Sigrid Wagner

Prospective non-randomized evaluation of four mediators of the systemic response after extraperitoneal laparoscopic and open retropubic radical prostatectomy.

Associate Editor

Laparoscopic adrenalectomy in urological centres – the experience of the German Laparoscopic Working Group

Study Type – Practice patterns (retrospective cohort)

Laparoendoscopic single-site radical nephrectomy for renal cancer: technique and surgical outcomes.

BACKGROUND Laparoendoscopic single-site (LESS) surgery has been developed in attempt to further reduce the morbidity and scarring associated with surgical intervention. OBJECTIVE To describe the technique and report the surgical outcomes of LESS radical nephrectomy (RN) in the treatment of renal cell carcinoma. DESIGN, SETTING, AND PARTICIPANTS LESS-RN was performed in 33 patients with renal tumours. The indications to perform a LESS-RN were represented by renal tumours not greater than T2 and without evidence of lymphadenopathy or renal vein involvement. SURGICAL PROCEDURE The Endocone (Karl Storz, Tuttlingen, Germany) was inserted through a transumbilical incision. A combination of standard laparoscopic instruments and bent grasper and scissors was used. The sequence of steps of LESS-RN was comparable to standard laparoscopic RN. MEASUREMENTS Demographic data and perioperative and postoperative variables were recorded and analysed. RESULTS AND LIMITATIONS The mean operative time was 143.7±24.3 min, with a mean estimated blood loss of 122.3±34.1 ml and a mean hospital stay of 3.8±0.8 d. The mean length of skin incision was 4.1±0.6 cm and all patients were discharged from hospital with minimal discomfort, as demonstrated by their pain assessment scores (visual analogue scale: 1.9±0.8). The definitive pathologic results revealed a renal cell carcinoma in all cases and a stage distribution of four T1a, 27 T1b, and 2 T2 tumours. All patients were very satisfied with the appearance of the scars, and at a median follow-up period of 13.2±3.9 mo, all patients were alive without evidence of tumour recurrence or port-site metastasis. CONCLUSIONS LESS is a safe and feasible surgical procedure for RN in the treatment of renal cell carcinoma and has excellent cosmetic results.

Laparoscopic vs open radical nephroureterectomy for upper urinary tract urothelial cancer: oncological outcomes and 5-year follow-up.

To compare the oncological outcomes of laparoscopic radical nephroureterectomy (LNU) vs open NU (ONU) for upper urinary tract transitional cell carcinoma (TCC).

Prospective Follow‐Up of Female Sexual Function after Vaginal Surgery for Pelvic Organ Prolapse Using Transobturator Mesh Implants

INTRODUCTION Although the use of transobturator mesh implants for pelvic organ prolapse repair has been shown to be safe and effective, concern exists that the presence of prosthetic material in the vagina may adversely affect sexual function. AIM To evaluate the impact of transobturator mesh implantation on sexual function using validated questionnaire. MAIN OUTCOME MEASURES Female Sexual Function Index (FSFI), a validated 19-item questionnaire that assesses six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain), was used. The questionnaire was administered preoperatively, and at 3, 6, 12, and 24 months postoperatively. Clinical data were also recorded at each time point. METHODS Prospective nonrandomized study including 96 women with pelvic organ prolapse (cystocele, rectocele, vault prolapse). Transvaginal anterior or posterior wall repair using transobturator mesh implants with or without concomitant transobturator sling procedure. RESULTS Mean age was 51.4 ± 5.2 years. Mean operating time was 47.6 ± 23.4 minutes, and the mean hospitalization period was 3.8 ± 1.6 days. After initial decrease during the first 3 months, patients experienced a steady improvement in their sexual function. At 24 months postoperatively, the total mean FSFI score reached significantly higher values compared to the baseline (P = 0.023). Furthermore, pain-free intercourse improved during the follow-up reaching mean score of 4.27 ± 0.79 (P < 0.05) after 2 years. Pelvic floor examination at 2 years follow-up showed excellent surgical results with only 3.1% of the patients presenting with stage II vaginal wall prolapse. CONCLUSIONS Surgical repair of symptomatic pelvic organ prolapse using mesh implants results in improvement of major parameters of sexual function. A worsening in pain with intercourse during the initial months postoperatively lessens after 3 months as healing is completed.

Bilateral vs unilateral laparoscopic intrafascial nerve-sparing radical prostatectomy: evaluation of surgical and functional outcomes in 457 patients.

Study Type – Therapy (case series)

Retroperitoneal Malignant Solitary Fibrous Tumor of the Small Pelvis Causing Recurrent Hypoglycemia by Secretion of Insulin-like Growth Factor 2

A 28-yr-old man presented with recurrent reduced consciousness, generalized seizures of unknown etiology, recurrent hypoglycemia, psychomotor retardation, and grade 2 ectasia of the left kidney. Abdominal computed tomography (CT) and positron emission tomography (PET) scans demonstrated a well-circumscribed suprapubic pelvic mass, measuring 18 x 15 x 11 cm, with involvement of para-aortic lymph nodes and dilatation of the left ureter suggestive of an extragonadal testicular tumor. We excised the tumor by laparotomy, and it was confirmed to be a solitary fibrous tumor (SFT). After surgery and R0 tumor resection, the patient had no further evidence of hypoglycemia or of recurrence.

Single-Portal Access Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma in Transplant Patients: The First Experience

We present the details of the first three single-portal access laparoscopic radical nephrectomies (S-Portal-RN) performed in patients with a malignant renal tumour that developed after a renal transplant. The mean operative time was 171.6 ± 37.5 min, with a mean blood loss of 126.6 ± 25.1 ml. A single small skin incision (5 cm) was performed to remove the kidney. No significant difference in glomerular filtration rate was observed postoperatively. The postoperative recovery was uneventful with favourable short-term outcomes and high patient satisfaction at the 2-mo follow-up. We believe that S-Portal-RN for renal cancer after a renal transplant can be performed without increased risks for the patients or for the transplanted kidney.

Laparoscopic vs open retropubic intrafascial nerve-sparing radical prostatectomy: surgical and functional outcomes in 300 patients

Study Type – Therapy (case series)
Level of Evidence 4

Subcutaneous Nephrovesical and Nephrocutaneous Bypass

Objective: We evaluated the effectiveness of the subcutaneous bypass for ureteral obstruction in patients with advanced malignancies. Two versions of the minimally invasive technique were performed: nephrovesical and nephrocutaneous bypass. Methods: A specially designed composite implant consisting of an inner smooth silicone-covered tube covered by a coiled e-PTFE-tube was used in 14 patients. Results: 10 subcutaneous nephrovesical bypasses were inserted in 10 patients, 8 nephrocutaneous bypasses in 4 patients. During the mean follow-up period of 13.1 months complications were observed in 2 patients with nephrocutaneous bypass, one encrustation and one infection of the bypass system. Conclusions: The subcutaneous nephrovesical and nephrocutaneous bypass is a safe alternative for palliative treatment of ureteral obstruction caused by pelvic malignancy.