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Yap RV, Buenafe AA, Bejasa MM, Calayag G, Tankiatsy J, Mahani IN, Baguilat JA. Outcomes after ventral hernia repair using the extended totally extraperitoneal approach: Initial experience from the Philippines. Asian J Endosc Surg 2024; 17:e13278. [PMID: 38212265 DOI: 10.1111/ases.13278] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Newer extraperitoneal techniques of laparoscopic ventral/incisional hernia repair (LVIHR) have been continually introduced since the popularity of the laparoscopic intraperitoneal onlay mesh technique began in 1993. One of which is the extended totally extraperitoneal (eTEP) approach allowing wide mesh augmentation, concurrent repair of diastasis recti, and performance of transversus abdominis release (TAR) for large/complex hernias. However, minimally invasive/laparoendoscopic ventral hernia repair is not yet widely adopted in the Philippines. We aim to share our preliminary experience with LVIHR using the eTEP approach. METHODS This was a retrospective review of all consecutive eTEP repairs for ventral hernia between January 2019 and September 2023. The clinical profiles of all patients were gathered. Hernia characteristics, operative profile, and postoperative outcomes were reported. RESULTS Thirty-five patients were included in the study with a mean age of 54.7; 60% were incisional hernias, and the most common hernia location was the umbilical area. A defect size between 4 and 10 cm was reported in 54.3%. eTEP-TAR was necessary in 12 patients. At a median follow-up of 16 months, two patients developed seroma, one hematoma, and two surgical site infections. All were successfully managed conservatively. Only one patient developed recurrence. CONCLUSION eTEP approach is safe and feasible for repairing ventral hernias. Our preliminary experience showed acceptable outcomes similar to the published literature. Surgeons interested in this technique should be familiar with the abdominal wall anatomy, carefully select patients during preoperative planning, and undergo mentorship with hernia surgeons experienced with the technique to shorten the learning curve.
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Affiliation(s)
- Ralph Victor Yap
- Unified Minimally Invasive Surgery Training, Quezon City, Philippines
- Section of Minimally Invasive Surgery, Cardinal Santos Medical Center, San Juan, Philippines
- Department of Surgery, Cebu Doctors' University Hospital, Cebu City, Philippines
| | - Alfred Allen Buenafe
- Unified Minimally Invasive Surgery Training, Quezon City, Philippines
- Section of Minimally Invasive Surgery, Cardinal Santos Medical Center, San Juan, Philippines
- Philippine Center for Advanced Surgery, Cardinal Santos Medical Center, San Juan, Philippines
| | | | - Glenford Calayag
- Unified Minimally Invasive Surgery Training, Quezon City, Philippines
| | - James Tankiatsy
- Unified Minimally Invasive Surgery Training, Quezon City, Philippines
| | | | - Johan Abraham Baguilat
- Unified Minimally Invasive Surgery Training, Quezon City, Philippines
- Section of Minimally Invasive Surgery, Quirino Memorial Medical Center, Quezon City, Philippines
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Gupta S, Attri AK, Iqbal Mir Z, Bansal I. Pre-peritoneal Fat as a Guide to Extended View Total Extraperitoneal (eTEP) Repair for Inguinal Hernia. Cureus 2024; 16:e52327. [PMID: 38361684 PMCID: PMC10868912 DOI: 10.7759/cureus.52327] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
In the extra-peritoneal approach for inguinal hernias, pre-peritoneal space creation is one of the most crucial steps. In the absence of well-defined landmarks, it is difficult to identify the correct plane of dissection, and blind dissection can sometimes lead to peritoneal injury, resulting in loss of working space. In this article, we describe our technique of pre-peritoneal space creation by following the fatty tissue of the median umbilical ligament and fatty tissue along the rectus muscle. The data of all patients (total 84) who underwent surgery with this technique between January 2021 and May 2023 were retrieved and assessed for demographics, hernia type, and perioperative complications. Except for two peritoneal injuries, there were no other intraoperative complications.
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Affiliation(s)
- Sanjay Gupta
- Surgery, Government Medical College & Hospital, Chandigarh, IND
| | - Ashok K Attri
- Surgery, Government Medical College & Hospital, Chandigarh, IND
| | - Zahid Iqbal Mir
- General Surgery, Government Medical College & Hospital, Chandigarh, IND
| | - Ishan Bansal
- General Surgery, Government Medical College & Hospital, Chandigarh, IND
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Fu J, Luo W, Ding Y, Liu X, Fang W, Yang X. Clinical study of 3D laparoscopic radical prostatectomy by transperitoneal and extraperitoneal approaches. Am J Clin Exp Urol 2023; 11:549-558. [PMID: 38148938 PMCID: PMC10749385] [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] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/15/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Comparison of the clinical effectiveness and safety of three-dimensional transperitoneal laparoscopic radical prostatectomy (3D TLRP) versus 3D extraperitoneal LRP (3D ELRP) for prostate cancer. MATERIALS AND METHODS To retrospectively analyze the clinical and regular postoperative follow-up data of patients who underwent 3D LRP performed by the same attending surgeon at the Affiliated Hospital of Bengbu Medical College between 2017 and 2022. A total of 82 patients who met the criteria were included. They were divided into 3D TLRP (n = 39) and 3D ELRP groups (n = 43) according to the surgical approach. The preoperative, intraoperative, and postoperative data were compared. RESULTS There were no statistically significant differences in preoperative characteristics between the two groups. There were also no statistically significant differences between the 3D TLRP and 3D ELRP groups in terms of intraoperative blood transfusion rate (12.82% vs. 2.33%), positive lymph node rate (11.11% vs. 2.38%), positive surgical margin rate (12.82% vs. 6.98%), pathological Gleason score, postoperative clinical stage, perioperative complication rate (10.26% vs. 4.65%), immediate urinary control rate (56.41% vs. 58.14%), 3-month postoperative urinary control rate (76.92% vs. 74.42%), 6-month postoperative urinary control rate (87.18% vs. 83.72%), 6-month postoperative biochemical recurrence rate (7.69% vs. 9.30%), or 6-month postoperative sexual function recovery rate (2.56% vs. 2.33%) (P > 0.05). Compared with the 3D ELRP group, the 3D TLRP group had a longer operative time (232.36 ± 48.52 min vs. 212.07 ± 41.76 min), more estimated blood loss (150.000 [100.0, 200.0] vs. 100.000 [100.0, 125.0]), longer recovery of gastrointestinal function (2.72 ± 0.89 vs. 2.26 ± 0.88), longer duration of drainage tube retention (5.69 ± 1.79 vs. 4.28 ± 2.68), and longer hospitalization time (12.54 ± 4.07 vs. 10.88 ± 2.97), with statistical significance (P < 0.05). CONCLUSION 3D TLRP and 3D ELRP have similar oncologic and functional outcomes. Clinically, physicians can choose a reasonable procedure according to the patient's specific situation and their own surgical experience.
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Affiliation(s)
- Jie Fu
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical CollegeBengbu 233020, Anhui, China
| | - Wenhao Luo
- Department of Urology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu 233099, Anhui, China
| | - Yonghui Ding
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical CollegeBengbu 233020, Anhui, China
| | - Xiao Liu
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical CollegeBengbu 233020, Anhui, China
| | - Wenge Fang
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical CollegeBengbu 233020, Anhui, China
| | - Xuezhen Yang
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical CollegeBengbu 233020, Anhui, China
- Department of Urology, Qingdao West Coast New District People’s HospitalQingdao 266400, Shandong, China
- Affiliated Hospital of Weifang Medical UniversityWeifang 261031, Shandong, China
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Sharma A, Biswal D, Sharma S, Roy S. An elderly male with lower urinary tract symptoms during COVID-19 pandemic: Extraperitoneal perforation of bladder diverticulum. Urologia 2023; 90:763-765. [PMID: 34082626 DOI: 10.1177/03915603211022945] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CASE We present a case of spontaneous extra-peritoneal rupture of an acquired diverticulum an elderly male with symptoms of bladder outlet obstruction who presented in emergency with acute abdomen. OUTCOME The acute phase was managed conservatively with bladder drainage and intravenous antibiotics. He recently underwent Transurethral Resection of Prostate. He is asymptomatic on follow-up. CONCLUSIONS Acquired bladder diverticulum are rare in adults and are mostly seen in patients with high pressure bladder due to bladder outlet obstruction. Atraumatic extraperitoneal ruptures of diverticulum are uncommonly reported.
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Affiliation(s)
- Amit Sharma
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Deepak Biswal
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Satyadeo Sharma
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Siddhant Roy
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Purnomo S, Hamid ARAH, Siregar MAR, Afriansyah A, Mirza H, Seno DH, Purnomo N. Transperitoneal Versus Extraperitoneal Approach for Laparoscopic and Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis. Urol Res Pract 2023; 49:285-292. [PMID: 37877876 PMCID: PMC10646806 DOI: 10.5152/tud.2023.23008] [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] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/28/2023] [Indexed: 10/26/2023]
Abstract
To conduct a comparative analysis of outcomes from 2 different surgical approaches, transperitoneal radical prostatectomy (TP-RP) and extraperitoneal radical prostatectomy (EP-RP) in minimally invasive surgery. A comprehensive search was conducted up to September 2022 using 5 online databases, namely PubMed, Cochrane, Scopus, EMBASE, and Science Direct. Studies were screened per the eligibility criteria, and outcomes included operative duration, estimated blood loss (EBL), hospital stay, operative complication, and positive surgical margin. Total of 13 studies compiled of 2387 patients were selected, with TP-RP and EP-RP performed on 1117 (46.79%) and 1270 (53.21%) patients, respectively. Six laparoscopy radical prostatectomy (LRP) studies and 7 robotassisted radical prostatectomy (RARP) studies with 1140 and 1247 patients, respectively, were also included. The EP-RP demonstrated a marked advantage in terms of operative complications (Risk Ratio [RR]=0.78, 95% CI=0.62, 0.98; P=.04), but no significant difference concluded for operative duration, EBL, hospital stay, and surgical margin. In the RARP group, there was a significant difference in operative duration for EP-RARP and TP-RARP (Mean difference [MD]=-17.27, 95% CI=-26.89, -7.65; P=.0004), hospital stay (MD=-0.54, 95% CI=-0.94, -0.14; P=.008), and operative complications (RR=0.7, 95% CI=0.49, 0.99; P=.04). There were no noteworthy variations identified in EBL and surgical margin. Furthermore, the LRP group did not show any significant differences. This study shows that regardless of the techniques used, EP-RP has a lower risk of operative complications than TP-RP, with no significant difference in other outcomes.
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Affiliation(s)
- Stefanus Purnomo
- Department of Urology, Universitas Indonesia – Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Jakarta, Indonesia
| | | | - Moammar Andar Roemare Siregar
- Department of Surgery, Persahabatan General Hospital - Universitas Indonesia, Faculty of Medicine, Division of Urology, Jakarta, Indonesia
| | - Andika Afriansyah
- Department of Surgery, Persahabatan General Hospital - Universitas Indonesia, Faculty of Medicine, Division of Urology, Jakarta, Indonesia
| | - Hendy Mirza
- Department of Surgery, Persahabatan General Hospital - Universitas Indonesia, Faculty of Medicine, Division of Urology, Jakarta, Indonesia
| | - Doddy Hami Seno
- Department of Surgery, Persahabatan General Hospital - Universitas Indonesia, Faculty of Medicine, Division of Urology, Jakarta, Indonesia
| | - Nugroho Purnomo
- Department of Surgery, Persahabatan General Hospital - Universitas Indonesia, Faculty of Medicine, Division of Urology, Jakarta, Indonesia
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Chopra A, Rothstein A, Mohamed Ahmed A, Pannell S. Small Bowel Evisceration Through a Perforated Stercoral Ulcer. Am Surg 2023; 89:2885-2887. [PMID: 35128955 DOI: 10.1177/00031348221075733] [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] [Indexed: 07/28/2023]
Abstract
Stercoral ulcers are localized areas of loss of colonic mucosal integrity. They result from pressure necrosis of the colonic mucosa, secondary to chronic constipation and fecal inspissation. These ulcers are rare and, are associated with serious complications, including bleeding and perforation. We present the case of a 50-year-old woman who presented with small bowel evisceration through the anal canal secondary to extraperitoneal perforation of the rectum. The patient underwent emergent exploratory laparotomy with reduction of the bowel, followed by second look laparotomy in 24 hours. A full thickness defect in the rectum was identified and Hartmann's procedure was performed. The patient's postoperative course was uneventful. Extraperitoneal perforation and evisceration of bowel is a rare clinical entity. These cases are diagnosed early due to the obvious clinical presentation and however may be misdiagnosed as prolapse. They necessitate urgent and careful surgical planning, to ensure preservation of bowel and complete recovery.
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Affiliation(s)
- Asmita Chopra
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
| | - Anna Rothstein
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
| | - Amin Mohamed Ahmed
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
| | - Stephanie Pannell
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
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Franco A, Pellegrino AA, De Nunzio C, Salkowski M, Jackson JC, Zukowski LB, Checcucci E, Vourganti S, Chow AK, Porpiglia F, Kaouk J, Crivellaro S, Autorino R. Single-Port Robot-Assisted Radical Prostatectomy: Where Do We Stand? Curr Oncol 2023; 30:4301-4310. [PMID: 37185441 PMCID: PMC10136812 DOI: 10.3390/curroncol30040328] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 03/13/2023] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
In 2018, the da Vinci Single Port (SP) robotic system was approved by the US Food and Drug Administration for urologic procedures. Available studies for the application of SP to prostate cancer surgery are limited. The aim of our study is to summarize the current evidence on the techniques and outcomes of SP robot-assisted radical prostatectomy (SP-RARLP) procedures. A narrative review of the literature was performed in January 2023. Preliminary results suggest that SP-RALP is safe and feasible, and it can offer comparable outcomes to the standard multiport RALP. Extraperitoneal and transvesical SP-RALP appear to be the two most promising approaches, as they offer decreased invasiveness, potentially shorter length of stay, and better pain control. Long-term, high-quality data are missing and further validation with prospective studies across different sites is required.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL 60612, USA
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | - Antony A Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Unit of Urology/Division of Oncology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | | | - Jamal C Jackson
- Department of Urology, Rush University, Chicago, IL 60612, USA
| | | | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy
| | | | | | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy
| | - Jihad Kaouk
- Department of Urology, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
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Yang H, Zhang Z, Zhao K, Zhang Y, Yin X, Zhu G, Wang Z, Li X, Li Z, Wang Q, Sui Y, Xing N, Wang K. Initial experience with 161 extraperitoneal laparoscopic radical cystectomy procedures: Comparison with transabdominal laparoscopic radical cystectomy. Int J Urol 2023; 30:155-160. [PMID: 36349911 PMCID: PMC10098523 DOI: 10.1111/iju.15076] [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: 06/03/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES There is substantial concern about traditional transperitoneal laparoscopic radical cystectomy (TLRC) due to multiple postoperative complications. In contrast, extraperitoneal laparoscopic radical cystectomy (ELRC) appears to cause a lower rate of morbidity. The present study aimed to compare the efficacy of ELRC and TLRC for bladder cancer (BCa). METHODS The clinical data of patients undergoing laparoscopic radical cystectomy for BCa from April 2018 to October 2021 were retrospectively analyzed, as ELRC and TLRC groups. The postoperative follow-up data of 275 patients were collected and the incidence of postoperative complications and other perioperative outcomes were compared between the two groups. RESULTS Surgery was successfully completed in all patients without conversion to open surgery. There was no significant difference in the duration of cystectomy surgery (67.32 ± 23.53 vs 72.17 ± 25.72 min, p = 0.106), intraoperative blood loss (178.06 ± 110.4 vs. 174.56 ± 127.40 ml, p = 0.413), or the number of lymph node dissection (15.1 ± 5.7 vs. 14.5 ± 5.1, p = 0.380) between the two groups. The length of stay (11.6 ± 3.8 vs 14.7 ± 5.6 d, p < 0.001), time to resume food intake after surgery (2.3 ± 0.9 vs 3.0 ± 1.3 d, p < 0.001), and the incidence of ileus (p < 0.001) in the ELRC group were significantly lower than in the TLRC group. CONCLUSIONS ELRC is a safe procedure that can reduce the incidence of postoperative complications, shorten postoperative hospital stay, reduce the duration of recovery of patients, and, therefore, should be promoted.
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Affiliation(s)
- Han Yang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zongliang Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kai Zhao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yulian Zhang
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinbao Yin
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guanqun Zhu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhenlin Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xueyu Li
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhaofeng Li
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qinglei Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuanming Sui
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Nianzeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Huang FH, Cheng PL, Hou WH, Duh YC. Laparoscopic Hernia Repair with the Extraperitoneal Approach versus Open Hernia Repair in Pediatric Inguinal Hernia: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:321. [PMID: 35054015 DOI: 10.3390/jcm11020321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis investigated the feasibility and effectiveness of laparoscopic hernia repair with the extraperitoneal approach in pediatric inguinal hernias. SUMMARY BACKGROUND DATA Inguinal hernia repair is the most common operation in pediatric surgical practice. Although open hernia repair (OHR) is a well-established procedure with good outcomes, studies have reported acceptable or even better outcomes of laparoscopic hernia repair with the extraperitoneal approach (LHRE). However, a meta-analysis comparing LHRE with OHR is lacking. METHODS PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) and comparative studies (prospective or retrospective). Outcomes were metachronous contralateral inguinal hernia (MCIH), hernia recurrence, surgical site infection, operation time, and hospitalization length. A meta-analysis was performed, and risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were calculated using random-effects models. RESULTS Five RCTs and 21 comparative studies involving 24,479 patients were included. Lower MCIH incidence (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001) and a trend of shorter operation time (WMD: -11.90 min, 95% CI: -16.63 to -7.44; p < 0.00001) were found in the LHRE group. No significant differences in ipsilateral recurrence hernias, surgical site infection, and length of hospitalization were found between the groups. CONCLUSIONS LHRE presented lower MCIH incidence and shorter operation times, with no increase in hernia recurrence, surgical site infection, or length of hospitalization. As more surgeons are increasingly becoming familiar with LHRE, LHRE would be a feasible and effective choice for pediatric inguinal hernia repair.
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Clements HA, Nabi G. Extra-peritoneal Laparoscopic Resection of Benign Prostate Adenoma >150 CC with preservation of posterior wall of prostatic urethra: Dundee Technique and early outcomes. Scott Med J 2021; 67:30-37. [PMID: 34939516 DOI: 10.1177/00369330211068123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/21/2022]
Abstract
BACKGROUND There are limited options for men with large benign prostates (>150cc) and bladder outflow obstruction due to benign prostatic hyperplasia (BPH). Management options include surgery (open or minimal access) and endoscopic procedures. There is a paucity of literature on outcomes for prostates >150cc. METHODS In this case series we describe a step-by-step, illustrated, modified extra-peritoneal technique of laparoscopic prostatectomy with preservation of the posterior prostatic urethra. This involves creation of extra-peritoneal space, transverse incision of prostate capsule, progressive adenoma dissection, resection, and closure of the capsule. RESULTS Ten patients underwent this procedure between 2015 and 2019. The mean age was 72.4 years and mean prostate size was 215.5cc. Mean procedure duration was 200 min and there were no intraoperative complications. Most patients were discharged on postoperative day 1. Mean intraoperative blood loss was 120 ml with no patient requiring blood transfusion. At follow up (mean 37 months) no patients had residual symptoms of BPH. CONCLUSION We describe a novel extraperitoneal laparoscopic technique for benign prostates of >150cc with very good outcomes. The transferability of this technique to centres with laparoscopic expertise at minimal extra cost and future adaptability in the robotic setting are some of the advantages of this technique.
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Affiliation(s)
- Hollie A Clements
- Foundation Doctor, 59805Ninewells Hospital and Medical School, Dundee
| | - Ghulam Nabi
- Professor of Surgical Uro-oncology, 59805Ninewells Hospital and Medical School, Dundee
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Vuille-Dit-Bille RN, Muff JL, Sommer V, Holland-Cunz SG, Frech-Dörfler M. Minimally Invasive Total Extraperitoneal Varicocele Repair: First Description in Children. J Laparoendosc Adv Surg Tech A 2021; 31:1496-1500. [PMID: 34748421 DOI: 10.1089/lap.2021.0306] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The aim of this study was to report the first pediatric case series treated with minimally invasive total extraperitoneal varicocele (MITEV) repair using the total extraperitoneal (TEP) approach. Materials and Methods: Five male adolescents (12-17 years) were included in this study, all with left-sided Grade III varicoceles. A 5 mm camera port was inserted just below the umbilicus and two 5 mm working ports were used, one above the symphysis in the midline and the other in the left lateral hemiabdomen just below the arcuate line. Results: Operation time ranged from 47 to 61 minutes (mean: 53 minutes). There were no intra- or postoperative complications. The peritoneum was not perforated, and the abdominal cavity was not entered. Two patients had resolution from varicoceles on follow-up clinical examination and ultrasonography was performed 6 months after surgery. In 3 patients, long-term follow-up was pending. Conclusion: MITEV repair reflects a new minimally invasive access to the retroperitoneum in children with varicocele.
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Affiliation(s)
| | - Julian L Muff
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Vivienne Sommer
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Stefan G Holland-Cunz
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Martina Frech-Dörfler
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
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12
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Jiang H, Thapa DM, Cai X, Ma C, Wang M. Modified Laparoscopic Sugarbaker Repair of Parastomal Hernia With a Totally Extraperitoneal Technique. Front Surg 2021; 8:740430. [PMID: 34676240 PMCID: PMC8524127 DOI: 10.3389/fsurg.2021.740430] [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: 07/13/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Many patients develop a parastomal hernia within the first 2 years of stoma formation, and even surgical repair is associated with high recurrence rates. An intraperitoneal approach is typically used for the laparoscopic repair of parastomal hernia; it is unknown whether a totally extraperitoneal technique (TEP) is feasible. Here we describe a laparoscopic TEP approach using a modified Sugarbaker method for the repair of parastomal hernia. Methods: Seven patients underwent parastomal hernia repair. The retrograde puncture technique was used to create the extrapneumoperitoneum, and the peritoneum was separated with a laparoscopic TEP approach; the mesh was placed using a modified Sugarbaker technique. Results: All patients had an oncologic etiology for stoma creation. The mean (±SD) size of the hernia defect was 3.1 ± 2.7 cm and the mesh size was 303.4 ± 96.8 cm2. The mean operative time was 195.5 ± 20.7 min and average length of hospital stay after surgery was 4.8 ± 2.1 days. One patient had intraoperative subcutaneous emphysema. The average follow-up time was 8.5 ± 2.7 months; mild pain occurred in 2 patients, 3 experienced seroma formation (with no special treatment required), and 1 had early intestinal obstruction (which was treated with conservative care). There was no hernia recurrence, wound complications, or infections of the surgical site or mesh during follow-up. Conclusion: A laparoscopic TEP technique is technically challenging but feasible. Modified laparoscopic Sugarbaker repair of a parastomal hernia with the TEP technique is safe and effective, although the recurrence rate and late complications require confirmation in more cases with long-term follow-up.
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Affiliation(s)
- Huiyong Jiang
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Dil Momin Thapa
- Clinical Medical School, Inner Mongolia University for the Nationalities, Tongliao, China.,The Second Department of General Surgery, The Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
| | - Xiangjun Cai
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Chun Ma
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Mofei Wang
- Clinical Medical School, Inner Mongolia University for the Nationalities, Tongliao, China.,The Second Department of General Surgery, The Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
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13
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Abstract
Robot-assisted radical prostatectomy (RARP) is currently the standard minimally invasive procedure for the surgical management of localized prostate cancer. It has been shown that the minimally invasive robotic approach offers comparable oncologic and functional outcomes with potential advantages, including decreased blood loss, shorter hospital stay, and recovery period when compared with open surgery. Generally, the transperitoneal RARP approach is the most commonly performed among robotic surgeons, owing to its wider space and early adoption. However, similar oncologic outcomes have been reported with the extraperitoneal approach. Owing to its perceived technical difficulty, extraperitoneal RARP is less adopted nowadays. This approach, however, has its merits particularly in cases where intraperitoneal access can be problematic with extensive adhesions from previous surgeries. Also, extraperitoneal approach allows for minimal bowel manipulation, less steep Trendelenburg positioning, and less pneumoperitoneum, which reflect on early recovery of bowel function after RARP. Both transperitoneal and extraperitoneal approaches can be performed using either the conventional multiport robotic system or the more recent single-port (SP) robotic system. With respect to extraperitoneal RARP, there has been an increased adoption of the SP system, with purported advantages such as better cosmesis, less postoperative analgesic and opioid requirements, and shorter duration of hospital stay. Herein, we describe the technical steps relevant to extraperitoneal single-port robot-assisted radical prostatectomy, and elaborate on the clinical outcomes reported in the literature.
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Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
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14
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15
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Yıldız A, Anıl H, Akdemir S, Aksaray EE, Ateş M, Arslan M. Extraperitoneal Laparoscopic Versus Transperitoneal Robot-Assisted Laparoscopic Approaches for Extended Pelvic Lymph Node Dissection During Radical Prostatectomy. J Laparoendosc Adv Surg Tech A 2021; 32:355-359. [PMID: 33960836 DOI: 10.1089/lap.2021.0174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/12/2022] Open
Abstract
Background: We aim to directly compare the feasibility and safety of extended pelvic lymph node dissection (PLND) during transperitoneal robotic-assisted radical prostatectomy (Tp-RARP) and extraperitoneal laparoscopic radical prostatectomy (Ep-LRP). Materials and Methods: We retrospectively identified the prospectively maintained database records of 162 patients diagnosed with prostate cancer (PC) who underwent Ep-LRP or Tp-RARP with extended PLND. Patients with risk of nodal metastases over 5% according to Briganti nomogram received extended PLND. All data analyzed in this study were based on the documentation in our PC database including age, body mass index, Charlson comorbidity index score, preoperative prostate-specific antigen, history of abdominal surgery, biopsy Gleason score, total operation time, postoperative pelvic drainage time, pathological results, lymph node yield (LNY), percentage lymph node involvement (%LNI), and perioperative complications. Patients were followed up for biochemical recurrence in the postoperative period. Results: Eighty-two of the 162 enrolled patients were in group 1 (Ep-LRP+PLND) and 80 were in group 2 (Tp-RARP+PLND). There were no statistically significant differences between the groups regarding preoperative demographics and clinical characteristics. The median LNY was 17 (range 8-27) and 17.5 (range 10-29) in groups 1 and 2, respectively, and no statistically significant difference was found. There was no significant difference between the groups in terms of biochemical recurrence-free survival with mean follow-up of 44.8 months after radical surgery. Conclusion: Our results support the view that extended PLND through the Ep-LRP approach is a feasible and safe procedure without compromising oncological efficacy compared with a similar template attempted during Tp-RARP. Clinical Trial Registration number is 01/21-2.
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Affiliation(s)
- Ali Yıldız
- Department of Urology, Faculty of Medicine, Okan University Hospital, Istanbul, Turkey
| | - Hakan Anıl
- Department of Urology, Adana Seyhan State Hospital, Adana, Turkey
| | - Serkan Akdemir
- Department of Urology, Tınaztepe Galen Hospital, İzmir, Turkey
| | - Eren Erdi Aksaray
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mutlu Ateş
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Murat Arslan
- Department of Urology, Faculty of Medicine, Okan University Hospital, Istanbul, Turkey
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16
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Li CC, Chien TM, Lee MR, Lee HY, Ke HL, Wen SC, Chou YH, Wu WJ. Extraperitoneal Robotic Laparo-Endoscopic Single-Site Plus1-Port Radical Prostatectomy Using the da Vinci Single-Site Platform. J Clin Med 2021; 10:jcm10081563. [PMID: 33917705 PMCID: PMC8068145 DOI: 10.3390/jcm10081563] [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: 03/27/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
Currently, over 80% of radical prostatectomies have been performed with the da Vinci Surgical System. In order to improve the aesthetic outlook and decrease the morbidity of the operation, the new da Vinci Single Port (SP) system was developed in 2018. However, one major problem is the SP system is still not available in most countries. We aim to present our initial experience and show the safety and feasibility of the single-site robotic-assisted radical prostatectomy (LESS-RP) using the da Vinci Single-Site platform. From June 2017 to January 2020, 120 patients with localized prostate cancer (stage T1–T3b) at Kaohsiung Medical University Hospital were included in this study. We describe our technique and report our initial results of LESS-RP using the da Vinci Si robotic system. Preoperative, intraoperative and postoperative patient variables were recorded. Prostate-specific antigen (PSA)-free survival was also analyzed. A total of 120 patients were enrolled in the study. The median age of patients was 68 years (IQR 63–71), with a median body mass index of 25 kg/m2 (IQR 23–27). The median PSA value before operation was 10.7 ng/mL (IQR 7.9–21.1). The median setup time for creat-ing the extraperitoneal space and ports document was 25 min (IQR 18–34). The median robotic console time and operation time were 135 min (IQR 110–161) and 225 min (IQR 197–274), respectively. Median blood loss was 365 mL (IQR 200–600). There were 11 (9.2%) patients who experienced complications (Clavien–Dindo classification Gr II). The me-dian catheter duration was 8 days (IQR 7–9), with a median of 10 days (IQR 7–11) of hospital stay. The PSA free-survival rate was 86% at a median 19 months (IQR 6–28) of follow up. Robotic radical prostatectomy using the da Vinci Single-Site platform system is safe and feasible, with acceptable outcomes.
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Affiliation(s)
- Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80756, Taiwan;
| | - Tsu-Ming Chien
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Correspondence: (T.-M.C.); (W.-J.W.); Tel.: +886-7-320-8212 (T.-M.C. & W.-J.W.)
| | - Ming-Ru Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80756, Taiwan;
| | - Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Sheng-Chen Wen
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Yii-Her Chou
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Correspondence: (T.-M.C.); (W.-J.W.); Tel.: +886-7-320-8212 (T.-M.C. & W.-J.W.)
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17
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Lee W, Tang J, Li A, Zhu Y, Ling X, Cang J, Jiang S, Fang F. Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy on postoperative hepatic and renal function. Gland Surg 2020; 9:759-766. [PMID: 32775266 DOI: 10.21037/gs-20-533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/06/2022]
Abstract
Background In this retrospective study, we evaluated the effect of two approaches of robotic-assisted laparoscopic radical prostatectomy (RALP). The first approach was pneumoperitoneum via transperitoneal (TP-RALP), and the second approach was extraperitoneal (EP-RALP) on visceral function. We aimed to provide clinical evidence for the perioperative safety with RALP and to help the surgical team choose an appropriate approach for those with hepatic or renal insufficiency. Methods One hundred and fifty-seven eligible prostate cancer patients from 2015 to 2019 were included in this study. The postoperative related laboratory tests were compared between transperitoneal and extraperitoneal. The primary endpoint was hepatic and renal function. We also evaluate the intraoperative amount of bleeding, the length of postoperative hospital stays, the occurrence of postoperative complications (lymphatic leakage, bleeding, and infection), and the prostate-specific antigen (PSA). Results Postoperative total bilirubin and bound bilirubin in both groups were significantly increased, while total protein, albumin, globulin, urea, and uric acid were significantly decreased (P<0.05). The total protein, albumin, and globulin are significantly higher in the EP-RALP group than in the TP-RALP group (P<0.05) postoperatively. There are no statistical differences in estimated glomerular filtration rate (eGFR) and creatinine clearance (CCR) between these two groups, postoperatively. Conclusions RALP had a significant effect on hepatic function after both TP-RALP and EP-RALP approaches, while the latter showed a lesser extent. Our results suggested that pneumoperitoneal pathways have significant effects on protein consumption. Thus, we should require a more cautious choice of surgical approaches when it comes to patients with impaired hepatic function or under risk of hepatic malfunction.
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Affiliation(s)
- Weishan Lee
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Tang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ailun Li
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiqi Zhu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaomin Ling
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Cang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuai Jiang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fang Fang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
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18
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Zwols TLR, Akkersdijk WL, Bökkerink WJV, Andeweg CS, Pierie JPEN, Koning GG. Emergency TREPP for Strangulated Inguinal Hernia Repair: A Consecutive Case Series. Surg J (N Y) 2020; 6:e62-e66. [PMID: 32258411 PMCID: PMC7108950 DOI: 10.1055/s-0040-1705171] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/03/2020] [Indexed: 10/31/2022] Open
Abstract
Background Patients with strangulated inguinal hernia (SIH) require emergency surgical treatment. International guidelines do not specify the surgical technique of preference. Frequently, an open anterior approach such as the Lichtenstein technique is used. The TransREctus sheath Pre-Peritoneal (TREPP) technique is an alternative, open posterior approach, which has shown promising results in the elective treatment of inguinal hernias. This study aims to evaluate the feasibility and safety of the TREPP technique in the emergency setting of SIHs. Materials and Methods After medical ethical approval was warranted, all consecutive patients, who underwent emergency TREPP (e-TREPP) at a high-volume hernia institute, were retrospectively included from 2006 up to and including 2016. Data retrieved from the electronic patient files were combined with the findings during a long-term outcome physical investigation at an outpatient department visit. e-TREPP was, prior to the start of the study, defined as TREPP performed immediately at the operation room. Results Thirty-three patients underwent e-TREPP for SIH. Ten patients were clinically evaluated, ten patients were deceased, nine patients could not be contacted, and four patients did not or could not consent. Of the ten deceased patients, one patient died perioperatively due to massive aspiration followed by cardiac arrest. Nine patients died due to other causes. Two patients developed a recurrence after (after 13 days and 16 months respectively). Two patients were surgically treated for a wound infection (mesh removal in one). No patient reported chronic postoperative inguinal pain. Conclusion e-TREPP in experienced hands seems feasible and safe (Level of Evidence 4) for the treatment of patients with strangulated inguinal hernia, with percentages of postoperative complications comparable to other techniques.
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Affiliation(s)
- T L R Zwols
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.,Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands
| | - W L Akkersdijk
- Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands
| | - W J V Bökkerink
- Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands.,Department of Surgery, Gelderse Vallei Hospital, The Netherlands
| | - C S Andeweg
- Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands
| | - J P E N Pierie
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.,Postgraduate School of Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - G G Koning
- Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands
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19
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Weng E, Valencia DN, Krudy ZA, Ali M. Intraperitoneal and Extraperitoneal Colonic Perforation Following Diagnostic and Therapeutic Colonoscopy with Crohn's-related Stricture Dilation. Cureus 2020; 12:e7162. [PMID: 32257705 PMCID: PMC7112721 DOI: 10.7759/cureus.7162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 12/18/2022] Open
Abstract
Colonic perforation is an uncommon but known and feared complication of colonoscopy, which carries a high mortality rate. We present an uncommon case of extensive intra- and extraperitoneal air following colonic perforation in a patient undergoing inpatient colonoscopy for evaluation of unintentional weight loss and constipation. During colonoscopy, a splenic flexure stricture was identified and dilated. Postprocedural hemodynamic instability prompted further imaging which revealed pneumoperitoneum, bilateral pneumothorax, pneumomediastinum, pneumopericardium, and severe subcutaneous emphysema. Emergent exploratory laparotomy found perforation of the proximal transverse colon which required resection and transverse colostomy placement. The patient also underwent bilateral chest tube placement and was treated with antibiotics for peritonitis. The patient was eventually diagnosed with Crohn’s disease and discharged to an extended care facility with outpatient follow-up. Extraperitoneal colonic perforations are fairly rare, and to our knowledge, we present the most severe case that has been published in recent years.
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Affiliation(s)
- Emily Weng
- Internal Medicine, Kettering Medical Center, Kettering, USA
| | | | - Zoltan A Krudy
- Internal Medicine, Kettering Medical Center, Kettering, USA
| | - Median Ali
- Pulmonary Medicine and Critical Care, Kettering Medical Center, Kettering, USA
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20
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Rapoport L, Yossepowitch O, Shpot E, Chinenov D, Chernov Y, Yurova M, Enikeev D. Radical prostatectomy performed via robotic, transperitoneal and extraperitoneoscopic approaches: functional and early oncological outcomes. Cent European J Urol 2018; 71:378-385. [PMID: 30680229 PMCID: PMC6338822 DOI: 10.5173/ceju.2018.1739] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/24/2018] [Accepted: 10/28/2018] [Indexed: 01/02/2023] Open
Abstract
Introduction Oncological remission along with high postoperative functionality [continence and erectile function (EF)] are the main aspects of prostate cancer (PCa) treatment. The aim of this study was to compare functional and oncological treatment results achieved after a nerve-sparing radical prostatectomy (RP) via transperitoneal (TPRP), extraperitoneal (EPRP) and robot-assisted (RARP) approach. Material and methods From March 2015 to March 2016, 507 RP were performed at the Institute for Urology and Reproductive Health (Moscow, Russia). A total of 264 patients with localized (cТ1а–2с) prostate cancer [prostate-specific antigen (PSA) <20 ng/ml, Gleason score ≤7], intact prostate capsule (according to MRI), International Index of Erectile Function (IIEF-5) ≥19 and a life expectancy >10 years were included into the retrospective study. All the surgeries were performed by a single surgeon. The outcomes were evaluated after urethral catheter removal and 3–6–12 months after RP. Results Nerve preservation (NP) was performed for 153 patients without significant distinctions in time (р = 0.064) and blood loss (р = 0.073). The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) score was lower for NP: 9.23 ±6.59 and 3.86 ±5.38 after 3 and 12 months respectively compared with continence after RP without nerve preservation (NP): 14.27 ±5.1 vs. 6.15 ±4.76 (р <0.001). Continent was 52.2% vs. 83.3% vs. 81.8% in TPRP, RARP and EPRP groups; р <0.001. IIEF-5 scores were 14.67 ±9.4, 4.2 ±4.26 and 4.0 ±2.07 after RARP, TPRP and EPRP respectively (р = 0.002). After 12 months the PSA: TPRP = 0.11 ±0.19, RARP = 0.03 ±0.05 and EPRP = 0.53 ±1.87 ng/ml (р <0.001). Outcomes depend on surgical approach and was better in the RARP-group (AUC = 0.768 ±0.034 (CI 95% 0,701–0.834; р <0.001). Conclusions We suggest RARP with NP as a method of choice for treatment of prostate cancer in patients interested in preservation of EF and quality of life in general.
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Affiliation(s)
- Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Evgeniy Shpot
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Denis Chinenov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Yaroslav Chernov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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21
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Tulina IA, Kitsenko YE, Ubushiev MN, Efetov SK, Wexner SD, Tsarkov PV. Laparoscopic technique of modified extraperitoneal (retrotransversalis) end colostomy for abdominoperineal excision. Colorectal Dis 2018; 20:O235-O238. [PMID: 29779245 DOI: 10.1111/codi.14267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/09/2018] [Indexed: 02/08/2023]
Abstract
AIM To describe the technique of a modified extraperitoneal retrotransversalis end colostomy as part of a laparoscopic abdominoperineal excision (APR). METHOD The colostomy site is preoperatively chosen and used intra-operatively for a trocar. After the rectum has been mobilized the descending colon is freed. The peritoneal margin is gently grasped and the parietal peritoneum and extraperitoneal together with the transversalis fascia are separated from the transverse abdominal muscle fibres upwards for 3-4 cm aiming at the trocar site to form the extraperitoneal retrotransversalis canal. The stoma site trocar is partially withdrawn and its head is turned laterally until its tip is positioned in the layer between the abdominal wall muscles and underlying transversalis and extraperitoneal fascia together with the parietal peritoneum. The CO2 source can be attached so that the gas helps to separate the layers, after which the colostomy trephine is formed at the site of the trocar, the grasper is inserted to gently deliver the blunt end of the descending colon through the canal and the end colostomy is formed in a usual way. RESULTS No procedure-specific complications were noted in 39 patients who had laparoscopic APR with extraperitoneal retrotransversalis end colostomy from 2009 to 2016. In 23 patients who survived for 3.7 ± 1.7 years after surgery there were no clinical or CT signs of parastomal hernia or prolapse. CONCLUSION This single-institution retrospective case series demonstrates that laparoscopic extraperitoneal retrotransversalis end colostomy is feasible, safe and effective in preventing parastomal hernias and stomal prolapse.
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Affiliation(s)
- I A Tulina
- Department of surgery - Faculty of preventive medicine, Clinic of Colorectal and minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.,Clinic of Colorectal and Minimally Invasive Surgery, Moscow, Russia
| | - Yu E Kitsenko
- Department of surgery - Faculty of preventive medicine, Clinic of Colorectal and minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.,Clinic of Colorectal and Minimally Invasive Surgery, Moscow, Russia
| | - M N Ubushiev
- Department of surgery - Faculty of preventive medicine, Clinic of Colorectal and minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.,Clinic of Colorectal and Minimally Invasive Surgery, Moscow, Russia
| | - S K Efetov
- Department of surgery - Faculty of preventive medicine, Clinic of Colorectal and minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.,Clinic of Colorectal and Minimally Invasive Surgery, Moscow, Russia
| | - S D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - P V Tsarkov
- Department of surgery - Faculty of preventive medicine, Clinic of Colorectal and minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.,Clinic of Colorectal and Minimally Invasive Surgery, Moscow, Russia
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22
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Horovitz D, Lu X, Feng C, Messing EM, Joseph JV. Rate of Symptomatic Lymphocele Formation After Extraperitoneal vs Transperitoneal Robot-Assisted Radical Prostatectomy and Bilateral Pelvic Lymphadenectomy. J Endourol 2017; 31:1037-1043. [PMID: 28741376 DOI: 10.1089/end.2017.0153] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE With the peritoneum acting as a natural surface for lymphatic reabsorption, transperitoneal robot-assisted radical prostatectomy (tRARP) is thought to be associated with a lower incidence of symptomatic lymphoceles (SLs) compared with its extraperitoneal counterpart (eRARP) when bilateral pelvic lymph node dissection (BPLND) is performed. In this study, we aim to determine if there is a difference in SL formation and characteristics between the two approaches. MATERIALS AND METHODS We retrospectively reviewed the records of patients who underwent eRARP or tRARP and BPLND by a single surgeon at a tertiary care academic center from July 1, 2003, to May 31, 2016. Patients with a history of prior pelvic radiotherapy, concomitant inguinal hernia repair, RARP without BPLND, or nonadenocarcinoma of the prostate were excluded. The resulting eRARP and tRARP groups were propensity matched for age, body mass index (BMI), American Association of Anesthesiologists (ASA) score, D'Amico risk classification, and pathological lymph node (LN) count. RESULTS A total of 3183 RARPs were performed during this time period. After applying exclusion criteria and propensity score matching, 671 patients remained in each group. No statistically significant differences were noted between the groups with regard to age, BMI, ASA, pre-RARP prostate-specific antigen, D'Amico risk classification, biopsy and pathological Gleason sum score, pathological T stage, or margin status. The tRARP group had a higher clinical T stage (p = 0.0015), length of stay (LOS; p = 0.005), pathological N stage (4.92% vs 1.36%, p = 0.0002), and high total LN count (7.22 ± 5.54 vs 5.78 ± 4.18 LNs, p < 0.0001). The eRARP group had higher operating room times (197.4 ± 48.96 minutes vs 192.2 ± 44.12 minutes, p = 0.04) and estimated blood loss (218.4 ± 152.0 mL vs 179.9 ± 119.4 mL, p < 0.0001). No differences were noted in the frequency of SL formation [eRARP: 19/671 (2.83%) vs tRARP: 10/671 (1.49%), p = 0.09] or any clinical characteristics of the SL. Logistic regression analysis showed no effect of LN count (p = 0.071), pathological N stage (p = 0.111), or both combined (p = 0.085) on SL formation. CONCLUSIONS In this cohort, the rate and clinical characteristics of SL were similar among patients treated with eRARP or tRARP and BPLND. The low event rate of SL in each group and trends favoring higher SL with LN yield and pN1 disease in the tRAPR group may deem the study underpowered to make definitive conclusions.
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Affiliation(s)
- David Horovitz
- 1 Department of Urology, University of Rochester Medical Center , Rochester, New York
| | - Xiang Lu
- 2 Department of Biostatistics and Computational Biology, University of Rochester Medical Center , Rochester, New York
| | - Changyong Feng
- 2 Department of Biostatistics and Computational Biology, University of Rochester Medical Center , Rochester, New York
| | - Edward M Messing
- 1 Department of Urology, University of Rochester Medical Center , Rochester, New York
| | - Jean V Joseph
- 1 Department of Urology, University of Rochester Medical Center , Rochester, New York
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Pucheril D, Chun B, Dalela D, Abdollah F, Laker SA, Rogers CG. Robot-Assisted Laparoscopic Repair of Extraperitoneal Ureteral Inguinal Hernia with Mesh Placement. J Endourol Case Rep 2017; 3:97-100. [PMID: 28894843 PMCID: PMC5587904 DOI: 10.1089/cren.2017.0046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 12/02/2022] Open
Abstract
Background: Ureter involvement within indirect hernias is a rare phenomenon usually identified incidentally during herniorrhaphy. Even more rare are extraperitoneal ureteral inguinal hernias, which represent about 20% of these cases and are characterized by a substantial amount of extraperitoneal fat in the hernia defect, the absence of a peritoneal sac, and associated with hydroureteronephrosis and nephroptosis. To date, repair of ureteral inguinal hernias has been performed exclusively using open surgical techniques. We report the first case of successful robot-assisted laparoscopic repair of this rare presentation. Case Presentation: A morbidly obese 70-year-old male with an unremarkable surgical and urological history presents with a 15-year history of nonpainful, enlarging right scrotal swelling measuring 25 cm in diameter. CT imaging revealed right nephroptosis and a hernia defect containing a dilated right ureter looping into the scrotum surrounded by significant extraperitoneal fat. Retrograde pyelography and ureteral catheter placement confirmed a >100 cm ureter. The patient underwent a robot-assisted laparoscopic repair. The inferior epigastric artery, spermatic cord vessels, vas deferens, and ureter were identified. The defect was reduced using external scrotal pressure and reinforced with ProGrip™ self-fixating laparoscopic mesh. The patient was discharged 2 days later following an uneventful postoperative course. Conclusion: Although rare and usually incidentally discovered, extraperitoneal ureteral inguinal hernias can be identified preoperatively by the astute clinician. Preoperative identification allows for improved surgical planning, including a minimally invasive approach. Robot-assisted laparoscopic repair with mesh placement is a feasible alternative to traditional open techniques.
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Affiliation(s)
- Daniel Pucheril
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Brian Chun
- Wayne State University School of Medicine, Detroit, Michigan
| | - Deepansh Dalela
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Scott A Laker
- Michigan Institute for Laparoscopic Surgery, West Bloomfield, Michigan
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
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Liu Z, Li D, Chen Y. Endoscopic extraperitoneal radical prostatectomy after radical resection of pT1-pT2 rectal cancer: a report of thirty cases. Wideochir Inne Tech Maloinwazyjne 2017; 12:68-74. [PMID: 28446934 DOI: 10.5114/wiitm.2017.66475] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/29/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Endoscopic extraperitoneal radical prostatectomy (EERPE) has gained popularity for the treatment of localized prostate cancer. However, prior complex lower abdominal or pelvic surgery can complicate subsequent EERPE. To date, there have been few reports on patients who underwent EERPE after radical resection of pT1-pT2 rectal cancer. AIM To present our experience with EERPE in patients after radical resection of pT1-pT2 rectal carcinoma and introduce a simple and effective way to create an extraperitoneal working space. MATERIAL AND METHODS Thirty patients after radical resection of pT1-pT2 rectal carcinoma were treated with EERPE for biopsy-proven localized prostate cancer. Operation time, estimated blood loss, conversion to open surgery rate, transfusion rate and transurethral catheter time were recorded. Meanwhile, functional outcome (continence and potency) and oncological outcome were reviewed. RESULTS The average operative time was 168 min. Mean blood loss was 195 ml. There was no need for conversion to open surgery or transfusion. The catheter was removed on postoperative day (POD) 7.8. After a mean follow-up time of 53.1 months, 3 patients had a prostate-specific antigen level relapse over 0.1 ng/ml. At the follow-up time, 26 patients were completely continent, and 4 needed 1-2 pads/day. Of the 6 patients who underwent neurovascular bundle preservation, none have experienced return of erections at the last follow-up time. CONCLUSIONS Endoscopic extraperitoneal radical prostatectomy after radical resection of rectal carcinoma appears promising, with feasibility in experienced hands. The operative data, postoperative urinary incontinence and oncological outcomes appear encouraging, but the rate of erectile dysfunction seems to be disappointing.
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Kusunoki S, Huang KG, Magno A, Lee CL. Laparoscopic technique of para-aortic lymph node dissection: A comparison of the different approaches to trans- versus extraperitoneal para-aortic lymphadenectomy. Gynecol Minim Invasive Ther 2016; 6:51-57. [PMID: 30254875 PMCID: PMC6113969 DOI: 10.1016/j.gmit.2016.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 08/19/2015] [Revised: 12/29/2015] [Accepted: 01/04/2016] [Indexed: 11/27/2022] Open
Abstract
Since Dr Dargent first reported endoscopic surgery using retroperitoneal pelvicoscopy to perform pelvic lymph node sampling in 1987, many literature reviews on the safety and feasibility of laparoscopic staging surgery of gynecologic malignancies have been published. However, the procedure of laparoscopic lymphadenectomy is more difficult to perform due to the limited surgical space and associated technical problems. Especially in the para-aortic lymphadenectomy procedure, there are many barriers to overcome in the surgical field, learning curve, and technique. We present a review of lymphadenectomy, especially para-aortic lymphadenectomy.
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Affiliation(s)
- Soshi Kusunoki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
| | - Angelito Magno
- Department of Obstetrics and Gynecology, University of Perpetual Help Medical Center, Las Pinas and De La Salle University Medical Center, Cavite, Philippines
| | - Chyi-Long Lee
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
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26
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Qazi HAR, Rai BP, Do M, Rewhorn M, Häfner T, Liatsikos E, Kallidonis P, Dietel A, Stolzenburg JU. Robot-assisted laparoscopic total extraperitoneal hernia repair during prostatectomy: technique and initial experience. Cent European J Urol 2015; 68:240-4. [PMID: 26251753 PMCID: PMC4526615 DOI: 10.5173/ceju.2015.562] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 02/01/2015] [Revised: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction To describe the technique of total extraperitoneal inguinal hernia repair performed during Robot-assisted Endoscopic Extraperitoneal Radical Prostatectomy (R-EERPE) and to present the initial outcomes. Material and methods 12 patients underwent inguinal hernia repair during 120 R-EERPEs performed between July 2011 and March 2012. All patients had a clinically palpable inguinal hernia preoperatively. The hernia was repaired using a Total Extraperitoneal Patch (TEP) at the end of the procedure. Results Sac dissection and mesh placement was simpler compared to conventional laparoscopy due to improved, magnified, 3-D vision along with 7° of movement, and better control of mesh placement. The median operating time was 185 minutes, with on average, an additional 12 minutes incurred per hernia repair. The median blood loss for the procedures was 250 ml, and the mean pathological prostate weight was 55 gm. No additional blood loss was noted and there were no postoperative complications. None of the patients had a recurrence at 12 months. We await long-term follow-up data. Conclusions Robot-assisted TEP is feasible and should be considered in patients with hernia at the time of R-EERPE.
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Affiliation(s)
- Hasan A R Qazi
- Department of Urology, University of Leipzig, Leipzig, Germany
| | | | - Minh Do
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Matthew Rewhorn
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Tim Häfner
- Department of Urology, University of Leipzig, Leipzig, Germany
| | | | - Panagiotis Kallidonis
- Department of Urology, University of Leipzig, Leipzig, Germany ; Department of Urology, University of Patras, Patras, Greece
| | - Anja Dietel
- Department of Urology, University of Leipzig, Leipzig, Germany
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Agrawal V, Joseph J. Bladder rupture - a rare complication of extraperitoneal balloon dissection during robot-assisted radical prostatectomy. Int J Med Robot 2015; 11:395-9. [PMID: 25613575 DOI: 10.1002/rcs.1634] [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: 09/21/2014] [Revised: 11/30/2014] [Accepted: 12/03/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Balloon dissection to create the extraperitoneal space to facilitate laparoscopic procedures is generally a safe step. However, complications can include vascular and visceral injuries. Bladder injury during balloon dilation of extraperitoneal space has previously been described during herniorraphy. This is the first reported case of bladder injury during balloon dilation of the extraperitoneal space during robot-assisted radical prostatectomy. METHODS We report transection of bladder at the prostato-vesical junction, during balloon dilation of extraperitoneal space, in a 66-year-old man undergoing extraperitoneal robot-assisted radical prostatectomy. RESULTS The patient had an uneventful procedure due to immediate recognition of this intra-operative complication. At 6-month follow-up, he reports complete return of urinary continence and is free from biochemical recurrence from prostate cancer. DISCUSSION Albeit uncommon, balloon-related complications can occur. Surgeons performing extraperitoneal laparoscopic procedures should be aware of the range of potential complications specifically related to balloon dilation of extraperitoneal space. With experience, these complications can be mitigated.
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Affiliation(s)
- Vineet Agrawal
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
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28
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Dogra PN, Saini AK, Singh P, Bora G, Nayak B. Extraperitoneal robot-assisted laparoscopic radical prostatectomy: Initial experience. Urol Ann 2014; 6:130-4. [PMID: 24833824 PMCID: PMC4021652 DOI: 10.4103/0974-7796.130555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 10/31/2012] [Accepted: 03/05/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To report our initial experience and technique of performing robot-assisted laparoscopic radical prostatectomy (RALP) with the extraperitoneal approach. MATERIALS AND METHODS Twenty-seven patients, between September 2010 to January 2012, were included in the study. All patients underwent extraperitoneal robot-assisted radical prostatectomy. Patients were placed supine with only 10-15(0) Trendelenburg tilt. The extraperitoneal space was developed behind the posterior rectus sheath. A five-port technique was used. After incision of endopelvic fascia and ligation of the deep venous complex, the rest of the procedure proceeded along the lines of the transperitoneal approach. RESULTS The mean patient age, prostate size and Gleason score were 67 ± 1.8 years, 45 ± 9.55 g and 6, respectively. The mean prostate-specific antigen (PSA) was 6.50 ng/mL. The mean time required for creating extraperitoneal space, docking of robot and console time were 22, 7 and 94 min, respectively. The mean time to resume full oral feeds was 22 ± 3.45 h. There were no conversions from extraperitoneal to transperitoneal or open surgery in our series. Pathological stage was pT1, pT2a and pT3b in 11 (40.74%), 14 (51.85%) and two (7.4%) patients, respectively. Two patients had positive surgical margins and two had biochemical recurrence at the last follow-up. Our mean follow-up was 12 ± 3.30 (2-17) months. The overall continence rate was 83.33% and 92.4% at 6 and 12 months, respectively. CONCLUSIONS Extraperitoneal RALP is an efficacious, minimally invasive approach for patients with localized carcinoma of the prostate.
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Affiliation(s)
- Prem Nath Dogra
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Kumar Saini
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Girdhar Bora
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Rondelli F, Bugiantella W, Vedovati MC, Balzarotti R, Avenia N, Mariani E, Agnelli G, Becattini C. To drain or not to drain extraperitoneal colorectal anastomosis? A systematic review and meta-analysis. Colorectal Dis 2014; 16:O35-42. [PMID: 24245821 DOI: 10.1111/codi.12491] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/30/2013] [Indexed: 12/13/2022]
Abstract
AIM Anastomotic leakage is the one of the most serious complications in rectal cancer surgery and is associated with high mortality, morbidity and an increased incidence of local recurrence. Although many studies have compared drained and undrained colorectal anastomoses, to date the role of pelvic drainage in extraperitoneal colorectal anastomosis remains undefined. METHOD We carried out a systematic review of the literature, performing an unrestricted search in MEDLINE and Embase up to 30 October 2012. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. We performed a meta-analysis of the data currently available on the incidence of extraperitoneal anastomotic leakage, according to the presence or absence of pelvic drainage. RESULTS Overall, eight studies - three randomized clinical trials (RCTs) and five non-RCTs, comprising a total of 2277 patients - were included in the meta-analysis. Pelvic drainage was demonstrated to reduce both the leak rate and the rate of reintervention in patients who underwent anterior rectal resection with extraperitoneal colorectal anastomosis (OR = 0.51, 95% CI: 0.36-0.73; and OR = 0.29, 95% CI: 0.18-0.46, respectively) compared with patients without drainage. Overall mortality and infection rates were also evaluated, but a nonsignificant correlation was found with the presence of drainage. CONCLUSION The meta-analysis shows that the presence of a pelvic drain reduces the incidence of extraperitoneal colorectal anastomotic leakage and the rate of reintervention after anterior rectal resection.
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Affiliation(s)
- F Rondelli
- "San Giovanni Battista" Hospital, Foligno, Perugia, Italy; Department of Surgery, School of Medicine, University of Perugia, Perugia, Italy
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Wosnitzer B, Mirtcheva R. Extraperitoneal urinary bladder perforation detected by FDG PET/CT. J Radiol Case Rep 2011; 5:32-40. [PMID: 22470789 DOI: 10.3941/jrcr.v5i4.656] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Accurate localization of areas of increased metabolic activity on PET only imaging can be challenging. Fusion of PET with CT imaging provides anatomic detail which aids in localization of functional information. As a result, the overall sensitivity and specificity of information provided by PET or CT alone is improved with combined PET/CT resulting in improved diagnosis and patient management. We report a case of an unexpected emergent finding of urinary bladder perforation on PET/CT to stress the importance of accurately interpreting the anatomic and functional data. To our knowledge, diagnosis of bladder perforation on PET/CT has not been previously reported in the literature. Failure to recognize such complications may lead to adverse outcomes.
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Affiliation(s)
- Brian Wosnitzer
- Division of Nuclear Medicine, St Luke's Roosevelt Hospital Center, New York, NY 10025, USA.
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