Iván Pinto

Complications in laparoscopic radical cystectomy. The South American experience with 59 cases.

OBJECTIVE In this study, we have gathered the second largest series yet published on laparoscopic radical cystectomy in order to evaluate the incidence and cause of intra and postoperative complication, conversion to open surgery, and patient mortality. MATERIALS AND METHODS From 1997 to 2005, 59 laparoscopic radical cystectomies were performed for the management of bladder cancer at 3 institutions in South America. Twenty nine patients received continent urinary diversion, including 25 orthotopic ileal neobladders and 4 Indiana pouches. Only one case of continent urinary diversion was performed completely intracorporeally. RESULTS Mean operative time was 337 minutes (150-600). Estimated intraoperative blood loss was 488 mL (50-1500) and 12 patients (20%) required blood transfusion. All 7 (12%) intraoperative complications were vascular in nature, that is, 1 epigastric vessel injury, 2 injuries to the iliac vessels (1 artery and 1 vein), and 4 bleedings that occurred during the bladder pedicles control. Eighteen (30%) postoperative complications (not counting mortalities) occurred, including 3 urinary tract infections, 1 pneumonia, 1 wound infection, 5 ileus, 2 persistent chylous drainage, 3 urinary fistulas, and 3 (5%) postoperative complications that required surgical intervention (2 hernias - one in the port site and one in the extraction incision, and 1 bowel obstruction). One case (1.7%) was electively converted to open surgery due to a larger tumor that precluded proper posterior dissection. Two mortalities (3.3%) occurred in this series, one early mortality due to uncontrolled upper gastrointestinal bleeding and one late mortality following massive pulmonary embolism. CONCLUSIONS Laparoscopic radical cystectomy is a safe operation with morbidity and mortality rates comparable to the open surgery.

Cirugía laparoscópica en el tratamiento de enfermedades adrenales:experiencia en 200 casos

Resumen Objetivo Presentamos nuestra experiencia en adrenalectomia laparoscopica, luego de 10 anos de adoptar la tecnica laparoscopica como primera opcion en la cirugia suprarrenal. Metodos Se incluyeron 200 cirugias adrenales laparoscopicas realizadas en forma consecutiva en 183 pacientes con patologia quirurgica suprarrenal entre noviembre de 1994 y noviembre de 2005. Fueron 67 (36,6%) hombres y 116 (63,4%) mujeres con una edad promedio de 49,1 anos (rango: 8 meses – 78 anos). Resultados Los diagnosticos clinicos mas frecuentes fueron hiperaldosteronismo (17,5%), cancer metastasico (15,8%), feocromocitoma (15,3%), sindrome de Cushing (7,1%), quiste adrenal (4,9%) y mielolipoma (2,7%). Se realizaron 164 adrenalectomias totales, 29 adrenalectomias parciales y 7 marsupializaciones de quistes adrenales. El tiempo operatorio promedio fue de 82,6 minutos (rango: 25-240 minutos) y el tiempo de hospitalizacion fue de 2,5 dias (rango: 1- 10 dias). El tamano de la glandula y/o tumor suprarrenal vario entre 1 y 14 cm (promedio: 5,6 cm). La tasa de complicaciones fue del 6%. En 8 pacientes ademas de la cirugia adrenal, se realizo otro procedimiento quirurgico laparoscopico: colecistectomia (2), marsupializacion de quiste renal (2), nefrectomia en bloque (2), nefrectomia parcial por tumor (1) y quistectomia pancreatica (1). A un paciente a quien se le realizo adrenalectomia laparoscopica derecha, se le practico nefrolitotomia percutanea ipsilateral en el mismo acto quirurgico. Conclusion La experiencia acumulada en 200 cirugias adrenales laparoscopicas nos ha permitido manejar satisfactoriamente patologias endocrinas como aldosteroma, feocromocitoma, sindrome de Cushing, y entidades raras como quistes y mielolipomas; ademas, extender los beneficios de un procedimiento minimamente invasivo para grandes masas adrenales y casos oncologicos seleccionados.

Laparoscopic repair of an iliac artery injury during radical cystoprostatectomy.

Laparoscopy has experienced significant growth in the last 5 years and became more popular among practicing urologists. Even though laparoscopy is considered a safe technique it is not free of complications, some of which can be devastating. Vascular injuries are the second most frequent complication during laparoscopic surgery with a reported incidence of 0.22% to 1.1%. With the standardization of surgical techniques and the increasing proficiency of the teams performing it, serious surgical complications may be corrected without the need for conversion. We report a case in which the right external iliac artery was injured while pelvic lymph node dissection was carried out before a planned laparoscopic radical cystoprostatectomy. The complication was successfully managed entirely by means of laparoscopy.

Drenaje de absceso retroperitoneal por lumboscopia: Presentación de un caso

Resumen Las publicaciones existentes evaluan el manejo de las necrosis pancreaticas infectadas. Dichas son tratadas por diversos autores en forma percutanea o por la via retroperitoneoscopica. La morbilidad y mortalidad de dicha patologia prevalece por encima de la via empleada para su resolucion dificultando la evaluacion objetiva del metodo empleado. Presentamos un caso de drenaje de una coleccion pancreatica por retroperitoneoscopia con resolucion favorable evidenciando la escasa morbilidad y las ventajas de este metodo

Complicaciones de la nefrectomía laparoscópica

Resumen Objetivos Presentamos las complicaciones en nuestra serie de nefrectomia laparoscopica y el manejo dado a cada una de ellas. Metodos Entre noviembre de 1992 y marzo de 2004, 319 pacientes fueron llevados a cirugia renal ablativa con tecnica laparoscopica: 152 mujeres y 167 hombres, con edad promedio de 45 anos (rango: 0,5 - 82 anos). Se realizaron 70 nefrectomias radicales, 16 nefroureterectomias radicales, 63 nefrectomias parciales, 124 nefrectomias simples, 15 nefroureterectomias simples, 8 heminefrectomias y 23 nefrectomias de donante vivo para trasplante. Resultados La tasa de complicaciones fue del 5,64%. Las complicaciones mas frecuentes fueron sangrado (2,5%) y hematoma retroperitoneal (1,2%). No hubo diferencia estadisticamente significativa en la tasa de complicaciones por sexo, edad o via de abordaje: transperitoneal o lumboscopica. El realizar una tecnica laparoscopica pura o con asistencia manual, no represento cambio en la tasa de complicaciones. No hubo casos de mortalidad en la serie. Conclusiones Nuestra serie de nefrectomia laparoscopica muestra una baja tasa de complicaciones. Consideramos que en manos experimentadas, la laparoscopia es una tecnica segura en pacientes que requieren cirugia renal ablativa.

Laparoscopic radical cystoprostatectomy and in block urethrectomy in urethral cancer: initial experience in 2 cases.

We introduce laparoscopic radical cystoprostatectomy and in block urethrectomy as an option for the treatment of urethral cancer in men. Using a 5-port transperitoneal approach, a radical cystoprostatectomy is completed laparoscopically with bilateral iliac and pelvic lymphadenectomy. Urethrectomy and extraction of bladder and prostate is performed through a perineal incision. A segment of ileum is isolated and exteriorized to create an extracorporeal ileal conduit and restore ileo-ileal continuity by open standard technique. Bilateral stented uretero-ileal anastomosis is extracorporeally performed. Total operative time ranges from 4.5 to 4.8 hours. Laparoscopic radical cystoprostatectomy with perineal urethrectomy and an extracorporeally made ileal conduit is a feasible technique that can be reproduced. To our knowledge, this is the first report of laparoscopic radical surgery in the treatment of urethral cancer in men.

V5-10 RIGHT RADICAL NEPHRECTOMY WITH DISSECTION OF THROMBUS IN THE INFERIOR VENA CAVA LEVEL III

INTRODUCTION AND OBJECTIVES: The renal cell carcinoma has a known tendency to spread forming tumor thrombus to the renal vein or inferior vena cava (4-10%) The level that reach the tumor, it’s in direct relation with the 5-years survival METHODS: We show a case of a male 58 years old patient with history of diabetes and smoking. The patient complains of hematuria that started ten months ago. In the general lab work, the patient was anemic with a hemoglobin of 8 gr/dL and a serum creatinine of 1.1 mg/mL. The CT-Scan showed an 18 cm right kidney tumor with a thrombus in the inferior vena cava up to the diaphragm (Level III) with no seen metastatic disease or malignant lymphnodes Anterior open nephrectomy was performed, followed by control of inferior vena cava which it’s open entirely to perform the thrombectomy. RESULTS: The estimated operative time was 260 minutes, with a bleeding of 1600ml, requiring 3 units of blood during the surgery. No complications was reported. The post-op management was in the ICU for only 24 hours, with a total of length of stay of 5 days. The patient evolved without any complication, showing in the control lab, a serum creatinine of 1.3 mg/dL. To the date there is no evidence of residual disease, clinical nor in the images. CONCLUSIONS: The radical nephrectomy it’s the standard of care in the, level III inferior vena cava thrombus, in the setting of kidney cancer. It should be done in patients in conditions to have surgery.

Diagnostic capability of prostate multiparametric magnetic resonance in prediction of cancer and histological grade.

161 Background: The prostatic multiparametric MRI (mpMRI) can enhance the performance of the prostate core biopsy to detect cancer. The objective of this study is to assess the capability of MpMRI to identify high- and intermediate-risk prostate cancer. Methods: Prospective cohort. MpMRI was performed to patients with TRUS-guided biopsy indication prior to the biopsy. Diffusion, PIRADS, DCE and T2 parameters were observed on the MRI, and the presence of cancer and Gleason score on the biopsy. The results were divided between no cancer, and presence of cancer Gleason 6 or higher. Logistic regression test was performed with a 95% confidence interval. We assigned different values, depending on the importance of each factor, applying binominal regression. Ordinal regression was then performed and Odds ratio calculated. Results: Seventy three patients met the described criteria. Cancer detection rate was 60.27% (44 patients). Seventeen of these patients were Gleason score six. The calculated score, gave 7 poin...

Diagnostic capability of multiparametric MRI in patients with transrectal prostate biopsy

155 Background: The prostatic multiparametric MRI (mpMRI) is the combination of anatomical imaging and functional sequences. Nowadays this technique is still being researched due to its positive published results. The objective of this study is to show our experience in the application of the mpMRI in patients, prior to the TRUS-guided biopsy, and the sensitivity and specificity of its measured parameters and their combination. Methods: Prospective cohort. MpMRI was indicated to patients prior to the TRUS-Guided biopsy. Diffusion, PIRADS, DCE and T2 parameters were observed on the MRIs, and the presence of cancer and Gleason score on the biopsy. Logistic regression test was performed with a 95% confidence interval. We assigned different values, depending of the importance of each factor, applying binominal regression. Results: We registered 73 patients with mpMRI prior to the TRUS-Guided Biopsy, and their results. The cancer detection rate was 60.27% (44 patients). The T2 signal had a sensibility of 81.82...

Vías no realizadas en el cine político chileno: Parodia, extrañamiento y reflexividad

Resumen es: En el marco de un convulsionado periodo politico que llevara al golpe de estado de 1973, el cine chileno enfatiza la pregunta por su funcion como generad...