Biomedical subjects

Kossen Ho

Publications and source records attributed to Kossen Ho.

3 recordsLinked to original sources

PubMed2005

Endoscopic extraperitoneal radical prostatectomy in patients with prostate cancer and previous laparoscopic inguinal mesh placement for hernia repair.

INTRODUCTION: Since laparoscopic inguinal hernia repair has become a frequently performed surgical procedure, it is inevitable that patients who have been candidates for laparoscopic radical prostatectomy (LRP) may have had such prior intervention. The inguinal hernia repair might take the form of either total extraperitoneal hernioplasty (TEP) or transabdominal extraperitoneal hernioplasty (TAPP), with mesh placement. The objective was to show that performing endoscopic extraperitoneal radical prostatectomy (EERPE) in such patients was safe and feasible, and also to suggest modifications of the technique to facilitate the surgery. PATIENTS AND METHODS: There were no specific selection criteria and patients with prior mesh placements were encountered during the management of all consecutive patients undergoing EERPE. Modifications in the port placements were made to accommodate for previous mesh placements on the right and left side. The area of prior mesh placement was excluded from the dissection when creating the extraperitoneal space. The operation was performed, thereafter, using the standard EERPE method. RESULTS: Out of a total of 750 patients operated on with EERPE, 14 had prior TEP or TAPP with mesh placement. In both groups there were no differences found in the mean operative time. There were no major complications or reinterventions in patients with prior mesh placement. In each group (i.e. TEP and TAPP), a small bladder injury was diagnosed and managed intraoperatively with no further complication. One vascular injury to the inferior epigastric vessels was managed intraoperatively without significant blood loss. None of the 14 patients required blood transfusion. The mean catheterization time was 6.9 days. CONCLUSION: Although certain problems were presented by previous TEP/TAPP, it is nevertheless feasible to perform EERPE. By adapting port placements and surgical techniques the operation can be performed safely and with a good operative outcome.

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PubMed2005

Endoscopic extraperitoneal radical prostatectomy: oncological and functional results after 700 procedures.

PURPOSE: We review our experience with endoscopic (totally) extraperitoneal radical prostatectomy (EERPE) as first line therapy for localized prostate cancer. MATERIALS AND METHODS: A total of 700 consecutive patients underwent EERPE. Mean patient age was 63.4 years (range 42 to 77). Mean preoperative prostate specific antigen was 10.7 ng/ml (range 1.4 to 82). A total of 206 patients (29.4%) had a history of previous lower abdominal or pelvic surgery including inguinal hernioplasty with mesh placement and 43 patients (6.1%) had a history of prostatic intervention (transurethral resection of the prostate, high intensity focused ultrasound, Millin prostatectomy, radiotherapy). After preparation of the preperitoneal space the technique of EERPE duplicates the steps of classic open descending retropubic radical prostatectomy including a nerve sparing EERPE when indicated. RESULTS: Mean operative time was 151 minutes (range 50 to 320). There was no conversion and the transfusion rate was 0.9% in 6. Four patients (0.6%) had intraoperative rectal injuries which were treated endoscopically with a 2-layer suture. A total of 14 patients (2%) required early and 3 patients (0.4%) required late postoperative reintervention. Pathological stage was pT2a in 89 patients (12.7%), pT2b in 54 (7.7%), pT2c in 245 (35%), pT3a in 229 (32.7%), pT3b in 79 (11.2%) and pT4 in 4 patients (0.6%). Positive surgical margins were found in 10.8% (42 of 388) of patients with a pT2 tumor and in 31.2% (96 of 308) of patients with a pT3 tumor. Pelvic lymph node dissection was performed in 266 patients (38%), of whom 14 (5.3%) were found to have lymph node involvement. Mean catheterization time was 6.2 days. Six months after surgery 83.8% of the patients were completely continent, 10.4% needed 1 to 2 pads daily and 5.8% of patients needed more than 2 pads daily. Of all patients who underwent nerve sparing procedures, 100 patients had a postoperative followup of 6 months. Of the 66 patients with the unilateral nerve sparing approach 8 (12.1%) had erections sufficient for intercourse and 16 of 34 patients (47.1%) with the bilateral nerve sparing procedure had erections sufficient for intercourse with or without the help of phosphodiesterase type 5 inhibitors. CONCLUSIONS: The results of this series are promising. Perioperative morbidity is low, and short-term oncological and functional results are favorable. Although the followup is too short to draw definite conclusions, it is obvious that a nerve sparing approach in EERPE is feasible and reproducible. Our data demonstrate that EERPE can be performed with equal efficacy and results compared with laparoscopic transperitoneal radical prostatectomy, while providing the ease and safety of a totally extraperitoneal approach, completely avoiding intraperitoneal complications.

Adult↗

PubMed2005

Modular surgical training for endoscopic extraperitoneal radical prostatectomy.

OBJECTIVE: To develop a modular training scheme which enabled the use of individual steps of laparoscopic radical prostatectomy (RP) for teaching and training surgeons with varied experience, including residents with no experience in open RP, as in extending laparoscopic surgery to more complex operations like RP, the proper training of urologists is crucial. SUBJECTS AND METHODS: The technique of endoscopic extraperitoneal RP (EERP) was divided into 12 individual steps of differing complexity. The levels of difficulty were called "modules" and graded according to their requisite skills from module 1 (lowest level of difficulty) to module 5 (highest level). Based on this modular system we established a training programme whereby the trainee learns the procedure in a mentor-initiated schedule. During each training operation the trainee only performs the modules (steps) of the operation, which correspond with his or her actual skill level. The mentor performs all the other steps, with the trainee assisting. Four trainees with different surgical experience participated in the study. RESULTS: After a phase of assisting and camera holding during EERP, the trainees entered the modular training programme and required 32-43 procedures until they were considered to be competent. An analysis of the first 25-50 procedures done independently by the trainee showed mean operative times of 176-193 min and a transfusion rate of 1.3%. Complications during and after EERP requiring re-intervention were one each of recto-urethral fistula, haemorrhage, symptomatic lymphocele and anastomotic leak. The positive margin rate for pT2 disease was 12.2% and for pT3 tumours 37%. CONCLUSION: The modular concept for teaching EERP is an attractive concept, which overcomes many of the problems involved in complex laparoscopic procedures. Based on a highly standardized technique, this concept offers a short learning curve; it enables training on different sites in cooperation with a high-volume centre, and it makes it possible to start with this complex procedure as a beginner or with no experience in open RP.

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