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Ingolf A Tuerk

Publications and source records attributed to Ingolf A Tuerk.

6 recordsLinked to original sources
PubMed2006

Progression of laparoscopic radical prostatectomy: improved outcomes with the extraperitoneal approach and a running anastomosis.

PURPOSE: To compare the operative and perioperative outcomes of patients undergoing either a transperitoneal or an extraperitoneal laparoscopic radical prostatectomy (TLRP or ELRP) with either an interrupted or a running urethrovesical anastomosis (IUVA or RUVA). PATIENTS AND METHODS: From January 2003 through December 2004, 265 patients underwent LRP by one surgeon at the Lahey Clinic Medical Center. They were divided into three groups according to the operative approach (TLRP or ELRP) and the suture anastomosis (IUVA or RUVA): group 1 = TLRP and IUVA (N = 58; 21.6%), group 2 = TLRP and RUVA (N = 35; 13.1%), and group 3 = ELRP and RUVA (N = 172; 64.2%). RESULTS: Group 3 had statistically better outcomes, as judged by operative time (222, 191, and 170 minutes for groups 1, 2, and 3, respectively; P < 0.0001), postoperative analgesic use (39.6, 30.4, and 18.9 mg of narcotic; P < 0.0001), length of stay (3.76, 2.74 days, and 1.67 days; P < 0.0001), leak on postoperative cystogram (17.9%, 11.4%, and 3.5%; P = 0.001), and complication rate (32.8%, 11.4%, and 9.9%; P < 0.0001). The groups had similar estimated blood loss (168, 145, and 176 mL) and positive surgical-margin rates (15.5%, 14.3%, and 14.5%). CONCLUSIONS: We demonstrate improved surgical outcome for ELRP with RUVA in regard to operative time, analgesic use, length of stay, leak rate, and complication rate. Long-term follow-up will determine whether a difference exists in disease recurrence, continence, and erectile function.

Anastomosis, Surgical↗
PubMed2004

Laparoscopic radical cystectomy with continent urinary diversion (rectosigmoid pouch) performed completely intracorporeally: an intermediate functional and oncologic analysis.

OBJECTIVES: To present our experience with the first series of rectosigmoid pouch creation performed completely laparoscopically for continent urinary diversion after radical cystectomy to treat transitional cell carcinoma of the bladder. We evaluated the intermediate functional and oncologic outcomes. METHODS: Between April 2000 and January 2004, 20 patients underwent laparoscopic radical cystectomy with urinary diversion for transitional cell carcinoma at the Department of Urology, Charite Hospital, Campus Mitte. Of the 20 patients, 12 received a rectosigmoid pouch for urinary diversion. The procedures were performed completely laparoscopically, including free-hand laparoscopic suturing and in situ knot tying techniques. The mobilized specimens were removed in an endoscopy bag by way of the rectum or vagina. RESULTS: All operations were completed laparoscopically by two surgeons without conversion to open surgery. The median operating time was 485 minutes. One patient needed a blood transfusion of 2 U. All specimens had negative surgical margins. Two patients required reoperation. The median follow-up was 33 months. All patients were continent during the day, and 11 patients were continent at night. One patient developed unilateral hydronephrosis with loss of kidney function. No patient developed local recurrence, but 3 patients had systemic progression. Two of the three died of metastatic disease. CONCLUSIONS: This is the first series of laparoscopic radical cystectomy using an intracorporeal rectosigmoid pouch. Our functional data for continence and upper urinary tract obstruction were comparable with those of open rectosigmoid pouch studies. We were able to demonstrate an oncologic outcome similar to that achieved by the open surgical approach.

Adult↗
PubMed2004

Transperitoneal laparoscopic radical prostatectomy: descending technique.

Laparoscopic radical prostatectomy has evolved over the last decade to become a common treatment for clinically localized prostate cancer at specialized institutions. During that time, various technical modifications have been pioneered by groups throughout the world. We present our technique of transperitoneal laparoscopic radical prostatectomy through a descending approach. We believe that the transperitoneal approach affords better visual landmarks, a larger operative space, and a stable pneumoperitoneum. Our technique employs a five-trocar approach to the prostate. All dissection and suturing is performed intracorporeally. The perioperative morbidity and short-term efficacy are similar to those of the open procedure.

Adult↗
PubMed2003

Laparoscopic radical prostatectomy--an analysis of factors affecting operating time.

OBJECTIVES: Although laparoscopic radical prostatectomy (LRP) is accomplished within 2 to 3 hours by experienced surgeons, less is known about the operating times (OTs) for recently trained surgeons or the influence of additional factors. As of November 2001 at our institution, two senior surgeons had each performed more than 100 cases of LRP and two junior surgeons had each performed fewer than 30. We prospectively studied the next 100 consecutive LRPs to assess the factors influencing the OT. METHODS: Transperitoneal LRPs were performed by two senior (n = 62) and two junior surgeons (n = 38) with random case assignment. We assessed body mass index, prostate size, prior abdominal surgery, androgen deprivation, surgeon experience, procedures in addition to LRP, lymph node dissection, nerve sparing, and sural nerve grafting as potential predictors of the OT. RESULTS: Prostate weight, androgen deprivation, and prior abdominal surgery did not significantly affect the OT, but grade 1 obesity increased the OT by an average of 38 minutes. The mean OT by surgeon experience was 214 minutes for seniors and 347 minutes for juniors (P <0.001). By procedure type, the OT ranged from 180 minutes for LRP only by seniors to 459 minutes for LRP plus lymph node dissection plus sural nerve grafting by juniors. Lymph node dissection and sural nerve grafting significantly increased the OT by 46 and 101 minutes, respectively, and nerve sparing did not. For each combination of procedures, seniors averaged significantly shorter times than did juniors. A multiple regression model with stepwise selection showed that prostate weight, sural nerve grafting, pelvic lymph node dissection, use of a surgical robot, and surgeon experience significantly affected the OT. CONCLUSIONS: The results of this prospective study of 100 cases of LRP showed that the OT for senior surgeons averaged 2 to 3 hours, but less experienced surgeons, and additional procedures, add significantly to the OT.

Abdomen↗
PubMed2003

Positive margins after laparoscopic radical prostatectomy: a prospective study of 100 cases performed by 4 different surgeons.

OBJECTIVE: Laparoscopic radical prostatectomy (LRP) has been refined by experienced surgeons into a competitive treatment alternative for localized prostate cancer. Less is known, however, about the outcomes of "learning curve" cases from newly trained surgeons. We prospectively studied 100 cases of LRP performed by 2 senior and 2 junior surgeons and addressed the rates of positive margins-an important early endpoint of oncologic efficacy. METHODS: 100 consecutive cases of LRP were performed by two senior (n=62) and two junior surgeons (n=38) by a 5-port transperitoneal route. Whole-mount step-section prostate specimens were examined by Stanford protocol. RESULTS: Positive margins occured in 25% of cases: 18% for pT2a (2/11), 18% for pT2b (11/61), 45% for pT3a (10/22), and 50% for pT3b (2/4) (p=0.002 pT2 vs. pT3). By surgeon experience, the rates were 19% (12/62) for senior and 34% (13/38) for junior (p=0.04). However, in a multiple logistic regression analysis, only pathologic stage (p=0.083) and Gleason sum (p=0.0133) reached statistical significance, while surgeon experience did not (p=0.0992). CONCLUSION: Positive margin rates after laparoscopic radical prostatectomy are significantly influenced by pathologic stage and Gleason score, and are within the range reported from open series. The higher positive margin rate from junior surgeons, although not statistically significant, suggests the need for further study and continued mentoring during surgery and/or video review of cases to improve oncologic results.

General Surgery↗