Isabel Galante Romo

Long-term outcomes after robotic sacrocolpopexy in pelvic organ prolapse: prospective analysis.

OBJECTIVE To evaluate the feasibility and long-term outcomes of our initial series of robot-assisted laparoscopic sacrocolpopexy. METHODS We conducted a prospective analysis of our series of robotic sacrocolpopexy. INCLUSION CRITERIA patients with grades III and IV cystocele and or other symptomatic pelvic organ prolapse. We performed a transperitoneal four-trocar technique with the Da Vinci robotic system using two polypropylene meshes for fixation to the sacral promontory. The primary outcome was recurrence; secondary outcomes included operating room time, blood loss, conversion to open surgery, complications and length of stay. RESULTS 31 consecutive procedures were included. Mean patient age was 65.2 (50-81) years. Mean operating room time was 186 (150-230) min. We converted 1 case to laparoscopy (3.2%). There were two major complications (1 acute myocardial infarction and 1 reoperation for excess tension with syncopes), two minor complications (1 wound infection and 1 ileus) and no recurrences at a mean follow-up of 24.5 (16-33) months. CONCLUSIONS Robotic sacrocolpopexy could possibly improve with experience after overcoming the learning curve. There is no doubt it is a reproducible technique, but its safety and efficacy still need to be proven. Our initial series demonstrated good outcomes and no recurrences at 24.5 months of follow-up.Objective: To evaluate the feasibility and long-term outcomes of our initial series of robot-assisted laparoscopic sacrocolpopexy. Methods: We conducted a prospective analysis of our series of robotic sacrocolpopexy. Inclusion criteria: patients with grades III and IV cystocele and or other symptomatic pelvic organ prolapse. We performed a transperitoneal four-trocar technique with the Da Vinci robotic system using two polypropylene meshes for fixation to the sacral promontory. The primary outcome was recurrence; secondary outcomes included operating room time, blood loss, conversion to open surgery, complications and length of stay. Results: 31 consecutive procedures were included. Mean patient age was 65.2 (50–81) years. Mean operating room time was 186 (150–230) min. We converted 1 case to laparoscopy (3.2%). There were two major complications (1 acute myocardial infarction and 1 reoperation for excess tension with syncopes), two minor complications (1 wound infection and 1 ileus) and no recurrences at a mean follow-up of 24.5 (16–33) months. Conclusions: Robotic sacrocolpopexy could possibly improve with experience after overcoming the learning curve. There is no doubt it is a reproducible technique, but its safety and efficacy still need to be proven. Our initial series demonstrated good outcomes and no recurrences at 24.5 months of follow-up.

Prognostic significance of circulating tumor cell count in patients with metastatic hormone-sensitive prostate cancer.

OBJECTIVE To analyze the correlation between circulating tumor cell (CTC) levels and clinicopathologic parameters (prostate-specific antigen level, Gleason score, and TNM stage) in patients with metastatic hormone-sensitive prostate cancer (PCa) and to establish its prognostic value in overall survival (OS) and progression-free survival (PFS). MATERIALS AND METHODS A prospective, 3-arm study was performed that included 30 patients with localized PCa; 30 patients with metastatic PCa, and 30 healthy volunteers. A single 7.5-mL peripheral blood sample was taken. The CTCs were isolated using an immunomagnetic method based on the CellSearch system. Kendalls tau and Spearmans rho coefficients of correlation were used. The multivariate Cox regression model addressed OS and PFS. RESULTS The median follow-up was 42.9 months (interquartile range 27.14-49.5). A significant positive correlation was demonstrated between the CTC level and all tumor burden markers (prostate-specific antigen and T, N, and M stage; P <.001), except for Gleason score (tau = 0.16). A cutoff of ≥ 4 CTCs/7.5 mL was chosen to distinguish patients with a poor prognosis. These patients had a significantly shorter median OS and PFS (24 vs 45 months and 7 vs 44 months, respectively; P <.001). As the CTC level increased, the OS and PFS decreased. The risk of mortality and progression for the patients with ≥ 4 CTCs was 4.1 (P = .029) and 8.5 (P <.001) times greater. Multivariate analyses indicated that a CTC of ≥4 was an independent prognostic factor for PFS (hazard ratio 5.9, P <.005). CONCLUSION The CTC count in peripheral blood could provide a method of staging PCa correctly and be of value when assessing the prognosis of metastatic hormone-sensitive PCa.

Colposacropexia laparoscópica asistida por robot como tratamiento del prolapso urogenital

Laparoscopic colposacropexy has become a substitute for open surgery in the treatment of pelvic organ prolapse. In the same way, robotic assisted surgery is a new step in the evolution of the procedure. In this paper we intend to show our surgical technique and preliminary results. From November 2006 to date, 10 patients have undergone this procedure at the Hospital Clinico San Carlos. The main indication for the operation was existence of symptomatic pelvic prolapse. Both patients with or without hysterectomy have been operated, without making significant differences between them. Preoperative evaluation workout included: cystogram, urinary tract ultrasound and urodynamics in all cases; urinary tract MRI was performed only in selected cases. All patients underwent surgery under general anesthesia, with at least three robotic trocars (8 mm) and one conventional trocar for the assistant; 2 accessory trocars were necessary in some cases, mainly at the beginning of the series. Most procedures in our series were associated with a transobturator suburethral sling for the treatment of stress urinary incontinence or prevention of its appearance after prolapse repair. Our results are comparable to those reported in other larger series in terms of operative time, hospital stay and early or late complications. Pending an evaluation on the long term with larger series, we can include robot assisted colposacropexy among the therapeutic options for symptomatic pelvic floor prolapse repair.Laparoscopic colposacropexy has become a substitute for open surgery in the treatment of pelvic organ prolapse. In the same way, robotic assisted surgery is a new step in the evolution of the procedure. In this paper we intend to show our surgical technique and preliminary results. From November 2006 to date, 10 patients have undergone this procedure at the Hospital Clinico San Carlos. The main indication for the operation was existence of symptomatic pelvic prolapse. Both patients with or without hysterectomy have been operated, without making significant differences between them. Preoperative evaluation workout included: cystogram, urinary tract ultrasound and urodynamics in all cases; urinary tract MRI was performed only in selected cases. All patients underwent surgery under general anesthesia, with at least three robotic trocars (8 mm) and one conventional trocar for the assistant; 2 accessory trocars were necessary in some cases, mainly at the beginning of the series. Most procedures in our series were associated with a transobturator suburethral sling for the treatment of stress urinary incontinence or prevention of its appearance after prolapse repair. Our results are comparable to those reported in other larger series in terms of operative time, hospital stay and early or late complications. Pending an evaluation on the long term with larger series, we can include robot assisted colposacropexy among the therapeutic options for symptomatic pelvic floor prolapse repair.OBJETIVOS La colposacropexia laparoscopica es una tecnica que ha venido a sustituir a la cirugia abierta para el tratamiento de los prolapsos del suelo pelvico. De la misma manera, la cirugia asistida por robot supone un nuevo paso en la evolucion de la tecnica. En este articulo pretendemos mostrar, tanto nuestra tecnica quirurgica como los resultados preliminares obtenidos con la misma. En el Hospital Clinico San Carlos han sido intervenidas con esta tecnica un total de 10 pacientes, desde Noviembre de 2006 hasta la fecha. La principal indicacion en nuestro caso ha sido la presencia de prolapsos pelvicos sintomaticos, habiendose intervenido tanto pacientes histerectomizadas como no histerectomizadas, sin poder establecer diferencias significativas entre ambos casos. Como estudio preoperatorio se ha incluido: Cistografia, Ecografia Reno-vesical, Estudio Urodinamico en todos los casos, y tan solo en aquellos en los que se ha considerado oportuno una Uro-Resonancia. Todas las pacientes han sido intervenidas bajo anestesia general, mediante colocacion de un minimo de tres trocares roboticos (8mm) y uno convencional para el ayudante, aunque en algunos casos, sobretodo al inicio de la serie se precisaron 2 trocares accesorios. Asi mismo, en nuestra serie en la mayoria de los casos se ha asociado una tecnica anti-incontinencia tipo sling suburetral transobturatriz, bien para tratamiento de la incontinencia urinaria de esfuerzo (IUE), bien para prevenir su posible aparicion tras la correcion del prolapso. Los resultados obtenidos son comparables a los descritos en otras series mas numerosas en cuanto a duracion, estancia hospitalaria y complicaciones tanto precoces como tardias. A expensas de realizar una valoracion a largo plazo y con series mas amplias, podemos incluir la colposacropexia laparoscopica asistida por robot entre el arsenal terapeutico disenado para la reparacion de los prolapsos del suelo pelvico sintomaticos.

Surgical Repair and Analysis of Penile Fracture Complications

BACKGROUND The objective of this study is to describe and analyze the experience over a period of 10 years at our center through a retrospective study of a series of diagnosed and treated cases of penile fracture. MATERIAL AND METHODS From 2005 to 2009 the Urology Department of the Hospital Clínico San Carlos of Madrid carried out a retrospective case study of a total of 15 cases of penile fracture. The diagnosis was reached through physical exploration of the patient aided by a penile ultrasound; the immediate treatment performed on the patients was emergency surgical repair. RESULTS From the total in the series (n = 15), only 1 case was associated with a complete urethral fracture (6.6%). Surgical repair was performed in all cases; the average hospital stay was 2.6 days (range 1-5), and the most frequent long-term complication was erectile dysfunction in 3 of 15 cases (20%). CONCLUSIONS A penis fracture diagnosis is mostly clinical; complementary tests, such as ultrasound, are helpful but not definitive. Surgical treatment consists of an incision that allows adequate exposure of the corpora cavernosa and urethra to repair the suspected lesions found upon diagnosis. Ambulatory follow-up is essential to diagnose and treat possible complications.Background: The objective of this study is to describe and analyze the experience over a period of 10 years at our center through a retrospective study of a series of diagnosed and treated cases of penile fracture. Material and Methods: From 2005 to 2009 the Urology Department of the Hospital Clinico San Carlos of Madrid carried out a retrospective case study of a total of 15 cases of penile fracture. The diagnosis was reached through physical exploration of the patient aided by a penile ultrasound; the immediate treatment performed on the patients was emergency surgical repair. Results: From the total in the series (n = 15), only 1 case was associated with a complete urethral fracture (6.6%). Surgical repair was performed in all cases; the average hospital stay was 2.6 days (range 1–5), and the most frequent long-term complication was erectile dysfunction in 3 of 15 cases (20%). Conclusions: A penis fracture diagnosis is mostly clinical; complementary tests, such as ultrasound, are helpful but not definitive. Surgical treatment consists of an incision that allows adequate exposure of the corpora cavernosa and urethra to repair the suspected lesions found upon diagnosis. Ambulatory follow-up is essential to diagnose and treat possible complications.

Nuevo sling masculino "Argus" para el tratamiento de la incontinencia urinaria de esfuerzo

Resumen es: Objetivos: La incontinencia urinaria masculina de esfuerzo, habitualmente se produce como consecuencia o secuela de una intervencion quirurgica prostatic...

Cabestrillo de tensión regulable "Remeex" en el tratamiento de la incontinencia urinaria femenina: Técnica quirúrgica personal

Objectives: Currently, there is not agreement about the adequate tension for each patient with female stress urinary incontinence treated with urethral sling...

Multidisciplinary development of robotic surgery in a University Tertiary Hospital: Organization and outcomes

Background: Da Vinci system (Intuitive Surgical ® ) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation…) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in

Desarrollo multidisciplinario de la cirugía robótica en un hospital universitario de tercer nivel: organización y resultados

Background Da Vinci system (Intuitive Surgical®) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation…) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC.BACKGROUND Da Vinci system (Intuitive Surgical) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation...) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC. MATERIAL AND METHODS Starting from joint management and joint scrub nurses team, General and Digestive Surgery, Urology and Gynaecology Departments were progressively incorporated into the Robotic Surgery Plan, with several procedures increasing in complexity. A number of intra and extra-hospital teaching and information activities were planned to report on the Robotic Surgery Plan. RESULTS Between July 2006 and July 2008, 306 patients were operated on: 169 by General Surgery, 107 by Urology and 30 by Gynaecology teams. The outcomes showed feasibility and a short learning curve. The educational plan included residents and staff interested in robotic technology application. CONCLUSION The structured and gradual incorporation of robotic surgery throughout the PCR-HCSC has made it easier to learn, to share designed infrastructure, to coordinate information activities and multidisciplinary collaboration. This preliminary experience has shown the efficiency of an adequate organization and motivated team.

OriginalDesarrollo multidisciplinario de la cirugía robótica en un hospital universitario de tercer nivel: organización y resultadosMultidisciplinary development of robotic surgery in a University Tertiary Hospital: Organization and outcomes

Background Da Vinci system (Intuitive Surgical®) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation…) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC.BACKGROUND Da Vinci system (Intuitive Surgical) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation...) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC. MATERIAL AND METHODS Starting from joint management and joint scrub nurses team, General and Digestive Surgery, Urology and Gynaecology Departments were progressively incorporated into the Robotic Surgery Plan, with several procedures increasing in complexity. A number of intra and extra-hospital teaching and information activities were planned to report on the Robotic Surgery Plan. RESULTS Between July 2006 and July 2008, 306 patients were operated on: 169 by General Surgery, 107 by Urology and 30 by Gynaecology teams. The outcomes showed feasibility and a short learning curve. The educational plan included residents and staff interested in robotic technology application. CONCLUSION The structured and gradual incorporation of robotic surgery throughout the PCR-HCSC has made it easier to learn, to share designed infrastructure, to coordinate information activities and multidisciplinary collaboration. This preliminary experience has shown the efficiency of an adequate organization and motivated team.

Utilidad del láser en el tratamiento de las estenosis uretrales.

OBJETIVOS Describir la utilidad de la energia laser en las estenosis uretrales, fundamentalmente recurrentes y analizar la experiencia existente con los diferentes tipos de laser (diodo, Nd:Yag, Holmium, KTP, Argon, etc). METODOS Hemos realizado una revision sistematica de la bibliografia, basada en una busqueda en Medline y analisis detallado de los articulos seleccionados. CONCLUSIONES 1). El uso del laser en el tratamiento de las estenosis uretrales se revela por el momento como una alternativa valida, eficaz y segura, al menos a medio plazo, a la uretrotomia optica; sin embargo por el momento no se ha demostrado que sea mejor que esta. 2). La eleccion del tratamiento es cirujano dependiente, y ninguna tecnica ha mostrado claramente ser superior a las demas. 3). Se precisan estudios prospectivos a largo plazo, con un mayor numero de pacientes y con mayor seguimiento. 4). La tecnologia laser es cara y no esta disponible en todos los centros.