Introduction. The three-dimensional (3D) imaging during laparoscopic procedures can improve the quality of that surgeries. There is a shortage of publications about the potential benefits of 3D navigation in laparoscopic surgery with urological diseases. Radical prostatectomy (RPE) is known as the gold standard of treatment of localized prostate cancer (PC), and investigation of imaging technologies in laparoscopic surgery in PC patients is a hot topic. Aim. To compare the perioperative outcomes of laparoscopic RPE performed with 3D and two-dimensional (2D) imaging. Materials and methods. We performed retrospective analysis of perioperative outcomes in 146 patients who had undergone radical surgery with localized PC. All the patients were divided into 4 groups by the surgery features: 1) 2D imaging with the technique for neurovascular bundles preservation (TNVBP) (n=52); 2) 2D without TNVBP (n=46); 3) 3D with TNVBP (n=23); 4) 3D without TNVBP (n=25). We assessed operative time, intraoperative blood loss volume (IBLV), duration of the bladder drainage, positive surgical margin (PSM) detection rate, duration of the postoperative inpatient period, urinary continence recovery rate, erectile function recovery (EFR) rate. Results and discussion. In groups 1, 2, 3, 4 the operative time was 171,4±21,1, 168,3±23,2, 98,7±17,3, 92,2±22,2 min, and the IBLV was 294,2±62,1, 281,2±53,2, 144,2±31,7, 148,5±33,0 mL, respectively. PSM detection rate was 1,92±0,11%, 2,17±0,04% in groups 1, 2, while PSM had not been detected in groups 3, 4. In all the participants, duration of the bladder drainage was 5–7 days, and the full recovery of urinary continence was detected at both 6 and 12 months after the surgery. The postoperative inpatient period was 8–10 days in groups 1, 2, and 8–9 days in groups 3, 4. The EFR at 3 months after the surgery was detected in 38,4%, 28,3%, 34.8%, 28.0% of patients, while at 12 months it was detected in 59,6%, 41,3%, 82,6%, 56,0% of patients in groups 1, 2, 3, 4, respectively. Conclusion. We revealed the following features of perioperative period of laparoscopic RPE performed with 3D imaging compared to 2D: 1) the operative time was reduced by 42–45% (р<0,05); 2) the IBLV was reduced by 47–51% (р<0,05); 3) the PSM had not been detected; 4) there was the tendency to the shorter postoperative inpatient period; 5) the EFR rate was increased by 1,3–1,4 times (р<0,05), and the best EFR outcomes were obtained via 3D imaging together with TNVBP. Thus, our study demonstrates the advisability of usage of both 3D imaging and TNVBP during the laparoscopic RPE.
BACKGROUND: The number of older patients with kidney tumors is steadily increasing. Surgical methods are the main ones in the treatment of patients with localized forms of renal cell carcinoma, including the elderly. AIM: to conduct a comparative analysis of perioperative data and functional results of surgical interventions for renal cell carcinoma in patients of different age groups. MATERIALS AND METHODS: The study included 256 patients with kidney tumors (mean age 65.2 8.6 years). 146 (57.0%) patients aged 56 to 64 years made up group I, and 110 (43.0%) patients aged 65 to 75 years group II. In 210 (82.0%) patients, the tumor diameter did not exceed 4 cm (T1a), in 46 (18.0%) patients it ranged from 4 to 6.2 cm (T1b). Radical nephrectomy and partial nephrectomy were performed respectively in 44 (30.1%) and 102 (69.9%) patients of group I and 58 (52.7%) and 52 (47.3%) patients of group II. All operations were performed laparoscopically. RESULTS: In patients of group I, the duration of radical nephrectomy was 115.0 18.0 min, and partial nephrectomy 135.5 25.0 min (p 0.0001), in patients of group II, 120.0 20.5 and 138.0 25.5 min (p 0.0001), respectively. Warm ischemia time during partial nephrectomy was 17.6 1.2 min in patients of group I and 18.2 1.5 min in patients of group II (p = 0.25). The volume of blood loss in patients of both groups I and II was significantly higher during partial nephrectomy. The average volume of blood loss in patients of group I was 130.0 20.0 ml when performing radical nephrectomy and 236.5 20.0 ml when performing partial nephrectomy (p 0.0001), and in group II 125.0 18.5 ml for radical nephrectomy and 246.0 22.0 ml for partial nephrectomy (p 0.0001). The frequency of significant complications did not differ in patients of groups I and II. Grade IIIa complications according to the ClavienDindo classification of surgical complications were observed in 5 (3.4%) patients of group I and 4 (3.9%) patients of group II (p 0.05), and grade IIIb in 3 (2.1%) and 2 (1.8%) patients (p 0.05). Intraoperative bleeding developed in 19 (7.4%) patients: in 13 (8.4%) of 154 patients with partial nephrectomy, and in 6 (5.9%) of 102 patients with radical nephrectomy. In the early postoperative period in patients of group I after radical nephrectomy and partial nephrectomy, normal glomerular filtration rates was observed in 34.0% and 54.0% of patients, respectively, and in group II in 31.0% and 52.0% of patients, respectively. Renal function significantly decreased in patients of both groups after radical nephrectomy compared with partial nephrectomy (p 0.05). The results of GFR 3 months after surgery improved in patients after partial nephrectomy, and did not change significantly in the radical nephrectomy group. CONCLUSIONS: The results of the study showed no differences in perioperative parameters (volume of intraoperative blood loss, warm ischemia time) during radical nephrectomy and partial nephrectomy in patients aged 5664 and 6575 years. The functional results of partial nephrectomy in patients of both groups were better compared to patients after radical nephrectomy. Thus, our data indicate the justification for performing organ-preserving operations, including in elderly patients.
Introduction. Urothelial carcinoma of the upper urinary tract in Western countries of Erope and USA occurs in 1-2 cases per 100,000 populations. Nephroretrectomy remains the main method of treatment of this pathology, however, the role of organ-sparing surgeries increases with the bilateral localization of the tumor process. Due to the rarity of bilateral upper urinary tract lesions with urothelial cancer and the lack of data evaluating the results of organ-sparing surgeries in such situations, each clinical case is of interest. Materials and methods. The article describes a case of surgical treatment of a patient with non-invasive papillary urothelial carcinomas of both ureters and the pelvis of the right kidney, which were manifested by macrohematuria. Results. The diagnosis was confirmed by computer tomography (CT) and ureteroscopy with tumor biopsy, which revealed a neoplasm of the right kidney pelvis, multiple tumors of the distal part of the right ureter and a solitary neoplasm of the middle part of left ureter. The patient underwent laparoscopic nephrureterectomy on the right with transurethral resection of the bladder wall in the area of the mouth of the right ureter and endoscopic removal of the neoplasm in the middle third of the left ureter using laser energy. At the control examination 1,5 months after the surgical treatment, according to the results of CT, cystoscopy with biopsy of the bladder and ureteroscopy, as well as histological examination of the biopsies, no data for tumor growth were found. At CT 6 months after the surgery, no data for the recurrence of cancer were obtained. Сonclusions. This clinical observation demonstrates the technical feasibility and oncological feasibility of using organ-preserving surgical treatment for bilateral localization of low-grade urothelial carcinoma.
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