This study aimed to report the learning curve in robot-assisted radical prostatectomy (RARP) performed by one surgeon who is experienced in laparoscopic prostatectomies. The records of 145 RARP cases performed between 2015 and 2017 were evaluated retrospectively. Patients were divided into three groups: group 1 comprised the first 49 cases, group 2 comprised 50–88 cases, and the rest of the cases were assigned to group 3. Continence was defined as the necessity to use at least one pad during a day. Additionally, erectile function recovery was defined as having erection sufficient for sexual intercourse regardless of using a phosphodiesterase type 5 inhibitor. Continence and erectile function recovery were assessed during interviews at 3, 6, and 12 months after surgery. First, all procedures were successfully performed without conversions or blood transfusions. The median follow-up period was 22 months. Moreover, the median skin-to-skin operative time (OT) was 220 minutes. The median blood loss was 150 ml, and the mean hospital stay was 8.9 ± 3.87 days. The median prostate volume was 36 cm³. The overall positive surgical margin rate was 13.1%. Overall, 38 (26.2%) postoperative complications were observed, and 17.9% of them were graded as minor. Anastomotic leakage decreased significantly from group 1 to group 3 (26.5% and 7%, respectively). The continence recovery (0-1 pad) rates were 60.6%, 75.7%, and 84.9% at 3, 6, and 12 months after surgery, respectively. Subsequently, the erectile function recovery rates were 50.9% and 65.4% at 6 and 12 months after surgery, respectively. In conclusion, there are several types of learning curves for RARP. First, the shallowest learning curve was observed for the OT. Regarding the analysis of “advanced learning curve,” demonstrating the improvement of OT and blood loss is considered insufficient. Therefore, additional oncological and functional results that require a longer period of investigation are required.
Радикальная простатэктомия и цистэктомия с тазовой лимфодиссекцией являются наиболее распространенными операциями в онкоурологии, и развитие лимфатических осложнений, таких как лимфоцеле, лимфорея и лимфедема, часто осложняет их выполнение. Однако не все лимфатические осложнения проявляются клинически и требуют хирургического вмешательства. Существует множество факторов риска и методов профилактики лимфогенных осложнений при онкоурологических операциях на органах малого таза. В настоящем обзоре рассмотрены потенциально провоцирующие факторы, которые следует учитывать при проведении онкоурологических вмешательств в малом тазу, а также методы их профилактики, позволяющие свести к минимуму образование лимфогенных осложнений.
Background. Since partial nephrectomy and radical nephrectomy demonstrate comparable oncological safety, nephronsparing surgery is the method of choice in patients with stage T1-T2aN0M0 renal cell carcinoma.Objective: to compare the main perioperative parameters and short-term functional outcomes of treatment for localized stage cT1aN0M0 and cT1b-T2aN0M0 renal cell carcinoma.Materials and methods. A total of 148 laparoscopic partial nephrectomies were performed at N.I. Pirogov City Clinical Hospital No. 1, N.I. Pirogov Russian National Research Medical University between 2016 and 2020. Study participants were divided into two groups. Group 1 included patients with stage cT1aN0M0 tumors (n = 89; 60.1 %), whereas group 2 comprised patients with stage T1b-T2aN0M0 tumors (n = 59; 39.9 %).Results. The duration of surgery was 120 min (range: 90-150 min) in group 1 and 145 min (range: 120-170 min) in group 2 (p = 0.001). The median time of warm ischemia was 13 min (range: 7-17) and 15 min (range: 12-19 min) in groups 1 and 2, respectively (p = 0.002). Seven individuals from group 1 (7.9 %) and 12 individuals from group 2 (22.3 %) had their pelvicalyceal system lanced. The median glomerular filtration rate calculated using the MDRD (Modification of Diet in Renal Disease) formula was 56.4 mL/min/1.73 m2 in group 1 and 54.3 mL/min/1.73 m2 in group 2 (p = 0.252). Three patients in group 1 (3.4 %) had positive resection margin. The median follow-up time was 21 months.Conclusion. Nephron-sparing surgeries are an acceptable option for patients with stage cT1b-T2aN0M0 tumors in terms of their oncological and functional safety. Tumors exceeding 4 cm were associated with an increased risk of disease progression.
Мужское бесплодие-достаточно распространенное явление, имеющее большое социальное значение. В настоящее время отмечается тенденция к росту удельного веса мужского фактора в бесплодном браке. В течение последних 20 лет он увеличился с 30 до 50% и продолжает расти, поэтому исследование репродуктивной функции мужчин и способов лечения бесплодия в настоящее время остается актуальной задачей [1-3]. Сведения о распространенности мужского бесплодия довольно противоречивы, поскольку показатели сильно варьируют в различных регионах. Согласно ВОЗ, мужское бесплодие реже всего встречается на Среднем Востоке и чаще всего в Центральной Африке. В России 15% сексуально активных пар не достигают беременности в течение 1 года и обращаются по этому поводу за медицинской помощью, из них 5% пар остаются бездетными, несмотря на лечение [4]. Нарушение фертильности приводит к росту числа бездетных браков и ухудшению демографических показателей. Основными причинами мужского бес
Background. Bladder cancer is very common and real problem in oncourology. The main treatment for muscle invasive bladder cancer is radical cystectomy (RC). RC with pelvic lymph node dissection (PLND) may be associated with an increased risk of developing lymphatic complications such as lymphedema, prolonged lymphorrhea, and the formation of lymphocele.Objective: to compare the efficiency of clips and surgical instruments for preventing the development of lymphatic complications during PLND at the time of RC.Materials and methods. From January 2016 to October 2020 at the N.I. Pirogov Russian National Research Medical University on the basis of N.I. Pirogov City Clinical Hospital No. 1 were performed 60 RC with PLND. All patients were divided into two groups. The 1st group included patients who underwent the sealing of lymphatic vessels using titanium/polymer clips (n = 30). In the 2nd group the sealing was performed using ultrasonic/bipolar instruments (n = 30). All operations were performed by one surgeon. The study used univariate and multivariate logistic regression analysis.Results. The overall percentage of lymphatic complications was 29 (48.3 %) out of 60 patients. Out of them 7 (11.7 %) patients developed symptomatic lymphocele, and 3 (5.0 %) developed asymptomatic lymphocele, prolonged lymphorrhea was observed in 17 (28.3 %) patients, lymphedema of the lower extremities or genitals in 2 (3.3 %). The percentage of lymphatic complications in the 1st group was 66.7 % (n = 20), and in the 2nd group - 30.0 % (n = 9) (p = 0.004). In multivariate analysis the statistical significance was (p = 0.014), a high odds ratio (6.83; 95 % confidence interval 1.48-31.49) was observed with sealing of lymphatic vessels with clips, while a low odds ratio (0.14; 95 % confidence interval 0.03-0.67) was found with electrosurgical instruments.Conclusion. The use of ultrasonic or bipolar electrosurgical instruments can be an effective method for preventing the development of lymphatic complications during PLND at the time of RC.
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