RESUMENIntroducción: La litiasis coraliforme es una patología que de no ser tratada efectivamente lleva al daño renal progresivo e irreversible, con consecuencias que pueden ser letales. El abordaje clásico con cirugía abierta, aunque efectivo en la remoción del cálculo y sus fragmentos, está asociado a morbilidad importante. En las últimas décadas se han impuesto técnicas menos invasivas como la litotripsia extracorpórea, que tiene baja morbilidad pero un rendimiento discutible como monoterapia en cálculos complejos del riñón. Presentamos nuestra experiencia en nefrolitectomía percutánea de la litiasis coraliforme, técnica que conjuga una alta efectividad con baja morbilidad. Material y Método: Se analizan en forma retrospectiva los resultados de 42 pacientes portadores de litiasis coraliforme sometidos a nefrolitectomía percutánea como tratamiento único o combinado con litotripsia extracorpórea. Los pacientes se trataron en decúbito prono, con nefroscopio rígido, litotripsia endoscópica, con uno o más accesos en una o más sesiones. Todos fueron sometidos a tratamiento antibiótico previo. Entre los pacientes hubo un niño de 11 años, un paciente monorreno y una litiasis coraliforme en un riñón en herradura. Resultados: Se trataron 22 mujeres y 20 hombres de una edad promedio de 40,7 años (rango 11-74). En 27 casos el cálculo era derecho y en 15 izquierdo. En 33 casos (78,5%) se realizó un acceso único, en 9 casos (21,4%) se realizó 2 accesos y en 3 casos (7,1%) se necesitó de 3 accesos. En 9 casos hubo litiasis residual que se trató con litotripsia extracorpórea y en 1 con ureteroscopía. En 40 pacientes se logró finalmente la remoción completa del cálculo y sus fragmentos (95,3%). En la serie no hubo pérdida de unidades renales ni mortalidad. Conclusiones: La cirugía percutánea de la litiasis renal es una técnica mínimamente invasiva efectiva en el tratamiento de la litiasis coraliforme asociada a una baja morbilidad.PALABRAS CLAVE: Nefrolitotomía percutánea, litiasis coraliforme. ABSTRACTBackground: Stag horn calculi may cause irreversible renal damage. Percutaneous nephrolithotomy is a minimally invasive surgical therapy than can be useful for these calculi. Aim: To report the experience with percutaneous nephrolithotomy for stag horn calculi. Material and Methods: Retrospective analysis of * Recibido el 29 de Enero de 2008 y aceptado para publicación el 5 de Marzo del 2008.
RESUMENIntroducción: La cirugía es el único tratamiento que ofrece cura en cáncer renal. La nefrectomía radical laparoscópica (NR-L) constituye hoy en día el estándar terapéutico quirúrgico. Presentamos los resultados de una serie de 150 casos de NR-L, operados en forma consecutiva por un único cirujano. Material y Métodos: Entre Febrero de 1994 y Agosto del 2006, 150 pacientes con diagnóstico de tumor renal fueron operados, realizándose NR-L. Los datos fueron recolectados en forma prospectiva, incluyendo: edad, sexo, indicaciones del procedimiento, tiempo operatorio, sangrado operatorio, complicaciones intraoperatorioas, tasa de conversión y complicaciones perioperatorias. Además se evaluó el análisis patológico final y se registro el seguimiento. Resultados: La edad promedio fue 60 años (rango 18-86 años), con una relación hombre/mujer 2:1. Las indicaciones para cirugía incluyeron tumor renal o hipernefroma en 137 casos, lesiones quísticas complejas en 5 casos y angiomiolipoma en 1 caso. Se realizó nefrectomía laparoscópica con asistencia manual en 83 casos (58%) y laparoscopia pura en 60 casos (42%). El tiempo promedio operatorio fue de 107 minutos (rango 40-240 minutos). El sangrado intraoperatorio promedio fue de 160 cc (rango 0-2000 cc). Hubo complicaciones intraoperatorias en 5 pacientes (3,5%) y postoperatorias en 9 pacientes (6,3%). El examen anatomopatológico demostró carcinoma renal pT1-T3c en 135 pacientes, Oncocitoma en 2 pacientes, Angiomiolipoma en 2 pacientes, Carcinoma de células transicionales en 1 paciente, Mixoliposarcoma en 1 paciente, metástasis de tumor pulmonar en 1 paciente y Pseudotumor inflamatorio en 1 caso. Se obtuvieron márgenes quirúrgicos negativos en todos los casos. El tiempo de seguimiento oncológico promedio es de 33 meses (1-138 meses). Conclusiones: La nefrectomía radical laparoscópica tiene resultados oncológicos iguales a la cirugía abierta, con todas las ventajas de la cirugía laparoscópica. Hoy en día constituye el estándar de oro en tumores renales estadio TNM T1, T2 y algunos T3.
Single-site port robotic-assisted simple nephrectomy (LESS) Introduction: Minimally invasive surgery in urology is rapidly advancing and Laparo-endoscopic single-site surgery (LESS) is not the exception. Such laparoscopic procedures are technically challenging and require an experienced laparoscopic surgeon due to the lack of port placement triangulation and instrument clashing. The benefi t of the da Vinci surgical system has recently introduced to LESS. We present two cases of robotic LESS nephrectomy. Matherials and Methods: Two patients, a female of 23 years old, diagnosed with right renal atrophy secondary to chronic pyelonephritis and one male patient with diagnosis of left staghorn calculi and renal atrophy. Both underwent to a total nephrectomy assisted by the da Vinci S surgical system through a single port incision using the GelPoint® access system. Results: The fi rst surgery was performed without incidents or conversion. The second patient required the installation of an additional robotic port for triangulation. The dock time and the mean operative time was 18 and 110 min. The mean estimated blood loss was 100 cc and the hospital stay was 27 hours. There were no complications. Conclusions: LESS robotic surgery is feasible using current robotic systems. However, there are several limitations. The design of specifi c technology for the use of the robot through single incision can solve this problem.
Percutaneous renal surgery. Experience in 301 patients Introduction: Percutaneous renal surgery was introduced more than 20 years ago in urological practice. Extracorporeal Shock Wave Lithotripsy (ESWL) enter the urological scene shortly after. Our objective is to show our experience in percutaneous renal surgery after the introduction of the ESWL in our institution. Material and Methods: Surgical outcomes of 301 patients who underwent percutaneous renal surgery as treatment of renal stones were analyzed. This series begins just before the introduction of ESWL in our unit. Results: Renal pelvis was the most frequent localization with 142 cases (47.2%). There were 51 patients with straghorn calculi. 255 (84.7%) were stone free after one single procedure. Residual fragments were managed with many methods, until only 16 patients (5.4%) had residual fragments. Complications occurred in 26 patients (8.9%). There was no mortality. Conclusions: Percutaneous surgery is an important tool in the management of renal stones. In general, renal stones managed with this procedure, are more complex, however the achievement of good results is possible.
Extraperitoneal laparoscopic radical prostatectomy experience in 310 patientsBackground: Laparoscopic prostatectomy is one of the standard treatments for localized prostate cancer. Aim: To report our experience with extraperitoneal laparoscopic radical prostatectomy (ELRP). Material and Methods: Prospective recording of 310 ELRP performed between 2001 and 2005. The series was divided chronologically in three groups. Group 1 was formed by the first 100 operated patients and groups 2 and 3 by subsequent series of 100 subjects, to show the learning curve. ELRP was performed using an anterograde technique, placing five trocars. Results: Median age of patients was 62 years. No differences in the clinical data of patients in the different groups were observed. Median prostate specific antigen was 13.3 ng/ml. One hundred eighty patients (60%) had a Gleason score of 2 to 6: 80 patients (25%) had a score of 7 and 50 patients(15%) had a score of 8 to 10. Two hundred fourteen patients (69%) were in clinical stage T1c, 62 patients (20%) were in stage T2a and 34 patients (11%) were in stage T2b. Surgical times were 185, 139 and 134 min in groups 1,2 and 3 respectively (p < 0.05). Blood transfusions were required in 20, 22 and 3% of patients in groups 1, 2 and 3 respectively. The figures for blood loss were 624, 451 and 268 cc, respectively. Positive surgical margins were observed in 24, 9 and 12% of patients in groups 1, 2 and 3 respectively. Rectal injuries occurred in 9, 2 and none patient of groups 1, 2 and 3 respectively. Urinary fistula occurred in 4, 1 and no patient of groups 1, 2 and 3 respectively. Late complications such as bladder neck stricture and incontinence decreased in consecutive groups. Conclusions: ELRP is a safe and effective technique for the treatment of localized prostate cancer, but it has a learning curve to reduce the incidence of complications.
No abstract
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.