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Urological Procedures (urological + procedure)

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Medical Sciences100%

Selected Abstracts

Renal artery pseudoaneurysm after laparoscopic partial nephrectomy for renal cell carcinoma in a solitary kidney

INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2005
HIROMITSU NEGORO
Abstract Renal artery pseudoaneurysms are a well-documented complication following trauma or percutaneous urological procedures, but are rare after partial nephrectomy. We present the case of a 34-year-old woman who, after undergoing a left nephrectomy in childhood due to Wilms' tumor, had a pseudoaneurysm in a solitary kidney after laparoscopic right partial nephrectomy with extraperitoneal approach for a renal cell carcinoma. The segmental renal artery feeding the pseudoaneurysm was embolized with coils without significant loss of residual renal function. [source]

Estimating the duration of common elective operations: implications for operating list management

ANAESTHESIA, Issue 8 2006
J. J. Pandit
Summary Over-running operating lists are known to be a common cause of cancellation of operations on the day of surgery. We investigated whether lists were overbooked because surgeons were optimistic in their estimates of the time that operations would take to complete. We used a questionnaire to assess the estimates of total operation time of 22 surgeons, 35 anaesthetists and 16 senior nursing staff for 31 common, general surgical and urological procedures. The response rate was 66%. We found no difference between the estimates of these three groups of staff, or between these estimates and times obtained from theatre computer records (p = 0.722). We then applied the average of the surgeons' estimates prospectively to 50 consecutive published surgical lists. Surgical estimates were very accurate in predicting the actual duration of the list (r2 = 0.61; p < 0.001), but were poor at booking the list to within its scheduled duration: 50% of lists were predictably overbooked, 50% over-ran their scheduled time, and 34% of lists suffered a cancellation. We suggest that using the estimates of operating times to plan lists would reduce the incidence of predictable over-runs and cancellations. [source]

Transumbilical laparoscopic urological surgery: are special devices strictly necessary?

BJU INTERNATIONAL, Issue 8 2009
Anibal W. Branco
OBJECTIVE To evaluate the safety and feasibility of transumbilical laparoscopic surgery using conventional laparoscopic instruments and ports. PATIENTS AND METHODS Since January 2008 we have been using laparoscopic transumbilical procedures. Patient selection was determined by any situation, pathological or not, for which laparoscopy was deemed appropriate as the standard of care in our practice. Exclusion criteria included patients who had undergone multiple abdominal procedures. The Veress needle was placed through the umbilicus, to allow insufflation with carbon dioxide. A 10-mm trocar was placed in the peri-umbilical site for the laparoscope, followed by placing two additional 5-mm peri-umbilical trocars. The entire procedure was done using conventional laparoscopic instruments. At the end of surgery the trocars were removed and all three peri-umbilical skin incisions were united for specimen retrieval. Patients undergoing surgery using this approach were evaluated prospectively and data were collected during and after surgery for analysis. RESULTS Six procedures were performed using this technique (three nephrectomies, one adrenalectomy, one ureterolithotomy and one retroperitoneal mass resection). The mean operative duration and blood loss were 70.5 min and 108.3 mL, respectively. There were no complications during surgery and no patients needed a blood transfusion. Analgesia comprised metamizole (1 g intravenous every 6 h) and ketoprofen (100 mg intravenous every 12 h). The time to first oral intake was 8 h and the mean hospital stay was 28 h. CONCLUSION Laparoscopic transumbilical surgery seems to be feasible and safe even using conventional laparoscopic instruments, and can be considered a potential alternative for traditional laparoscopic urological procedures. [source]

Introduction of an enhanced recovery protocol for radical cystectomy

BJU INTERNATIONAL, Issue 6 2008
Nimalan Arumainayagam
OBJECTIVE To describe and assess an enhanced recovery protocol (ERP) for the peri-operative management of patients undergoing radical cystectomy (RC), which was started at our institution on 1 October 2005, as RC is associated with increased morbidity and longer inpatient stays than other major urological procedures. PATIENTS AND METHODS An ERP was introduced in our institution that focused on reduced bowel preparation, and standardized feeding and analgesic regimens. In all, 112 consecutive patients were compared, i.e. 56 before implementing the ERP and 56 since introducing the ERP. The primary outcome measures were duration of total inpatient stay and interval from surgery to discharge, and the morbidity and mortality. Data were analysed retrospectively from cancer network and hospital records. RESULTS The demographics of the two groups showed no significant difference in age, gender distribution, American Society of Anesthesiologists grade, or type of urinary diversion. Re-admission, mortality and morbidity rates showed no statistically significant difference between the groups. The median (interquartile range) duration of hospital stay was 17 (15,23) days in the no-ERP group, and 13 (11,17) days in the ERP group (significantly different, P < 0.001, Wilcoxon rank-sum test). The median duration of recovery after RC was 15 (13,21) days in the no-ERP group and 12 (10,15) days in the ERP group (significantly different, P = 0.001, Wilcoxon rank-sum test). CONCLUSION The introduction of an ERP was associated with significantly reduced hospital stay, with no deleterious effect on morbidity or mortality. [source]