Principles and initial experience of a new device for dissection and hemostasis

LAPAROSCOPIC RADICAL PROSTATECTOMY WITH THE HEILBRONN TECHNIQUE: AN ANALYSIS OF THE FIRST 180 CASES

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.

293 - Laparoscopic Procedures in Urology

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.

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.

BACKGROUND: Robot-assisted radical prostatectomy (RARP) offers advantages over open and laparoscopic approaches, including superior visualization and enhanced surgeon ergonomics. This study analyzed the short-term outcomes of the first RARP performed at the N.N. Petrov National Medical Research Center of Oncology, comparing them with laparoscopic radical prostatectomy (LRP). AIM: To compare the outcomes of RARP and LRP in patients with clinically localized prostate cancer of low and favorable intermediate risk. MATERIALS AND METHODS: The study included patients who underwent radical prostatectomy (RP) for localized prostate cancer of low and favorable intermediate risk (according to the NCCN classification) between 2022 and 2023. The final cohort consisted of 49 patients who underwent LRP and 58 patients who underwent RARP. RESULTS: There were no significant differences between the groups in the incidence of early postoperative complications. However, positive surgical margins were significantly more frequent in the RARP group (51.7%) than in the LRP group (20.4%). Urethral catheter removal occurred earlier in the LRP group (median: 4 days) than in the RARP group (median: 6 days). At six months postoperatively, erectile function, including with conservative therapy, was preserved in 36.4% of patients after RARP and in 21.4% after LRP (χ2 = 0.202). Severe urinary incontinence was observed in 3.5% of patients in the LRP group and 12.5% in the RARP group (χ2 = 0.249). CONCLUSIONS: The study demonstrated a significantly lower rate of positive surgical margins following LRP compared to RARP. However, it should be noted that the RARP group included patients operated on at the N.N. Petrov National Medical Research Center of Oncology during the initial implementation of this technique, which may have influenced the outcomes. Further studies are required.

VLSI design requires design methodologies which are tailored to the implementation technology. Symbolic layout has been addressed in the past for MOS technology, while bipolar technology has largely been ignored. This paper describes a novel symbolic design technique which addresses both bipolar and MOS technologies. The technique allows the designer to symbolically layout nMOS, CMOS, and bipolar circuit structures. The symbol set is used for both MOS and bipolar devices in an integrated and consistent way. It is closely related to the mask layout information rather than circuit schematics. Thus, it allows the creation of any circuit structure based on bipolar, MOS, CMOS, BIMOS, and BICMOS technologies. Design examples are given.

The purpose of the study was to update the current modifications of transurethral resection of the prostate (TURP) using bipolar high frequency current and to report on our first own clinical experience. Based on a Medline search covering the period from January 2000 to September 2006 and our clinical experience with three different devices (VISTA‐ACMI, Gyrus, Storz), the technical basis of these modifications was described. In addition, an analysis of the actual outcome (handling, complications, morbidity) of bipolar TURP (n = 124) compared to a parallel series of monopolar TURP (N = 148) was carried out. Recently, five different modifications of bipolar resection devices (ACMI, Gyrus, Olympus, Storz, Wolf) have been introduced. Experimental and clinical data were available for four of these modifications (VISTA‐ACMI, Gyrus, Olympus, Storz). The devices differ in terms of modification of the passive electrode (two loops, single loop, resectoscope sheath). Bipolar technology allows the use of 0.9% sodium chloride (instead of glycine) as irrigant. In all bipolar devices, a slight prolongation was noted for initiation of the cut, with the VISTA showing the poorest cutting behaviour. Finest apical dissection could be performed with the Storz device. Phase III‐studies comparing bipolar and monopolar TURP showed advantages for bipolar concerning the rate of TUR‐syndrome/fluid absorption, bleeding, catheter time, whereas the resection speed was similar. In two studies using two different devices (Gyrus, Olympus) a higher rate of urethral strictures was detected. We conclude that TURP still represents the reference standard in the management of benign prostatic hyperplasia. Initial data suggest that bipolar technology is safe and effective. It may offer some advantages with respect to the reduction of TUR‐syndrome, less conductive trauma (i.e. tissue charring), cheaper irrigation solution, and a shorter catheter time. In addition to already existing phase III‐studies, larger randomized mulit‐institutional trials will have to substantiate these advantages.

Laparoscopic radical prostatectomy: perioperative complications in an initial and consecutive series of 80 cases.

Robotic laparoscopic surgery: a comparison of the da Vinci and Zeus systems

Background: In auditing the surgical procedures of a hospital, services rendered to patients are reviewed using the data generated from the procedures, hence the outcome is used as a framework for improvement in future and capacity building. Objectives of the study were to analyze the indications for Urological procedures with the procedures performed at Yobe State University Teaching Hospital (YSUTH) and share our experience, with recommendation for future improvement.Methods: Retrospective hospital-based study on patients who had urological procedures done in YSUTH between March 2018 to April 2020. Urology patients that have not undergone any urological procedure were excluded from the study. Data obtained from the records in the operation theatre, emergency unit and medical record department of the hospital.Results: There were 185 patients with indications for surgery, constituting 41.0% of all general surgery patients. Male to female ratio was 8.7:1 and the median age range was 70-79 years. A sum of 212 urology procedures performed. Benign prostate hyperplasia (BPH) and prostatectomies were the commonest diagnoses and elective procedures respectively, while urethral stricture and bladder cancer were the 2nd and 3rd diagnose respectively. Urethral catheterization for urine retention in BPH was the commonest emergency procedure. Cystoscopy was the commonest day case and the commonest among endo-urology procedures.Conclusions: BPH, followed by urethral strictures and bladder cancers were the commonest diagnoses and indications for surgery. Urine retention in BPH is the commonest emergency requiring urthral catherization. Creation of dedicated day surgery unit and employment of permanentt consultant urologists and more health personnels relevant to urology, will improve the quality and quantity of services rendered.

Hysteroscopic Metroplasty Using Holmium: YAG Laser for Treatment of Septate Uterus

A1150 - Initial experience with 3D visualization in laparoscopic radical prostatectomy. A bicentric case series

Periprostatic Fat Area Is an Independent Factor That Prolonged Operative Time in Laparoscopic Radical Prostatectomy

Objective To evaluate the learning curve of three–port extraperitoneal laparoscopic radical prostatectomy(ELRP) and to minimize operative time and blood loss about this procedure. Methods From August 2013 to October 2014, the data from 95 consecutive patients, who had undergone three–port ELRP for prostate cancer, were retrospectively analyzed. The mean age was 65.9±7.7 years, mean total PSA level was 15.4±12.7 μg/L, and mean body mass index(BMI) was 24.8±3.2 kg/m2. According to the number of procedures performed by the surgeon, all patients were classified into three chronologic groups, including group A(No.1–32), group B(No.33–64) and group C(No.65–95). There were no significant differences including age, BMI, tPSA, estimated prostate volume, clinical stages, history of neoadjuvant endocrine therapy, history of transurethral resection of the prostate(TURP) among group A, B and C (P>0.05). The operative outcomes analyzed were operative time, estimated blood loss, hospital stay, drainage tube indwelling days, pathological Gleason scores, pathological stages, positive surgical margin rates, biochemical recurrence rates and urinary incontinence rates. Among these 95 patients, the results of the first 32 cases were compared with those of the remaining 63 cases, the first 64 with the remaining 31. Results The average operative time in 95 patients was 81.0±18.6 min. The sloping learning curve for this surgeon showed that the operative time for all 95 cases was strongly correlated with additional experience(|rs|=0.612, P 0.05). Group A had longer operative time than that of Group B plus C(96.4±11.3 min vs 73.2±16.7 min, P 0.05). There were no significant correlation between the accumulation of experience and positive surgical margin rates, biochemical recurrence rates and urinary incontinence rates. Conclusion Our experience of three–port ELRP cases appears to be favorable with decreasing tendency in operative time, estimated blood loss with experience accumulation. Exposure to 32 surgeries, operative time and estimated blood loss reduced significantly, and after 64 cases operative time and estimated blood loss further reduced. Key words: Prostate cancer; Radical prostatectomy; Extraperitoneal approach; Laparoscopy; Learning curving