[Show abstract][Hide abstract] ABSTRACT: Laparoscopic partial nephrectomy is still one of the more challenging procedures in urology. Minimizing warm ischemia time (WIT) and bleeding requires efficient intracorporeal suturing. In addition, achieving negative surgical margins requires complete excision of the tumor. Robotic-assisted partial nephrectomy (RALPN) adds the advantages offered by the "Da Vinci system" to laparoscopy, such as the 3-D vision, and the better degree of freedom of surgical instruments.
The objective of this study is to report our experience with RALPN.
From August 2009 to October 2012, 60 patients underwent RALPN for kidney cancer. The average age of the patients (35 female, 25 male) was 63 (range 48-80) years. Average BMI was 25 (range 21.8-29.7) kg/m2. Average tumor size was 3.2 cm (range 2-6.7 cm). All the procedures were performed by a transperitoneal approach. Ilar clamping was used in all cases: in 47 patients by one intracorporeal tourniquet for the artery and one for the vein; in three cases, ilar clamping was "en block" by Satinsky.
Mean operative time was 167.2 min (140-250) with a WIT of 23.8 min (15-28). The mean estimated blood loss was 260 mL (50-300). In one case, nephrectomy was necessary because the tumor involved the renal pedicle. One patient had pulmonary embolism and one urinary leakage conservatively managed.Pathologic examination revealed clear cell renal cell carcinoma in 58 patients, oncocytoma in one patient, and angiomyolipoma in one patient. All resection margins were free from tumor.
Partial nephrectomy, facilitated by robotic technology, is more and more frequently performed as a safe and effective minimally invasive procedure.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to assess the effectiveness of University of California San Francisco Cancer of Prostate Risk Assessment (UCSF-CAPRA) as a predictor of positive surgical margins (PSM) after robot-assisted radical prostatectomy (RARP).
This is a two-center retrospective study. The dataset included patients who underwent RARP between January 2012 and January 2014. Patients were stratified in accordance with D'Amico and UCSF-CAPRA criteria. PSMs were defined as cancer cells at the inked surface of the specimen. Surgical margin status (negative and positive) was compared with pre, intra, and postoperative characteristics using Mann-Whitney U test and Pearson χ2 correlation. Wilcoxon signed log rank test was performed to evaluate the difference between clinical and pathological stage and biopsy and pathological Gleason score. Two regression models (one with preoperative characteristics and one with postoperative characteristics) were build to evaluate independent factors associated with PSM.
We reported a PSM rate of 23.1% (53 of 229) between two centers. In the logistic regression, pre-operative predictors of PSMs were UCSF-CAPRA class risk, UCSF-CAPRA coded as continuous variable, and biopsy Gleason score. Pathological stage and pathological Gleason score were postoperative independent factors related with PSM.
This study shows that CAPRA score is a good and simple tool to stratify patients before surgery. The use of CAPRA score system can help the surgeons in planning the best treatment for patients to reduce PSM rate after RARP.
[Show abstract][Hide abstract] ABSTRACT: Ureteral stents placement may be required in patients undergoing robot-assisted radical prostatectomy (RARP) in case of a large median lobe or previous transurethral surgery to prevent damage of the ureteral orifices. Unpredictable anatomical variants or technical difficulties in bladder neck section may require intraoperative stents placement. We describe our original, simple and feasible transurethral stent placement technique during RARP, which could be a valid option to preoperative technique.
Journal of endourology / Endourological Society 04/2014; 28(8). DOI:10.1089/end.2014.0061 · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction: Percutaneous ablation in the kidney is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection. Its increasing use has been largely prompted by the rising incidental detection of renal cell carcinomas with cross-sectional imaging and the need to preserve renal function in patients with comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. To date, clinical studies indicate that cryoablation is an effective therapy with acceptable short- to intermediate-term outcomes and with a low risk in the appropriate setting.
This article focuses on the efficiency of contrast enhanced ultrasound scan (CEUS) as compared to contrast enhanced magnetic resonance imaging (MRI) during the follow-up after cryoablation of small renal tumors.
Material & methods: In our Department, percutaneous or laparoscopic assisted cryoablation is offered in the treatment of small renal masses.
Between January 2009 and January 2013, 25 patients (pts) were treated with laparoscopic assisted cryoablation or percutaneous cryoablation for renal tumors <3.5 cm in pts unfit for surgery. All pts had severe comorbidities (ASA score 3). Transperitoneal laparoscopic approach was performed in
11 pts, extraperitoneal approach in 3 pts, percutaneous technique was performed in 11 patients.
"Tru-cut biopsy" of the renal mass was always performed before cryoablation.
The SeedNet system (Galil Medical, Arden Hills, MN) was used in 12/25 pts; the Precise system (Galil Medical, Arden Hills, MN) was used in 13/25 pts. In all cases, IceRod needles were used. Real-time ultrasound guidance was used to localize the tumour and to monitor the progression of "iceball". A double "freeze-thaw cycle" was used.
All pts had MRI and CEUS before cryoablation and the follow-up consisted in CEUS/MRI every
3 months during the first year and every 6 months thereafter.
Results: The mean age of the 25 pts was 67.7 years (range 56-79); 5 pts were females and 20 were males. The mean tumor size was 2.8 cm (range 1.5-3.5). No patient required conversion to open procedure. 19 tumors were located at the lower pole, 4 were interpolar and 2 tumors were located at the upper pole. There were no intraoperative complications. The mean hospital stay was 4 days (range 1-7). Two pts required a blood transfusion; there was no statistically significant difference between preoperative and postoperative serum creatinine levels. The biopsy showed RCC in all cases. In 24/25 patients both CEUS and MRI showed no enhancement. In 1/25 pts, during the follow-up, CEUS and MRI showed a well visible recurrence at the perfusion study. It was histologically confirmed. The final results of CEUS and MRI were concordant in all pts.
Conclusions: CEUS is effective during the follow-up of renal tumor cryoablation. It could be an alternative technique to standard CT and MRI, with some advantages: low cost, short time consuming procedure, no radiation exposure, reduced amount of contrast agent (1-2 mL) and rare adverse reactions.
[Show abstract][Hide abstract] ABSTRACT: Renal angiomyolipoma is a uncommon benign tumor, considered an hamartoma. The lesion, usually benign, can be single or multiple and well-circumscribed. In letterature only few cases of infiltrating angiomyolipomas have been described. The aim of the paper is to describe a paradigmatic case of a giant kidney angiomyolipoma, not associ- ated with tuberous sclerosis, invading the pelvis and the renal vein. The lesion have been discovered incidentally during abdominal ultrasound for other pathology. Owing to the extent of the lesion and the appreciable risk of bleeding, we opted for surgical treatment.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 06/2013; 85(2):107-108. DOI:10.4081/aiua.2013.2.107
[Show abstract][Hide abstract] ABSTRACT: Training in endourology by ex vivo models is an effective tool for unskilled urologists to get qualification. Urologists have different kinds of training models at urological conferences, but, in order to get skilled, they need models available at their own department.
The article describes how to build an ex vivo porcine model to train on the main endourological procedures.
Questionnaires filled by the trainers attending the courses at our department, over the last three years, have proved the high degree of satisfaction about this kind of training system.
Validation studies about these models still lack. The growing interest about them requires randomized controlled validation studies in the future, including large numbers of participants.
[Show abstract][Hide abstract] ABSTRACT: We report a case of chylous ascites developing the first post-operative day after laparoscopic adrenalectomy. The early initiation of treatment with total parenteral nutrition and somatostatin analog led to rapid resolution of the ascites. To the best of our knowledge, this is the first case of chylous ascites after laparoscopic adrenalectomy and we report it to stress the need for greater awareness and attention (meticulous dissection, permanent use of hemoclips and/or suture ligatures instead of electrocautery) even for simpler laparoscopic urologic procedures.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 09/2010; 82(3):186-8.
[Show abstract][Hide abstract] ABSTRACT: We present a case of laparoscopic transperitoneal heminephrectomy involving a large renal cell carcinoma of 7 cm centrally located on the left side of a horseshoe kidney in a 48 years old male patient detected by ultrasound scan and CT scan.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 09/2010; 82(3):175-7.
[Show abstract][Hide abstract] ABSTRACT: Vesico-urethral anastomosis is a technically challenging part of the laparoscopic radical prostatectomy. Our aim was to simplify the anastomosis-step by adopting a new device "Capio" (Boston Scientific), already known in open surgery, together with "Alesix" (Applied), a device used in hand assisted laparoscopy.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 10/2008; 80(3):109-10.
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic Nephron Sparing Surgery (LNSS) is a technically challenging procedure. Technical aspects and the outcome of LNSS are investigated. A total of 592 LNSS procedures were collected from 12 Centres, either in extraperitoneal or transperitoneal fashion. Mean tumor size was 2.2 cm. Eight centers reported on tumor position for a total of 407 cases with 338 exophytic tumors (83%) and 69 deep lesions (17%). Four centers, accounting for 185 cases, did not report on tumor position. All the centers performed their LNSS by clamping the hilum. The warm ischemia time was < 30 min in all the centers. The positive margin rate was 2% (12/592). Hemostatic agents and/or sealant or tissue glues were used in 86% of cases (511/592). Types of sealants used included: gelatine matrix (Floseal), fibrin gel (Tissucol), bovine serum albumin (BioGlue) and cianacrylate (Glubran). Two Centres never used sealants, one center used only sealants without suturing and 9 centers used a combination of sealants and bolstering-sutures. The intraoperative open conversion rate was 3.5% (21/592). Postoperative complications included bleeding in 15/592 (2.5%) and urine leak in 13/592 (2.1%). No tumor seeding was reported. LNSS has similar results of open partial nephrectomy. The use of hemostatic agents and/or sealants or tissue glues during LNSS is largely diffuse in European centers and may be an effective add on reducing bleeding and urine leakage when used in combination with bolstering-suturing.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 10/2008; 80(3):85-91.
[Show abstract][Hide abstract] ABSTRACT: A middle aged male patient (39 year old) presented with right renal pain. During evaluation a small renal stone was found in the right kidney, and a mass 6 cm in diameter related to the upper pole of the left kidney was discovered. An endocrinologic evaluation was negative and a laparoscopic transperitoneal adrenalectomy was performed. Final pathology was adrenocortical oncocytoma with malignant potential.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 07/2008; 80(2):82-4.