J. Salvador Bayarri

Nefrectomía parcial laparoscópica transperitoneal en el tratamiento del tumor renal

Resumen La cirugia laparoscopica constituye una tecnica quirurgica que el urologo debe incorporar a su armamentario quirurgico. Su realizacion intenta simular los pasos quirurgicos de la cirugia abierta, asi como sus indicaciones. La nefrectomia parcial laparoscopica es una tecnica compleja que implica para su desarrollo una experiencia amplia en el manejo de las tecnicas endoscopicas. Presentamos nuestra experiencia de 35 nefrectomias parciales laparoscopicas transperitoneales con una media de seguimiento de 25 meses. El tiempo medio de cirugia fue de 200 minutos, el sangrado de 190 cc, y la estancia media de cinco dias. Se han objetivado dos sangrados postoperatorios, ninguna conversion y en dos casos se informo de margenes positivos, optandose por una actitud conservadora.

Historia de la robótica: de Arquitas de Tarento al Robot da Vinci. (Parte II)

HISTORY OF ROBOTICS: FROM ARCHYTAS OF TARENTUM UNTIL DA VINCI ROBOT. (PART II) Robotic surgery is a reality. In order to to understand how new robots work is interesting to know the history of ancient (see part i) and modern robotics. The desire to design automatic machines imitating humans continued for more than 4000 years. Archytas of Tarentum (at around 400 a.C.), Heron of Alexandria, Hsieh-Fec, Al-Jazari, Bacon, Turriano, Leonardo da Vinci, Vaucanson o von Kempelen were robot inventors. At 1942 Asimov published the three robotics laws. Mechanics, electronics and informatics advances at XX th century developed robots to be able to do very complex self governing works. At 1985 the robot PUMA 560 was employed to introduce a needle inside the brain. Later on, they were designed surgical robots like World First, Robodoc, Gaspar o Acrobot, Zeus, AESOP, Probot o PAKI-RCP. At 2000 the FDA approved the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a very sophisticated robot to assist surgeons. Currently urological procedures like prostatectomy, cystectomy and nephrectomy are performed with the da Vinci, so urology has become a very suitable speciality to robotic surgery.

Incidentally Detected Renal Angiomyolipoma with Tumour Thrombus into the Inferior Vena Cava

A right-renal angiomyolipoma with tumour thrombus into the inferior vena cava was incidentally detected. This is the ninth published case of its type and the second incidental case. Presence of a thrombus does not imply invasive disease, but the tumour then is often bigger than 6 cm and radical surgery is mandatory.

[Evolution of open versus laparoscopic/robotic surgery: 10 years of changes in urology].

Abstract Introduction Laparoscopic surgery has been increasingly used in urology in recent years. Laparoscopy has been performed at our center since 2001. Changes over time in the indication of open versus laparoscopic/robotic surgery, hospital stay, and learning curve are reviewed. Materials and methods A retrospective review of our database from 1997 to the end of 2007. A total of 3622 procedures were performed during this time (endoscopic procedures were excluded): 67,75% open, 26,17% laparoscopic, 2,29% perineal, and 3,78% robotic surgeries. Of these, 83,79% were performed in males and 16,20% in females. Mean patient age was 58,8 years. Data from the study period, including mean hospital stay and changes over time in operating time as a function of the learning curve, were analyzed and compared to data for the last 12 months of the study period. Results The percentages of all surgical procedures performed using a laparoscopic approach in the 1997–2006 versus the last 12 study months were as follows: nephrectomy, 31,8% versus 74,7%; living donor nephrectomy, 93% versus 100%; nephroureterectomy, 28,1% vs. 93,4%; partial nephrectomy, 31,3% vs 87%; and radical prostatectomy, 17,6% versus 73,5% including laparoscopic and robotic approaches. Shorter mean hospital stays and operating times were also seen. Conclusions Use of the laparoscopic approach has greatly increased in the 10-year period studied. In renal surgery, few indications remain for open surgery. In prostate surgery, introduction of robotic surgery in 2005 and learning of laparoscopy by several of our urologists have dramatically changed the therapeutic approach. Gradual incorporation of laparoscopic surgery has led to a decreased hospital stay and to a shortening of the learning curve.

Tumores vesicales superficiales iniciales: Nuestra experiencia.Nuestro criterio

Resumen Objetivos Evaluacion de una serie homogenea de tumores vesicales superficiales iniciales (T.V.S.I.). Utilidad de las biopsias randomizadas (BMN). Estudio de factores y grupos de riesgo y basado en ello establecer propuestas terapeuticas y de seguimiento. Material y metodos Estudio de 1.529 T.V.S.I. sometidos a RTU y BMN, seguidos una media de 4,2 anos. Tratamiento estadistico: analisis multivariante mediante la regresion de Cox y segun curvas da Kaplan-Meier. Resultados Entre las caracteristicas tumorales, destacan el alto porcentaje de tumores unicos (65%), menores de 1,5 cm (45%), de alto grado (g3: 26%) y estadio (t1: 64%). la bmn permitio demostrar cis asociado en 284 c. (19%). los principales factores de riesgo para recurrencia fueron la multiplicidad, el tamano > 3 cm y asociacion a cis. el principal riesgo de progresion fue el grado 3 (or 19,9). este y la asociacion a cis aumentan el riesgo de mortalidad. basandonos en estos datos hemos agrupado los tumores en tres grupos de bajo, medio y alto riesgo y segun ellos hemos establecido una propuesta de tratamiento y seguimiento. Conclusiones El estudio multivariante de una cohorte homogenea de 1.529 tumores vesicales superficiales iniciales, nos ha permitido agrupar los tumores segun riesgo y establecer propuestas terapeuticas y de seguimiento.