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Invasive Treatment Option (invasive + treatment_option)
Selected AbstractsRadio-frequency ablation of renal cell carcinoma in patients who were at significant riskINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2004OSAMU UKIMURA Abstract, Objective:, Although radio-frequency ablation (RFA) has been recently applied as a minimally invasive treatment option for renal cell carcinoma (RCC), indication of this modality remains a critical issue due to the lack of complete tumor destruction as well as the uncertainty of its long-term efficacy. We report the efficacy of RFA for nine carefully selected patients with RCC who had significant reason to avoid invasive surgical treatment under general anesthesia. Methods:, Radio-frequency ablation was performed under epidural or local anesthesia by ultrasound or computed tomography (CT) guidance in nine patients with biopsy proven RCC (mean diameter, 38 mm; range, 20,53 mm), who were at significant operative or anesthetic risk for invasive surgery. Follow-up enhanced CT scans or magnetic resonance images were evaluated every 3,6 months and an evaluation of metastasis was performed every 6 months. Results:, At a mean follow-up of 17 months, seven (78%) of the nine patients with renal tumor showed no tumor enhancement. The renal function of all patients was well preserved. All patients were able to continue undergoing their respective treatments for active diseases in other organs in parallel to the RFA treatment. No distant metastasis, urine leakage were reported and one case of temporary hematuria and one case of peri-renal hemorrhage not requiring blood transfusion were encountered. Intra-operative ultrasonography was useful in the real-time monitoring of the minimally excessive extension of ablation into the normal parenchyma. Conclusion:, Radio-frequency ablation appears to be an effective and safe minimally invasive therapeutic option for selected patients with RCC who have reason to avoid invasive surgery under general anesthesia. [source] Cost-effective laparoscopic pyeloplasty: Single center experienceINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2003ASHOK KUMAR HEMAL Summary Objective:, Laparoscopic pyeloplasty (LPP) is a minimally invasive treatment option for ureteropelvic junction (UPJ) obstruction. We report here our experience of performing cost-effective LPP on 24 patients at a single center. Methods:, Between October 1999 and March 2002, LPP was performed in 24 patients (17 male, seven female; age range 8,51 years) including two patients who had failed previous endourologic treatments. In two patients with concomitant renal stones, laparoscopic pyelolithotomy was also performed. LPP was conducted in a cost-reductive manner by both transperitoneal (n = 12) and retroperitoneal (n = 12) access. To reduce the cost, an indigenous balloon to create the retroperitoneal space, reusable ports, ordinary polyglactin suture and intracorporeal free-hand suturing were employed. To reduce operative time, antegrade stenting was also performed in some cases. Results:, Laparoscopic Anderson,Hynes pyeloplasty was performed in 16, Foley Y,V pyeloplasty in five and Fenger pyeloplasty in three patients. One patient required conversion to open surgery due to tension at the anastomosis site during Anderson,Hynes pyeloplasty. The mean operating time, blood loss, analgesic (pethidine) requirement, duration of drain and hospital stay for the retroperitoneal and transperitoneal groups were 170.3 and 187.6 min, 102.2 and 145.9 mL, 125 and 136.4 mg, 2.1 and 2.5 days, and 3.4 and 4.3 days, respectively. No significant complications were encountered apart from prolonged ileus in three patients in the transperitoneal group. The mean follow-up period was 10.8 months with a range of 2,24 months. Postoperative renal scan was performed at 3 months in 21 patients, and 1 year in 11 patients. There was evidence of equivocal obstruction in one patient, but there were no obstructions in the remaining patients. Conclusion:, Although LPP is technically demanding, it is emerging as a viable, minimally invasive alternative to open pyeloplasty for UPJ obstruction with a success rate similar to that of open pyeloplasty. It allows the duplication of open surgery steps (unlike endoscopic procedures), thereby providing durable and sustained results. LPP can also be performed safely, effectively and efficiently in a cost-efficient manner. [source] Therapeutic embolization in the treatment of recurrent haemarthrosis following knee arthroplastyANZ JOURNAL OF SURGERY, Issue 4 2010Michael Tat-Sing Law Abstract Recurrent spontaneous haemarthrosis after knee arthroplasty occurs in less than 1% of cases, commonly thought to be the result of impingement of hypertrophic vascular synovium or fat pads, and exacerbated by anti-coagulation or anti-platelet therapy. Traditional treatment comprises an initial period of rest followed by open or arthroscopic washout, and by synovectomy if bleeding recurs or fails to settle. We present three cases of recurrent haemarthrosis following knee arthroplasty, which were successfully treated by angiography and feeding vessel coil embolization. An injury to one of the genicular arteries was identified as the cause of bleeding in all three cases; one manifest as a traumatic arteriovenous fistula. Bleeding ceased in all cases without recurrence (follow-up period 6 months , 5 years, median of 2 years). Endovascular treatment offers a minimally invasive treatment option in selected cases of recurrent post-operative haemarthrosis. [source] Endoscopic laser coagulation of feeding vessels in large placental chorioangiomas: report of three cases and review of invasive treatment optionsPRENATAL DIAGNOSIS, Issue 3 2009Waldo Sepulveda Abstract Objective To report three cases of large placental chorioangiomas managed with endoscopic laser coagulation of the feeding vessels, and review the literature regarding cases of chorioangioma treated with invasive techniques. Methods Intrauterine endoscopic surgery was performed using a 2.5-mm fetoscope under epidural anesthesia. Coagulation of the feeding vessels was attempted with laser energy, and the operation was completed with amniodrainage. Results The feeding vessels were successfully coagulated in one case, resulting in a term delivery. Histopathologic examination of the placenta confirmed a capillary chorioangioma with extensive necrosis. There were intraoperative complications in the other two cases, including bleeding at the site of coagulation requiring intrauterine transfusion in one, and incomplete vascular ablation in the other. In the former case the infant was born prematurely and developed chronic renal insufficiency. In the latter, the fetus died within the first week of the surgery. Conclusions There are limited interventions available for the management of large, symptomatic placental chorioangiomas. Although they can be treated with endoscopic laser coagulation of the feeding vessels, fetal bleeding, exsanguination, and death are potential complications of the procedure; therefore, this technique should be used with caution. The role of this treatment modality in the early devascularization of placental chorioangiomas prior to the development of significant complications warrants consideration. Copyright © 2009 John Wiley & Sons, Ltd. [source] | ||||||||||