Biomedical subjects

Carlos Arroyo

Publications and source records attributed to Carlos Arroyo.

11 recordsLinked to original sources

PubMed2006

The use of polymer (Hem-o-lok) clips for management of the renal hilum during laparoscopic nephrectomy.

OBJECTIVE: Control of the renal pedicle is the most challenging step during laparoscopic nephrectomy. The standard method is to clip the artery and control the vein with an endovascular gastrointestinal anastomosis stapler. However, this device is expensive and has been reported to malfunction, leading to major complications even death. We describe an easy, quick, and cost-effective alternative technique. METHODS: From June 2002 to July 2005, two surgeons used this simplified technique to control the renal vein during laparoscopic nephrectomy. After pedicle dissection and control of the artery with a clip, the vein was grasped and gently pulled with a laparoscopic Babcock to reduce its diameter. Two Hem-o-lok clips (Weck Closure Systems, Research Triangle Park, NC) were easily placed on the renal vein, which was then transacted safely. RESULTS: We used this technique successfully for 130 consecutive laparoscopic nephrectomies (10 simple, 47 radical, 7 nephroureterectomies, and 66 live donor nephrectomies). No perioperative complications occurred with this technique in this series. There was no increase in the warm ischemia time when used during laparoscopic live donor nephrectomy. CONCLUSIONS: The Hem-o-lok technique is easy, safe, and rapid and offers cost savings when compared to the endovascular gastrointestinal anastomosis stapler. We recommend its use during laparoscopic nephrectomy and live donor nephrectomy.

Blood Loss, Surgical↗

PubMed2006

Benefits of laparoscopic prostate-sparing radical cystectomy.

PURPOSE: Prostate-sparing radical cystectomy has been described in the literature and has proven to be a promising procedure owing to the continence and erectile function results without necessarily compromising the oncologic outcome in selected patients. TECHNIQUE POINTS: A transperitoneal approach is used. Lymph node dissection is performed with frozen section, and then the ureters are ligated and biopsied. The seminal vesicles are dissected, followed by complete mobilization of the bladder. Incision of the bladder neck is performed, followed by simple prostatectomy. Finally, bowel reconstruction is carried out via a small infra-umbilical incision that also permits the extraction of the surgical specimen and the anastomosis of neobladder to the prostate capsule. A total of 25 patients have undergone this procedure, with average surgical times of 285 min and blood loss of 640 ml. The complications encountered included: one bowel incarceration, one urinary leak, one lymphocele and one port hernia. At median 9 months follow-up, no patient presented with daytime incontinence, although seven complained of nocturia. A total of 20 patients maintained their preoperative sexual potency, and four reported a postoperative decrease in their erectile function. CONCLUSIONS: Laparoscopic prostate-sparing radical cystectomy appears to be oncologically safe, reproducible and has promising functional benefits. The authors believe this procedure presents a good option in very select patients.

Anastomosis, Surgical↗

PubMed2005

Laparoscopic assisted radical cystectomy: the montsouris experience after 84 cases.

PURPOSE: Radical cystectomy is the gold standard treatment for transitional cell carcinoma of the bladder, and the laparoscopic approach is currently being evaluated worldwide. We report our preliminary results of this laparoscopic surgical approach. MATERIALS AND METHODS: Between May 2001 and February 2005, we have performed a total of 84 laparoscopic assisted prostatocystectomies or cystectomies for transitional cell carcinoma of the bladder on 71 male and 13 female patients. The 2002 TNM staging for these tumors were: pTa-1: 13 cases; pT2: 59 cases; pT3: 11 cases; pT4: 1 case. Technical aspects are described and the initial results are reported. RESULTS: The median operating time was 280 min. The median blood loss was 550 cc with a transfusion rate of 5%. There has been no conversion to an open technique. COMPLICATIONS: No death, one pulmonary embolism, two urinary fistulas, three haematomas, one pyelonephritis. ONCOLOGICAL RESULTS: The pathology reports confirmed that all the surgical margins were free of tumor invasion. After 18 months of follow up no trocar seeding was observed. CONCLUSION: Laparoscopic assisted cystectomy is a feasible technique which results in decreased bleeding and less postoperative pain. Long term follow-up is needed to confirm the oncologic outcomes.

Adult↗

PubMed2005

Laparoscopic sacral colpopexy approach for genito-urinary prolapse: experience with 363 cases.

OBJECTIVE: To evaluate the surgical outcome, complications and benefits of laparoscopic double promonto-fixation for patients with pelvic prolapse. METHODS: Women with genito-urinary prolapse underwent a transperitoneal placement of a 100% polyester mesh on the anterior vaginal wall and a posterior mesh on the levator ani muscle. Both of these were anchored to the sacral promontory. A TVT was placed simultaneously in patients who had concurrent stress urinary incontinence. RESULTS: A total of 363 patients were operated upon between 1996 and 2002. Their mean age was 63 (range 35-78), average follow-up was 14.6 months, the mean operating time was 97 minutes. There were 8 conversions due to anesthetic or surgical difficulties. Follow up was done by a postal questionnaire and physical examination at 6 months and then yearly. 96% were satisfied with the results of their operation and no patients complained of sexual dysfunction. There was a 4% recurrence rate of prolapse, 3 vaginal erosions, 2 urinary retentions that required TVT section, 1 bowel incarcerations, 1 spondylitis and 2 mesh infection. CONCLUSIONS: Laparoscopic promonto-fixation is feasible and highly effective technique that offers good long-term results with complication rates similar to open surgery, with the added benefits of minimally invasive surgery.

Adult↗

PubMed2005

Laparoscopic prostate-sparing radical cystectomy: the Montsouris technique and preliminary results.

BACKGROUND AND PURPOSE: Prostate-sparing radical cystectomy has been described in the literature and has proven to be a promising procedure because of the continence and erectile function results which does not necessarily compromise the oncologic outcome in properly selected patients. We report our preliminary results with this technique performed laparoscopically. PATIENTS AND METHODS: A total of 25 patients with an average age of 60 years have undergone this procedure. Through a transperitoneal approach, lymph-node dissection is done with frozen-section examination, and the ureters are ligated and biopsied. The seminal vesicles are dissected, followed by complete mobilization of the bladder. Next the bladder neck is incised followed by the bladder-pedicle dissection. A simple prostatectomy can be performed if required. Finally, the neobladder is reconstructed via a small infraumbilical incision that also permits extraction of the surgical specimen. The neobladder is anastomosed to the prostate capsule. RESULTS: The average surgical time was 285 minutes and the mean blood loss 640 mL. The complications encountered (4) were: one case each of bowel incarceration, urinary leak, lymphocele, and port-site hernia. All but one of the patients are alive at 9-month follow-up, with the one patient dying of cancer progression. No patient presented with daytime incontinence, although seven reported nocturia. There were 20 patients who maintained their preoperative sexual potency, and four described a decrease in erectile function postoperatively. CONCLUSIONS: We have been performing laparoscopic prostate-sparing radical cystectomy for more than 2 years and have found it oncologically safe and reproducible with promising functional benefits. It presents a good option for properly selected patients.

Adult↗

PubMed2004

Laparoscopic radical prostatectomy: the new gold standard?

Radical prostatectomy is the reference treatment for localized prostate cancer. The minimal invasive approach is gaining support in a large number of centers around the world because the laparoscopic approach seems to maintain the oncological control of open surgery with added benefits for the patient. In this paper, the main aspects of the different laparoscopic approaches, their benefits, difficulties, complications, and results are described and compared with the open radical prostatectomy. A critical review of the literature on radical prostatectomy comparing the open and laparoscopic techniques and the differences between each approach was done.

Humans↗

PubMed2004

Extraperitoneal standard laparoscopic radical prostatectomy.

PURPOSE: To describe our preliminary experience with the extraperitoneal approach for laparoscopic radical prostatectomy. PATIENTS AND METHODS: Between February and December 2002, we performed 100 laparoscopic radical prostatectomies by an extraperitoneal approach. RESULTS: Of the procedures, 98 were completed as planned, while conversion to a transperitoneal approach was necessary in 2 patients with previous mesh hernia repair. The mean operative time was 163 minutes. The mean operative blood loss was 375 mL. The transfusion rate was 3%. No rectal, bowel, ureteral, or nervous injury was observed. There were no major complications. There were nine minor complications (four anastomotic leakages, one rectus muscle hematoma, four cases of acute urinary retention). The mean hospital stay was 6.1 days. Mean catheterization lasted 6 days. The pathologic stage was T2a, T2b, T2c, T3a, and T3b in 17%, 22%, 39%, 12%, and 10%, respectively. The mean Gleason score was 7. The margins were positive in 15% of the pT2 and in 35% of the pT3 tumors; 48% of the positive margins occurred in the first 25 cases. The median follow-up was 12 months; 93% of the patients had a serum prostate specific antigen concentration <0.2 ng/mL. No patient has presented with clinical port-site metastasis. All the patients were evaluated by questionnaire sent by mail before and after the surgery. With a median follow-up of 12 months, 86% of the patients were continent (no pads), 7% of the patients used 1 precaution pad, and 7% had need for 1 pad routinely. With a median follow-up of 6 months, among the preoperatively potent patients (IIEF5 >20), the postoperative erection and intercourse rate was 64% and 43% in patients with bilateral and unilateral nerve-bundle preservation, respectively. CONCLUSION: The extraperitoneal technique is a reliable approach for laparoscopic radical prostatectomy. The choice between a transperitoneal or an extraperitoneal approach depends on the surgeon's experience.

Erectile Dysfunction↗

PubMedDate not supplied

[Kidney oncocytoma: diagnostic and therapeutic approach in the INCMNSZ].

INTRODUCTION: Renal oncocytoma is a benign tumor that in some series represents up to 18% of all solid neoplasms measuring 4 cm or less. Since radiologic distinction between a renal cell carcinoma and oncocitoma is practically impossible, the histologic examination represents the cornerstone of diagnosis. Follow up will be greatly modified by the diagnosis of oncocytoma since it displays a benign course. Eight cases are presented here that were treated at our institution with special mention to diagnosis and therapy. MATERIAL AND METHOD: A retrospective review was performed using records of 288 patients with kidney tumors from 1971 to 2002. Cases had to have several tissue staining including E&O, Schiff's peryodic acid, coloidal Iron, Alcian blue and mucicarmin. RESULTS: A total of 8 cases (4 men and 4 women) of oncocitoma were detected (2.7%). Patients had a mean age of 50 years (36-69), none had familial history of renal tumors and hipertension was detected in 6. Patients were diagnosed after surgery since radiologic studies suspected renal carcinoma in all patients. The neoplasms measuring more than 8 cm and association with renal cancer in a patient. Follow up was course benign in all patients without recurrence. DISCUSSION: Renal oncocytoma represent a small proportion of renal tumors seen in our institution. It must be suspected in solid renal neoplasms measuring less than 4 cm more so if a centrally located scar is seen on CT scan creating a wagon wheel appearance. Definitive diagnosis is made by histologic examination after a chromophobe tumor is ruled out. Since it has a benign course, minimal radiologic follow up is warrented.

Adenoma, Oxyphilic↗

PubMedDate not supplied

[Prostate cancer].

Explore the source record for details and available documents.

Aged↗

PubMedDate not supplied

[Uncommon metastases in renal carcinoma].

INTRODUCTION: Renal clear cell carcinoma (RCCCa) represents 2-3% of the neoplasms in the adult population, and can be metastastatic in up to 30% at the time of diagnosis. In these cases its mortality can be of up to 99% in 5 years, due to the lack of response to current treatments, unless it is a single, surgically resectable metastasis. Currently, there is no explanation for its routes of progression, it even seems to be non existent based on the rare tumor implant sites. OBJECTIVE: To report unusual metastasis from RCCCa and a review of the literature. MATERIAL AND METHODS: We reviewed retrospectively 15 years of patient records diagnosed with metastasic CaRCC different from: local lymph nodes, lung, bone or liver. We identified 11 cases: brain (2), duodenum (2), tonsils, thyroid, esophagus, diaphragm, testicle, adrenal gland and soft tissue of the knee. CONCLUSION: A description of this and other literature series with rare metastasis was done, as well as an analysis of possible routes and mechanisms responsible for the unusual tumor progression in RCCCa. We need to continue investigating the dissemination pathways and other cellular conditions involved in metastastatic kidney cancer in order to better understand and improve the treatment of patients in advanced stages.

Adult↗

PubMedDate not supplied

[Evaluation of the living kidney donor].

Currently, due to the deficit of cadaveric tissues available for transplantation and due to the long waiting list for a kidney transplant, there is a clear tendency towards living donor kidney transplantations. Most donors are genetically related. Living donation should be considered a gift of extraordinary value, and should be made easy whenever a suitable donor is available. Worldwide, the number of patients on the waiting lists for a kidney transplantation has increased, in the last decades. Renal transplantation with living donor kidneys, is currently considered the best treatment for patients with end stage renal failure, due to the improved short and long-term survival benefits over dialysis treatment. Since considerable difference exist between countries in the evaluation and selection criteria for kidney donors, especially in selected patients such as older donors and those with associated comorbid conditions, it is necessary to discuss and establish minimal selection criteria for this cases. A common trend includes a complete clinical record, laboratory and radiologic evaluation which are described in detail in this paper. We also discuss the increasing acceptance of older kidney donors as well as the acceptance of individuals with comorbidities (such as obesity, hypertension, hyperglucemia, lithiasis and cancer) that were previously considered as not eligible for kidney donation.

Age Factors↗