Julien Vincent G. A. Schwartz

High‐power potassium‐titanyl‐phosphate laser fibres for endovaporization of benign prostatic hyperplasia: how much do they deteriorate during the procedure?

Study Type – Therapy (case series)

[Robot-assisted surgery in urology].

Since 1990, laparoscopic surgery has undergone a tremendous evolution. As patients and surgeons alike push toward minimally invasive surgery, more and more complex operations have been performed by laparoscopy. However, highly complex and technically demanding procedures--such as radical prostatectomy--have revealed the limits of classical laparoscopic surgery. The introduction of the Da Vinci robot has changed the face of modern laparoscopy because it provides the surgeon with three-dimensional vision, more instrumental degrees of freedom, and greater ergonomics. Thus, laparoscopy has been able to strengthen its role in urology and is increasingly being used for radical prostatectomies, pyeloplasties, and ureteral operations such as ureterovesical reimplantations. For most types of operations, functional and early oncological outcomes appear similar to those of conventional laparoscopy or open surgery. The main drawbacks of robotic surgery are the costs of the disposable instruments and maintenance, which overshadow the initial purchase price. The near future will show how European health systems will react to this new financial burden. Our institution, within a university hospital with moderate patient recruitment, was equipped with a four-arm Da Vinci robot in February 2006. As of April 2008, 120 urological operations had been performed. Because robotic surgery is associated with a specific learning curve, divisions with limited case numbers may refrain from doing this type of surgery. The aim of this article is to evaluate the feasibility and efficiency of the initial period of a robotic program in a midsize division.

Roboterassistierte Operationen in der Urologie

Since 1990, laparoscopic surgery has undergone a tremendous evolution. As patients and surgeons alike push toward minimally invasive surgery, more and more complex operations have been performed by laparoscopy. However, highly complex and technically demanding procedures--such as radical prostatectomy--have revealed the limits of classical laparoscopic surgery. The introduction of the Da Vinci robot has changed the face of modern laparoscopy because it provides the surgeon with three-dimensional vision, more instrumental degrees of freedom, and greater ergonomics. Thus, laparoscopy has been able to strengthen its role in urology and is increasingly being used for radical prostatectomies, pyeloplasties, and ureteral operations such as ureterovesical reimplantations. For most types of operations, functional and early oncological outcomes appear similar to those of conventional laparoscopy or open surgery. The main drawbacks of robotic surgery are the costs of the disposable instruments and maintenance, which overshadow the initial purchase price. The near future will show how European health systems will react to this new financial burden. Our institution, within a university hospital with moderate patient recruitment, was equipped with a four-arm Da Vinci robot in February 2006. As of April 2008, 120 urological operations had been performed. Because robotic surgery is associated with a specific learning curve, divisions with limited case numbers may refrain from doing this type of surgery. The aim of this article is to evaluate the feasibility and efficiency of the initial period of a robotic program in a midsize division.

S&T-26 COMBINED INGUINAL HERNIA REPAIR WITH A SYNTHETIC MESH DURING ROBOT ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVES: About 10 % of patients undergoing radical prostatectomy (RP) present with an inguinal hernia. Its cure simultaneously with RP remains a concern with respect to the type of technique, and the risk to infect an eventual mesh The aim of this study was to evaluate the feasability, morbidity and efficacy of combined inguinal hernia synthetic mesh repair during robot assisted radical prostatectomy (RARP). METHODS: 526 medical records of patients who underwent transperitoneal RARP from 2006 to 2015 were reviewed. Demographics and peri-operative datas were analyzed for two groups (RARP alone vs RARP and hernia repair). Pre-operative iv cefazoline and gentamycine was given to all patients. Cure was performed using a polyester mesh (Parietex Covidien, New Haven, USA), placing the porous side against the wall for an efficient tissue integration, and the smooth side facing the structures on which tissular attachment had to be limited. The mesh was cut in a rectangle of approximately 10x8 cm or 18x8 cm for respectively unilateral and bilateral cures, and was anchored with absorbable staples (Absorbatack e Covidien), so as non absorbable sutures around the iliac vessels. Early complications were classified using ClavienDindo classification. Hernia recurrence was assessed during regular follow-up, or self-reported by patients. RESULTS: 49 patients (9 %) had a hernia repair associated with RARP (35 unilateral and 14 bilateral). Median age, BMI and ASA score were the same in both groups. Total operative time was 278 min for RARP vs 290 min for combined procedure. Post-operative length of stay (median 4 days) and blood loss were not affected by the combined procedure. There were no mesh infections nor migrations. Complication rate was identical in both groups. After a median follow-up of 44 months (IQR 17-86), 46 patients (94 %) were hernia-free, while 3 (6 %) presented a hernia recurrence. CONCLUSIONS: Combined inguinal hernia repair with a synthetic mesh during RARP is a feasible and efficient procedure which added no morbidity to standard RARP. Placing the mesh during an operation with urine spillage led to no infections. Efficacy after medianterm follow-up is similar to laparoscopic hernia repair alone. Combined hernia repair should therefore be discussed for patients undergoing RARP suffering from inguinal hernia.

Management of unusual genital lymphedema complication after Fournier's gangrene: a case report.

BackgroundFournier’s gangrene is a bacterial infection characterized by necrotizing fasciitis, skin and soft tissue involvement, and eventually myositis of the perineal region. Aggressive debridement of devitalized tissue and overlying skin is of paramount importance, but often leaves large defects to be reconstructed. The present case reports successful extensive perineal defects coverage following Fournier’s gangrene and management of subsequent penile lymphoedema impairing sexual function in a young patient.Case presentationFollowing perianal abscess drainage, a healthy young man presented with scrotal pain. Fournier’s gangrene was diagnosed and treated with multiple surgical debridements. Tissue excision extended through the entire perineal area, base of the penile shaft, lower abdominal region, the inner thighs, and gluteal region, corresponding to 12% of the total body surface area. After serial debridements and negative pressure dressings, the defect was covered by two stages of skin grafting. Graft take was 90%. Healing was achieved without hypertrophic or retractile scar. However, chronic penile lymphedema remained and was first treated with compressive garments for 2 years. Upon failure of this conservative approach, we performed a circumcision, but only a “penile lift” allowed a satisfactory esthetical and functional result.ConclusionFournier’s gangrene can be complicated by a chronic lymphedema of the penis. Conservative treatment is likely to fail in severe cases and can be treated surgically by “penile lift”.

Roboterassistierte Operationen in der Urologie@@@Robot-assisted surgery in urology

Since 1990, laparoscopic surgery has undergone a tremendous evolution. As patients and surgeons alike push toward minimally invasive surgery, more and more complex operations have been performed by laparoscopy. However, highly complex and technically demanding procedures--such as radical prostatectomy--have revealed the limits of classical laparoscopic surgery. The introduction of the Da Vinci robot has changed the face of modern laparoscopy because it provides the surgeon with three-dimensional vision, more instrumental degrees of freedom, and greater ergonomics. Thus, laparoscopy has been able to strengthen its role in urology and is increasingly being used for radical prostatectomies, pyeloplasties, and ureteral operations such as ureterovesical reimplantations. For most types of operations, functional and early oncological outcomes appear similar to those of conventional laparoscopy or open surgery. The main drawbacks of robotic surgery are the costs of the disposable instruments and maintenance, which overshadow the initial purchase price. The near future will show how European health systems will react to this new financial burden. Our institution, within a university hospital with moderate patient recruitment, was equipped with a four-arm Da Vinci robot in February 2006. As of April 2008, 120 urological operations had been performed. Because robotic surgery is associated with a specific learning curve, divisions with limited case numbers may refrain from doing this type of surgery. The aim of this article is to evaluate the feasibility and efficiency of the initial period of a robotic program in a midsize division.