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Soriano Hervás M, Robles-Hernández D, Serra A, Játiva-Porcar R, Gómez Quiles L, Maiocchi K, Llorca S, Climent MT, Llueca A. Analysis of Intraoperative Variables Responsible for the Increase in Lactic Acid in Patients Undergoing Debulking Surgery. J Pers Med 2023; 13:1540. [PMID: 38003855 PMCID: PMC10672096 DOI: 10.3390/jpm13111540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
Background: Cytoreductive surgery (CRS) is a complex procedure with a high incidence of perioperative complications. Elevated lactacidaemia levels have been associated with complications and perioperative morbidity and mortality. This study aims to analyse the intraoperative variables of patients undergoing CRS and their relationship with lactacidaemia levels. Methods: This retrospective, observational study included 51 patients with peritoneal carcinomatosis who underwent CRS between 2014 and 2016 at the Abdomino-Pelvic Oncological Surgery Reference Unit (URCOAP) of the General University Hospital of Castellón (HGUCS). The main variable of interest was the level of lactic acid at the end of surgery. Intraoperative variables, including preoperative haemoglobin, duration of surgery, intraoperative bleeding, fluid therapy administered, administration of blood products, and intraoperative peritoneal cancer index (PCI), were analysed. Results: Positive correlations were found between lactic acid levels and PCI, duration of intervention, fluid therapy, intraoperative bleeding, and transfusion of blood products. Additionally, a negative correlation was observed between haemoglobin levels and lactic acid levels. Notably, the strongest correlations were found with operative PCI (ρ = 0.532; p-value < 0.001) and duration of surgery (ρ = 0.518; p-value < 0.001). Conclusions: PCI and duration of surgery are decisive variables in determining the prognosis of patients undergoing debulking surgery. This study suggests that, for each minute of surgery, lactic acid levels increase by 0.005 mmol/L, and for each unit increase in PCI, lactic acid levels increase by 0.060 mmol/L.
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Affiliation(s)
- Marta Soriano Hervás
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Daniel Robles-Hernández
- Department of Anaesthesiology, University La Plana Hospital, Road from Vila-Real to Burriana, km 0.5, 12540 Castellón, Spain
| | - Anna Serra
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Rosa Játiva-Porcar
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Luis Gómez Quiles
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Karina Maiocchi
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Sara Llorca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - María Teresa Climent
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Antoni Llueca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
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Sholklapper TN, Ballon J, Sayegh AS, La Riva A, Perez LC, Huang S, Eppler M, Nelson G, Marchegiani G, Hinchliffe R, Gordini L, Furrer M, Brenner MJ, Dell-Kuster S, Biyani CS, Francis N, Kaafarani HM, Siepe M, Winter D, Sosa JA, Bandello F, Siemens R, Walz J, Briganti A, Gratzke C, Abreu AL, Desai MM, Sotelo R, Agha R, Lillemoe KD, Wexner S, Collins GS, Gill I, Cacciamani GE. Bibliometric analysis of academic journal recommendations and requirements for surgical and anesthesiologic adverse events reporting. Int J Surg 2023; 109:1489-1496. [PMID: 37132189 PMCID: PMC10389352 DOI: 10.1097/js9.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/31/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Standards for reporting surgical adverse events (AEs) vary widely within the scientific literature. Failure to adequately capture AEs hinders efforts to measure the safety of healthcare delivery and improve the quality of care. The aim of the present study is to assess the prevalence and typology of perioperative AE reporting guidelines among surgery and anesthesiology journals. MATERIALS AND METHODS In November 2021, three independent reviewers queried journal lists from the SCImago Journal & Country Rank (SJR) portal (www.scimagojr.com), a bibliometric indicator database for surgery and anesthesiology academic journals. Journal characteristics were summarized using SCImago, a bibliometric indicator database extracted from Scopus journal data. Quartile 1 (Q1) was considered the top quartile and Q4 bottom quartile based on the journal impact factor. Journal author guidelines were collected to determine whether AE reporting recommendations were included and, if so, the preferred reporting procedures. RESULTS Of 1409 journals queried, 655 (46.5%) recommended surgical AE reporting. Journals most likely to recommend AE reporting were: by category surgery (59.1%), urology (53.3%), and anesthesia (52.3%); in top SJR quartiles (i.e. more influential); by region, based in Western Europe (49.8%), North America (49.3%), and the Middle East (48.3%). CONCLUSIONS Surgery and anesthesiology journals do not consistently require or provide recommendations on perioperative AE reporting. Journal guidelines regarding AE reporting should be standardized and are needed to improve the quality of surgical AE reporting with the ultimate goal of improving patient morbidity and mortality.
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Affiliation(s)
- Tamir N. Sholklapper
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
- Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jorge Ballon
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Aref S. Sayegh
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Anibal La Riva
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
- Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Laura C. Perez
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
- Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Sherry Huang
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Michael Eppler
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | | | | | - Luca Gordini
- Division of Endocrine Surgery, “Agostino Gemelli” School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome
| | - Marc Furrer
- Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London
- Department of Urology, University of Bern, Inselspital, Bern
| | - Michael J. Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Salome Dell-Kuster
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy; University Hospital Basel, Switzerland
| | | | - Nader Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil
| | | | - Matthias Siepe
- Department of Cardiac Surgery, Cardiovascular Center, Inselspital, Bern
| | - Des Winter
- Center for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland
| | - Julie A. Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Robert Siemens
- Department of Urology, Queen’s University, Kingston, Ontario, Canada
| | - Jochen Walz
- Department of Urology, Intitut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele
- University Vita-Salute San Raffaele, Milan
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andre L. Abreu
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Mihir M. Desai
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Rene Sotelo
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | | | - Keith D. Lillemoe
- Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA, USA
| | - Steven Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Gary S. Collins
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Inderbir Gill
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Giovanni E. Cacciamani
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
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Zaręba A, Jaskulski J, Orłowski P, Obarzanowski M, Niedziela Ł. The Comprehensive Complication Index. Proposed modification to improve estimates of perioperative morbidity after radical cystectomy. A pilot study. Cent European J Urol 2021; 74:288-294. [PMID: 34729215 PMCID: PMC8552924 DOI: 10.5173/ceju.2021.0371.2.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/27/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The aim of this article was to compare the 30-day morbidity after radical cystectomy comparing the prevalent Clavien-Dindo Classification (CDC) and the novel Comprehensive Complication Index (CCI). Additionally, we evaluated the correlation between particular clinical features and the severity of perioperative morbidity. Material and methods A total of 42 patients were included into the study (33 men and 9 women) who underwent open radical cystectomy (RC) with bilateral lymphadenectomy for bladder cancer. The selection of complications was based on groundbreaking research on morbidity after RC. The assessment of perioperative complications was performed using the CDC and then the CCI. Results The CCI was found to be a significant upgrade in capturing cumulative morbidity in comparison to the CDC when used as the only evaluational tool. Conclusions Using only the CDC may underestimate the severity of perioperative complications. Unfavorable clinical features e.g. older age, chronic kidney disease (CKD), persistent nodal (pN+) disease, prior abdominal and pelvic surgeries as well as smoking are of significant importance for the increase of the severity of perioperative complications.
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Affiliation(s)
- Anita Zaręba
- Holy Cross Cancer Center in Kielce, Kielce, Poland
| | - Jarosław Jaskulski
- Holy Cross Cancer Center in Kielce, Kielce, Poland.,School of Medicine, Jan Kochanowski University of Kielce, Department of Urology, Kielce, Poland
| | - Paweł Orłowski
- Holy Cross Cancer Center in Kielce, Kielce, Poland.,School of Medicine, Jan Kochanowski University of Kielce, Department of Urology, Kielce, Poland
| | - Mateusz Obarzanowski
- Holy Cross Cancer Center in Kielce, Kielce, Poland.,School of Medicine, Jan Kochanowski University of Kielce, Department of Urology, Kielce, Poland
| | - Łukasz Niedziela
- Holy Cross Cancer Center in Kielce, Kielce, Poland.,School of Medicine, Jan Kochanowski University of Kielce, Department of Urology, Kielce, Poland
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Porcaro AB, Rizzetto R, Amigoni N, Tafuri A, Shakir A, Tiso L, Cerrato C, Antoniolli SZ, Lacola V, Gozzo A, Odorizzi K, Orlando R, Di Filippo G, Brunelli M, Migliorini F, De Marco V, Artibani W, Cerruto MA, Antonelli A. Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy. J Robot Surg 2021; 16:463-471. [PMID: 34131882 PMCID: PMC8960588 DOI: 10.1007/s11701-021-01262-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
To evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001-1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien-Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien-Dindo complications were seen.
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Affiliation(s)
- Antonio Benito Porcaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy.
| | - Riccardo Rizzetto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Nelia Amigoni
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy. .,Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy.
| | - Aliasger Shakir
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Leone Tiso
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Clara Cerrato
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Stefano Zecchini Antoniolli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Vincenzo Lacola
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Alessandra Gozzo
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Katia Odorizzi
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Rossella Orlando
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Giacomo Di Filippo
- Department of General and Hepatobiliary Surgery, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Vincenzo De Marco
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Walter Artibani
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Maria Angela Cerruto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
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Hervás MS, Játiva-Porcar R, Robles-Hernández D, Rubert AS, Segarra B, Oliva C, Escrig J, Llueca JA. Evaluation of the relationship between lactacidemia and postoperative complications after surgery for peritoneal carcinomatosis. Korean J Anesthesiol 2020; 74:45-52. [PMID: 32434292 PMCID: PMC7862932 DOI: 10.4097/kja.20089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background Cytoreductive surgery was developed as a treatment for peritoneal carcinomatosis. However, this surgery is associated with important complications. The present study aimed to assess the relationship between lactacidemia and the rate of associated complications during the immediate postoperative period in the intensive care unit (ICU) in patients undergoing cytoreductive surgery. Methods This was a retrospective observational study. A total of 57 patients underwent cytoreductive surgery. All patients were admitted to the ICU immediately after the surgery. Data on lactic acid levels at the time of admission and discharge from the ICU were collected. Postsurgical complications that occurred during the ICU stay were recorded according to failure-to-rescue analysis and their severity stratified according to the Clavien-Dindo classification. Results The lactic acid levels at admission to the ICU were significantly higher in patients who developed complications, with an almost tripled unadjusted relative risk (2.9, 95% CI: 1.6, 5.3), than in those who did not develop complications for the lactacidemia threshold established in the cumulative sum curve graphs. After adjustment for confounding effects, the relative risk became even higher (3.1, 95% CI: 1.8, 3.6). Lactic acid levels were still significantly higher in this group at the time of discharge from the ICU. Conclusions Serum lactate level is a risk factor for postoperative complications in patients undergoing cytoreductive surgery for peritoneal carcinomatosis. This study suggests that the risk of developing severe complications almost triples with a lactic acid level of 2.5 mmol/L or higher at the time of admission in the ICU.
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Affiliation(s)
- Marta Soriano Hervás
- Department of Anesthesiology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Rosa Játiva-Porcar
- Department of Anesthesiology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Daniel Robles-Hernández
- Department of Anesthesiology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Anna Serra Rubert
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Blanca Segarra
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Cristina Oliva
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Javier Escrig
- Department of General Surgery, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - José Antonio Llueca
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón de La Plana, Spain
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Martínez-Holguín E, Herranz-Amo F, Hernández-Cavieres J, Lledó-García E, Subirá-Ríos D, Renedo-Villar T, Hernández-Fernández C. Laparoscopic radical prostatectomy compared to open radical prostatectomy: Comparison between surgical time, complications and length of hospital stay. Actas Urol Esp 2020; 44:41-48. [PMID: 31806247 DOI: 10.1016/j.acuro.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 05/06/2019] [Accepted: 06/17/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION There are very few articles comparing open radical prostatectomy (OPR) with laparoscopic radical prostatectomy (LRP). OBJETIVES To compare the surgical time, the postoperative complications and the hospital stay in patients with localized prostate cancer treated with ORP or LRP. MATERIAL AND METHODS Comparison between two patients cohorts (312 with ORP and with 206 LRP) between 2007-2015. Postoperative complications were collected as defined in to the EAU Guidelines recommendations and they were classified according to the Clavien-Dindo classification. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variables and a lineal regression with dependent continuous variables. RESULTS The mean duration of ORP was 3:05hours and 4:35hours for LRP (p=.0001). The 26.4% of the patients presented any postoperative complication. 31.2% of ORP and 19.3% of LRP (p=.003). The mean of hospital stay was 4 days. In ORP group was 4 days in contrast to LRP with 3 days (p=.008). The LRP (p=.0001), lymphadenectomy (p=.02) and nerve-sparing (p=.01) were independent predictor factors of extension of surgical time. LRP was a protector independent factor of complications (OR=0.48 p=.007). The type of prostatectomy didn't influence in the length of hospital stay. CONCLUSIONS LRP showed higher surgical time, less complications and it didn't influence the hospital stay.
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Jin L, Yang B, Zhou Z, Li N. Comparative Efficacy on Flexible Ureteroscopy Lithotripsy and Miniaturized Percutaneous Nephrolithotomy for the Treatment of Medium-Sized Lower-Pole Renal Calculi. J Endourol 2019; 33:914-919. [PMID: 31596612 DOI: 10.1089/end.2019.0504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Lianchao Jin
- Department of Urology, Peking University Shougang Hospital, Beijing, China
| | - Bing Yang
- Department of Urology, Peking University Shougang Hospital, Beijing, China
| | - Zhe Zhou
- Department of Urology, Peking University Shougang Hospital, Beijing, China
| | - Ningchen Li
- Department of Urology, Peking University Shougang Hospital, Beijing, China
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González Palanca SJ, González Veiga EJ, Palmeiro Fernández G, Domínguez Salgado JC, Mariño Méndez H, Varela Ponte C. Long-term results of genital prolapse surgery with polypropylene mesh. Actas Urol Esp 2019; 43:254-261. [PMID: 30955903 DOI: 10.1016/j.acuro.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/20/2018] [Accepted: 12/02/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVE The risk of intervention due to urogenital prolapse in a woman's life is 11.1%. Recurrences after classic surgery reach up to 38%. With the aim of improving these results, transvaginal mesh kits are used. The purpose of the study is to describe the results of efficacy and long-term safety of vaginal prolapse surgery with polypropylene mesh, assess subjective symptoms before and after surgery and the level of satisfaction. PATIENTS AND METHODS A descriptive, retrospective study of 58 women with symptomatic genital prolapses operated with polypropylene mesh between September / 2011-November / 2016. Mean age: 66.53 years, 98.27% menopausal women, 77.59% overweight/obesity, 29.31% with previous gynaecological surgery and 55.17% with combined prolapse. 46 Elevate anterior and 12 posterior were inserted. The mean follow-up period was 34.02 months. The PFDI questionnaire was used pre and post-surgery, as well as the satisfaction questionnaire. RESULTS Healing rate of 91.38%. Recurrences were associated with a higher BMI and with background of recurrence of previous surgery. Mean length of stay: 2.5 days. 70.69% did not need analgesia at discharge. Clavien-Dindo complications: 1 type I (urinary retention), 5 type II (urinary tract infection) and 1 type IIIa (erosion). De novo stress urinary incontinence occurred in 3.44%, while de novo dyspareunia 14.28%. 89.36% patients improved subjective symptoms, and 95.92% were satisfied. CONCLUSION This surgery achieves high healing rates, with few complications, improvement of subjective symptoms and high level of satisfaction of the patients.
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Affiliation(s)
- S J González Palanca
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España.
| | - E J González Veiga
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España
| | - G Palmeiro Fernández
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España
| | - J C Domínguez Salgado
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España
| | - H Mariño Méndez
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España
| | - C Varela Ponte
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España
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Caño-Velasco J, Herranz-Amo F, Barbas-Bernardos G, Mayor-de Castro J, Aragón-Chamizo J, Arnal-Chacón G, Lledó García E, Hernández-Fernández C. Postsurgical complications in patients with renal tumours with venous thrombosis treated with surgery. Actas Urol Esp 2018; 42:531-7. [PMID: 29631912 DOI: 10.1016/j.acuro.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/26/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Surgery on renal tumours with venous thrombosis suffers a high rate of complications and non-negligible perioperative mortality. Our objective was to analyse the postoperative complications, their relationship with the level of the thrombus and its potential predisposing factors. MATERIALS AND METHODS A retrospective analysis was conducted of 101 patients with renal tumours with venous thrombosis operated on between 1988 and 2017. Two patients were excluded because of intraoperative pulmonary thromboembolism and exitus (2%). The postsurgical complications were classified according to Clavien-Dindo. To compare the qualitative variables, we employed the chi-squared test. We performed a multivariate analysis using binary logistic regression to identify the independent predictors. RESULTS Some type of postsurgical complication occurred in 34 (34.3%) patients, 11 (11.1%) of which were severe (Clavien III-V). There were significant differences in the total complications (P=.003) and severe complications (Clavien≥III; P=.03) depending on the level of the tumour thrombus.
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Moreira AM, de Assis AM, Carnevale FC, Antunes AA, Srougi M, Cerri GG. A Review of Adverse Events Related to Prostatic Artery Embolization for Treatment of Bladder Outlet Obstruction Due to BPH. Cardiovasc Intervent Radiol 2017; 40:1490-500. [DOI: 10.1007/s00270-017-1765-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 07/28/2017] [Indexed: 02/06/2023]
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11
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Contreras-garcía R, García-perdomo HA, Robayo-ramirez J. Experiencia en el manejo de la estrechez uretral en un centro de tercer nivel en Colombia. Rev Urol 2017; 26:98-103. [DOI: 10.1016/j.uroco.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Contreras-García R, García-Perdomo H, García-Ángel A. Mortalidad perioperatoria en pacientes sometidos a cistectomía radical en un hospital universitario. Rev Urol 2017. [DOI: 10.1016/j.uroco.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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García-García ML, Martín-Lorenzo JG, Lirón-Ruiz R, Torralba-Martínez JA, García-López JA, Aguayo-Albasini JL. Perioperative complications following bariatric surgery according to the clavien-dindo classification. Score validation, literature review and results in a single-centre series. Surg Obes Relat Dis 2017; 13:1555-1561. [PMID: 28601534 DOI: 10.1016/j.soard.2017.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/23/2017] [Accepted: 04/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is no unified system for reporting surgical complications after bariatric surgery. One increasingly used system for notifying postoperative complications is the Clavien-Dindo classification, which focuses on their therapeutic implications. OBJECTIVE The aim of this study is to validate and apply the Clavien-Dindo scale to a series of cases of bariatric surgery and systematically review its use worldwide. SETTING University hospital. METHODS A cohort of 321 patients with morbid obesity (Mean BMI: 45.4±5.5 kg/m2) underwent surgery by the same team of surgeons, fundamentally using a laparoscopic gastric bypass. Initially, the Clavien-Dindo scale was translated and validated for its acceptability and reproducibility using the Kappa index. The scale was then applied to the whole of the bariatric series. A systematic review was also conducted in the literature regarding the use of the Clavien-Dindo classification after bariatric surgery. Lastly, a comparison was made with our results. RESULTS The classification was validated without any difficulty. Most of the postoperative complications are grades I (8.4%) and III (7.8%). We found it used in 15 series (including our own), which accounts for 10,347 patients. The overall results are analogous to our series. CONCLUSIONS The Clavien-Dindo scale has been validated and translated into Spanish. Application is quick and simple and enables comparisons to be made between centers and series. Our results are similar to those reported by other authors.
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Affiliation(s)
| | | | - Ramón Lirón-Ruiz
- Department of Surgery, University Hospital "Jose María Morales Meseguer," at Murcia, Murcia, Spain
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Kriegmair MC, Hetjens S, Mandel P, Wadle J, Budjan J, Michel MS, Pfalzgraf D, Wagener N. Tumor size and invasiveness matters for partial nephrectomy: External validation and modification of the arterial based complexity score. J Surg Oncol 2017; 115:768-774. [DOI: 10.1002/jso.24565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 01/20/2023]
Affiliation(s)
| | - Svetlana Hetjens
- Medical Faculty MannheimDepartment of Medical StatisticsUniversity of HeidelbergMannheimGermany
| | - Philipp Mandel
- Department of UrologyUniversity Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Jula Wadle
- Department of UrologyUniversity Medical Centre MannheimMannheimGermany
| | - Johannes Budjan
- Department of Radiology and Nuclear MedicineUniversity Medical Centre MannheimMannheimGermany
| | - Maurice S. Michel
- Department of UrologyUniversity Medical Centre MannheimMannheimGermany
| | - Daniel Pfalzgraf
- Department of UrologyUniversity Medical Centre MannheimMannheimGermany
| | - Nina Wagener
- Department of UrologyUniversity Medical Centre MannheimMannheimGermany
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Joukhadar R, Wöckel A, Herr D, Paulus V, Radosa J, Hamza A, Solomayer E, Baum S. Challenges of Longevity: Safety of Vaginal and Laparoscopic Urogynecological Procedures in Septuagenarians and Older Patients. Biomed Res Int 2016; 2016:5184595. [PMID: 28070510 DOI: 10.1155/2016/5184595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/06/2016] [Indexed: 11/29/2022]
Abstract
Introduction. Pelvic organ prolapse (POP) and urinary incontinence (UI) have increasing prevalence in the elderly population. The aim of this study was to compare the comorbidities of these procedures between <70 y/o and ≥70 y/o patients. Materials and Methods. In our retrospective study over a period of 2.5 years, 407 patients had received an urogynecological procedure. All patients with POP were treated by reconstructive surgery. Complications were reported using the standardized classification of Clavien-Dindo (CD). The study can be assigned to stage 2b Exploration IDEAL (Idea, Development, Exploration, Assessment, Long-term study)-system of surgical innovation. Results. Operation time, blood loss, and intraoperative complications have not been more frequent in the elderly, whereas hospital stay was significantly longer in ≥70 y/o patients. Regarding postoperative complications, we noticed that ≥70 y/o patients had an almost threefold risk to develop mild early postoperative complications compared to younger patients (OR: 2.86; 95% CI: 1.76–4.66). On the contrary, major complications were not more frequent. No case of life-threatening complication or the need for blood transfusion was reported. Conclusion. After urogynecological procedures, septuagenarians and older patients are more likely to develop mild postoperative complications but not more intraoperative or severe postoperative complications compared to younger patients.
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Mothes AR, Lehmann T, Kwetkat A, Radosa MP, Runnebaum IB. Gynaecological Prolapse Surgery in Very Old Female Patients: A Case-Control Study on Co-Morbidity and Surgical Complications. Geburtshilfe Frauenheilkd 2016; 76:869-874. [PMID: 27582580 DOI: 10.1055/s-0042-109868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The aim of this study is to compare very elderly female patients with a younger control group after prolapse surgery with regard to co-morbidity and complications. METHOD In a case-control design, the consecutive data of patients after prolapse surgery at the age of over 80 years and those of a control group were analysed by means of the Clavien-Dindo (CD) classification of surgical complications, the Charlson Comorbidity Index and the Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistics: Student's t, Fisher's exact and Mann-Whitney U tests. RESULTS The analysis comprised n = 57 vs. n = 60 operations. In the very elderly patients there was often a grade IV prolapse (p < 0.001), apical fixations were more frequent (p < 0.001), but the operating times were not different. In the very elderly patients 21 % CD II+III complications were observed, in the control group 6.6 % (p = 0.031). No CD IV and V complications occurred in either group, the duration of inpatient stay amounted to 5 (± 1) vs. 4.1 (± 0.8; p < 0.001) days, the very elderly patients needed an inpatient follow-up more frequently (p < 0.001). The co-morbidities of the very elderly patients differed from those of the control group in number (median 2.0 vs. 1.5; p < 0.001), in CIRS-G (4.1 ± 2.2 vs. 2.4 ± 1.7; p < 0.01) and in Charlson Index (1.6 ± 1.6 vs. 0.5 ± 0.7; p < 0.001). CONCLUSIONS A prolapse in very elderly women can be safely managed by surgery. In no case did the complications require intensive care treatment nor were they life-threatening, but they did lead to a longer duration of hospital stay and more frequently to further treatment geriatric or inpatient internal medicine facilities.
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Affiliation(s)
- A R Mothes
- Universitätsfrauenklinik, Friedrich-Schiller-Universität, Jena
| | - T Lehmann
- Institut für Medizinische Statistik, Informatik und Dokumentation, Friedrich-Schiller-Universität, Jena
| | - A Kwetkat
- Klinik für Geriatrie, Universitätsklinikum, Friedrich-Schiller-Universität, Jena
| | - M P Radosa
- Universitätsfrauenklinik, Friedrich-Schiller-Universität, Jena
| | - I B Runnebaum
- Universitätsfrauenklinik, Friedrich-Schiller-Universität, Jena
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Oliveros Pasión C, Solano Perdomo LK, Salgado Tovar JM, Valero Pulido JC, Buitrago C. Experiencia en pieloplastia laparoscópica durante 5 años. Rev Urol 2016. [DOI: 10.1016/j.uroco.2016.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Peña-Fernández M, Solar-Vilariño I, Rodríguez-Álvarez MX, Zapardiel I, Estévez F, Gayoso-Diz P. Assessment of morbidity in gynaecologic oncology laparoscopy and identification of possible risk factors. Ecancermedicalscience 2015; 9:606. [PMID: 26715943 PMCID: PMC4679209 DOI: 10.3332/ecancer.2015.606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Indexed: 11/15/2022] Open
Abstract
Background The aim of this study was to ascertain the incidence of and the risk factors associated with morbidity in laparoscopy performed on patients with cervical cancer and endometrial cancer. Methods This was an observational study of a cohort of 128 women, 89 with endometrial cancer and 39 with cervical cancer from January 2000 to December 2011. We used the Student’s t-test or the Mann-Whitney U test for continuous variables, and the Chi-square or Fisher’s exact test for categorical variables. Results Complications were found in 44 patients (34.4%). After a multivariate analysis, among the risk factors associated with the presence of complications as the only type of surgery was found to be statistically significant (p = 0.043), more frequent in the most complex procedures such as Wertheim operation, trachelectomy, and para-aortic lymphadenectomy. Type of surgery (p = 0.003) and tumour type (p = 0.003) were risk factors associated with conversion to laparotomy. It was more frequent among the most complex procedures and cervical cancer cases. Regarding the need for transfusion, significant differences were observed in terms of surgery duration (p < 0.001), more frequent in longer surgery. Conclusion Morbidity in laparoscopic surgical oncology is related to the surgery complexity, where the basal characteristics of the patient are not a factor of influence in the development of complications.
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Affiliation(s)
- Maite Peña-Fernández
- Department of Gynecology and Obstetrics, Santiago de Compostela University Clinical Teaching Hospital, Spain
| | - Inés Solar-Vilariño
- Department of Gynecology and Obstetrics, Santiago de Compostela University Clinical Teaching Hospital, Spain
| | - María Xosé Rodríguez-Álvarez
- Clinical Epidemiology and Biostatistics Unit, Santiago de Compostela University Clinical Teaching Hospital and Santiago Health Research Institute, Spain
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Francisco Estévez
- Department of Gynecology and Obstetrics, POVISA Hospital, Vigo, Spain
| | - Pilar Gayoso-Diz
- Clinical Epidemiology and Biostatistics Unit, Santiago de Compostela University Clinical Teaching Hospital and Santiago Health Research Institute, Spain
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Pan K, Zhang Y, Wang Y, Wang Y, Xu H. A systematic review and meta-analysis of conventional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy. Int J Gynaecol Obstet 2015; 132:284-91. [PMID: 26797199 DOI: 10.1016/j.ijgo.2015.08.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/19/2015] [Accepted: 11/26/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Robot-assisted laparoscopic sacrocolpopexy (RALSC) has spread rapidly without the availability of comprehensive and systematically recorded outcome data. OBJECTIVE To systematically review and compare the outcomes of laparoscopic sacrocolpopexy (LSC) and RALSC. SEARCH STRATEGY PubMed and Scopus were searched for reports published from 2000 to 2014, using the search terms "robotic sacrocolpopexy," "laparoscopic sacrocolpopexy," and "sacral colpopexy." SELECTION CRITERIA Studies were included if they directly compared the outcomes of RALSC and LSC, the sample size in each group was more than 15, the follow-up duration was longer than 3 months, and the report was in English. DATA COLLECTION AND ANALYSIS The studies' characteristics, quality, and outcomes were recorded. Random-/fixed-effects models were used to combine data. MAIN RESULTS Data on 264 RALSC and 267 LSC procedures were collected from seven studies. The mean operative time was longer in the RALSC group (245.9 minutes vs 205.9 minutes; P<0.001). The estimated blood loss in the two groups was similar (114.4 mL vs 160.1 mL; P=0.36). The differences in incidence of intraoperative/postoperative complications were also similar (P=0.85 vs P=0.92). The costs of RALSC were significantly higher than were those of LSC series in each of three studies (P<0.01 for all). CONCLUSIONS The clinical outcomes of prolapse surgery are similar with RALSC and LSC, but RALSC is less efficient in terms of cost and time.
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Affiliation(s)
- Ke Pan
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yao Zhang
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China; Evidence-based Medicine and Clinical Epidemiology Center, Third Military Medical University, Chongqing, China
| | - Yanzhou Wang
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yunle Wang
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Huicheng Xu
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China.
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Soto-Mesa D, Amorín-Díaz M, Pérez-Arviza L, Fernández-Pello Montes S, Martín-Huéscar A. Holmium laser enucleation of the prostate and retropubic prostatic adenomectomy: morbidity analysis and anesthesia considerations. Actas Urol Esp 2015; 39:535-45. [PMID: 26007624 DOI: 10.1016/j.acuro.2015.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Holmium laser enucleation of the prostate (HoLEP) is an alternative to prostatic adenomectomy for the surgical treatment of benign prostatic hypertrophy. We analyzed our learning curve for this technique, and we compared it in a secondary manner with prostatic adenomectomy. MATERIALS AND METHODS A retrospective comparative study was conducted that included the first 100 cases of HoLEP performed in our center and the latest 50 cases of retropubic adenomectomy. We collected data on the patients, the surgery, the anesthesia, the perioperative variables, the anesthesia complications and the postoperative variables, with a 6-month follow-up. We analyzed the learning curve without mentors for HoLEP and compared the characteristics of HoLEP in 2 separate phases (learning and stabilization phases) with the latest retropubic prostatic adenomectomies performed. RESULTS Intradural anesthesia was the most common technique. The transfusion needs, length of stay (P<.01) and postoperative morbidity were lower for HoLEP than for adenomectomy. However, the retropubic adenomectomy group had larger initial prostate volumes (P<.001) and shorter surgical times (P<.001). Better surgical performance (P<.001) and a lower incidence of complications were observed in the HoLEP-B group (once the learning curve had been overcome) compared with the HoLEP-A group. CONCLUSION In our center, HoLEP was introduced as a valid alternative to open retropubic adenomectomy, with excellent results in terms of morbidity and reduced hospital stay. In terms of the learning curve, we consider that approximately 50 patients (without mentor) is an appropriate cutoff. Local anesthesia is a good choice for the anesthesia technique.
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Affiliation(s)
- D Soto-Mesa
- Servicio de Anestesiología y Reanimación, Hospital de Cabueñes, Gijón, España.
| | - M Amorín-Díaz
- Servicio de Neurología, Fundación Hospital de Jove, Gijón, España
| | - L Pérez-Arviza
- Servicio de Anestesiología y Reanimación, Hospital de Cabueñes, Gijón, España
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Soto-Mesa D, Amorín-Díaz M, Pérez-Arviza L, Fernández-Pello Montes S, Martín-Huéscar A. Holmium laser enucleation of the prostate vs. retropubic prostatic adenomectomy: Morbidity analysis and anesthesia considerations. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.acuroe.2015.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Pan K, Cao L, Ryan NA, Wang Y, Xu H. Laparoscopic sacral hysteropexy versus laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse. Int Urogynecol J 2015; 27:93-101. [DOI: 10.1007/s00192-015-2775-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
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Mateo E, García-Tello A, Ramón de Fata F, Romero I, Núñez-Mora C, Angulo JC. A comparative study between open and laparoscopic approach in radical cystectomy with orthotopic ileal neobladder. Actas Urol Esp 2015; 39:92-7. [PMID: 25015318 DOI: 10.1016/j.acuro.2014.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/06/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Probably, laparoscopic radical cystectomy with ileal neobladder and neovesicourethral anastomosis is one of the most complex procedures in minimally invasive surgery. MATERIAL AND METHODS Prospective study carried out in 72 patients surgically treated for invasive bladder neoplasia between January 2008 and October 2013. Patients were undergone to radical cystectomy with ileal neobladder (open approach in 33 patients and laparoscopic approach in 39). The study assessed comparatively surgical outcomes, continence rate and postoperative complications. RESULTS Mean age was 63.5±9 years (64.3 open vs. 62.7 laparoscopic, P=.46) mean surgery time 323.6±78.7 minutes (321.3 vs. 326.5, P=.77), average hospital stay 14.8 days±8,1 (16.2 vs. 13.6, P=.2), transfusion rate 40.3% (66.7% vs. 17.9%, P<.0001) and complications rate 47.2% (63.6% vs. 33.3%, P=.01). Major complications were reported in 29.1% of cases (39.4% open vs. 20,5% laparoscopic, P=.07). With a mean follow-up rate of 42.5±19.2 months (range 15-70), 50 (69.4%) patients remain alive and free of disease. Continence was evaluated in these patients: total continence rate was 38% (50% vs. 27%, P=.09) and diurnal continence rate 58% (70.8% vs. 46.1%, P=.07). Self-catheterization rate was 8% (4.2% vs. 11.5%, P=.67). Total incontinence rate was 34% (25% vs. 42.3%, P=.19). CONCLUSION According to our experience, transfusion rate, number and severity of complications are lower in laparoscopic cystectomy with ileal neobladder. No statistically significant impact on operative time and on hospital stay was observed. In patients undergone to laparoscopic approach, continence rate is lower but not statistically significant.
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Gimbernat H, Arance I, Redondo C, Meilán E, Andrés G, Angulo J. Treatment for long bulbar urethral strictures with membranous involvement using urethroplasty with oral mucosa graft. Actas Urol Esp 2014; 38:544-51. [PMID: 24948356 DOI: 10.1016/j.acuro.2014.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Urethroplasty with oral mucosa grafting is the most popular technique for treating nontraumatic bulbar urethral strictures; however, cases involving the membranous portion are usually treated using progressive perineal anastomotic urethroplasty. We assessed the feasibility of performing dorsal (or ventral) graft urethroplasty on bulbar urethral strictures with mainly membranous involvement using a modified Barbagli technique. MATERIAL AND METHODS This was a prospective study of 14 patients with bulbomembranous urethral strictures who underwent dilation urethroplasty with oral mucosa graft between 2005 and 2013, performed using a modified technique Barbagli, with proximal anchoring of the graft and securing of the graft to the tunica cavernosa in 12 cases (85.7%) and ventrally in 2 (14.3%). The minimum follow-up time was 1 year. We evaluated the subjective (patient satisfaction) and objective (maximum flow [Qmax] and postvoid residual volume [PVRV], preoperative and postoperative) results and complications. Failure was defined as the need for any postoperative instrumentation. RESULTS A total of 14 patients (median age, 64+13 years) underwent surgery. The main antecedent of note was transurethral resection of the prostate in 9 cases (64.3%). The median length of the stenosis was 45+26.5mm. Prior to surgery, 50% of the patients had been subjected to dilatations and 4% to endoscopic urethrotomy. The mean surgical time and hospital stay were was 177+76min and 1.5+1 day, respectively. The preoperative Qmax and PVRV values were 4.5+4.45mL/sec and 212.5+130 cc, respectively. The postoperative values were 15.15+7.2mL/sec and 6+21.5cc, respectively (P<.01 for both comparisons). Surgery was successful in 13 cases (92.9%). None of the patients had major complications. There were minor complications in 1 (7.1%) patient, but reintervention was no required. CONCLUSION The repair of long bulbar urethral strictures with membranous involvement using urethroplasty with free oral mucosa grafts represents a viable alternative for patients with nontraumatic etiology and little fibrosis. The dilation of the urethral lumen achieves good results with minimum failure rates and little probability of complications. For many of these patients, the length of the stricture is too long to perform the tension-free anastomosis technique.
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Radosa MP, Meyberg-Solomayer G, Radosa J, Vorwergk J, Oettler K, Mothes A, Baum S, Juhasz-Boess I, Petri E, Solomayer EF, Runnebaum IB. Standardised Registration of Surgical Complications in Laparoscopic-Gynaecological Therapeutic Procedures Using the Clavien-Dindo Classification. Geburtshilfe Frauenheilkd 2014; 74:752-758. [PMID: 25221343 DOI: 10.1055/s-0034-1382925] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/18/2014] [Accepted: 06/30/2014] [Indexed: 10/24/2022] Open
Abstract
Introduction: The registration of complications represents an important component in the evaluation of surgical therapeutic procedures. The aim of the present study was to examine the frequency of occurrence as well as the severity of surgical complications after laparoscopic-gynaecological operations in a standardised manner using the Clavien-Dindo system. Material and Methods: Altogether 7438 treatment courses after laparoscopic-gynaecological interventions by 9 working groups were evaluated. Covariates recorded were the technical complexity of the operation, type of study cohort, study size, data acquisition as well as study centre. Target variables recorded were the surgical morbidity rate, subdivided into mild (Clavien-Dindo grade I-II) and severe complications (Clavien-Dindo grade III-V). In addition, a binary logistic regression analysis for the mentioned covariates and the occurrence of surgical complication was carried out. Results: 946 complications were recorded (overall complication rate: 13 %). These included 664 mild complications (8.9 %) and 305 severe complications (4.1 %). A correlation was found between the covariates technical complexity (relative risk [rR] 1.37; p < 0.01), study size (rR: 0.35; p < 0.01) and study centre (rR 0.19; p < 0.01) and the occurrence of surgical complications. Conclusion: By means of a standardised registration of complications using the Clavien-Dindo classification it appears to be possible to limit the methodologically caused underestimation of surgical morbidity in the retrospective evaluation of gynaecological-endoscopic therapeutic procedures. Factors decisively influencing the surgical morbidity of gynaecological-laparoscopic therapeutic procedures are the respective operative experience of the treating facility as well as the technical complexity of the intervention.
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Affiliation(s)
- M P Radosa
- Department of Gynecology and Obstetrics, Jena University Hospital, Jena
| | - G Meyberg-Solomayer
- Department of Obstetrics and Gynecology, University of Saarland, Homburg/Saar
| | - J Radosa
- Department of Obstetrics and Gynecology, University of Saarland, Homburg/Saar
| | - J Vorwergk
- Department of Gynecology and Obstetrics, Jena University Hospital, Jena
| | - K Oettler
- Department of Gynecology and Obstetrics, Jena University Hospital, Jena
| | - A Mothes
- Department of Gynecology and Obstetrics, Jena University Hospital, Jena
| | - S Baum
- Department of Obstetrics and Gynecology, University of Saarland, Homburg/Saar
| | - I Juhasz-Boess
- Department of Obstetrics and Gynecology, University of Saarland, Homburg/Saar
| | - E Petri
- Department of Obstetrics and Gynecology, University Greifswald, Greifswald
| | - E F Solomayer
- Department of Obstetrics and Gynecology, University of Saarland, Homburg/Saar
| | - I B Runnebaum
- Department of Gynecology and Obstetrics, Jena University Hospital, Jena
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Gimbernat H, Arance I, Redondo C, Meilán E, Ramón de Fata F, Angulo J. Analysis of the factors involved in the failure of urethroplasty in men. Actas Urol Esp 2014; 38:96-102. [PMID: 24051326 DOI: 10.1016/j.acuro.2013.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Outcome of urethroplasty techniques in our environment and risk factors for recurrence of stenosis in these patients are studied in this paper. MATERIAL AND METHODS Retrospective study on men with urethral strictures treated with urethroplasty in the period 2000-2012. Maximum flow (Qmax), post-void residual (PVR) urine and patient perception of voiding were obtained pre- and postoperatively. Complications were recorded according to the Clavien-Dindo scale. Recurrent stricture was defined according to clinical criteria and endoscopic or imaging confirmation (failure of urethroplasty). Univariate analysis (log-rank) and multivariate (Cox regression) were performed to define the variables implied in the recurrence. RESULTS 82 patients with mean age 55.6 ± 17.4 (19-84 years) underwent surgery for urethroplasty. 28% of patients showed multiple stricture, 73.2% bulbar stricture, 41.54% penile stricture and 14.6% membranous stricture. End-to-end anastomosis was performed in 26 cases (31.7%), flap urethroplasty in 21 (25.6%), urethroplasty with free graft in 31 (37.8%) and two-time urethroplasty in 4 (4.9%). Graft urethroplasty showed a longer operative time (p = 0.02) and shorter hospital stay (P = 0.0035). The results were: mean ΔQmax (mean on baseline) 9.1 ± 7.5 and mean ΔPVR -65.8 ± 136 (both P < 0.0001). Minor early complications occurred in 8 (9.8%) and major in 3 (3.6%). Recurrence occurred at a mean time of 39.8 ± 39.2 months in 18 patients (21.9%). The percentage of recurrence-free patients was: 91.4% (1-year), 82.1% (5-year) and 78.1% (10-year). Univariate analysis assessed technique used (log-rank, P = 0.13), age (P = 0.2), length stricture (P = 0.003), previous Sachse (P = 0.18), associated lichen (P = 0.18), multiplicity (P = 0.36), year of surgery (P = 0.2), Qmax (P = 0.3) and RPM (P = 0.07) preoperative. End to end anastomosis (HR 4.98, P = 0.04) and length > 3 cm (HR 4.6, P = 0.01) were identified by regression analysis as independent variables associated with poor prognosis. CONCLUSION Length stricture is both prognostic factor and criterion on choosing the type of urethroplasty, and it makes more complicated to compare the success rates of each surgical procedure. Whatever the stricture size is, the results of anastomotic urethroplasty are worse than those of urethroplasty with buccal mucosal-free grafts.
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Tasci A, Simsek A, Tugcu V, Bitkin A, Sonmezay E, Torer B. Abdominal wall haemorrhage after robotic-assisted radical prostatectomy: is it a complication of robotic surgery? Actas Urol Esp 2013; 37:634-9. [PMID: 23768503 DOI: 10.1016/j.acuro.2013.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/23/2012] [Accepted: 01/07/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Robotic-assisted radical prostatectomy (RARP) is the minimally invasive surgical treatment for patients with localized prostate cancer. Perioperative or postoperative complications following RARP have been reported in some studies and severe postoperative bleeding after RARP is rare, but hemodynamic instability may necessitate open surgical exploration and be associated with considerable morbidity. We reported postoperative bleeding cases, which is a kind of complication associated with robotic surgery and requiring massive transfusion after RARP. PATIENTS AND METHODS From August 2009 to May 2012, 317 consecutive patients who underwent RARP performed at our institution were analyzed. Patients with serious postoperative bleeding that caused hemodynamic instability after surgery were enrolled. RESULTS A total of 5 among 317 (1.6%) patients had bleeding requiring postoperative transfusion. In these cases, mean operative time was 114 min. The mean estimated blood loss was 110 ml during operation. In these patients, hematocrit (Hct) levels gradually fell after surgery and ecchymosis was detected on the side and posterior walls of the abdomen on the second day. The mean preoperative Hct was 44.3% and mean lowest Hct was 23.1%. All patients were successfully treatment without surgical exploration. CONCLUSIONS Robotic radical prostatectomy has proven to be a safe surgical treatment with low morbidity. However, postoperative bleeding can reach serious problems. This is the first study to explain haemorrhage, associated with possible risk of robotic surgery.
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De Nunzio C, Lombardo R, Autorino R, Cicione A, Cindolo L, Damiano R, De Sio M, Falsaperla M, Franco G, Gacci M, Leonardo C, Presicce F, Tubaro A. Contemporary monopolar and bipolar transurethral resection of the prostate: prospective assessment of complications using the Clavien system. Int Urol Nephrol 2013; 45:951-9. [DOI: 10.1007/s11255-013-0476-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/18/2013] [Indexed: 11/27/2022]
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