Carlos Batagello

Laparoscopic versus standard appendectomy outcomes and cost comparisons in the private sector

Minimally invasive surgery has been proposed as the preferred treatment strategy for various gastrointestinal disorders due to shorter hospital stay, less pain, quicker return to normal activities, and improved cosmesis. However, these advantages may not be straightforward for laparoscopic appendectomy, and optimal management of remains controversial. One hundred forty-eight patients with clinical and radiologic diagnoses of acute appendicitis treated in two different hospitals were retrospectively reviewed. Seventy-eight patients underwent laparoscopic appendectomy in hospital A and 70 patients underwent standard appendectomy in hospital B. Patients treated by either type of surgery were compared in terms of clinical and pathologic features, operation characteristics, complications, and costs. There were no significant differences between both groups in terms of clinical features, radiologic studies, complications, and final pathology findings (P > .05). Hospital stay was significantly shorter and bowel movements recovered quicker in the laparoscopy group. However, overall and operating room costs were significantly higher in patients treated by laparoscopy (P < .01). Our series show a subtle difference in terms of hospital stay and bowel movement recovery, favoring patients treated by laparoscopy. However, these results have to be carefully examined and weighed, because overall costs and operating room costs were significantly higher in the laparoscopy group.

Recurrent Penile Fracture—Case Report and Alternative Surgical Approach

Introduction Penile refracture is an exceedingly rare event, with very few published studies. To the best of our knowledge, this is the first documented case in the literature of penile fracture with 3 same-site recurrences. Aims To describe the case of a 25-year-old Caucasian man with recurrent penile fracture ultimately treated with resuture and patch reinforcement. Methods Patient history (clinical and surgical) and literature review. Results After the 3rd same-site recurrence, patch reinforcement over the sutured area was performed. The patient had an uneventful recovery and no recurrences to date. Conclusion There is no evidence indicating the superiority of non-absorbable sutures. Bovine pericardium reinforcement over the sutured area was used to minimize the chance of another recurrence. More studies are necessary to investigate its safety and efficacy in this scenario. Nascimento B, Guglielmetti GB, Miranda EP, et al. Recurrent Penile Fracture—Case Report and Alternative Surgical Approach. Sex Med 2018;6:263–266.

Lipoma de ventrículo esquerdo: relato de caso

We report the case of a 21-year-old female referred to our institution complaining of dizziness when standing up, which improved in the dorsal decubitus position and at rest, after a few minutes. The symptom, which had lasted for years, was not accompanied by vertigo, syncope, or neurological changes, but was gradually getting worse. Transthoracic echocardiogram showed a hyperechoic mass in the middle-apical region of the left ventricular posterior wall and normal pericardium. The cardiac nuclear magnetic resonance allowed the diagnosis of the left ventricular tumor suggestive of lipoma. Surgery was performed and the tumor was resected. The patient recovered well and is currently asymptomatic.

V11-08 COMPLETE SUPINE PERCUTANEOUS NEPHROLITHOTOMY FROM THE SURGEON′S POINT OF VIEW WITH A GOPRO®. TEN STEPS FOR SUCCESS.

INTRODUCTION AND OBJECTIVES: ECIRS (Endoscopic Combined IntraRenal Surgery) is a combined rigid and flexible antegrade and retrograde approach for the treatment of large and/or complex urolithiasis, usually performed in the Galdakao-modified supine Valdivia (GMSV) position. The aim of the present video is to describe the main distinctive and standardized steps of this surgical procedure, and to highlight the relatedadvantages in terms of safety and efficacy. METHODS: From 2004 until 2016 more 750 ECIRS have been performed in our Department. Year after yearall the procedure has been standardized step-by-step, starting from patient positioning in the GMSV position (part 1 of the video). Since ECIRS involves manypeople and a number of devices the operating room is very crowded, and a meticulous organization is needed (part 2 of the video). Being a suitable percutaneous access key to the success of any percutaneous nephrolithotomy (PNL), a combined and reproducible guidancemethod for the renal puncture has been developed, performing an ultrasoundassisted, fluoroscopy-guided and endoscopy-checked percutaneous access (part 3 of the video). Retrograde semirigid and flexible ureteroscopy before and during PNL has both a diagnostic and active role, contributing to improve safety and efficacy of ECIRS (part 4 of the video). RESULTS: All the team in the operating room (urologists, anaesthetist, nurses) shares the responsability of positioning the patient correctly in the GMSV position, combining the supine Valdivia position with a modified arrangement of the lower limbs. This position presents a variety of anaesthesiological, urological and management advantages, optimally supporting ECIRS. The diagnostic role of retrograde ureteroscopy includes the preliminary evaluation of the dynamic anatomy of both lower and upper urinary tract, for a tailoringof the intraoperative choices (calyx of access, tract size, dilation method) on the single clinical case. Endovision control of each step of the renal access reduces radiation exposure and the risk of complications due to the insufficient introduction of the devices or to their overadvancement. Retrograde ureteroscopy allows treatment of stones in calyces parallel to the access tract. Final flexible nephroscopy and ureteroscopy optimize stone-free rates. CONCLUSIONS: ECIRS represents a safe, effective and comprehensive approach to PNL, allowing a versatile personalized stone management, and a perfect tailoring of all the intraoperative choices on the real-time situation of the patient.