N. Crisan

Iuliu Haţieganu University of Medicine and Pharmacy, Klausenburg, Cluj, Romania

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Publications (44)85.24 Total impact

  • Nicolae Crisan · Iulia Andras · Catalina Bungardean · Ioan Coman

    No preview · Article · Feb 2016 · Journal of B.U.ON.: official journal of the Balkan Union of Oncology
  • N. Crisan · Iulia Pop · I. Coman
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    ABSTRACT: The implementation of robotic surgery in the urological practice was extremely fast due to the advantages offered by this technology, advantages that outweigh the difficulties of the surgical techniques. Some of the challenges of the urological surgeries are the result of the limited access areas. Moreover, the surgery of the male pelvis (which is very narrow) is very difficult because the surgical gestures that are of great importance for the functional outcomes of the patient (urinary incontinence, erectile dysfunction) are performed in a limited access area. Also, the surgery of the retroperitoneum implies access in a narrow space in order to perform plastic or reconstructive interventions that involve the great abdominal blood vessels. Our aim was to evaluate the robotic surgical approach when performing urologic surgeries in limited access areas like the pelvis (radical prostatectomy, radical cystectomy) and the retroperitoneum (partial nephrectomy, radical nephrectomy, pyeloplasty). From a technical point of view, we evaluated the positioning of the trocars, the alignment between the trocars for the camera and for the instruments, the positioning of the trocar for the assistant surgeon, the conflicts between the robotic arms or between the robotic arms and the assistant surgeon’s instruments. The technical aspects were reported to the perioperative and postoperative parameters in order to evaluate the way in which the technical difficulties influence the surgical technique. For the retroperitoneal approach, we used 5 trocars with a particular type of positioning, developed at the Robotic Surgery Center in Cluj-Napoca. The final aspect of the positioning of the robotic trocars is triangular shaped, which offers a generous movement space for them, but also for the assistant surgeon. There were no conflicts between the robotic arms and none of surgeries required conversion. The hospital stay varied depending on the complexity of the procedure. The robotic surgery has well-known technical advantages, but it also shows improvement for the access in limited areas, like the male pelvis and the retroperitoneum. Using the robotic approach and a well studied trocar positioning, the surgeon is able to perform very complex maneuvers without difficulties due to the limited access and without altering the perioperative and postoperative outcomes.
    No preview · Chapter · Jan 2016
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    Preview · Article · Oct 2015
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    ABSTRACT: Contrast-enhanced ultrasound (CEUS) allows for real-time examination of signal intensity changes in a region of interest (ROI) and quantification of contrast agent kinetics. This study assessed the predictive ability of time-intensity curve (TIC) parameters for local tumor invasion and T stage of renal cell carcinoma (RCC). Renal tumors in 41 patients were examined by CEUS. Thirty-two met the inclusion criteria, with a total of 33 tumors (27 clear cell, 4 chromophobe, and 2 papillary type I). Nineteen (57.6%) tumors were included in group A (stages pT1 and pT2) and 14 (42.4%) in group B (stage pT3). ROIs were established as: whole tumor (TuW); tumor area with the highest signal intensity (TuMAX) and renal cortex (Ref). The TIC param­eters for each ROI were calculated as below: peak signal intensity, time to peak (TTP), rise time (RT), and mean transit time (MTT). They were analyzed as a whole value for each ROI and as a ratio between the different ROIs. There were significant differences between the tumors invading and not invading the renal sinus fat for TTP (TuW/Ref) [0.98 (0.67-1.25) vs. 1.18 (1.08-1.3), P < .05]. For differentiation between groups A and B, the following ratios were proven as predictors by univariate regression analysis: TTP (TuMAX/TuW); MTT (Tu­MAX/TuW); RT (TuMAX/TuW) (P = .03, P = .01 and P = .02, respectively). The value derived from the Receiver Operating Characteristic (ROC) curve for RT (TuMAX/TuW) was 0.8 with sensitivity = 78.6%, specificity = 89.5%, and cutoff value of > 0.91. TIC parameters were predictors of locally noninvasive and invasive RCC.&nbsp.
    No preview · Article · Jul 2015 · Urology journal
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    ABSTRACT: Purpose: Radical prostatectomy is the standard therapeutic approach for localized prostate cancer. After the implementation of robotic surgery in Romania, the indication extended progressively to locally advanced prostate cancer. Our objective was to evaluate the oncological and functional outcomes in patients undergoing robotic-assisted radical prostatectomy (RARP), 5 years after the first intervention in Romania. Methods: Between November 2009 and July 2014, 207 RARPs were performed using the da Vinci SI Surgical System. Perioperative data were prospectively collected. The oncological and functional follow-up was up to 55 months (range 3-55). Results: Patient stratification according to D'Amico risk categories was 16% low risk, 56.7% intermediate risk and 27.3% high risk. Median console time was 210 min (range 160-360). Median blood loss was 300 ml (range 50-1300), transfusion being required in 2.9% of the cases. Histopathological examinations showed pT3 in 40.8% of the cases, with a positive surgical margin rate of 21.1%, 13.6% for pT2, and 32.1% for pT3. Continence rate (0-1 daily safety pad) at 6, 12, 24 and 55 months was 88.3, 88.8, 90.1, and 93.7% respectively. Overall sexual function restoration rate at 6, 12, 24 and 55 months was 41.1, 44.4, 47.4 and 53%, respectively. Biochemical recurrence rate during follow-up was 6.9%. Conclusions: RARP is a minimally invasive therapeutic approach for prostate cancer, with acceptable outcomes, even in countries such as Romania, where the detection rate for localized prostate cancer is lower compared to other European countries due to lack of national screening programs.
    No preview · Article · Jul 2015 · Journal of B.U.ON.: official journal of the Balkan Union of Oncology
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    ABSTRACT: The main imagistic method for characterization of renal lesions is contrast enhanced computed tomography (CECT). Disadvantages of CECT are a contrast-induced nephropathy in patients with renal impairment, allergic reactions and high costs. Contrast-enhanced ultrasound (CEUS) evaluation of hepatic and non-hepatic lesions is a relatively new, but increasingly utilised, diagnostic method. In 2011 the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) updated the Guidelines and Recommendations on the Clinical Practice of CEUS and included in the recommendation the renal pathology. However, there are several possible new indications that have not been discussed (pyelocaliceal masses and renal vein thrombosis) and several issues that remain controversial such as the differentiation of benign and malignant tumours or the differentiation of lymphoma and metastasis. This study aims to review literature data, as well as reveal the latest findings in the field of renal CEUS.
    No preview · Article · Jun 2015 · Medical ultrasonography
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    ABSTRACT: The Wunderlich syndrome found after the rupture of primitive renal Ewing’s sarcoma is not a situation that we find often in everyday practice. The clinical findings are not specific, which is why the differential diagnosis must be made with a multitude of benign and malignant renal masses until the correct diagnosis can be made by the pathologist. The CT and MRI images are not characteristic. One treatment option is the multidisciplinary approach; however, the prognosis remains poor for patients with metastatic disease.
    Full-text · Article · Apr 2015
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    ABSTRACT: Liposarcomas are neoplasms of mesodermic origin, are derived from adipose tissue and represent <1% of all malignant tumours. Primary liposarcomas of the kidney are very rare. Here, we present the cases of two patients diagnosed with retroperitoneal perirenal myxoid liposarcoma. The patients were diagnosed via imaging, which in both cases revealed a huge right retroperitoneal tumour mass compressing the abdominal organs and large blood vessels. Surgical intervention consisting of en bloc resection of the tumour and the right kidney was performed using a transperitoneal approach. Three years after the surgery, both patients presented local recurrence, for which they underwent chemotherapy. Liposarcomas with renal origin are rare clinical entities with a high rate of malignancy and a poor prognosis. Because the use of chemotherapy and radiotherapy in the treatment of such liposarcomas is controversial, the treatment of choice is wide surgical resection with clean margins. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2015.
    Preview · Article · Mar 2015
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    ABSTRACT: Radical external beam radiotherapy (EBRT) is a standard treatment for prostate cancer patients. Despite this, the rate of intraprostatic relapses after primary EBRT is still not negligible. There is no consensus on the most appropriate management of these patients after EBRT failure. For these patients, local salvage therapy such as radical prostatectomy, cryotherapy, and brachytherapy may be indicated. The objectives of this review were to analyze the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method. A review of the literature was performed to identify studies of local salvage therapy for patients who had failed primary EBRT for localized prostate cancer. Most studies demonstrated that local salvage therapy after EBRT may provide long-term local control in appropriately selected patients, although toxicity is often significant. Our results suggest that for localized prostate cancer recurrence after EBRT, the selection of a local treatment modality should be made on a patient-by-patient basis. An improvement in selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological outcome and least comorbidity. © 2015 S. Karger AG, Basel.
    Full-text · Article · Mar 2015 · Urologia Internationalis
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    ABSTRACT: Primary mesenchymal chondrosarcoma of the kidney is an extremely rare malignant tumor. To our best knowledge, only 9 such cases have been reported so far. In the current paper, we present the case of a 67 year-old patient with recurrent left lumbar pain, increased fatigability and intermittent macroscopic hematuria. He underwent a surgical resection of the left kidney and left hemicolon.The pathological diagnosis was primary extraskeletal renal mesenchymal chondrosarcoma. Overall survival was 9 months, with pulmonary metastasis and local recurrence at 6 months. The management of the patient is described, from the initial differential diagnosis, after the first clinical examination to the surgical resection, with a special emphasis on the surgical procedures that were carried out. Extraskeletal chondrosarcoma of primary origin in the kidney are extremely rare tumors with a highly malignant potential and very poor prognosis. Because the role of chemotherapy or radiation therapy has not been evaluated properly yet, we underline the importance of surgery in the management of such cases as the main and best approach to achieve clinical remission and long-term survival, provided the patient is referred to a surgical consult in time.
    Full-text · Article · Dec 2014 · BMC Surgery

  • No preview · Article · Nov 2014 · European Urology Supplements
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    Nicolae Crisan · Iulia Andras · Ioan Coman

    Preview · Article · Sep 2014

  • No preview · Article · Jul 2014 · Urology journal
  • N. Crisan · I. Coman
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    ABSTRACT: In the past 10 years, robot-assisted surgery has developed exponentially. Our aim was to present the implementation of robotic surgery at the urology department wich has previously performed minimal invasive surgery (standard laparoscopy) and to present the results of the main robotic urological procedures. Method: Two hundred eleven robotic procedures were performed between November 2009 and February 2013 in our department; all types of available procedures were attempted, the most frequently being: pyeloplasty (PP), partial nephrectomy (PN) and radical prostatectomy (RP). The patients data were entered into an electronic database and the peri-operative, oncological and functional outcomes were evaluated. Results: The mean console time for PN, PP and RP was 161, 42 and 140 min, respectively. The warm ischemia time during the PN was 15 ± 11 min. The positive margin rate after RP was 15.3% in pT2 and 53.1% in pT3 (p˂0.0001).At the 6-month follow-up, 93.9%of the patients had undetectable PSA levels (˂0.1 ng/ml) (p˂0.0001), 88.9% of patients were continent (p˂0.0001) and 47.9% of patients were capable of having an erection. The duration for each of the three radical cystectomies with intracorporeal ileal neobladder was 725, 550 and 490 min respectively, with blood loss of 450, 600 and 350 ml, respectively. No positive margins were found. Conclusions: Every type of urological surgery can be performed by robotic approach, which tends to become standard for some procedures. The implementation of robotic surgery was ensured by the previous experience in uro-oncologic surgery and laparoscopy. Our center performed all types of available procedures and the short-term results are comparable to those obtained in similar centers.
    No preview · Article · Jan 2014
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    Full-text · Dataset · Dec 2013
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    ABSTRACT: The retroperitoneal approach is generally avoided because of the reduced working space, the difficulties in robot positioning and the risk of arms conflict. A new robotic retroperitoneal approach is presented that can be applied for upper urinary tract pathology and adrenal pathology. Between November 2009 and November 2011, 34 out of 114 robotic procedures were performed by the retroperitoneal approach using a triangle shaped trocar placement and the robotic cart positioned at the patient's head. All of the 34 retroperitoneal procedures were performed using this type of approach, with no conflict between the robotic arms and no conversions. The average operating time was 50 min for simple nephrectomies and 180 min for partial nephrectomies. The blood loss was not relevant. This approach enables excellent mobility for the robotic arms, generating no conflict and providing good maneuvering space for the bedside assistant. Copyright © 2013 John Wiley & Sons, Ltd.
    Full-text · Article · Dec 2013 · International Journal of Medical Robotics and Computer Assisted Surgery

  • No preview · Conference Paper · Oct 2013

  • No preview · Article · Oct 2013 · European Urology Supplements
  • A. Boc · C-D. Pop · N. Crişan · Z.A. Mihály · I. Coman

    No preview · Article · Oct 2013 · European Urology Supplements

  • No preview · Article · Oct 2013 · European Urology Supplements

Publication Stats

47 Citations
85.24 Total Impact Points

Institutions

  • 2013-2015
    • Iuliu Haţieganu University of Medicine and Pharmacy
      • Department of Urology
      Klausenburg, Cluj, Romania
  • 2012-2015
    • County Emergency Hospital Cluj-Napoca
      Klausenburg, Cluj, Romania
  • 2011
    • Alfried Krupp Krankenhaus
      Essen, Lower Saxony, Germany