Monopolar TURP, bipolar TURP and PVP by 120-W GreenLight laser for prostate size >80 mL do not have a significant impact on IIEF-5 score at 12-month follow up.
213The role of partial nephrectomy in clinical T1b renal tumors is still not established. Laparoscopic partial nephrectomy for clinical T1b renal tumors is a technically challenging procedure. We prospectively evaluated the feasibility, safety, efficacy, and long term oncological results of laparoscopic transperitoneal partial nephrectomy(LPN) in clinical T1b renal tumors. All consecutive patients undergoing LPN for clinical T1b renal tumors and normal contralateral kidney by a single surgeon between June 2011 and May 2016 at our institution were included. The various clinical data including patients' demographic profile, intraoperative and postoperative data, complications, and follow up were recorded and analyzed. We are presenting a video of one such case. A total of 53 patients were included in the study. The mean age was 51 years with mean preoperative serum creatinine and estimated glomerular filtration rate (\GFR) of 0.91 mg/dl and 73.1 ml/min/1.73 m 2 respectively. The mean tumor size was 5.1 cm. The tumor was mesorenal in 7 (13.2%)patients, superior polar in 25 (47.2%) patients, and inferior polar in 21 (39.6%) patients. Tumor growth pattern was cortical in 29 (54.7%) patients and cortico-medullary in 24 (45.3%) patients. The mean operating time and estimated blood loss were 129.3 min and 147.1 ml respectively. The mean ischemia time was 21.3 min. Three (5.6%) patients were converted to open surgery. Blood transfusion was required in 5 (9.4%) patients. The mean hospital stay and mean convalescence period were 3.3 days and 1.39 weeks respectively. Positive surgical margins were seen in 1 (1.8%) patient. In histopathology, renal cell carcinoma was found in 92.4% and oncocytoma in 7.6% of patients. The intraoperative and postoperative complications were present in 5.6% and 7.5% of patients respectively and were mainly Clavien grade 1 and 2. The mean estimated GFR at 1 year was not significantly lower than that of the preoperative value (p = 0.71).At mean follow up of 47.1 months, there was no local or distal recurrence. Laparoscopic transperitoneal partial nephrectomy for clinical stage T1b renal tumors is feasible, effective, with preservation of renal function, and has acceptable complications with good long term survival. However, it is a technically challenging procedure and should only be performed by surgeons with significant laparoscopic expertise.
Introduction: Leiomyosarcoma is malignant soft tissue tumor of mesenchymal origin arising from undifferentiated smooth muscle cells. Thera are two types of Leiomyosarcoma of scrotum namely para-testicular and intra-testicular. The Intra testicular tumor is relatively rare. Blood vessels or contractile cells of the seminiferous tubules is believed to be the origin of this rare tumor which is of mesenchymal origin. Objective: Prospective clinical evaluation of testicular leiomyosarcoma with retroperitoneal mass and metastasis to para-aortic and retro-caval lymph nodes. Material & Methods: All 21 consecutive patients who were diagnosed as testicular mass on evaluation from August 2018 to July 2021 were included in study after fulfillment of eligibility criteria. Prior to surgery all patients were evaluated. All patients operated with standard method of radical high inguinal orchidectomy, followed by chemo or radio therapy as and when required on further evaluation and histopathology checked. Patients demographic, clinical-pathological, testicular tumor parameters and tumor markers with perioperative data, metastatic parameters recorded prospectively and analysed. Outcome measures were demographic data, tumor response, perioperative data, complications and follow-up at 12 months. Results: In our study out of 21 patients, 13 patients (61.9%) were found to be in stage 1,4 patients (19%) were in stage 2 and another 4 patients (19%) were in stage 3 according to IGCCCG. Only 5 patients (23.8%) were found with retroperitoneal paraarotic and paracaval Lymphadenopathy. Metastasis to liver, lung, brain and major visceral organs were present in 4 of our patients (19.8%). Conclusion: As less cases have been reported so far, clinical and biological behavior of this tumor difficult to predict. Based on the literature review, the treatment of choice for an intratesticular leiomyosarcoma is a radical orchidectomy and clinico-radiological surveillance in cases at stage I. As there are no available data regarding the management of stage II or Stage III disease post radical orchidectomy.
Urachus is the embryological remnant of the allantois that connects the fetal bladder to the umbilicus. It usually obliterates in the 5 th month of gestation, giving rise to the median umbilical ligament. Several types of urachal anomalies have been described including urachal cyst, patent urachus, diverticulum, and sinus, of which urachal cysts is the most common anomaly, occuring in approximately 1/5,000 births. Urachal cysts are usually asymptomatic but may present as acute abdomen (secondary to infection), and become palpable. We performed a light assisted mucosa sparing laparoscopic excision of a urachal cyst in a 24-year-old girl who presented with lower abdominal midline swelling. MR of the abdomen and pelvis revealed an anterior midline urachal cyst located just superior to the bladder that measured 6.2 x 4.5 cm. Management options of the urachal cyst were discussed with the patient and she was planned for laparoscopic excision. On the table, cystoscopy and cystography were performed initially to identify any possible connection between the bladder and the urachal cyst. The patient was placed in the dorsal lithotomy and Trendelenberg position. port in the midline using a vertical incision halfway between the umbilicus and the xiphoid process. After creation of pneumoperitoneum, two additional ports (12 mm each) were inserted under direct vision at the anterior axillary lines just above the level of the umbilicus (one on each side). Dissection began with lysis of the omental adhesions. After adhesiolysis, both the obliterated umbilical arteries were cauterized and divided to gain access to the anterior bladder wall. The urachal cyst was dissected from the anterior abdominal wall and mobilized all around, except at its attachment to the bladder, using a harmonic scalpal. The cystoscopy was carried out at this stage to visualize the demarcation between the cyst and the bladder wall with the help of a cystoscopic light. The bladder was kept partially distended to assist dissection between the bladder mucosa and cyst wall. Under cystoscopic light guidance, the cyst was dissected from the bladder wall without opening the bladder mucosa. The bladder was distended via the Foley catheter to ensure that there was no rent in bladder mucosa. The muscle defect was closed by running a 3-0 vicryl suture. The cyst was decompressed after taking it in an endobag and delivered from camera port. The Foley catheter was kept indwelling for 24 hours.
Laparoscopic transperitoneal radical prostatectomy (LRP) is technically challenging in obese patients especially in those with a narrow and deep pelvis. We prospectively evaluated the surgical outcomes of laparoscopic transperitoneal radical prostatectomy in obese patients. All consecutive patients with BMI ≥30 Kg/m 2 who underwent LRP for localized prostate cancer by a single surgeon between January 2013 and May 2016 at our institution were included. The various clinical data including patients' demographic profile, peri-operative data, postoperative data and followup were recorded and analyzed. We demonstrate our surgical technique in a video of one such patient. A total of 31 patients were included in the study. The mean BMI was 31.74 Kg/m 2 . The clinical stage ≤T2 c and ≥T3 a were seen in 88.8% and 11.2% respectively. The D'Amico classification low /intermediate/high risk was seen in 25.2%, 47.4% and 25.4% patients respectively. The mean operating time and mean estimated blood loss were 193.9 min and 190.5 ml respectively. There were no conversions to open surgery. Blood transfusion was required in 2 (6.4%) patients. Right unilateral, left unilateral and bilateral nerve sparing was performed in 35.4%, 22.5% and 41.9% patients respectively. The mean hospital stay and mean catheterization time were 4.31 days and 10.8 days respectively. Intraoperative and postoperative complications were seen in 3 (9.6%) and 4 (12.9%) respectively. Positive surgical margins were found in 2 (6.4%) patients. At mean follow up of 15.1 months, the continence rate at 3 months and 12 months were 61.2% and 93.5% respectively. The potency rate at 12 months was 48.38% with biochemical recurrence of 9.6%. Laparoscopic transperitoneal radical prostatectomy in obese patients with clinically localized prostate cancer is technically feasible and safe, with acceptable peri-operative morbidity and excellent functional outcomes. However, this technically challenging procedure should be attempted by surgeons with significant expertise.
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