Antonino Inferrera

Laparoscopic adrenalectomy in urological centres – the experience of the German Laparoscopic Working Group

Study Type – Practice patterns (retrospective cohort)

Bilateral vs unilateral laparoscopic intrafascial nerve-sparing radical prostatectomy: evaluation of surgical and functional outcomes in 457 patients.

Study Type – Therapy (case series)

Single-Portal Access Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma in Transplant Patients: The First Experience

We present the details of the first three single-portal access laparoscopic radical nephrectomies (S-Portal-RN) performed in patients with a malignant renal tumour that developed after a renal transplant. The mean operative time was 171.6 ± 37.5 min, with a mean blood loss of 126.6 ± 25.1 ml. A single small skin incision (5 cm) was performed to remove the kidney. No significant difference in glomerular filtration rate was observed postoperatively. The postoperative recovery was uneventful with favourable short-term outcomes and high patient satisfaction at the 2-mo follow-up. We believe that S-Portal-RN for renal cancer after a renal transplant can be performed without increased risks for the patients or for the transplanted kidney.

Adipocytokine: A New Family of Inflammatory and Immunologic Markers of Invasiveness in Major Urologic Surgery

BACKGROUNDnLaparoscopic surgery has been proposed to reduce surgical trauma and diminish patients stress response.nnnOBJECTIVEnTo investigate the role of the adipocytokine, in combination with changes in other known inflammatory markers, in patients undergoing radical prostatectomy.nnnDESIGN, SETTING, AND PARTICIPANTSnA total of 580 patients were enrolled in this prospective study. Laparoscopic extraperitoneal radical prostatectomy (LRP) was performed in 286 patients, and open retropubic radical prostatectomy (RRP) in 294 patients.nnnINTERVENTIONnBlood samples were collected preoperatively and up to 5 d postoperatively.nnnMEASUREMENTSnSerum concentrations of acute phase markers, interleukins (IL), and the adipocytokine leptin were measured at each time point by means of enzyme-linked immunosorbent assay. Clinical data were collected and analysed.nnnRESULTS AND LIMITATIONSnPatients undergoing LRP had significantly lower IL-6 and adipocytokine levels at all measurement time points. However, biphasic kinetics of adipocytokine serum levels were observed during the postoperative course in all patients. LRP was associated with less adipocytokine and IL-6 release, indicating a smaller degree of surgical insult and the minimal invasive nature of this procedure. The limitation of this study was its nonrandomised design.nnnCONCLUSIONSnAdipocytokines might serve as additional immunologic markers of invasiveness in major urologic surgery.

Laparoscopic vs open retropubic intrafascial nerve-sparing radical prostatectomy: surgical and functional outcomes in 300 patients

Study Type – Therapy (case series)u2028Level of Evidenceu20034

Clampless laparoendoscopic single-site partial nephrectomy for renal cancer with low PADUA score: technique and surgical outcomes

Laparoendoscopic single‐site (LESS) surgery has proved to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons in well‐selected patients. All extirpative and reconstructive urological procedures have been described in the literature, but LESS partial nephrectomy (PN) is one of the most complex procedures and few studies have been published on this subject. The study describes a clampless technique for LESS PN, by reducing the blood pressure and increasing the intra‐abdominal pressure of the pneumoperitoneum to 20u2009mmHg, timed to precisely coincide with excision of the tumour. This technique was found to be safe and feasible in the treatment of low‐risk T1a RCC.

Laparoscopic dismembered pyeloplasty: technique and results in 105 patients

PurposeTo evaluate the postoperative and functional results of the laparoscopic dismembered pyeloplasty (LDP).Patients and methodsBetween May 2000 and April 2008, we performed in our department 105 LDP. All patients presented an ureteropelvic junction obstruction with dilatation of renal calyx system with an enlarged renal pelvis. Demographic data (age, gender), perioperative and postoperative parameters, including operating time, estimated blood loss, complications, length of hospital stay, functional outcome were collected and evaluated.ResultsThe mean operative time for LDP was 150xa0min (range 120–180xa0min) and the mean estimated blood loss was negligible in all patients. The mean hospital stay was 4xa0days (4–8). No conversion to open surgery occurred. In the follow-up, we noted a successful rate in 96.2% of the patients.ConclusionLaparoscopic dismembered pyeloplasty, if performed by expert surgeons in high-volume centres, presents results that are comparable with open surgery, with a lower surgical trauma for the patients.

Male-to-Female Transsexualism: Technique, Results and 3-Year Follow-Up in 50 Patients

Aim: To evaluate the functional and cosmetic results of male-to-female gender-transforming surgery. Patients and Methods: Between May 2001 and April 2008 we performed 50 male-to-female gender-transforming surgeries. All patients had been cross-dressing, living as women, and receiving estrogen and progesterone for at least 12 months, which was sufficient for breast development and atrophy of the testes and prostate to occur. This hormonal therapy was suspended 1 month before the operation. Results: The mean operative time was 190 min and the mean depth of the vagina was 10 cm. On follow-up, the most common complication (10%) was shrinkage of the neovagina, which could be corrected by a second surgical intervention. Of the 50 patients, 45 (90%) were satisfied with the esthetic results; 42 patients (84%) reported having regular sexual intercourse, 2 of whom had pain during intercourse. Of the 50 patients, 35 (70%) reported achieving clitoral orgasm. Conclusion: Male-to-female gender-transforming surgery can assure satisfactory cosmetic and functional results, with a reduced intra- and postoperative morbidity. Nevertheless the experience of the surgeon and the center remains central to obtaining optimal results.

Laparoendoscopic single-site versus conventional laparoscopic radical nephrectomy for renal cell cancer in patients with increased comorbidities and previous abdominal surgery: preliminary results of a single-centre retrospective study

ObjectiveLaparoendoscopic single-site surgery (LESS) represents an evolution of laparoscopy for the treatment for urologic diseases. The aim of this study is to investigate the feasibility of LESS in patients with increased comorbidities and previous abdominal surgery undergoing radical nephrectomy (LESS-RN) for renal cell carcinoma.Materials and methodsA total of 25 patients with increased comorbidities and previous abdominal surgery who underwent LESS-RN were compared to 31 patients with the same characteristics after conventional laparoscopic radical nephrectomy (LRN). LRN was performed between January 2009 and May 2010, and LESS-RNs were performed between June 2010 and November 2011. Demographic data and perioperative and postoperative variables were recorded and analysed.ResultsThe mean ASA score in the LESS-RN and LRN groups was 3.2xa0±xa00.4, and the mean BMI was 32.7xa0±xa02.1 and 34.2xa0±xa00.8xa0kg/m2, respectively.The mean operative time in the LESS-RN and LRN groups was 143.7xa0±xa024.3 and 130.6xa0±xa026.5xa0min, (pxa0=xa00.11), and the mean hospital stay was 3.8xa0±xa00.8 versus 4.2xa0±xa01.4xa0days in the two groups (pxa0=xa00.06), respectively.Three and four complications were recorded in the LESS-RN and in the LRN groups, for a mean complication rate of 12 and 12.9xa0% (pxa0=xa00.12), respectivelyAll tumours were organ-confined with negative surgical margins, and the mean R.E.N.A.L nephrometry score for LESS-RN and LRN was 9.78xa0±xa01.7 and 9.82xa0±xa01.3 (pxa0=xa00.14), respectively.ConclusionsLESS-RN in patients with increased comorbidities and previous abdominal surgery is equally effective as LRN without compromising on surgical, oncologic short-term and postoperative outcomes.

Laparoscopic versus open bilateral intrafascial nerve-sparing radical prostatectomy after TUR-P for incidental prostate cancer: surgical outcomes and effect on postoperative urinary continence and sexual potency.

ObjectiveTo evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRPT) and nerve-sparing retropubic radical prostatectomy (nsRRPT) after TUR-P for incidental prostate cancer.Materials and methodsBetween January 2003 and August 2011, 125 nsLRPT and 128 nsRRPT for incidental prostate cancer diagnosed after TUR-P were performed at our clinic. Demographic data, peri- and postoperative measurements and functional outcomes were compared.ResultsThe mean operative time was 153.1xa0±xa035.4xa0min for nsLRPT and 122.5xa0±xa067.5xa0min for nsRRPT (pxa0=xa00.03). The mean catheterization time was 8xa0±xa01xa0days in the laparoscopic group and 11xa0±xa02xa0days in the open group (pxa0=xa00.02). Also, the length of hospitalization presents statistical significant difference in the two groups. Positive margins were detected in 2.4 and 4.7xa0% of patients with pT2c tumours in the laparoscopic and open groups, respectively (pxa0=xa00.09). At a mean follow-up of 26.9xa0±xa09.3xa0months for the nsLRPT group and of 27.8xa0±xa09.7xa0months for the nsRRPT group, all patients were alive with no evidence of tumour recurrence. Twelve months postoperatively, complete continence was reported in 96.8xa0% of patients who underwent an nsLRPT and in 89.4xa0% of patients in the nsRRPT group (pxa0=xa00.02). At that time, 74.4xa0% of patients in the nsLRPT group and 53.1xa0% in the nsRRPT group reported the ability to engage in sexual intercourse (pxa0=xa00.0004).ConclusionnsLRPT after TUR-P, performed by expert surgeons, results to be a safe procedure with excellent functional outcomes with regard to the urinary continence and sexual potency.