Objective: To investigate the feasibility of adopting laparoscopic radical prostatectomy in treating organconfined adenocarcinoma of the prostate in a low volume urology centre. Methodology: We applied the technique to 21 patients with early prostate cancer from March 2002 to July 2003. Modifications of the technique were described. Methods to shorten the learning time were discussed. Results: Operative time and blood loss improved after the first 10 cases and were averaged at 260 min and 650 mL, respectively, in the last 10 cases. Two patients required re-operation for complications. A total of 14.7% of specimens showed positive surgical margin. Only one of the 15 patients needed to wear a pad for incontinence. Two of the eight patients regained the ability to have an erection after attempts of nerve sparing. A longer follow-up was required for the evaluation of oncological control. Conclusion: Adoption of the technique was feasible for an Asian centre with a caseload of approximately 20 cases per year.
Introduction: Laparoscopic radical prostatectomy (LRP) was first attempted in 1992. It was not until 1998 that this technique was recognized as an feasible alternative to traditional open surgery. Laparoscopy offers good visualization, magnification and allows precise dissection and intracorporeal suturing. An audit on the clinical outcomes was done on this novel technique.
Patients and Methods: 28 patients underwent LRP from March 2002 to February 2004. Inclusion criteria for surgery were similar to conventional open surgery's criteria: patients with high chance for organ‐confined disease and life expectancy of more than 10 years were included. Earlier series of open retropubic radical prostatectomy in the same hospital was used as the audit's standard for comparison.
Results: Favourable results over the open series were found with regard to catheter time, transfusion, hospital stay and later functional outcomes including continence and erectile function. Complications and oncological control was found to be similar for the two groups. Operative time was observed to have reduced from 480 min to less 200 min in the 28‐case series for the laparoscopic cases.
Conclusion Early results suggested favourable outcomes, but longer follow up and a controlled comparative study is needed to justify any definite conclusion for this relatively novel technique.
Both 120 and 180 W Greenlight lasers produced deeper HDZ than the other energy sources. Urologists need to be aware of HDZ that cause tissue damage outside the operative field.
A clinical audit encompasses both quality assessment and improvement and is now an important component of the clinician's practice. The present project applied clinical audit in monitoring both the clinical outcomes and the process of patient management. The first audit cycle in 1999 reviewed the performance of the hospital with respect to clinical outcomes and patient management process. An area of weakness was identified with regard to the process of managing patients with the problem of retention of urine. Subsequent change in the management of patient with retention of urine was implemented. The second audit cycle was completed in 2002. A reduction in hospital stay for patients with retention of urine was achieved.
Aim: Ureteral resection and reimplantation is one of the treatment options for pathology in the middle and distal ureter. Laparoscopic ureteral reimplantation has been shown to be a feasible alternative to the open approach. Among the various techniques of laparoscopic reimplantation, the dome advancement technique has been reported as a simple and effective method.
Patients and Methods: Five patients were found to have distal ureteric stricture necessitating partial ureterectomy and ureteral reimplantation. Their results are reviewed and compared to published results.
Results: Laparoscopic distal ureterectomy and ureteral reimplantation was successfully performed in all five patients using the dome advancement technique. All patients made good postoperative recovery without evidence of obstruction on follow‐up imaging.
Conclusion: Laparoscopic ureteral reimplantation is a feasible minimally‐invasive option for patients requiring ureteral reconstruction. The dome advancement technique is simple and reproducible, with a good functional outcome.
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