Laparoscopic surgery for complex cysts is safe, feasible, and effective. Nevertheless, regardless of surgical approach, patients with complex renal cysts have excellent overall survival with short-term follow-up.
INTRODuCTIONUrologic surgery continues to evolve focusing efforts on adequate treatment of pathologic urologic conditions in a safe and minimally invasive manner (1).Laparoscopic surgery has well defined benefits for the patient and has, over time, become accepted as a standard of care access strategy for the management of benign and malignant Urologic diseases. Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding. Unlike open surgery, at the end of laparoscopic extirpative procedures, the Urologist is often faced with the additional challenges of specimen retrieval and extraction.Laparoscopic specimen entrapment and extraction occur at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a drainage system and the best option for wound closure. Laparoscopic specimen entrapment and extraction occurs at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is simply lifted out of the larger incision which has been made to achieve the surgical objectives. In contrast, significant laparoscopic skill is required to entrap and safely extract laparoscopic specimens. Indeed, the Urologist and surgical team which are transitioning from open surgery may disregard this important part of the procedure which may lead to significant morbidity. As such, it is imperative that during laparoscopic procedures, the "end of the procedure" be strictly defined as the termination of skin closure and dressing placement. Taking a few minutes to focus on safe specimen entrapment and extraction will substantially reduce major morbidity. The following review focus on the technology and technique of specimen entrapment and extraction, on the matter of whether to install a drainage system of the abdominal cavity and the options for adequate closure of trocar site wounds. This article's primary objectives are to focus on how to minimize morbidity while maintain the advantages of a minimally invasive surgical approach.
Objectives. To evaluate the trends of surgical treatment of the renal tumor in an academic medical center. Methods. Between 2001 and 2010, 505 were treated surgically at the Federal University of Sao Paulo for renal tumors. The following variables were observed and analyzed according to their evolution through time: frequency and types of surgeries performed, operative time, hospital stay, and warm ischemia time for partial nephrectomy.Results. An increase in the frequency of laparoscopic radical nephrectomies, open partial nephrectomies, and laparoscopic partial nephrectomies was observed when comparing the periods from 2001 to 2005 (4.3%, 2.6%, and 12.6%, resp.) and from 2006 to 2010 (13.2%, 18.6%, and 20.2%, resp.; < 0.001). The average of operative time, hospital stay, and tumor size diminished (from 211.7 to 177.17 minutes, from 5.52 to 4.22 days, and from 6.72 to 5.29 cm, resp.) when compared to the periods from 2001 to 2005 and from 2006 to 2010 ( < 0.001, = 0.016, < 0.001, resp.). Conclusion. As time goes by, there has been a significant reduction in the hospital stay time, surgery time, and size of renal tumor in patients treated surgically. The frequencies of minimally invasive and nephron-sparing surgeries have increased over the last years.
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