Objective To present the complications from our first staghorn calculi, polycystic kidney disease, and xanthogranulomatous pyelonephritis. While there was no 100 cases of laparoscopic nephrectomy, a technically demanding procedure requiring lengthy experience, discernible decline in the decrease in complications with experience, operative duration decreased from a and to define the risk factors. Patients and methods Indications for laparoscopic nephmean of 204 min for the first 20 cases to 108 min for the last 20. Complications and conversions were more rectomy included patients requiring nephrectomy for benign pathology and those requiring nephroureterecclosely associated with diagnosis than with the surgeon's experience. tomy for upper tract transitional cell carcinoma confined to the upper ureter and/or renal pelvis. AllConclusion Laparoscopic nephrectomy and nephroureterectomy can be undertaken for a variety of indications patients were operated on by one surgeon (D.A.T.) via a transperitoneal route and data on diagnosis, outwith reasonable complication and conversion rates. Although inflammatory conditions increase the diBcome and complications collected prospectively. Results The overall complication rate was 18%, of which culty of these procedures, we feel that patients requiring nephrectomy for benign disease should be oCered 3% were major and 15% minor complications. Five cases were converted to open surgery electively. a trial of laparoscopic surgery. Keywords Laparoscopy, nephrectomy, complications Complications and conversions were associated with a history of pyonephrosis, previous renal surgery, Several risk factors have been associated with compli-
Objective To review our experience with laparoscopic ureterolithotomy. Patients and methods Since 1993, we have performed laparoscopic ureterolithotomy in 14 patients with ureteric stones. Laparoscopy was carried out in nine patients as a salvage procedure after failed ureteroscopy (six), shock wave lithotripsy (two), or both (one), and in five patients as a primary procedure for large stones (mean 27.2 mm, range 18–40). Patients in the former group had already undergone a mean of 1.88 procedures (range 1–4). Laparoscopic ureterolithotomy was carried out via a transperitoneal approach. Associated ureteric strictures were incised at the time of ureterotomy. Results All procedures were completed laparoscopically and all patients were rendered stone‐free after a single procedure. The mean operative duration was 105 min. Ureteric strictures were incised in three patients, in two of whom dilatation was subsequently required; all three had a successful result. There were three minor complications. Conclusions Laparoscopic ureterolithotomy can be a safe and effective procedure; it should be considered as a primary procedure for large mid‐ and upper ureteric stones.
Objectives. To assess the effectiveness and cost-effectiveness of prophylaxis with clotting factor against bleeding in patients with severe haemophilia and von Willebrand's disease (vWD). Design. Treatment details that related to 179 patients with severe (Ͻ 1 u dL Ϫ1 ) haemophilia A, B and vWD were retrospectively examined for the period 1980-95. A subgroup of these patients, 25 adults and 22 children, who had previously received treatment on demand and who had switched to treating with prophylaxis, were studied in order to examine the effects of the change. The cost-effectiveness of prophylaxis was also analysed using another subgroup of 38 patients and by adjusting their treatment details by age and method of treatment. Setting. Data were obtained on patients who were solely registered at the Royal Free Hospital Haemophilia Centre (RFHHC), London, UK. Outcome measure. Bleeds. Results. The median annual number of bleeds decreased from 23.5 (range 1-107) in 1980, to 14 (range 0-45) in 1995 (P < 0.0001). Switching from treating on demand to prophylaxis reduced bleeding frequency in 41 out of 47 patients within the period of 1 year. At the base scenario, switching to prophylaxis cost an additional £547 per averted bleed; however, this figure was highly sensitive to certain variables. Conclusion. Prophylaxis can reduce bleeding frequency but requires more clotting factor than treatment on demand. More detailed proof of cost-effectiveness is likely to require the use of modelling techniques.
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