Jorge A Hoyos

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.

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.

Papiloma invertido vesical

Objetives: To report a series of patients with bladder inverted papilloma, pointing out the clinical features, presentations, treatment options and outcomes....