#274: Subcapsular kidney urinoma after Percutaneous Nephrolithotomy
Inviato da: eugeniodigrazia@hotmail.com
#276: Two-stage urethroplasty using buccal mucosa graft in patient with penile stricture and Lichen sclerosus
Inviato da:
#277: Martius flap like approach for neobladder -vaginal fisulae after orthotopic urinary diversion in woman.
Inviato da: inca67@hotmail.com
#258: Calicotomia sinistra lomboscopica per idrocalice litiasico
Inviato da: andreapolara@yahoo.it
Abstract
Presentiamo il trattamento di un paziente di 48 anni, affetto da coliche renali a sinistra ed IVU ricorrenti, con riscontro TC di litiasi renale sinistra in idrocalice superiore sinistro.
E' stata posta indicazione al trattamento laparoscopico del caso clinico.
Il video descrive la sede dei trocars, la preparazione dello spazio di lavoro retroperitoneale e l’isolamento parziale del polo superiore del rene sinistro, l’incisione della corticale renale assottigliata, la litolapassi con pinza.
Attraverso cateterino ureterale preventivamente posizionato, si inietta indaco di carminio, con individuazione del collettore puntiforme del calice superiore, che viene suturato. Segue prova di tenuta idraulica negativa.
Il tempo operatorio è stato di 80 minuti, sono state registrate perdite ematiche pari a 50 ml. L'emoglobina preoperatoria è stata 15.4, in I giornata postoperatoria 14.6.
La creatininemia preoperatoria è stata 1.0, in I giornata 0.8.
Al paziente è stato rimosso il catetere ed il cateterino ureterale in I giornata. Le dimissioni sono state in II giornata dopo rimozione del drenaggio.
L'ecografia di controllo a 3 mesi evidenzia assenza di ectasia calico pielica, in paziente asintomatico con urine abatteriche.
#261: Ureterocistoneostomia laparoscopica destra con lembo di Boari per stenosi uretrale > 8 cm
Inviato da: andreapolara@yahoo.it
Abstract
Il video descrive il trattamento laparoscopico di una stenosi ureterale destra in una donna di 65 anni.
La stenosi dell’uretere, secondaria ad intervento chirurgico di sigmoidectomia , appendicectomia, linfoadenectomia lomboaortica e pelvica effettuato nel Gennaio 2016 per recidiva di carcinoma ovarico, è’ stata valutata mediante TC addome completo e pielografia ascendente e transnefrostomica, con misurazione di soluzione di continuo ureterale destra > 8 cm.
E’ stata posta indicazione al trattamento laparoscopico mediante ureteroneocistostomia con lembo vescicale, dopo tentativi infruttuosi di posizionamento stent ureterale dx.
Il video descrive l’isolamento dell’ uretere e la mobilizzazione della vescica. Per la soluzione di continuo rilevata, è stato necessario psoizzare la vescica. Si descrive l’incisione di lembo vescicale, l’anastomosi ureterovescicale del piatto posteriore, lo stenting retrogrado intracorporeo, la tubularizzazione del lembo e la prova di tenuta.
I tempi operatori sono stati 150 min, le perdite ematiche intraoperatorie 100ml.
In IV giornata è stata eseguita cistografia ed è stato rimosso il catetere vescicale.
La paziente è stata dimessa in VI giornata postoperatoria dopo rimozione del drenaggio.
Lo stent ureterale è stato rimosso in XXVIII giornata postoperatoria.
La contrastografia mostra la riconfigurazione vescicale e l'integrità delle alte vie escretrici, in paziente asintomatica.
#64: Single setting 3D MRI-US guided frozen section and focal cryoablation of the index lesion: proof of principle and initial series
Inviato da: gabriele.tuderti@gmail.com
Abstract
In this video we first report reliability of frozen section for the diagnosis of prostate cancer combined with a real time 3D focal cryoablation of the index lesion.
NaviGo system provided a real time 3D monitoring of the index lesion, while focal cryoablation is performed using the Endocare CryoCS. V-probes are used to tailor the ice ball size to the treatment area. Systematic prostate biopsy is performed to confirm absence of cancer outside the index lesion. Complications, functional and early oncologic outcomes are reported.
This initial report includes 3 patients with a clinical suspicious of prostate cancer based on PSA and a single MRI lesion with a PIRADS score 4 or 5. All patients denied consent to any radical treatment.
Prostate cancer diagnosis was histologically confirmed in all 3 patients by frozen sections. Postoperative course was uneventful and all patients were discharged on first postoperative day.
Mean PSA values decreased from 12.51 (baseline) to 1.72 ng/mL at 3-mo evaluation. Three-mo postoperative MRI images showed complete ablation of the index lesion in all patients.
Urinary continence and erectile function were preserved in all patients.
Achieving diagnosis and focal treatment of prostate cancer index lesion in a single session is a further step towards a minimally invasive and patient tailored approach.
#65: Purely off-clamp robotic partial nephrectomy
Inviato da: gabriele.tuderti@gmail.com
Abstract
In this video we describe our surgical technique, reporting perioperative, 3-yr oncologic and functional outcomes of a single centre series of 308 patients treated with robotic off-clamp PN (OFF-RPN).
Data of all patients underwent OFF-RPN between 2010 and 2015 in a high-volume centre were collected.
Patients were placed in an extended flank position and a 5-port access with a side docking was performed. Hilar vessels were not clamped in any case; pure tumour enucleation or enucleoresection were the resection techniques used; renorraphy was omitted for small and exophytic masses and minimized with a “point specific haemostasis” for hilar tumours.
Perioperative complications, 3-yr oncologic and functional outcomes were reported. Univariable and multivariable analyses were performed to identify independent predictors of RF deterioration.
Out of 308 patients treated, 41 (13.3%) experienced perioperative complications, 2.9% of which were Clavien grade ≥3. Three-yr local recurrence free survival and cancer specific survival rates were 99.5% and 97.9%, respectively.
No patient with preoperative CKD-stage ≤3B developed severe RF deterioration (CKD-stage 4) at 1-yr follow-up.
Preoperative eGFR (p=0.005) was the only independent predictor of a new onset CKD-stage ≥3 in patients with preoperative CKD-stages 1 or 2.
OFF-RPN is a safe surgical approach in tertiary referral centres, with adequate oncological outcomes and negligible impact on RF.
#66: Robotic intracorporeal “Padua Ileal Bladder”: Surgical technique, perioperative, oncologic and functional outcomes
Inviato da: gabriele.tuderti@gmail.com
Abstract
Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder reconstruction is a challenging procedure. The aim of this video is to illustrate our technique for RARC and totally intracorporeal orthotopic “Padua Ileal Bladder”.
From August 2012 to February 2014, 45 patients underwent RARC, extended pelvic lymph node dissection and intracorporeal partly stapled neobladder at a single tertiary referral centre. Surgical steps are demonstrated in the accompanying video. Demographics, clinical and pathological data were collected. Perioperative, 2-yr oncologic and 2-yr functional outcomes were reported.
Intraoperative transfusion or conversion to open surgery was not necessary in any case and intracorporeal neobladder was successfully performed in all 45 patients. Median operative time was 305 minutes (IQR 282-345). Median estimated blood loss was 210 ml (IQR 50-250). Median hospital stay was 9 days (IQR 7–12). The overall incidence of perioperative, 30-d and 180-d complications were 44.4%, 57.8% and 77.8%, respectively, while severe complications occurred in 17.8%, 17.8% and 35.5%, respectively. Two-yr daytime and night-time continence rates were 73.3% and 55.5%, respectively. Two-yr disease free survival, cancer specific survival and overall survival rates were 72.5%, 82.3% and 82.4%, respectively.
Our experience supports the feasibility of totally intracorporeal neobladder following
RARC. Operative times and perioperative complication rate are likely to be reduced with increasing experience.
#70: Robotic ureteral reimplantation for uretero-enteric anastomotic strictures in different urinary diversions
Inviato da: gabriele.tuderti@gmail.com
Abstract
In this video we describe the techniques and outcomes of robotic ureteral reimplantation for ureteroenteric anastomotic strictures in different UDs.
From April 2013 to July 2016 12 patients underwent robotic ureteral reimplantation in three tertiary referral centers.
Out of 12 patients, 7 had orthotopic neobladder, 4 ileal conduit and 1 Indiana pouch. All patients had prior robot assisted radical cystectomy and all but one had intracorporeal UD.
Surgical steps include a careful ureteral dissection on the surface of the ureter/s to avoid injurying the iliac vessels, spatulation of the ureters, JJ stent insertion and finally uretero-ileal anastomosis.
Three cases (one ileal conduit, one neobladder and one Indiana Pouch) are demonstrated in the video.
Baseline, perioperative and functional outcomes data are reported.
Mean stricture length was 2 cm (range 0.5-3), median operative time was 201 minutes (83-310) and median length of stay was 2 days (2-12).
Intraoperative blood loss was negligible. Four patients experienced a Clavien grade 2 complication (urinary tract infection requiring antibiotics). At a mean follow-up of 1-yr no patient developed recurrence.
The suboptimal success rate of endoscopic treatment, the minimally invasiveness of robotic surgery and the high success rate of robotic repair may contribute to an increased adoption of this surgical option in the near future.
#71: Robotic pyelolithotomy for a staghorn stone of kidney
Inviato da: armando.serao@gmail.com
Abstract
The video shows a case of a staghorn stone of the right kidney in a female patient 48 years old.The patient complained of recurrent infections and flank pain.The stone occupied entirely the pelvis and most of the calyces.There was no evidence of ureteropelvic junction obstruction. Two minor calculi were in the mid calyces.
The stone was approched by robotic procedure. The renal pelvis was prepared and opened with V incision. Marked edema and hyperemia were present. The stone filling the entire pelvis and the calyces was dislocated and removed. During maneuver part of stone in the upper calyx ruptured and was removed apart.The operative time was about 120 minutes . The two residual minor calculi were approched in a second time by endourological procedure.
There was no post operative complication.The patient was discharged after two days.Double J was removed at the third month after endoscopic laser lithotripsy of two minor calculi. TC control after three months demonstrated the absence of residual stone and a normal configuration of the urinary tract.
In selected cases of large renal staghorn calculi the robotic surgery is very effective. The specific articulation and the finest movements of the robotic arms allow a complete removal of stone and a precise reconstruction of the urinary tract.
#110: Pieloplastica videolaparoscopica robot-assistita sinistra. Iniziale esperienza
Inviato da: francescok86@gmail.com
Abstract
Il video mostra uno dei nostri primi interventi chirurgici di correzione della stenosi del giunto pielo-ureterale effettuato con l’ausilio del robot da Vinci XI. il paziente viene posizionato in decubito laterale, con una spezzatura del bacino di circa 10 gradi. -Viene effettuato un accesso open all’incrocio tra la linea ombelicale trasversa e la pararettale. Introdotto il primo trocar robotico da 8mm per l’ottica, si posizionano in visione sulla linea pararettale alta e bassa e a circa 7-8 cm dal primo, altri due trocar per l’operatività robotica. Il trocar per il sistema AerSeal da 8mm viene posizionato tra il trocar dell’ottica e il trocar posizionato sulla pararettale bassa, quasi a ridosso della linea xifopubica. Quando possibile preferiamo effettuare un isolamento “in situ” del giunto; in questo caso clinico specifico, il paziente presentava una pelvi anteriorizzata e l’uretere decorreva a ridosso del polo inferiore del rene. Per cui, prima di procedere alla pieloplastica, è stato effettuato anche l’isolamento del polo inferiore del rene. Viene ricostruito prima il piatto posteriore in Vicryl 5-0, successivamente lo stent viene posizionato per via retrograda e viene conclusa la pieloplastica con la ricostruzione del piatto anteriore in Vicryl 5-0.
#111: Reimpianto ureterale robotico. Iniziale esperienza in un centro di alta specialità laparoscopica
Inviato da: francescok86@gmail.com
Abstract
Il video mostra il caso di una stenosi ureterale da danno iatrogeno dell’uretere pelvico in una giovane donna. La paziente viene posizionata in posizione supina, con un Trendelemburg di circa 20°. Viene effettuato un primo accesso open per un trocar robotico sulla linea mediana a 2cm dall’ombelico verso l’appendice xifoidea. Sulla linea trasversale passante per il primo trocar vengono posizionati altri 2 trocar da 8 mm robotici (uno a destra e uno a sinistra). Viene posizionato un trocar ausiliario robotico a due centimetri dalla SIAS sinistra lungo una linea che congiunge la SIAS al trocar centrale. Viene posizionato un trocar airseal da 8 mm a due centimetri dalla SIAS destra lungo una linea che congiunge la SIAS al trocar centrale. Dopo aver liberato il sigma dalle sue aderenze con l’ovaio, il mesosigma viene inciso fino a raggiungere la regione in cui l’uretere incrocia i vasi iliaci. Si procede ad isolamento dell’uretere e si incide a tutto spessore la regione cupolare vescicale dove si effettuerà il reimpianto in Vicryl 5-0, su stent doppio J. La sutura in due emicontinue viene effettuata a tutto spessore, comprendendo anche la mucosa vescicale ed alcuni punti di rinforzo vengono posizionati al termine della procedura.
#260: Enucleazione lomboscopica di neoplasia renale destra dal diametro 4.2 cm
Inviato da: andreapolara@yahoo.it
Abstract
Il video descrive il trattamento laparoscopico di una neoplasia renale destra in paziente donna di 48 anni.
La patologia è stata stadiata mediante RM addome completo, con riscontro di neoformazione solida dal diametro di 4 cm, prevalentemente endofitica, sita al margine convesso-anteriore del rene destro.
Alla lesione è stato attribuito un valore PADUA score 9.
E’ stata posta indicazione al trattamento conservativo, con accesso lomboscopico.
Nel video sono esposte le sedi degli accessi, la preparazione dello spazio di lavoro retroperitoneale, l’identificazione e l’isolamento dell’arteria renale destra.
E’ descritta l’identificazione della massa,la marcatura della linea di sezione e l’enucleazione clampless della neoformazione con forbici e pinza bipolare.
L’emostasi è stata eseguita mediante sliding suture su tampone di tachosyl prerolled.
Il tempo operatorio è stato di 45, sono state registrate perdite ematiche pari a 150 ml.
Il catetere vescicale ed il drenaggio sono stati rimossi rispettivamente in prima ed in seconda giornata.
I valori di emoglobina pre e post operatoria sono stati rispettivamente 141 e 123 g/L, mentre la creatininemia 0.7 mg/dl e 0.8 mg/dl
la paziente è stata dimessa in II giornata.
L’esame istologico della lesione è esitato in carcinoma renale a cellule papillari, grado nucleolare ISUP 2, necrosi assente, pseudocapsula presente e spessa, margini di exeresi esenti da infiltrazione.
#257: Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer in chemotherapy-naive patients: an Italian multicentre “real life” 1 year study
Inviato da: maida.bada@yahoo.com
#267: Spermioculture enriched with BHI-OXOID in the diagnosis of chronic bacterial prostatitis: a prospective comparative study
Inviato da: enzagiglio@hotmail.it
#268: SMALL RENAL MASSES IN 100 PATIENTS: HOW MANY TUMOURS ARE DETECTED WITH IMAGING-GUIDED RENAL BIOPSY
Inviato da: sebadoc22@gmail.com
#262: Renal stones treatment in Spinal-Cord–Injured patients
Inviato da: eliodarrigo@libero.it
#269: case report: urthritis by syphilis
Inviato da: maurizioforesio@libero.it
#249: The diagnostic and staging performance of mpMRI/US guided fusion prostate biopsy: prospective analysis on 41 consecutive whole mount radical prostatectomy specimens
Inviato da: gabriele.tuderti@gmail.com
#252: Diagnostic performance of multiparametric MRI in prostate cancer: per core analysis of three prospective ultrasound/MRI fusion biopsy datasets
Inviato da: gabriele.tuderti@gmail.com
#255: The adherence to the EAU Guidelines on penile cancer treatment could influence the survival: multicenter, retrospective, European study
Inviato da: maida.bada@yahoo.com
#63: Anatomic robot assisted radical cystectomy in female: step by step technique
Inviato da: gabriele.tuderti@gmail.com
Abstract
Robot assisted radical cystectomy (RARC) in female is a challenging procedure. We describe step by step surgical technique, presenting perioperative outcomes of a 66 yr-old female patient with a cT1/N0/M0 high grade recurrent bladder cancer who underwent RARC with totally intracorporeal orthotopic neobladder (iON).
Key steps were: ligation of gonadic pedicles, dissection of umbilical and uterine arteries and the ureters, dissection of bladder pedicles, opening of the vagina and creation of the plane between vagina and bladder. Urethra was cut and Foley catheter secured with the entire specimen into an Endocatch bag to minimize any urine spillage. Specimen was removed through the vagina. Extended pelvic lymph node dissection. Vagina was sutured and a peritoneal flap used as posterior neobladder support.
Operative time was 295 minutes, EBL was 250 mL, time to flatus was 3 days. Hemoglobin and creatinine at discharge were 10.3 g/dL and 0.76 mg/dL, respectively. Pathologic stage was pT0 pN0. Nodes removed were 26. Postoperative course was uneventful. Daytime continence was recovered after 45 days.
A meticulous dissection of bladder vascular suppliers, a natural orifice specimen retrieval and the ease of posterior neobladder support, thanks to a perfect vision of the small pelvis anatomic structures, may contribute to minimize invasiveness, improving outcomes of RARC in female patients.
#67: Robot assisted radical nephrectomy and inferior vena cava thrombectomy: surgical technique, perioperative and oncologic outcomes
Inviato da: gabriele.tuderti@gmail.com
Abstract
In this video we highlight surgical steps of a right radical nephrectomy and level IIIb inferior vena cava (IVC) thrombectomy using an occluding balloon Fogarty catheter to control the upper boundary of IVC thrombus. Perioperative and oncologic outcomes of our first 35 patients treated between July 2011 and September 2016 in two tertiary referral centers were reported.
Preoperative arterial embolization was performed. A right template retroperitoneal lymph node dissection was performed; the left renal vein and the distal IVC segment were encircled with Roummel Tourniquet. Short hepatic veins were secured with Ligasure. Proximal IVC was encircled and right renal vein was stapled.
The distal IVC and left renal vein Tourniquets were cinched down. Cavotomy was performed and the thrombus progressively mobilized and secured into an endocatch bag.
Median operative time was 300 minutes. One patient (2.8%) had a Clavien grade 3a complication; two patients (5.7%) had Clavien grade 3b complications;one patient had a Clavien 4a complication.
Twenty-two patients received surgery with curative intent and 5 of these experienced disease recurrence: 2-yr metastasis free, cancer specific and overall survival rates were 56%, 100% and 94.4%, respectively.
The increasing experience with robotic surgery has made nephrectomy and IVC thrombectomy a feasible and safe treatment option in tertiary referral centers.
#68: Robotic partial adrenalectomy for symptomatic aldosterone-secreting adenomas: technique and outcomes
Inviato da: gabriele.tuderti@gmail.com
Abstract
Partial adrenalectomy for functioning adrenal masses is significantly underused.
We describe surgical technique and present perioperative and functional outcomes of a two center series including nine symptomatic aldosterone-secreting adenomas treated with robotic partial adrenalectomy (RPA) from June 2014 to October 2016
Surgical steps include: Incision of Gerota' s fascia at the level of the upper pole of the kidney and exposure of the adrenal gland; careful dissection of the medial aspect of the gland, preserving adrenal vessels with a selective control of vessels feeding the adrenal mass; progressive dissection of the mass with a pure enucleation technique in order to maximize the amount of adrenal parenchyma spared; specimen retrieval into an endocatch bag; hemostasis and closure of adrenal defect with a sliding clip technique.
Two cases are demonstrated in the video.
Baseline, perioperative and early functional outcomes data are reported.
All cases were completed robotically. Intraoperative blood loss was negligible, postoperative course was uneventful in all cases, except for 1 patient who required antibiotic therapy for post-operative fever (Clavien grade 2 complication). Median hospital stay was 3 days (IQR: 2-3).
Patients became normotensive immediately after surgery. Aldosterone and plasmatic renin activity levels returned within the normal range as well.
Robotic Partial Adrenalectomy is a safe and feasible technique.
#69: Intracorporeal partly stapled Padua Ileal Bladder using robotic staplers: surgical technique, perioperative and early functional outcomes of a prospective single center series
Inviato da: gabriele.tuderti@gmail.com
Abstract
In this prospective study (www.clinicaltrials.gov NCT02665156) we assessed the feasibility, safety and time efficiency of RARC with intracorporeal partly stapled “Padua Ileal Bladder” using robotic staplers.
Twenty-two consecutive patients with muscle invasive or high grade recurrent urothelial bladder carcinoma were treated between March 2016 and October 2016. Baseline, perioperative and follow-up data were prospectively collected. Key steps of surgery include: selection of 45 centimeters of ileum and division of the distal and proximal part of the ileum using robotic staplers; detubularization of the ileal loop; creation of the neo-bladder neck with one stapler load; double folding of the proximal ileal loop using two-three stapler loads; hand-sewing of the posterior neobladders wall with barbed suture; uretero-ileal anastomoses on JJ stents with a modified split-nipple technique; urethroneobladder anastomosis is performed according to Van Velthoven; hand-sewing of the anterior neobladders wall with barbed suture.
Median total operative time (“skin to skin”) was 270 minutes (IQR:255-295).
Median hospital stay was 9 days (IQR 8-11). Overall complication rate was 40.1% and overall severe complication incidence was 18.2%; at a median follow-up of 3 months, no patients developed recurrence, daytime continence rate was 59%.
We first report safety, feasibility and time efficiency in the use of robotic staplers to create orthotopic neobladder.
#129: A novel technique for robotic prostatic adenomectomy: an evolution of transdouglas robotic prostatectomy
Inviato da: bernardinodeconcilio@hotmail.com
Abstract
Robotic prostate adenomectomy has nowadays an unclear role in the treatment of prostatic enlargement because of the leading role of endoscopic treatment. Only few reports are known about the use of robotic surgery for prostate benign enlargement. Transdouglas approach has been tested in order to perform prostatic adenomectomy for severe benign prostatic enlargement. Four 8 mm robotic trocars and one 12 mm trocar for the assistant are placed, as during robotic assisted radical prostatectomy. Transdouglas approach is performed in order to perform bladder neck sparing adenomectomy. The video shows the opening of the prostate capsule from below, according to the access to the prostate described by Bocciardi. The adenoma, together with the middle lobe, is split by the capsule from the base to the veru montanum. The adenomectomy so performed by transdouglas access is easy and quick. Blood loss is almost undetectable because the dissection is anatomical, helped by great vision and assisted by bipolar haemostays. After the enuclation of the adenoma, the bladder neck is sutured to the prostatic capsule and then it is closed by double layer watertight suture. Finally the peritoneum is sutured. Robotic Transdouglas prostate adenomectomy is safe and effective minimally invasive treatment for benign prostatic enlargement.
#130: Ureteropieloscopia rigid and flexible: simplification of the technique in our experience
Inviato da: stefmarinacci@gmail.com
Abstract
ureteropieloscopy rigid and flexible: simplification of the technique according to our experience
The authors suggest some maneuvers to simplify the ureteropieloscopy diagnostic and therapeutic procedure that can reduce: 1) execution times, 2) minor urethral trauma, 3) reduction in the risk of dislocamneto rail, 4) use of simplified instrumentation
#132: The Use of Robotic Surgical Stapling Devices During Minimally Invasive Urinary Diversion
Inviato da: rnucciotti@gmail.com
Abstract
To date there exists no published study examining the safety and efficacy of the EndoWrist 45 (Intuitive Surgical, Inc.) robotic stapler. We compared outcomes between the robotic and comparable laparoscopic stapler in robotic-assisted neobladder and ileal-conduit. Advantages of the robotic stapler include large range of motion and 90° of articulation, which may provide a benefit when using the stapler in difficult areas like the pelvis. The robotic stapler has a comparable level of safety as a 45 mm laparoscopic stapler and is more cost effective.
The video shows how to use robotic stapler.
#135: Urinary continence after minimally invasive radical prostatectomy: intraoperative techniques to improve surgical outcome
Inviato da: rnucciotti@gmail.com
Abstract
Robot-assisted radical prostatectomy has been shown to have comparable and possibly improved postoperative continent rates compared with retropubic and laparoscopic radical prostatectomy. However, postoperative urinary incontinence has remained one of the most bothersome postoperative complications. The basic concept of the intraoperative technique to improve postoperative urinary continence is to maintain as normal anatomical and functional structure in the pelvis as possible. Therefore, improved knowledge of the normal structure in the pelvis should lead to a greater understanding of the pathophysiology of urinary incontinence, and further development of intraoperative techniques to improve the outcomes of urinary continence. It might be necessary to carry out three steps to realize improvement of the early return of urinary continence after robot-assisted radical prostatectomy: 1) preservation (bladder neck, neurovascular bundle, puboprostatic ligament, pubovesical complex, and/or urethral length, etc.); 2) reconstruction (posterior and/or anterior reconstruction, and/or reattachment of the arcus tendineus to the bladder neck, etc.). On the basis of these steps, further modifications during robot-assisted radical prostatectomy should be developed to improve urinary continence and quality of life after robot-assisted radical prostatectomy.
#140: A new technique for reconstruction of the bladder neck during Radical Prostatectomy
Inviato da: bernardinodeconcilio@hotmail.com
Abstract
The technique used for the bladder neck reconstruction during robotic assisted radical prostatectomy (RALP), can influence the continence rate. In this video we present a new technique we have adopted for the reconstruction of the bladder neck: this procedure belongs from gastrointestinal surgery and it is used to close bowel anastomosis according to the technique described by Gambee or O’ Conell. This technique consists in a single-layer through-and-through anastomosis: the suture goes from serous to mucosal surface, back into the mucosa on the same side of the incision, out into the middle of the cut surface to be approximated, across the incision into the wound edge opposite, down into gut lumen, back through the mucosa and through the wall to the serous surface and a tie with the tail of the suture across the incision. This technique allows to create a bladder neck more similar to the native one if compared with the anterior tennis racket technique and may lead to improved functional outcomes. An improved and more accurate reconstruction of the bladder neck may lead to more favourable functional outcome, this particular technique has never been utilized before to reconstruct the bladder neck. Urologists should consider to adopt it to increase the early continence rate.
#141: Ricostruzione Estetica del Pene in paziente adulto con Ipospadia Complicata
Inviato da: enzo.palminteri@gmail.com
Abstract
Il Video mostra i concetti di riparazione uretrale ed estetica del pene in un paziente adulto con riparazione fallita di ipospadia nell'infanzia.
Al momento dell'intervento il paziente presentava un meato ipospadico residuo ed un piatto uretrale distale ampio dopo innesto di cute prepuziale avvenuto durante un precedente intervento.
Il nostro intervento mostra la ricostruzione dell'uretra distale impiegando un lembo cutaneo secondo Mathieu.
Il Video inoltre mostra la creazione del neomeato e la preparazione delle ali glandari con lo scopo di ottenere quello che è il sogno di molti pazienti con Ipospadia fallita: la ricostruzione uretrale combinata ad una ricostruzione estetica del glande e del meato che si avvicini quanto più possibile ad un “pene normale”.
#142: Laparoscopic right nephrectomy and inferior vena cava thrombectomy with both retro and trans-peritoneal approch
Inviato da: willygiannubilo@virgilio.it
Abstract
Renal cell carcinoma with inferior vena cava (IVC) thrombus indicates biologically aggressive cancer, so the complete surgical resection remains standard of care with best long term outcomes. In this video we describe laparoscopic right nephrectomy and with thrombectomy by both retro and trans-peritoneal approach.
Patient is a 56 year old man with incidental diagnosis of a right renal mass (30 cm) with 2nd type of vena cava thrombus (6 cm).
The video shows our procedure: laparoscopic radical nephrectomy and inferior vena cava thrombectomy by both retro and trans-peritoneal approach.
Operative time was 320 minutes; blood loss 470 ml; IVC occlusion time 13 minutes; hospital stay 5 days.
Operative outcomes show that laparoscopic radical nephrectomy with inferior vena cava thrombectomy is safe and feasible also for level 2 tumor thrombus.
We chosed to perform retro and trans-peritoneal approach considering clinical case and necessity of better, complete and safe vascular control.
#151: Nefrolitotomia percutanea e cistolitolapassi di stent ureterale calcifico in rene trapiantato
Inviato da: gianfrancodeiana@virgilio.it
Abstract
Presentiamo il caso di un uomo di 64 anni con stent ureterale calcifico in rene trapiantato. Il paziente sottoposto a trapianto renale e posizionamento di stent ureterale a tutela dell’anastomosi uretero-vescicale 8 mesi prima , perso al follow up dal centro di riferimento , giungeva alla nostra osservazione per sintomatologia disurica irritativa e macroematuria. La TC addome mostrava la presenza di uno stent ureterale calcifico a livello del ricciolo situato in pelvi ed in vescica ed alcune calcificazioni segmentarie lungo il corpo dello stent medesimo. Descriviamo la strategia terapeutica utilizzata per la rimozione dello stent ureterale calcifico mediante litotrissia vescicale per via transureteroscopica, nefrolitotrissia ed estrazione dello stent per via percutanea ottenendo la bonifica completa della via escretrice in tempo unico. La procedura è stata priva di complicanze ed ha consentito di salvaguardare la funzione del rene trapiantato.
#157: Enucleoresezione laparoscopica di Neoplasie Renali Cistiche (Cisti di Bosniak tipo III- IV)
Inviato da: ecarace@libero.it
Abstract
Le lesioni renali di tipo cistico sono di osservazione relativamente frequente e possono essere trattate con chirurgia nephron sparing quando le caratteristiche della massa lo consentono.
L’approccio laparoscopico viene talvolta limitato per il timore di disseminazione neoplastica. Nel video sono mostrati due casi di enucleoresezione laparoscopica di lesioni cistiche.
Il video mostra i casi clinici completi di iconografia preoperatoria e controllo a sei mesi, la tecnica di enucleoresezione viene condotta mantenendo un margine di tessuto renale sano di sicurezza e clampando l’ilo in caso di necessità.
La tecnica di sutura laparoscopica viene effettuata in singolo o doppio strato (midollare e corticale) a seconda delle necessità impiegando clips Haemolock per l’ancoraggio del filo impiegato (Vicryl 1 con ago ampio) o barbed sutures.
Impieghiamo sempre uno stent preoperatorio nella via escretrice.
Uno dei casi illustrati è stato complicato da una lesione ureterale riparata in continua contestualmente.
Il controllo TAC a sei mesi evidenzia remissione completa della malattia in assenza di recidive o disseminazione.
Nella nostra esperienza con un follow-up medio di tre anni su 8 lesioni di questo tipo trattate non si sono verificate recidive o ripresa di malattia a distanza.
#160: Robotic vesico-vaginal fistula repair with bovine Pericardial Patch interposition
Inviato da: giorgiopomara@gmail.com
Abstract
A vesico-vaginal fistula (VVF) is a fistulous tract that connects bladder and vagina, causing
urine leakage via the vagina. Iatrogenic postoperative VVF is the most common case.
Classically, when treating a VVF via the abdominal route, an abdominal flap is mobilized and interposed between the bladder and the vagina. In our video, we describe a robotic VVF repair technique with bovine Pericardial Patch interposition instead of omental flap for a vaginal vault-located fistula. Duration of surgery was 115 min, estimated blood loss was <50 ml. The postoperative course was uneventful. At 40 days follow-up, which included clinical and cystographic examinations, the patient had not experienced any recurrence. In our opinion bovine Pericardial Patch interposition after a V-lock suturing technique using continuous sutures for vaginal closure and for perpendicular bladder closure is a safety procedure alternative to omental flap, reducing operating time and possible complications related to accidental peritoneal injuries.
#163: The use of the fourth arm and intraoperative ultrasound in robotic partial nephrectomy
Inviato da: rnucciotti@gmail.com
Abstract
The partial nephrectomy is the procedure in which the robotic approach is the best indication. The use of the fourth arm is particularly suitable in order to expose the anatomical structures and to leave the assistant the only task of having to suck. Many surgeons prefer not to use it to the risk of conflict but with a few simple precautions you can enjoy all the advantages of the fourth arm.
The video also shows the usefulness of intraoperative ultrasound in order to directly evaluate the surgical resection margins.
#169: Zero ischemia laparoscopic nephron sparing surgery for hilar renal tumor larger than 4 cm: technique and feasibility
Inviato da: willygiannubilo@virgilio.it
Abstract
The video shows the laparoscopic procedure used to remove a solid renal mass, (58×46 mm. on the left kidney) occasionally detected at CT scan, during the follow up for melanoma.
The patient underwent laparoscopic nephron sparing surgery(L-NSS) with zero ischemia technique, as usual in our Institution.
The access was trans-peritoneal. The mass was on the anterior kidney margin, strictly close to the kidney vessels. The outcome was favourable, without intra or post-operative complications and the patient was discarged in 3 days.
Histopathological diagnosis was angiosarcoma.
Zero ischemia laparoscopic nephron sparing surgery for renal tumor larger than 4 cm. positioned near the ilar vessels is technically feasible and safe. Very experienced laparoscopic surgeons are requested.
#171: ECIRS: a new proposal for the patient position
Inviato da: willygiannubilo@virgilio.it
Abstract
Intrarenal Combined Endoscopic Surgery (ECIRS) is a combination between retrograde intra-renal (RIRS) and percutaneous nephrolithotripsy (PCNL) surgery.
It is a very effective technique to treat: complex renal stones and contextual ureteral ones, in case of uretero-pelvic junction obstruction.
Most important things to perform this procedure are: surgical instruments, patient's position, side of kidney puncture/dilation, intracorporeal lithotripsy, nephrostomy/stenting.
Valdivia Uria – Galdakao modified position is milestone to the technique development, according to the undoubted surgical and anesthetic advantages.
The video shows our procedure to perform ECIRS, using a new modified position, which in our experience can allows:
– patient in supine position, avoiding his 30 ° inclination on the operatory table
– respect of anatomical access to the kidney
– more space for the surgeon to perform the procedure
– increased chance to spontaneous leaking gravity of stones fragments
#180: Ventral-lateral onlay urethroplasty using buccal mucosa graft
Inviato da:
Abstract
In questo video mostreremo un intervento di uretroplastica con innesto ventrale e laterale di mucosa buccale in un paziente con stenosi recidivante dell’uretra bulbare.
Il paziente era già stato sottoposto in altri centri a tre interventi di uretrotomia secondo Sachse e diversi tentativi di dilatazioni uretrali. Si pratica un primo tempo endoscopico per visualizzare la stenosi utilizzando un ureteroscopio e si inserisce un filo guida per facilitare il ritrovamento del lume uretrale stenotico una volta inciso il piatto uretrale.
L’incisione viene effettuata a livello perineale. Si procede all’apertura della fascia di Colles e si incide medialmente il muscolo bulbo-spongioso. Viene così esposta l’uretra bulbare. Si pratica un’incisione ventrale fino a repertare il filo guida.
L’incisione effettuata è di circa 5 cm fino al raggiungimento di mucosa uretrale sana. Si procede a prelevare un graft di mucosa buccale dalla guancia sinistra del paziente. Il difetto viene chiuso in sutura continua in Vicryl 5.0.
Si appone un catetere Foley Ch 16 in silicone che verrà tenuto per due settimane. Si sutura il graft lateralmente e ventralmente con due suture continue in Vicryl 6.0.
Il corpo spongioso dell’uretra viene richiuso sul graft. Chiusura del muscolo bulbo-spongioso, della fascia di Colles e del tessuto grasso sottocutaneo. Cute suturata in punti staccati Vicyil 5.0.
#205: Anterior-apical single-incision mesh surgery (SIMS) in the treatment of anterior vaginal wall prolapse, our experience
Inviato da: bcgentile@libero.it
Abstract
Thirty-five patients underwent surgery to treat their symptoms of POP (> stage II) .The primary objectives were the anatomical correction of anterior POP (> stage II), and resolution of cervico-urethral obstruction with elevated post-void residual assessed prior to surgery by means of urodynamic testing. Thirty-five women with cystocele (15 stage III, 20 stage IV ), underwent surgery using the single-incision technique via the transvaginal route. The intermediate follow-up was two years. Restorelle SmartMesh with the Digitex suture delivery system via a single-incision technique was used in all patients. All patients showed a significant improvement in terms of anatomical outcome after prolapse surgery (p <0.05), and there were no recurrences requiring further surgical intervention. The anatomical success coefficient was 97.7% with a significant improvement in quality of life (p <0.0001) and a significant reduction in post-void residual. There was a simultaneous significant improvement in POPDI-6, UDI-6, IIQ-7, and PISQ-12 scores after surgery. There were no cases of mesh dislocation. No de novo dyspareunia was reported. No mesh extrusion has been reported to date. The Anterior-apical single-incision mesh surgery is an evolution of the prolapse’s surgery. It have minor complications and the results are good and durable in a long time.
#46: Turp syndrome (Ts) case reported
Inviato da: beleggiafloriano@libero.it
#47: Grade-dependent lipid storage in ccRCC cells: molecular and functional study performed in primary cell cultures
Inviato da: cristina.bianchi@unimib.it
#72: Role of re-staging transurethral resection for T1 non-muscle invasive bladder cancer: a systematic review and meta-analysis
Inviato da:
#73: En bloc TUR of bladder tumours: a new standard?
Inviato da:
#75: GreenLight XPS: our approach
Inviato da: gianmariabadano@gmail.com
#77: Oncological outcomes of laparoscopic and open treatment (nephroureterectomy) for urothelial tumors of upper urinary tract
Inviato da: giuseppelotrec@libero.it
#78: Update on 3 year outcomes of a trans-obturator and pre-pubic four arm urethral sling for post-prostatectomy stress urinary incontinence
Inviato da: mauroseveso3@gmail.com
#79: SURGICAL CORRECTION OF PEYRONIE'S DISEASE VIA TUNICA ALBUGINEA PLICATION- LONG TERM FOLLOW UP
Inviato da: mauroseveso3@gmail.com
#80: Mid-urethral slings and sexual function
Inviato da: mauroseveso3@gmail.com
#81: Does RALP learning curve impact on patients’ outcomes?
Inviato da: mauroseveso3@gmail.com
#82: VOLUMINOUS ANGIOMYOLIPOMA TREATED WITH PERCUTANEOUS EMBOLIZATION: CASE REPORT AND LITERATURE REVIEW
Inviato da: giario.conti@auro.it
#83: ECONOMICAL IMPLICATIONS OF THE INTRODUCTION OF AN ALTERNATIVE TREATMENT MODALITY FOR PROSTATE CANCER (HIGH INTENSITY FOCUS ULTRASOUND) IN A MULTIDISCIPLINARY TEAM
Inviato da: giario.conti@auro.it
#85: EN BLOC RESECTION OF NON MUSCLE INVASIVE BLADDER CANCER: EXPERIENCE IN SANT’ANNA HOSPITAL – COMO
Inviato da: giario.conti@auro.it
#86: SALVAGE HIGH INTENSITY FOCUS ULTRASOUND (HIFU) FOLLOWING PRIMARY HIFU FOR PROSTATE CANCER HAS TO BE CONSIDERED AS AN ALTERNATIVE TREATMENT FOR RECURRENCE
Inviato da: giario.conti@auro.it
#87: SALVAGE HIGH INTENSITY FOCUS ULTRASOUND (HIFU) FOLLOWING PRIMARY BRACHYTHERAPY FOR PROSTATE CANCER: CASE REPORT AND LITERATURE REVIEW
Inviato da: giario.conti@auro.it
#88: STRATEGICAL IMPLICATIONS OF THE INTRODUCTION OF AN ALTERNATIVE TREATMENT MODALITY (HIGH INTENSITY FOCUS ULTRASOUND) IN A PROSTATE CANCER UNIT IN THE CONTEXT OF MULTIDISCIPLINARY TEAM
Inviato da: giario.conti@auro.it
#89: THE ROLE OF MULTIPARAMETRIC RESONANCE IN THE MULTIDISCIPLINARY TEAM FOR PROSTATE CANCER
Inviato da: giario.conti@auro.it
#90: THE ROLE OF MAGNETIC RESONANCE OF PROSTATE IN PATIENTS WITH HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASM AND ATYPICAL SMALL ACINAR PROLIFERATION
Inviato da: giario.conti@auro.it
#94: THE SUCCESS OF EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY BASED ON THE ULTRASOUND COLOR-DOPPLER TWINKLING ARTIFACT EVALUATION
Inviato da: stefano.masciovecchio@hotmail.com
#99: Ethical consultation for radical urological surgery in fragile elderly people
Inviato da: roberto.borsa@aslcn1.it
#103: Robot assisted nerve sparing radical prostatectomy using near infrared fluorescence technology and Indocyanine Green: initial experience
Inviato da: alberto.degobbi@yahoo.it
#105: Our surgical experience in bilateral benign testicular tumors. Is the conservative surgery an easy and safe approach?
Inviato da: francescok86@gmail.com
#107: Can the testicular parenchyma fibrosis be a predictor of testicular failure in the patients with varicocele?
Inviato da: francescok86@gmail.com
#108: Is the Vacuum Erection Device (VED) better than the ICI (Intra-Cavernous Injection) in preventing penile shortening after non nerve-sparing radical prostatectomy?
Inviato da: francescok86@gmail.com
#112: One shot renal dilation versus gradual metal telescopic dilation technique in percutaneous nephrolithotomy: comparison of safety and effectiveness
Inviato da: francescok86@gmail.com
#113: Cost Analysis of conventional Laparoscopic pyeloplasty (CLP) versus Robotic assisted laparoscopic pyeloplasty (RALP) at a single center study
Inviato da: francescok86@gmail.com
#123: Neuroendocrine Carcinoma of the Bladder
Inviato da: dotcur@libero.it
#52: MRI-based nomogram to predict the probability of Prostate Cancer diagnosis with MRI-US fusion biopsy
Inviato da: gabriele.tuderti@gmail.com
#54: MRI-based nomogram predicting the probability of diagnosing a clinically significant Prostate Cancer with MRI-US fusion biopsy
Inviato da: gabriele.tuderti@gmail.com
#55: On-clamp versus Off-clamp Partial Nephrectomy: Propensity Score Matched Comparison of Long Term Functional Outcomes
Inviato da: gabriele.tuderti@gmail.com
#56: Open versus robot assisted radical cystectomy and orthotopic neobladder: Mid-term single center propensity score matched analysis of perioperative and oncologic outcomes
Inviato da: gabriele.tuderti@gmail.com
#57: Robot assisted radical nephrectomy and inferior vena cava thrombectomy: surgical technique, perioperative and oncologic outcomes
Inviato da: gabriele.tuderti@gmail.com
#58: Intracorporeal partly stapled Padua Ileal Bladder using robotic staplers: perioperative and early functional outcomes of a single center prospective series
Inviato da: gabriele.tuderti@gmail.com
#59: Robotic partial adrenalectomy: initial report from two tertiary referral centers
Inviato da: gabriele.tuderti@gmail.com
#62: Purely Off-clamp Robotic Partial Nephrectomy: Preliminary 3-year Oncologic and Functional Outcomes
Inviato da: gabriele.tuderti@gmail.com
#95: COMPARISON OF TWO TEMPLATES OF LYMPHADENECTOMY IN PATIENTS AFFECTED BY HIGH RISK PROSTATE CANCER
Inviato da: giorgio.napodano@gmail.com
#96: PATHOLOGIC OUTCOMES IN PATIENTS AFFECTED BY VERY LOW RISK AND LOW RISK PROSTATE CANCER AND ELIGIBLE FOR ACTIVE SURVEILLANCE
Inviato da: giorgio.napodano@gmail.com
#97: PROGNOSTIC FACTORS OF UPSTAGING, UPGRADING AND ADVERSE PATHOLOGICAL FEATURES IN FAVOURABLE GS 3+4
Inviato da: giorgio.napodano@gmail.com
#98: PROGNOSITC FACTORS OF NODAL METASTASIS IN PATIENTS WITH ORGAN CONFINED PROSTATE CANCER
Inviato da: giorgio.napodano@gmail.com
#106: Role of FSHR polymorphism p.N680S in the therapy with FSH in patients who underwent varicocele surgery
Inviato da: francescok86@gmail.com
#114: Self-learning in robot-assisted laparoscopic radical prostatectomy. Intraoperative outcomes and initial experience without any assistance from a tutor
Inviato da: francescok86@gmail.com
#120: An alternative technique for treating complex ureteral strictures and defects
Inviato da: trentiemanuela@yahoo.it
#125: A new original surgical technique for Peyronie disease: albugineal graft-free lengthening z-plasty. Results with mean follow up over 24 months
Inviato da: andrea.moiso@gmail.com
#126: Fournier gangrene: experience of a secondary hospital
Inviato da: michelepotenzoni@hotmail.com
#127: Evaluation of the Fournier’s Gangrene Severity Index (FGSI) in our experincene
Inviato da: michelepotenzoni@hotmail.com
#128: Evauation of PIRADS 3 lesion with sotware fiosn biopsies
Inviato da: michelepotenzoni@hotmail.com
#131: Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse: Surgical Technique and Outcomes
Inviato da: rnucciotti@gmail.com
#139: A modified ileo conduit tecnique to avoid ureteroenteric stricture
Inviato da: mauromari@yahoo.com
#143: Spontaneous parenchymal rupture of the kidney, a rare but life-threatening entity: a single-center experience
Inviato da: francescok86@gmail.com
#144: EFFICACY AND SAFETY OF DIFFERENT DOSAGES OF FOSFOMYCIN AS ANTIMICROBIAL PROPHYLAXIS IN TRANSRECTAL BIOPSY OF THE PROSTATE
Inviato da: carolina.delia@sabes.it
#145: Radical nephrectomy versus nephron sparing surgery: run after a chimera?
Inviato da: carolina.delia@sabes.it
#146: FUNCTIONAL OUTCOMES AND HEALTH RELATED QUALITY OF LIFE AFTER ARTIFICIAL URINARY SPHINCTER IMPLANTATION: A MONOCENTRIC SERIES EVALUATION WITH VALIDATED QUESTIONNAIRES
Inviato da: carolina.delia@sabes.it
#147: INCIDENTAL DIAGNOSIS OF PHEOCHROMOCYTOMA OF THE URINARY BLADDER: WHAT ARE THE CLINICAL PROBLEMS THAT CAN ARISE ?
Inviato da: lauratoffoli1@yahoo.it
#148: LOW INTENSITY EMSW TREATMENT IN ERECTILE DISFUNCTION (PRELIMINARI EXPERIENCE ON 158 PTS)
Inviato da: carlomolinari1@gmail.com
#150: Malignant mesothelioma of tunica vaginalis testis: a case report
Inviato da: trentiemanuela@yahoo.it
#154: Penile length preservation after prosthesis: is Ams Lgx more effective than Ams Cx? A prospectic, randomized study
Inviato da: ecarace@libero.it
#155: Use of a Non–cross-linked Xenograft (Xenform) in Surgical Treatment of Peyronie's Disease
Inviato da: ecarace@libero.it
#159: TRENDS IN PSA TESTING, PROSTATE BIOPSIES AND RADICAL PROSTATECTOMY PROCEDURES IN MARCHE REGION
Inviato da: ecarace@libero.it
#161: Totally Robotic radical cystectomy with intracorporeal ileal conduit: initial experience
Inviato da: giorgiopomara@gmail.com
#162: Urinary continence outcomes after peri-urethral suspension according to Patel during Robot Assisted Laparoscopic Radical Prostatectomy (RALP). Results from a case-control study
Inviato da: giorgiopomara@gmail.com
#164: FOCAL TREATMENT OF PROSTATE CANCER USING FOCAL ONE DEVICE. ROLE OF FOCAL THERAPY, ONCOLOGICAL AND FUNCTIONAL RESULTS
Inviato da: alessandrorocca@me.com
#167: Urodynamics parameters and Metabolic syndrome: prospective pilot study
Inviato da: carolina.delia@sabes.it
#168: CENTRAL AND PERIFERIC PROSTATE DIFFUSION OF Fosfomycin trometamol in men with or without metabolic abnormalities
Inviato da: carolina.delia@sabes.it
#172: ZERO ISCHEMIA FOR PARTIAL NEPHRECTOMY: A SAFE PROCEDURE FOR THE MANAGMENT OF SMALL KIDNEY TUMORS
Inviato da: calberto.sepich@auro.it
#173: ECONOMICAL ASPECTS ABOUT THE COSTS OF ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY (RALP)
Inviato da: calberto.sepich@auro.it
#174: Different approaches in penile tri-component prosthesis surgery. A single Italian centre experience
Inviato da: ecarace@libero.it
#176: Salvage lymph node dissection for nodal recurrence after radical prostatectomy
Inviato da: trentiemanuela@yahoo.it
#178: Role of Benique in Single Incision Laparoscopic Prostatectomy. Our Experience
Inviato da: m.diambrini@tiscali.it
#179: C-MYC COPY NUMBER ANALYSIS IN URINE CELL FREE DNA FROM PRIMARY PROSTATE CANCER PATIENTS: A FEASIBILITY STUDY
Inviato da: fiorifo@tin.it
#181: ANALYZING SATISFACTION RATE IN PATIENTS WITH PEYRONIE’S DISEASE UNDERWENT ALBUGINEAL GRAFTING AND PENILE IMPLANT
Inviato da:
#182: Communicating in sexual matter. Informative questionnaire during professional training course
Inviato da: m.diambrini@tiscali.it
#183: Treating erectile dysfunction with a combination of Low-intensity shock waves and Vacuum erectile device
Inviato da:
#193: Rare presentation of a prostate cancer, case report
Inviato da: maurizioforesio@libero.it
#93: ROLE OF SILODOSIN IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS ASSOCIATED WITH BENIGN PROSTATIC ENLARGEMENT NON-RESPONDERS TO MEDICAL TREATMENT WITH TAMSULOSIN
Inviato da: stefano.masciovecchio@hotmail.com
#188: Treatment of urethral strictures using buccal mucosa graft. A single group experience
Inviato da:
#202: Anterior-apical single-incision mesh surgery (SIMS) in the treatment of anterior vaginal wall prolapse, 3 years of follow up
Inviato da: bcgentile@libero.it
#203: Bipolar plasma enucleation of the prostate (B-TUEP) in Benign Prostate Hypertrophy Treatment. Medium-term Results
Inviato da: bcgentile@libero.it
#245: NBI cystoscopy increases in a population of smokers the likelihood of detecting bladder tumors? Preliminary experience
Inviato da: bcgentile@libero.it
#246: Urotensin II Receptor Predicts the Clinical Outcome of Prostate Cancer Patients and Is Involved in the Regulation of Motility of Prostate Adenocarcinoma Cells
Inviato da: bcgentile@libero.it
#247: OUR TECHNICAL ENDOSCOPIC RESECTION IS CORRECT? AFTER WLTURBT NBI TECNIQUE CAN 'TO INCREASE OUR CAPACITY' TO FIND THE PERSISTENCE OF THE DISEASE? PRELIMINARY EXPERIENCE IN A SINGLE CENTER
Inviato da: bcgentile@libero.it
#158: Utilizzo di protaghi robotizzato per confezionare l'anastomosi vescico-ureterale durante prostatectomia radicale laparoscopica
Inviato da: vvarca@asst-rhodense.it
Abstract
Lo scopo di questo lavoro è quello di valutare l'utilità di un nuovo portaghi laparoscopico con punta robotizzata nell’eseguire l'anastomosi vescico-uretrale dopo prostatectomia radicale laparoscopica (LRP).
Abbiamo arruolato quaranta pazienti consecutivi randomizzati in 4 gruppi: gruppo A (LRP eseguita da un chirurgo esperto), gruppo B (chirurgia robotica eseguita dallo stesso chirurgo esperto), gruppo C (LRP eseguita da un giovane chirurgo) e gruppo D (LRP eseguita da un altro giovane chirurgo con l'aiuto del portaghi robotizzato). Abbiamo valutato il tempo di anastomosi (TA), l'assenza di leakage, il giorno di rimozione del catetere vescicale, il tasso di complicanze tardive, la continenza urinaria a 3, 6 e 12 mesi.
I nostri dati hanno dimostrato un TA significativamente ridotto nel gruppo C rispetto al D; 3/10 pazienti appartenenti del gruppo C presentavano un leakage, 1/10 pazienti appartenenti il gruppo D hanno prolungato la cateterizzazione. A tre mesi la continenza nei 4 gruppi era del 65%, 63%, 48%, 50%, rispettivamente; a sei mesi è stata dell'86%, 89%, 81%, 87%; infine a un anno è stata 95%, 97%, 93% e 95%.
I nostri dati suggeriscono che il portaghi robotizzato Dèxtèritè costituisce un aiuto tecnologico supplementare alla chirurgia laparoscopica arricchendo un portaghi laparoscopico dei vantaggi del robot.
#117: Ricostruzione 3D del peduncolo renale: tumorectomia laparoscopica con clampaggio selettivo di arteria di terzo ordine
Inviato da: vvarca@asst-rhodense.it
Abstract
Il nostro lavoro si propone di valutare l’utilità di una ricostruzione 3D dell’albero vascolare nell’eseguire un clampaggio arterioso superselettivo in corso di tumorectomia renale laparoscopica.
Mostriamo il caso di un paziente di 46 anni con riscontro incidentale TC di neoformazione renale destra di 4 cm.. Partendo dalle immagini TC abbiamo ricostruito un modello 3D utilizzando un software open-source completando con precisione la ricostruzione dei rami arteriosi segmentari e individuando alcune divisioni all’interno del parenchima renale.
Il paziente è stato sottoposto a tumorectomia renale laparoscopica. Isolando l’ilo renale, è stato possibile riconoscere la seconda e la terza divisione dell’arteria renale ed eseguire un clampaggio selettivo dell’arteria di terzo ordine. Successiva enucleoresezione; sutura del letto di resezione e approssimazione dei margini. Il tempo di ischemia parziale è stato 13 minuti. Non abbiamo registrato nessuna complicanza perioperatoria. Il follow-up oncologico a tre mesi è risultato negativo.
Molto spesso le sole immagini TC non sono sufficienti ad evidenziare particolari anatomici chirurgicamente significativi. Nella nostra casistica la costruzione di un modello 3D è risultata determinante per un approccio superselettivo. Visti questi risultati abbiamo deciso di procedere a ricostruzione 3D prima di ogni procedura laparoscopica renale con intento conservativo, per poter meglio pianificare l’intervento.