Rafael Coelho

The systematic use of intraoperative vascular Doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply

OBJECTIVE To evaluate the impact of systematic use of intraoperative Doppler ultrasound during microsurgical subinguinal varicocele repair. DESIGN Prospective clinical study. SETTING Andrology laboratory and male infertility section of the urology department of a tertiary care hospital. PATIENT(S) Two hundred and thirteen men with clinical varicocele. INTERVENTION(S) Subinguinal microsurgical varicocele ligation using an intraoperative vascular Doppler flow detector. MAIN OUTCOME MEASURE(S) Number of veins ligated, lymphatic spared, arteries identified or accidentally ligated. RESULT(S) A statistically significant greater number of arteries were identified and preserved when intraoperative vascular Doppler was used. In addition, the average number of internal spermatic veins ligated was statistically significantly greater in the same group. Accidental artery ligation occurred in two cases (1.1%) in which the Doppler was not applied. There was no statistically significant difference in number of lymphatics spared between groups. CONCLUSION(S) Our findings showed that concomitant use of intraoperative vascular Doppler during microsurgical varicocelectomy allows more arterial branches to be preserved, and more internal spermatic veins are likely to be ligated. This device should be considered an attractive tool to improve surgical outcomes and safety.

Significant heterogeneity in terms of diagnosis and treatment of renal cell carcinoma at a private and public hospital in Brazil

PURPOSE A great number of small renal lesions have now been detected. Nowadays, partial nephrectomy has more frequently been adopted for surgical treatment of earlier stage disease. Previous studies have associated patient, institutional, and health care system factors with surgery type. The aim of this study was to compare the diagnosis and treatment of renal cell carcinoma (RCC) according to hospital type, public versus private, in our country. MATERIALS AND METHODS We retrospectively evaluated 183 patients with RCC who underwent radical nephrectomy or nephron-sparing surgery between 2003 and 2007 in two hospitals, one private and one public. Patient demographic, clinical, surgery, and pathologic characteristics were analyzed. RESULTS The radical nephrectomy rate was higher at the public hospital than at the private hospital (75% vs. 57%, p = 0.008). Overall, patients at the public hospital presented larger tumors than did the patients who were cared for privately. Furthermore, small renal masses were significantly more prevalent in private care (57.8% vs. 28.3%). Patients at the public hospital showed a higher incidence of capsular invasion (p = 0.008), perirenal fat invasion (p < 0.01), lymph node involvement (p < 0.001), and a lower incidence of initial tumors. pT1 tumors were reported in 41% of patients at the public hospital and in 72% at the private hospital (p < 0.001). CONCLUSION Patients with RCC cared for at our public referral hospital showed a more advanced stage than RCC treated at the private institution.

The k-hop connected dominating set problem: hardness and polyhedra☆

Abstract Let G = ( V , E ) be a connected graph, and k a positive integer. A subset D ⊆ V is a k-hop connected dominating set (k-CDS) if the subgraph of G induced by D is connected and, for every vertex v in G, there is a vertex u in D such that the distance between v and u is at most k. We study the problem of finding a minimum k-hop connected dominating set, denoted by the acronym Min k-CDS. Firstly, we prove that Min k-CDS is NP -hard on planar bipartite graphs of maximum degree 4 and on planar biconnected graphs of maximum degree 5. We present an inapproximability threshold for Min k-CDS on bipartite and on (1, 2)-split graphs, and we also prove that Min k-CDS is APX -hard on bipartite graphs of maximum degree 4. These results are shown to hold for every positive integer k. For k = 1 , the classical minimum connected dominating set problem, we present an integer linear programming formulation and show some classes of inequalities that define facets of the corresponding polytope. We also present an approximation algorithm for this case.

Robotic surgery in public hospitals of Latin-America: a castle of sand?

IntroductionThere is no information about the evolution of robotic programs in public hospitals of Latin-America.ObjectiveTo describe the current status and functioning of robotic programs in Latin-American public hospitals since their beginning to date.MethodsWe conducted a survey among leading urologists working at public hospitals of Latin-America who had acquired the Da Vinci laparoscopic-assisted robotic system. Questions included: date the program started, its utilization by other services, number and kind of surgeries, surgery paying system, surgery related deaths, occurrence and reasons of robotic program interruptions and its use for training purposes. Medians and 25–75 centiles (IQR) were estimated.ResultsSince 2009, there are ten public hospitals of four Latin-American countries that acquired the Da Vinci robotic system. The median number of months robotic programs has been functioning without considering transitory interruption: 43 (IQR 35, 55). Median number of urologic and total surgeries performed: 140 (IQR 94, 168) and 336 (IQR 292, 621), respectively. The corresponding median number of urologic and total surgeries performed per month: 3 (IQR 2, 5) and 8 (IQR 5, 11). Median number of total surgeries performed per year per institution was 94 (IQR 68,123). The median proportion of urologic cases was 40% (IQR 31, 48), ranging from 24 to 66%. Five of ten institutions had their urology programs transitory or definitively closed due to the high burden costs.ConclusionAdoption and development of robotic surgery in some public hospitals of Latin-America have been hindered by high costs.