Biomedical subjects

Michael C Truss

Publications and source records attributed to Michael C Truss.

5 recordsLinked to original sources

PubMed2005

Impact of previous surgery on endoscopic extraperitoneal radical prostatectomy.

OBJECTIVES: To assess the impact of previous surgery on endoscopic extraperitoneal radical prostatectomy (EERPE). METHODS: A total of 500 patients who underwent EERPE for clinically localized prostate cancer between December 2001 and April 2004 were stratified into five groups: group 1, no previous abdominal, inguinal, or prostate surgery; group 2, previous upper abdominal surgery; group 3a, previous lower abdominal or pelvic surgery or open inguinal hernioplasty; group 3b, laparoscopic or endoscopic inguinal hernioplasty; group 4, previous prostate surgery; and group 5, a combination of groups 2, 3, and/or 4. Groups 1 and 2 were analyzed together, because the previous operative fields in group 2 were distant from the space of Retzius. The operative times, complications, and reinterventions were analyzed with the Mann-Whitney U test, chi-square test, and Fisher exact test. RESULTS: Of the 500 patients, 335 (67%) and 165 (33%) were in groups 1 and 2 and groups 3 to 5, respectively. The mean overall operative time was 149 +/- 30 minutes. Four patients (0.8%) required transfusions, with no conversion to open surgery and no mortality. A total of 90 complications (18%) and nine reinterventions (1.8%) occurred. EERPE was subjectively more demanding and challenging in patients with previous minimally invasive hernioplasty with mesh placement. No statistical significance was detected between the no=surgery (groups 1 and 2) and previous surgery (groups 3 to 5) patients in terms of overall operative time, positive surgical margin status, complications, or reinterventions. CONCLUSIONS: Endoscopic extraperitoneal radical prostatectomy is feasible in patients with various previous abdominal surgical procedures. Previous surgery did not seem to affect the overall operative time or complication or reintervention rate. Previous minimally invasive hernia repair with mesh placement made EERPE more demanding but was not a contraindication.

Abdomen↗

PubMed2004

Does the extraperitoneal laparoscopic approach improve the outcome of radical prostatectomy?

Laparoscopic radical prostatectomy (LRPE) became the operative procedure of choice for patients with clinically localized prostate cancer in selected urologic centers around the world. Principal advantages are the minimal invasive nature of the procedure, a superior visualization of the operative field because of the magnification of the optical system, an exact and watertight anastomosis, the possibility of early catheter removal, and a potentially reduced amount of blood loss. Recent data show that oncologic outcome is not compromised by the minimal invasive nature of the procedure. However, a major drawback of LRPE is the transperitoneal route of access to the extraperitoneal organ of the prostate. Therefore, principal disadvantages of LRPE are potential intraperitoneal complications. Endoscopic extraperitoneal radical prostatectomy is a further advancement of minimal invasive surgery because it overcomes the limitations of LRPE by the strictly extraperitoneal route of access, combining the advantages of minimal invasive surgery with the advantages of an extraperitoneal procedure. This article reviews the literature on minimally invasive (laparoscopic and endoscopic-extraperitoneal) radical prostatectomy.

Humans↗

PubMed2003

Evolution of endoscopic extraperitoneal radical prostatectomy (EERPE)--technical improvements and development of a nerve-sparing, potency-preserving approach.

During the last decade, laparoscopy has become a standard technique in the armoury of the urologist due to constant technological advances and refinements. Laparoscopic radical prostatectomy (LRPE), although technically demanding and associated with a considerable learning curve, has become the surgical procedure of choice in selected and specialized urological centers around the globe for patients with clinically localized prostate cancer. However, a major drawback of LRPE is the transperitoneal route of access to the extraperitoneal prostate. The principal disadvantages of LRPE are potential intraperitoneal complications, such as bowel injury, ileus, intraperitoneal bleeding, intraperitoneal urinary leakage, intraperitoneal adhesion formation and concomitant small bowel obstruction. Endoscopic extraperitoneal radical prostatectomy (EERPE) is a further advancement of minimal invasive surgery as it overcomes the limitations of LRPE by the strictly extraperitoneal route of access combining the advantages of minimal invasive surgery with those of an extraperitoneal procedure. Based on our growing experience with this procedure, we have introduced several technical modifications, improvements and refinements including a nerve-sparing, potency-preserving approach (nEERPE) in an effort to further improve this minimally invasive procedure.

Adult↗

PubMed2003

Endoscopic extraperitoneal radical prostatectomy: initial experience after 70 procedures.

PURPOSE: After our initial experience with 70 transperitoneal laparoscopic radical prostatectomies we developed a totally extraperitoneal retropubic approach to radical prostatectomy using laparoscopic instruments. We report our initial experience with 70 endoscopic extraperitoneal radical prostatectomy procedures. MATERIALS AND METHODS: A total of 70 patients underwent endoscopic extraperitoneal radical prostatectomy. Mean patient age was 63.4 years (range 49 to 76). Mean preoperative prostate specific antigen was 12.48 ng./ml. (range 1.4 to 50.7). There were no specific selection criteria for the procedure. The steps of the procedure are preparation of the preperitoneal space with the help of a balloon trocar, trocar placement (a 3 x 5 and a 2 x 12 mm. port), pelvic lymph node dissection, exposure of the prostate and the bladder neck, incision of the endopelvic fascia, ligation of Santorini's plexus, bladder neck dissection, mobilization of the seminal vesicles, incision of Denonvilliers' fascia, sectioning of the prostatic pedicles with or without preservation of the neurovascular bundles, dissection of Santorini's plexus and apex, urethrovesical anastomosis with 7 to 9 interrupted sutures and removal of the specimen via an extraction bag. During the 70 endoscopic prostatectomies 11 hernia defects were treated in 9 patients concomitantly. RESULTS: There was no conversions and no re-interventions. Mean operative time was 155 minutes (range 90 to 260). One patient required transfusion with 2 units of blood cells. Pathological stage was pT2a in 19 patients, pT2b in 14, pT3a in 25, pT3b in 9 and pT4 in 3. Positive surgical margins were found in 2 of the 33 patients (6.1%) with pT2 tumors and in 13 of the 37 (35.1%) with pT3 and pT4 tumors. Postoperatively edema and hematoma of the penis in 10 cases was treated conservatively. Furthermore, 4 patients had asymptomatic lymphoceles, 1 required lymphocele drainage and 2 had partial obturator nerve paralysis, which resolved spontaneously. In 1 patient deep venous thrombosis developed. CONCLUSIONS: The preliminary results of this series are promising. Operative and perioperative morbidity was low. Functional results and oncological control were similar to the results of laparoscopic radical prostatectomy. The data demonstrate that endoscopic extraperitoneal radical prostatectomy can be performed with efficacy and results equal to those of laparoscopic radical prostatectomy, while providing the benefits of a totally extraperitoneal approach. Therefore, totally endoscopic extraperitoneal radical prostatectomy represents a technical improvement of laparoscopic technique because it completely obviates intra-abdominal complications and combines the advantages of minimally invasive laparoscopy and the retropubic open approach.

Aged↗

PubMed2002

Mediators of the female sexual response: pharmacotherapeutic implications.

A basic understanding of the mediators and related mechanisms involved in the genital physiology of the female sexual response, and, in particular, the physiology of arousal, is paramount for the clinical practitioner whose medical knowledge and practice pertain to female sexual dysfunction. Familiarity with established and evolving scientific principles relating to female genital physiology offers insight into functional aspects as well as disturbances of function relating to the female sexual response. Improved knowledge with regard to the central and peripheral nervous system components of female genital responses, chemical mediators, including endocrine factors determining the female sexual response, and other cellular and subcellular mechanisms should advance pharmacologic management for female sexual arousal disorder.

Coitus↗