293 - Laparoscopic Procedures in Urology

The ability to maintain normothermia during surgical procedures is crucial for improvement of the quality of patient care and the outcome of the procedure. We tested the hypothesis of whether one warming protocol is able to maintain normothermic core temperatures equally well in major open and laparoscopic urologic procedures. In this prospective study, 300 patients who were scheduled for open (n=53) or laparoscopic (n=247) urologic procedures were included and received intraoperative warming using a combination of an upper and lower body forced-air warmer and a single warming blanket. Core temperature was measured at baseline, at induction of anesthesia, at the start of the operation, and at the end of the operation. A significant improvement in core temperature during the operation was achieved in all patients (P<0.001). There was no difference in the end-of-operation core temperature between laparoscopic and open procedures: (36.29 degrees C+/-0.03 degrees C v 36.23 degrees C+/-0.06 degrees C; P=0.224). Further, 23.3% of all patients had a core temperature of lower than 36.0 degrees C at the end of the operation (laparoscopy 23.8% v open 26.6%). Linear regression analysis revealed a correlation between duration of the operation and intraoperative core temperature (P<0.001). The present warming protocol is effective in maintaining perioperative normothermia during major open and laparoscopic urologic procedures.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

To examine the association between the duration of anaesthesia and non-urological complication (NUC) rates after surgery, as the increasing complexity of minimally invasive and laparoscopic procedures in urology has resulted in longer surgery and anaesthesia, and information on the effect of this on NUC rates is limited. We identified 2196 patients who had open radical nephrectomy or nephron-sparing surgery at our institution between 1989 and 2002. Patients were subdivided into groups I, II, and III according to the duration of general anaesthesia (<4, 4-6 and > or =6 h, respectively). NUCs after surgery, and mortality during and after surgery, were evaluated. There were 1340, 723, and 133 patients in groups I, II and III, respectively. The incidences of any NUC were 3.1%, 5.8% and 13.5%, respectively. The odds ratios for the likelihood of a NUC were 1.91 (P = 0.004) and 4.84 (P < 0.001) for groups II and III, respectively. These differences remained significant even after adjusting for patient and tumour characteristics. Perioperative mortality was highest in group III, at 2.3%, vs 0.4% in groups I and II. Longer anaesthesia is associated with an increase in the incidence of perioperative complications and mortality, especially when the duration of anaesthesia is >6 h. This increase appears to be independent of patient's preoperative health status, tumour extent and blood loss.

The Journal of Urology®-European Urology Writing Course: Collaboration > Competition.

Properties of Organic Acid Solutions which Determine their Irritability to the Bladder Mucous Membrane and the Effect of Magnesium Ions in Overcoming this Irritability

The Journal of Urology® Home Study Course 2022 Volume 207/208.

Benign Multilocular Cystic Nephroma: Report of Two Cases of So-Called Multilocular Cyst of the Kidney

1094 THE PREVALENCE AND EXPOSURE RISK OF HEPATITIS C AND HIV INFECTION IN UROLOGICAL PROCEDURES

Editorial Comment.

Postgraduate Seminar of the American Urological Association Sponsored by the Western Section

ESWL: Past, Present, and Future

PD33-05 A SEAT AT THE TABLE: AN 18 YEAR ANALYSIS OF FEMALE REPRESENTATION ON UROLOGIC JOURNAL EDITORIAL BOARD MEMBERSHIP

Aim: To present the experiences and results of laparoscopic surgeries we conducted in a year’s time in our clinic. Materials and Methods : A retrospective review of ninety-nine patients who underwent laparoscopic urological surgery between May 2013 and May 2014. Results: There were fifty-eight males and forty-two females in our study. Three of patients were pediatric. Transperitoneal approach was used for 99 patients. Mean age of all patients was 47.2 (2-76) years. The operation type and total numbers undergoing the operation were as follows: simple nephrectomy: 50; renal cyst exci­sion: 11; radical nephrectomy: 10; dismemberred pyeloplasty: 10; ureterolithotomy: 5; adrenalectomy: 3; orchiectomy: 1; orchiopexy: 1; nefroureterectomy with partial cystectomy: 3 (one of these patients was situs inversus totalis); partial nephrectomy: 2; and pyelolithotomy and hemi-nephrectomy 1. No intraoperative complications were experienced and we did not need to switch to open surgery in any of the cases. In three patients preoperatively and in one patient postoperatively blood transfusion was required. Superficial wound infection and dehiscence developed in 4 patients while two patients developed subileus and one incisional hernia. The mean postoperative hospitalization duration was 2.26 (1-4) days. Conclusion: Indication areas and popularity of the laparoscopic procedures in urology are increasing every day. Today, laparoscopic operations have increased frequency compared to open surgery due to shorter hospital stay, less pain, and high patient satisfaction. Laparoscopic surgery is a safe and feasible technique but it requires necessary experience in peripheral state hospitals. Keywords: Laparoscopy, Nephrectomy, Pyeloplasty, Adrenalectomy.

Electrosurgery is a commonly used technology in laparoscopy. Electrosurgical devices are being used in many medical subdisciplines in order to coagulate, cut, and ablate tissue and to produce hemostasis. The latest advance in electrosurgery is the introduction of novel simultaneous hemostatic sealing and cutting bipolar devices that minimize force by delivering energy as high current and low voltage output. One of these systems is the Gyrus Plasma Trissector (GPT), (Gyrus Group PLC, Gyrus International, Ltd.UK), a novel radiofrequency (RF) system based on bipolar technology, which consists of a proprietary PlasmaKinetic (PK) generator and specific instruments, designed as a system. The instrument consists of a 17 mm long gold‐coated curved jaw with a ceramic insulated cutting element. The PK system uses high‐powered pulsed bipolar energy to produce a plasmakinetic field around the working elements and is designed to operate at temperatures that allow effective tissue dissection but result in minimal collateral damage and adherence to tissue. The GPT was used with the Gyrus G400 WorkStation generator in laparoscopic radical prostatectomies (LRP). Our initial experience with this novel bipolar device demonstrates it to be safe and effective in dissection and hemostasis. The GPT permits us to act quickly when bloody fields are present, improves coagulation, reduces or eliminates sticking, seals large vessels such as dorsal vein complex (DVC) and allows secure grasping and dissecting of tissue.The urologist is familiar with electrosurgery, as we have become comfortable using GPT to dissect, cut, and coagulate tissue. We feel that the GPT can be used in a variety of laparoscopic procedures in urology.

Editorial Comment.