longer than those of other LPN studies, the interim results of our oncologic and renal functional outcomes were encouraging. Further refinement of the procedure is needed to shorten the warm ischemic time and improve the hemostatic technique. In addition, based on postoperative renal function, LPN does not significantly influence long-term renal function., (2010 Elsevier. Published by Elsevier B.V. All rights reserved.)

Background: We present our experience of complications of pure transperitoneal laparoscopic surgery in urology at Taipei Veterans General Hospital., Methods: Between September 2003 and March 2006, 185 laparoscopic urologic operations were performed, consisting of 70 nephrectomies (36 radical, 17 partial, 11 simple, 6 donor), 28 adrenalectomies, 28 nephroureterectomies, 22 radical prostatectomies, 17 ureterolithotomies, 6 radical cystectomies, 5 pyeloplasties, 2 renal cyst unroofings, 2 nephropexies and 5 other operations. We reviewed the database of the patients to evaluate the complications and analyze factors related to laparoscopic surgeries., Results: A total of 25 patients had 26 complications (14.1%, major in 4, minor in 22). The complications were categorized into intraoperative and postoperative complications in 10 and 16 patients, respectively. The mortality rate was 0%. The conversion rate was 0.54% (1 patient). The re-operation rate was 1.08% (2 patients). The most common intraoperative complication was vascular injury (5 patients). The incidence of complication was related to the difficulty level of operation. No statistically significant differences were found between complication rate and patient age, patient body mass index or the American Society of Anesthesiologist score., Conclusion: The complications of laparoscopic urologic surgeries are strongly correlated with the operative difficulties. In spite of elevated complication rates in difficult surgeries, the major complication rate in this study was very low. As the laparoscopic surgeries in urology involve more and more technique-dependent difficult fields, documentation and analysis of experience of complications is important for the development of this surgical modality.

Many accidents and complications may occur intraoperatively and postoperatively. Herein, we present an intraoperative accident of a missing yellowish silk strip, which was sucked out by a hook cautery and suction probe during laparoscopic radical cystectomy and bilateral nephroureterectomy.

Radical cystectomy is the gold standard for muscle-invasive urothelial carcinoma of the bladder because this operation provides excellent local cancer control. Laparoscopic radical cystectomy with different urinary diversions has been reported since 1992 and proposed as an alternative to open radical cystectomy. However, the reconstruction part of the operation is time-consuming and challenging. For a patient already under dialysis, concomitant radical cystectomy with bilateral nephroureterectomy could obviate the need to create urinary diversion and treat upper urinary tract tumors at the same time. Generally the specimen has to be removed through a mini-laparotomy. But for female patients, specimen extraction through the vagina has been reported to be safe and efficient. Thus, patients with multiple comorbidities can benefit from the avoidance of mini-laparotomy. Herein, we present a 65-year-old female with invasive urothelial carcinoma of the urinary bladder and end-stage renal disease who underwent laparoscopic radical cystectomy combined with bilateral nephroureterectomy, where the specimen was extracted transvaginally.

Initial access into the peritoneum and establishing pneumoperitoneum are required for laparoscopy. Various techniques have been described to achieve insufflation and place trocars. We describe our method of initial entry into the upper quadrant and subsequent incorporation of this site as a working port during upper urinary tract laparoscopy. This is an easy and safe means of entering the peritoneum, even after prior surgery, and provides a functional trocar for retraction and dissection.

Background Nephron-sparing surgery has become the standard treatment for T1 renal tumors. However, relevant data on the Taiwanese population are lacking, and most of the current literature uses global instead of split renal function (SRF) for postoperative renal function follow-up. We evaluated the postoperative renal function after minimally invasive partial nephrectomy in Taiwanese patients. Methods We retrospectively reviewed our database from April 2004 to July 2012 and enrolled patients who received laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RPN). The estimated glomerular filtration rate (eGFR) and SRF were calculated as representatives of renal function. The preoperative and 6- and 12-month postoperative renal functions were assessed. Freidman test was used to evaluate pre- and postoperative renal function changes; Wilcoxon test was used for comparing the renal function of each period. Results The 6- and 12-month postoperative SRF values were decreased compared with the preoperative values. Multivariate analysis revealed that older age was related to a lower postoperative eGFR, and a longer warm ischemia time was related to a decreased postoperative SRF. Patients with a warm ischemia time of >30 minutes were correlated with a larger mean tumor size, higher “preoperative aspects and dimensions used for an anatomical” score, greater amount of blood loss during the operation, longer postoperative hospital stay, and lower postoperative SRF compared with patients with a warm ischemia time of <30 minutes. Patients in the RPN group had shorter warm ischemia time and higher 6-month postoperative SRF compared with patients in the LPN group. Conclusion SRF is more sensitive for postoperative follow-up than eGFR. Longer warm ischemia time is associated with poorer postoperative renal function. RPN is a safe and feasible alternative to LPN. [ABSTRACT FROM AUTHOR]