Jesús Cisneros Ledo
Hospital Universitario La Paz
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BJUI | 2010
Mario Álvarez Maestro; Ángel Tabernero Gómez; Sergio Alonso y Gregorio; Jesús Cisneros Ledo; Javier de la Pena Barthel; Luis Martínez-Piñeiro
To report our experience with laparoscopic radical prostatectomy (LRP) for the treatment of localized prostate carcinoma in two renal transplant recipients and a review of the literature.
Central European Journal of Urology 1\/2010 | 2015
Pamela Portella Fontana; Sergio Alonso y Gregorio; Juan Gómez Rivas; Leslie Cuello Sánchez; Jesús Cisneros Ledo; Ángel Tabernero Gómez; Jesús Díez Sebastián; Jesús Javier de la Peña Barthel
Introduction Radical cystectomy in elderly patients is a controversial issue that has noticed an increase in importance overtime because of the lengthening average life span. Our objective was to determine if there were significant differences in the perioperative outcomes of patients over 70 years with bladder cancer treated with laparoscopic radical cystectomy (LRC) compared to those of younger patients. Material and methods We selected 180 patients who underwent LRC in our department in the period between 2005-2012. We divided them into 2 groups: 57% <70 years and 43% >70 years, and we compared the different parameters such as: comorbidities, intraoperative and post-operative complications, TNM stage and overall survival. Results The group <70 years had less comorbidities when compared with the group >70 years. Heterotopic urinary diversion was the diversion of choice in the elderly patients (97.4%). Paralytic ileus and the worsening of renal function were the only complications with statistical differences between the groups. Mean hospital length of stay was not significantly different between the groups. Younger and older patients had similar pathological staging : pT1 or less: 26,2 vs. 18.2%, pT2: 19.4 vs. 16.9%, pT3 38.8 vs. 37.7% and pT4 15.6 vs. 17.2%. Kaplan-Meier curves did not show significant differences in survival. Conclusions Laparoscopic radical cystectomy in the elderly patient has similar rates of perioperative morbidity when compared with the younger patient and may be offered as a treatment option in selected elderly patients.
Central European Journal of Urology 1\/2010 | 2014
Sergio Alonso y Gregorio; Juan Gómez Rivas; Susana Sánchez Molina; Ángel Tabernero Gómez; Jesús Cisneros Ledo; Jesús Díez Sebastián; Jesús Javier de la Peña Barthel
Introduction In the last decade, we have seen the advance of laparoscopic surgery in urology. All laparoscopic procedures in our department are performed by staff members and are assisted by a single resident, ensuring resident training in laparoscopic surgery. The aim of this study is to evaluate the results of the Hospital La Paz training program for residents in the field of laparoscopic surgery. Material and methods We have done a retrospective review of LRP performed by the residents in our department. We also evaluated different variables. Descriptive statistical analysis was done and the results were compared with the descriptive analysis of the initial series of our department. Results We reviewed 82 patients, with an average age of 61.6 years. Most cases were pT1c at diagnosis. Average surgical time was 288 minutes, with a transfusion rate of 9.7% and a intra and postoperative complication rates of 1.2% and 7.3%. The mean hospital stay was 3.3 days. Histological results of this series are: 76.8% of pT2 and 23.2% of pT3. The biochemical relapse rate is 15.8%. Global surgical margin rate is 20.7%. The global continence rate is 52.4%. Conclusions The outcomes of LRP performed by residents are similar to the ones reported in the initial series of our department. The fact that 84.6% of the residents formed in this period actually belong to different laparoscopic units supports the success of La Paz Hospital training model.
Central European Journal of Urology 1\/2010 | 2013
Juan Gómez Rivas; Sergio Alonso y Gregorio; María Portilla Eastmond; Ángel Tabernero Gómez; Jesús Cisneros Ledo; Luis Hidalgo Togores; Jesús Javier de la Peña Barthel
Introduction Laparoscopic pyeloplasty was first described by Schuessler. During the last decade, this technique has been developed in order to achieve the same results as open surgery, with lower rates of morbidity and complications. In this study we review our experience using laparoscopic pyeloplasty as the gold standard for the treatment of the ureteropelvic junction obstruction (UPJO). Material and methods We performed a retrospective review of 62 laparoscopic pyeloplasties carried out at our center. In the last 2 years we used 3 mm and 5 mm ports in order to achieve better cosmetics results. Demographic data is described and the functionality of the affected kidney and surgical data, among others were analyzed statistically. In the case of bilateral statistical tests were considered significant as those with p values <0.05. Results The most frequent reason for consultation was ureteral pain. Patients mean age was 40 years and 94% of them had preoperative renogram showing a full or partial obstructive pattern. The right side was affected in 61% of cases and the left in the remaining 39%. The presence of stones was observed in 12 patients and crossing vessels in 58% of cases. The average stay was 3.72 days. Post–surgery complications were observed in two patients. The operative time was 178 minutes. Mean follow–up was 45 months and a success was achieved in 91%. Conclusions The transperitoneal laparoscopic pyeloplasty has become the gold standard for the treatment of ureteropelvic junction stenosis in our center because of high success rate, shorter postoperative stay, and low intra and postoperative complications.
Current Urology | 2012
Manuel Pérez-Utrilla Pérez; Alfredo Aguilera Bazán; Jose Maria Alonso Dorrego; Rebeca Vitón Herrero; Jesús Cisneros Ledo; Javier de la Pena Barthel
Introduction: It is not unusual for bladder tumors to appear following transitional cell carcinoma of the upper urinary tract (UUT), with involvement of the UUT, following invasive bladder cancer, being less common. The synchronous presence of transitional cell carcinoma of the bladder and of the UTT is exceptional. Methods: Fifteen simultaneous cystectomies with nephroureterectomies were performed due to synchronous UUT and invasive bladder cancers (1997–2009). Surgery was performed using an open approach in 10 patients, while the last 5 procedures were performed laparoscopically. Results: The mean age was 68.7 years. Mean surgery time was 348.6 minutes. Mean blood loss was 816 ml. Acute renal failure was the most frequent postoperative complication being present in 5 patients (33%). There was 1 case of a leak in the ureter-intestinal anastomosis (open approach), which required placement of a left-sided percutaneous nephrostomy. There were 2 cases of postoperative mortality, both in the open approach series and with intestinal neobladder. Mean follow-up time for the whole series was 21.25 months. Eight cases experienced metastatic progression of the disease (mean follow-up 17 months). Conclusion: Though multi-site studies with longer follow-up and a greater numbers of patients are needed, the moment at which urothelial tumors appear seems to influence their prognosis, with lower survival rates for tumors that synchronically appear.Introduction: It is not unusual for bladder tumors to appear following transitional cell carcinoma of the upper urinary tract (UUT), with involvement of the UUT, following invasive bladder cancer, being less common. The synchronous presence of transitional cell carcinoma of the bladder and of the UTT is exceptional. Methods: Fifteen simultaneous cystectomies with nephroureterectomies were performed due to synchronous UUT and invasive bladder cancers (1997–2009). Surgery was performed using an open approach in 10 patients, while the last 5 procedures were performed laparoscopically. Results: The mean age was 68.7 years. Mean surgery time was 348.6 minutes. Mean blood loss was 816 ml. Acute renal failure was the most frequent postoperative complication being present in 5 patients (33%). There was 1 case of a leak in the ureter-intestinal anastomosis (open approach), which required placement of a left-sided percutaneous nephrostomy. There were 2 cases of postoperative mortality, both in the open approach series and with intestinal neobladder. Mean follow-up time for the whole series was 21.25 months. Eight cases experienced metastatic progression of the disease (mean follow-up 17 months). Conclusion: Though multi-site studies with longer follow-up and a greater numbers of patients are needed, the moment at which urothelial tumors appear seems to influence their prognosis, with lower survival rates for tumors that synchronically appear.
Archivos españoles de urología | 2007
Alfredo Aguilera Bazán; Sergio Alonso y Gregorio; Manuel P. Utrilla; Ramón Cansino Alcaide; Jesús Cisneros Ledo; Javier de la Peña
OBJETIVOS El principal reto de la nefroureterectomia laparoscopica es el manejo del ureter distal que ademas tendra una repercusion importante en el resultado oncologico en muchos de los casos. Presentamos nuestra experiencia en este aspecto, teniendo en cuenta que las 5 ultimas nefroureterectomias laparoscopicas las hemos realizado con una posicion de Trendelemburg forzado, lo que ha supuesto un manejo mas comodo y seguro del ureter distal. METODOS Desde agosto hasta diciembre de 2006 se han realizado 5 nefroureterectomias con rodete vesical puramente laparoscopico con el paciente en posicion de Trendelemburg forzado, muy similar a la posicion empleada en las cistectomias o prostatectomias radicales laparoscopicas. RESULTADOS El tiempo quirurgico medio es de 182 minutos (170-210). El sangrado medio intraoperatorio es de 100cc y ninguno de estos pacientes ha precisado transfusion. El tiempo hospitalario medio es de 4 dias. CONCLUSIONES Creemos que esta posicion es una buena alternativa para el manejo del ureter distal en el abordaje laparoscopico. Se trata de una tecnica muy similar a la cirugia abierta, que hoy por hoy continua siendo el gold Standard.
Central European Journal of Urology 1\/2010 | 2015
Juan Gómez Rivas; Sergio Alonso y Gregorio; Leslie Cuello Sánchez; Pamela Fontana Portella; Ángel Tabernero Gómez; Jesús Cisneros Ledo; Jesús Díez Sebastián; Jesús Javier de la Peña Barthel
Introduction The treatment of ureteropelvic junction has evolved considerably over the past 20 years, resulting in new surgical techniques, but traditional open surgery remains the gold standard treatment. Currently, less invasive techniques are used for the treatment of ureteropelvic junction obstruction. The purpose of our study is to compare the surgical and functional results between laparoscopic and open pyeloplasty performed at our department during the last 12 years. Material and methods This is a retrospective review of 92 cases performed in a period of 12 years. Two groups were compared: 30 patients were treated with open surgery (OP) and 62 with a laparoscopic approach (LP). Demographics, clinical presentation, functionality of the affected kidney, presence of polar vessels, kidney stones, hospital stay, complications and functional results were statistically analyzed. Results The mean age was 42 years. The most common clinical presentation was kidney or ureteral pain: 60% (OP) vs. 52% (LP). The right side was affected in 59%; presence of crossing vessels was 47% (OP) vs. 58% (LP); presence of kidney stones was 20% (OP) vs. 19% (LP), with an average hospital stay of 5.86 days (OP) vs. 3.36 days (LP) p <0.05. Post-operative complications were observed in 3 (OP) vs. 5 (LP) patients, with a success rate comparable between groups. Conclusions In our department, we recommend LP as the standard treatment for ureteropelvic junction obstruction because of the equal success rate compared to OP and the benefits of a minimally invasive surgery.
Actas Urologicas Espanolas | 2009
Sergio Alonso; Gregorio; Susan M. Sanchez; C. Soler; A. Rando; Manuel Giron; J. Ángel Tabernero Gómez; Alfredo Aguilera; Jesús Cisneros Ledo; Javier de la Pena Barthel
Resumen Introduccion La cirugia retroperitoneal constituye la indicacion mas indiscutible para el abordaje laparoscopico. Todavia persisten indicaciones de cirugia abierta en funcion de la complejidad del caso y de la experiencia del cirujano. Objetivos El objetivo principal es comunicar nuestra experiencia de nefrectomia radical laparoscopica en pacientes con tumores ?7 cm o con piezas quirurgicas cuyo peso haya sido ?700 g. Analizaremos sus caracteristicas, la tasa de complicaciones intraoperatorias, el tiempo quirurgico, el curso postoperatorio asi como la estancia postoperatoria. Material y metodos Desde julio del 2004 hasta julio del 2008 hemos realizado un total de 104 nefrectomias radicales laparoscopicas. Hemos seleccionado un subgrupo de 41 pacientes con criterios de pieza quirurgica de gran tamano. Resultados El tiempo quirurgico medio ha sido de 184,3 minutos. Hemos tenido un caso de reconversion a cirugia abierta y un fallecimiento intraoperatorio por causa cardiologico. La estancia media global ha sido de 3,51 dias. La tasa de complicaciones y el curso postoperatorio son comparables a toda la serie. Discusion La nefrectomia laparoscopica es tecnicamente menos compleja que la prostatectomia radical laparoscopica. Sin embargo, sus posibles complicaciones entranan una gravedad mucho mayor. Los casos mas complejos han de ser abordados por via laparoscopica solo cuando existe una dilatada experiencia. En general, en nuestro centro relegamos a cirugia abierta las piezas que sobrepasan la linea media y los casos con trombo tumoral que afecte a la vena renal principal y a la VCI.
Central European Journal of Urology 1\/2010 | 2016
Juan Gómez Rivas; Sergio Alonso y Gregorio; Ángel Tabernero Gómez; M. Alvarez-Maestro; Jesús Díez Sebastián; Jesús Cisneros Ledo
Introduction In 2008, our department introduced a modified technique of laparoscopic radical cystectomy in which the prostatic capsule is spared in selected patients with bladder cancer. The different series published are mostly using the standard open procedure. The aim of this study is to describe this technique using the laparoscopic approach and present our preliminary results. Material and methods This study includes 20 patients selected by clinical analysis and imaging criteria operated using laparoscopic radical cystectomy with prostate capsule sparing at our department in the period between 2008 and 2012. Results Patient mean age was 58 years. Mean operative time was 390 minutes. Median follow-up was 36 months. No patient had bladder cancer recurrence. Only one patient died of disease progression, as the pathological findings was a pT3 pN1 Mx. Mean PSA before surgery: 1.3 ng/ml (03–2), mean PSA after surgery 1.0 ng/ml (0.08–1.7). No patients had prostate cancer recurrence. Satisfactory daytime and night-time continence was achieved. 90% of patients have sexual function preserved. Conclusions Prostate-sparing radical cystectomy remains one of the most controversial topics in urology today. The laparoscopic approach could be an alternative to conventional radical cystoprostatectomy in well selected patients, done in experienced institutions in order to find better functional results, with a low disease progression and recurrence rate.
Central European Journal of Urology 1\/2010 | 2013
Sergio Alonso y Gregorio; Juan Gómez Rivas; Leslie Cuello Sánchez; Ángel Tabernero Gómez; Jesús Cisneros Ledo; Luis Hidalgo Togores; Jesús Javier de la Peña Barthel
We present what is to our knowledge, the first case of laparoscopic ureteral reimplantation reported in the renal transplant. The ureteral stenosis is one of the most difficult renal transplant complications to deal with. With the development of the endourological approach, this treatment has become the first treatment option for these patients. The patient is a 28-year-old female who received a renal allograft from a cadaver donor in 2008. Ureteral stenosis was diagnosed. The laparoscopic approach seems to be a good option over the open approach, with the benefits related with laparoscopic surgery.