Biomedical subjects

Richard E Link

Publications and source records attributed to Richard E Link.

At least 19 recordsLinked to original sources

PubMed2007

Complications of 2,775 urological laparoscopic procedures: 1993 to 2005.

PURPOSE: We assessed the complications associated with urological laparoscopic surgery at a single high volume center during a 12-year period. MATERIALS AND METHODS: A retrospective chart analysis was performed, focusing on complications associated with 2,775 laparoscopic surgeries occurring between 1993 and 2005. These included radical nephrectomy (549), partial nephrectomy (345), donor nephrectomy (553), simple nephrectomy (186), pyeloplasty (301), nephroureterectomy (105), retroperitoneal lymph node dissection (86), renal ablation (81), adrenalectomy (106) and radical prostatectomy (463). Complication data were tabulated according to case number, procedure type, patient age, the American Society of Anesthesiologists score, conversion status, length of hospitalization, Clavien classification system and annual complication rate during the study. Statistical analysis was performed with Fisher's exact and chi-square tests. RESULTS: A total of 614 complications (22.1%) occurred within each group, broken down into laparoscopic radical nephrectomy (20%), laparoscopic partial nephrectomy (28%), laparoscopic donor nephrectomy (28%), laparoscopic simple nephrectomy (15%), laparoscopic pyeloplasty (13.3%), laparoscopic nephroureterectomy (40.9%), laparoscopic retroperitoneal lymph node dissection (26.7%), laparoscopic renal tumor ablation (18.6%), laparoscopic adrenalectomy (25.4%) and laparoscopic radical prostatectomy (15%). Total intraoperative and postoperative complication rates were 4.7% and 17.5%, respectively. Vascular injuries were the most common intraoperative complications. Annual complication rates plateaued in the year 2000 and were not significantly different during the ensuing 4 years (p >0.05). Complications correlated with a greater American Society of Anesthesiologists score as well as a longer hospital stay (p <0.05). CONCLUSIONS: The data presented here help define the complication rates for laparoscopic urological procedures in experienced hands at a high volume institution.

Adult↗

PubMed2006

Results of computerized tomography guided percutaneous ablation of renal masses with nondiagnostic pre-ablation pathological findings.

PURPOSE: Ablative therapy for renal masses has been criticized because the entire tumor cannot be evaluated pathologically after the procedure. Diagnosis depends on imaging findings and the results of percutaneous needle biopsies, which may be nondiagnostic in up to 21% of cases. We determined outcomes in patients undergoing ablation who had nondiagnostic biopsies at the time of the procedure. MATERIALS AND METHODS: A total of 79 patients (88 renal masses) underwent percutaneous computerized tomography guided biopsy and ablation of a renal mass under conscious sedation. Patients with nondiagnostic biopsies were identified and the medical records were reviewed retrospectively. All patients had an enhancing renal mass on preoperative computerized tomography or magnetic resonance imaging and all underwent postoperative contrast imaging to evaluate persistent viable tumor. RESULTS: A total of 19 patients (20 tumors) with nondiagnostic percutaneous biopsy (22.7% or 20 of 88) were included in the study. No serious complications occurred. Tumors were treated with frequency ablation (12) or cryoablation (7). In 17 patients (89.5%) post-procedure imaging confirmed the absence of contrast enhancement at a median followup of 27.3 months (range 3 weeks to 56 months). In 2 cases (10.5%) post-procedure imaging showed a residual renal mass or recurrence with enhancement, suggesting that the original percutaneous biopsy result was false negative. In 1 patient residual tumor was identified on initial post-ablation imaging and the patient underwent laparoscopic partial nephrectomy. In another patient recurrence was diagnosed 30 months after ablation and the patient underwent laparoscopic radical nephrectomy. Although there was a nondiagnostic percutaneous biopsy in each case, pathological findings in the subsequent surgical specimen confirmed renal cell carcinoma. CONCLUSIONS: Nondiagnostic percutaneous biopsy at renal tumor ablation does not obviate the need for standard post-procedure imaging followup. Of patients with nondiagnostic biopsies in this series 10.5% still harbored viable renal cell carcinoma after percutaneous ablation.

Adult↗

PubMed2006

Percutaneous computerized tomography guided cryoablation for localized renal cell carcinoma: factors influencing success.

PURPOSE: We evaluated the factors that influenced the initial success rate and complication rate of percutaneous computerized tomography guided cryoablation of localized renal cell carcinoma of clinical stage T1N0M0. MATERIALS AND METHODS: A total of 21 patients with a mean age of 71.5 years and a pathological diagnosis of renal cell carcinoma were treated with percutaneous computerized tomography guided cryoablation under conscious sedation on an outpatient basis. We retrospectively reviewed clinical data, tumor characteristics, techniques and results. Tumors with complete loss of contrast enhancement were considered successfully treated. RESULTS: A total of 21 patients with 23 tumors underwent 25 cryoablation sessions. The mean intraoperative computerized tomography scan tumor size was 2.1 cm (range 0.5 to 4.3) and the mean ice ball size was 4.1 cm (range 2.2 to 7.2). Of the patients 82.6% (19 of 23) had a single treatment. Patients were followed with postoperative scans of 4.6 to 18.3 months (mean 12.3). There were 2 recurrences. The rate of successful complete tumor ablation was influenced by various factors. Tumor location and size were the major determinants for achieving tumor eradication. CONCLUSIONS: Percutaneous renal cryoablation using computerized tomography imaging proved to be a successful technique for guiding probe placement and monitoring ice ball formation. Patient selection based on tumor size and location may aid in improved outcomes. Further study and followup are necessary to determine long-term oncological efficacy.

Aged↗

PubMed2006

Age stratified functional outcomes after laparoscopic radical prostatectomy.

PURPOSE: We assessed health related quality of life in men treated for prostate cancer with laparoscopic radical prostatectomy. MATERIALS AND METHODS: Urinary continence and potency were prospectively assessed in 369 men stratified into age groups, including group 1-younger than 50, group 2-50 to 59 and group 3-60 years or older, by analyzing answers to the Expanded Prostate Cancer Index Composite questionnaire collected preoperatively, and 3, 6 and 12 months after laparoscopic radical prostatectomy. RESULTS: Younger men were more likely to achieve urinary continence (1 pad or less daily) 1 year after laparoscopic radical prostatectomy (groups 1 to 3 100%, 91% and 81%, respectively, p <0.01). Younger men were also more likely to be potent and engaging in intercourse 1 year after bilateral nerve sparing laparoscopic radical prostatectomy (groups 1 to 3 70%, 67% and 46%, respectively, p <0.01). The mean percent return to baseline Expanded Prostate Cancer Index Composite urinary continence subscale at 1 year in groups 1 to 3 was 80%, 79% and 74%, respectively (p = 0.49). The mean percent return to baseline Expanded Prostate Cancer Index Composite sexual function subscale at 1 year in groups 1 to 3 was 68%, 65% and 58%, respectively (p = 0.56). Binary logistic regression modeling using the variables age group, prostate weight, International Prostate Symptom Score and nerve sparing status demonstrated that only younger age group was associated with return to continence at all postoperative time points (p <0.05). Younger age group was associated with return to early potency at 3 and 6 months (p = 0.02 and <0.01, respectively). However, only nerve sparing status was associated with recovery of potency at all time points (p <0.05). CONCLUSIONS: Younger men treated with nerve sparing laparoscopic radical prostatectomy regain urinary control and potency earlier than older men. However, validated questionnaire subscale analyses demonstrated that the return to preoperative baseline urinary continence and sexual function is similar in all age groups by the end of postoperative year 1.

Age Factors↗

PubMed2006

Transmesenteric laparoscopic pyeloplasty.

PURPOSE: Traditionally transperitoneal laparoscopic access to ureteropelvic junction obstruction has been performed in retrocolic fashion. We assessed transmesenteric laparoscopic pyeloplasty to correct ureteropelvic junction obstruction and compared results to those in patients undergoing traditional retrocolic laparoscopic pyeloplasty. MATERIALS AND METHODS: Between August 1999 and July 2005, 188 consecutive transperitoneal laparoscopic pyeloplasties were performed at our institution. A total of 18 patients underwent a transmesenteric approach and 170 underwent the classic retrocolic approach. Patient selection for the transmesenteric approach was at surgeon discretion with the inclusion criterion of recognition of the renal pelvis and/or ureter through the descending colonic mesentery. RESULTS: Compared to patients undergoing traditional retrocolic procedure the transmesenteric approach was more commonly applied in younger individuals and males, and for pathological conditions on the left side and malrotated kidneys. The transmesenteric approach lowered operative time by a mean of 22.5% and decreased hospital stay by 19.2%. The patency success rate was 100% at a mean followup of 18.6 months for the transmesenteric approach and 94.1% at a mean followup of 22 months for the retrocolic approach. CONCLUSIONS: In a select group of patients transmesenteric pyeloplasty may represent a more rapid alternative to the transperitoneal retrocolic approach and speed convalescence with similar success rates.

Adolescent↗

PubMed2006

Comparison of surgical performance during laparoscopic radical prostatectomy of two robotic camera holders, EndoAssist and AESOP: a pilot study.

OBJECTIVES: Robotic camera holders provide steady camera movement and view during laparoscopic surgery. We compared two such robots, EndoAssist and AESOP, by evaluating timed setup and surgical performance during laparoscopic radical prostatectomy (LRP). METHODS: We prospectively collected data for 20 patients undergoing LRP using either the EndoAssist or AESOP. AESOP was mounted to the surgical bed and controlled by an experienced assistant using a hand-held remote control. The EndoAssist device was placed over the patient's right shoulder. Its movements were executed by the surgeon using a head-mounted optical emitter with brief head movements detected by a sensor mounted atop the surgeon's video monitor. The robot setup time and LRP operative steps were timed and compared between the two cohorts. RESULTS: The time for robot setup favored AESOP over the EndoAssist (2.0 minutes versus 5.3 minutes, P = 0.001). The time for accomplishing vas deferens and seminal vesicle dissection favored the EndoAssist (23 minutes versus 33 minutes, P = 0.04). However, no statistically significant difference was found in the efficiency of task performance between the two robots in any of the other 11 steps measured. CONCLUSIONS: The EndoAssist appears to be equally efficient to the assistant-controlled AESOP robot with respect to surgical performance during LRP. The advantages of the EndoAssist include its accurate response and ability to provide the surgeon with complete control of the desired operative view without relying on an assistant. Its disadvantages include its large profile, lack of a table-mounted design, and the need for pedal activation. Additional modifications are needed to improve the efficiency and design of this novel robotic device further.

Humans↗

PubMed2006

Exploration for hemorrhage following laparoscopic renal surgery: intraoperative findings.

PURPOSE: Bleeding after surgery is a rare but potentially life threatening complication. We reviewed operative and postoperative clinical features in patients who required surgical exploration secondary to hemorrhage following laparoscopic renal procedures. MATERIALS AND METHODS: We retrospectively reviewed the records of patients undergoing laparoscopic renal surgery between January 1996 and September 2004. Nine of 1,123 patients (0.8%) underwent early exploration for bleeding within 5 days of surgery. RESULTS: Two groups were identified. Group 1 consisted of 4 patients who underwent early exploration at less than 10 hours after surgery and had arterial bleeding. Group 2 consisted of 5 patients who underwent exploration a mean 38 hours after surgery and in whom no bleeding source was identified. Group 1 patients had pronounced hypotension with systolic blood pressure 70 to 79 mmHg and hematocrit decreases (mean 10.5%) in a short time course before repeat exploration (mean 4.5 hours). Arterial bleeding was identified in the hilum and adrenal bed. Group 2 patients demonstrated a decrease in hematocrit from an initial mean of 28.3% to 22.5% with tachycardia and mild hypotension (systolic blood pressure 90 to 99 mmHg). On exploration group 2 patients had diffuse oozing. Mean hospital stay in group 1 was 8 days (range 4 to 9) vs 12 (range 6 to 24) in group 2. CONCLUSIONS: Early hemodynamic instability after laparoscopic renal surgery is likely to indicate a discrete arterial bleeding source from the hilum or adrenal bed, requiring surgical control. In patients who underwent exploration after a delayed bleeding presentation no discrete source was found intraoperatively. Therefore, it is unclear whether these patients benefited from surgical exploration.

Adult↗

PubMed2006

Chylous ascites following retroperitoneal lymphadenectomy for testes cancer.

BACKGROUND: A 31-year-old man underwent a radical orchiectomy for a stage I mixed germ-cell tumor with angiolymphatic invasion. A subsequent laparoscopic retroperitoneal lymphadenectomy was complicated by a laceration to the aorta at the ostia of the more inferior of two right renal arteries. This was repaired following conversion to an open laparotomy. The patient presented 14 days later with genital swelling and increasing abdominal girth. INVESTIGATIONS: Physical examination, abdominal and pelvic CT, laboratory albumin testing, lymphoscintogram and lymphangiogram. DIAGNOSIS: Chylous ascites with tracking of lymphatic fluid into the left groin through a defect in the internal inguinal ring. MANAGEMENT: Conservative management with salt restriction, a medium-chain fatty-acid diet and diuretics; exploratory laparoscopy, during which a small left inguinal hernia was repaired and chylous fluid was drained. Following further leakage, the patient was placed on total parenteral nutrition, followed by image-guided sclerotherapy with doxycycline.

Adult↗

PubMed2006

Cost analysis of open, laparoscopic, and percutaneous treatment options for nephron-sparing surgery.

BACKGROUND AND PURPOSES: A variety of nephron-sparing options exist for the management of small renal masses. The perioperative cost of open (OPN) and laparoscopic (LPN) partial nephrectomy, laparoscopic (LCA), and CT-guided percutaneous (PCA) cryoablation was compared using a detailed computer model. PATIENTS AND METHODS: The model incorporates operative time, consumables, anesthesia, CT usage, percutaneous biopsy, hospitalization, and transfusion expenses. Starting values were derived from a retrospective review of 317 patients treated at the Johns Hopkins Medical Institutions within the past 7 years. Hypothesis testing was performed with sensitivity analysis. RESULTS: The PCA was 2.2 to 2.7 times less costly than the other options and resulted in a cost savings of $3625 to $5155 per case. For OPN, LPN, and LCA, the operative time and hospitalization accounted for 69% to 91% of the cost. In contrast, cryoprobe consumables were responsible for >70% of total cost of PCA. An OPN was 1.2x as costly as LPN and could achieve cost equivalence only with operative times of <2.8 hours or hospitalization of <3 days. An LCA was more costly than all forms of extirpative surgery if more than two cryoprobes were used. Reusing cryoprobes during LCA was always a less-costly option than adding a second cryoprobe to the procedure. The LCA was no longer cost advantageous over OPN if more than four CT scans were obtained during the first postoperative year or if local recurrence rates exceeded 23%. CONCLUSIONS: This model defines and simplifies a series of complex cost relations between the options for nephron-sparing surgery.

Costs and Cost Analysis↗

PubMed2006

A prospective comparison of robotic and laparoscopic pyeloplasty.

OBJECTIVE: To determine whether robotic-assisted pyeloplasty (RLP) has any significant clinical or cost advantages over laparoscopic pyeloplasty (LP) for surgeons already facile with intracorporeal suturing. SUMMARY BACKGROUND DATA: LP has become an established management approach for primary ureteropelvic junction obstruction. More recently, the da Vinci robot has been applied to this procedure (RLP) in an attempt to shorten the learning curve. Whether RLP provides any significant advantage over LP for the experienced laparoscopist remains unclear. METHODS: Ten consecutive cases each of transperitoneal RLP and LP performed by a single surgeon were compared prospectively with respect to surgical times and perioperative outcomes. Cost assessment was performed by sensitivity analysis using a mathematical cost model incorporating operative time, anesthesia fees, consumables, and capital equipment depreciation. RESULTS: The RLP and LP groups had statistically indistinguishable demographics, pathology, and similar perioperative outcomes. Mean operative and total room time for RLP was significantly longer than LP by 19.5 and 39.0 minutes, respectively. RLP was much more costly than LP (2.7 times), due to longer operative time, increased consumables costs, and depreciation of the costly da Vinci system. However, even if depreciation was eliminated, RLP was still 1.7 times as costly as LP. One-way sensitivity analysis showed that LP operative time must increase to almost 6.5 hours for it to become cost equivalent to RLP. CONCLUSIONS: For the experienced laparoscopist, application of the da Vinci robot resulted in no significant clinical advantage and added substantial cost to transperitoneal laparoscopic dismembered pyeloplasty.

Clinical Competence↗

PubMed2005

Modeling the cost of management options for stage I nonseminomatous germ cell tumors: a decision tree analysis.

PURPOSE: Patients with clinical stage I nonseminomatous germ cell tumors (NSGCTs) have been managed with surveillance, chemotherapy, or retroperitoneal lymphadenectomy (RPLND) with similar survival outcomes. Cost factors influencing the choice of therapy were evaluated using computer-based decision analysis. METHODS: A detailed model was developed that integrates projected costs for more than 60 possible treatment outcomes. It incorporates primary, adjuvant, and salvage chemotherapy, primary and post-chemotherapy RPLND, and both laparoscopic and open surgical approaches. Starting values and probabilities were derived from a comprehensive meta-analysis of the last 25 years of testes cancer literature. Hypothesis testing was performed using sensitivity analysis. RESULTS: The model predicts a cost premium for both primary chemotherapy (18.7%) and RPLND (51.7%) compared with surveillance. If laparoscopic RPLND was practiced, the cost premium for primary surgery (29.1%) approached that of chemotherapy (26.4%). Open RPLND was 1.25x as costly as laparoscopic RPLND, primarily because of longer hospitalization. The choice of open RPLND yielded a 6.9% cost premium for a surveillance program in this model. For such a program, primary chemotherapy became cost advantageous when the probability of recurrence during surveillance was more than 46%. CONCLUSION: This model allows a variety of treatment cost hypotheses to be tested. Primary RPLND is never cost advantageous over surveillance or primary chemotherapy. Surgical costs can significantly increase the overall cost of a surveillance program. In stage I patients with high-risk tumor characteristics, primary chemotherapy may have a cost advantage over surveillance.

Antineoplastic Agents↗

PubMed2005

Laparoscopic retroperitoneal lymph node dissection: duplication of open technique.

Laparoscopic retroperitoneal lymph node dissection has been used to stage germ cell testicular cancer. Since its initial description, this minimally invasive procedure has evolved into a therapeutic operation that adheres to established strict oncologic principles. A modified template dissection that fully duplicates the open technique is now routinely performed at our institution. We describe and show in the accompanying video segments a laparoscopic modified template dissection.

Humans↗

PubMed2005

Laparoscopic ureteral reimplantation: a simplified dome advancement technique.

Laparoscopic Boari flap reimplantation has been used to treat long distal ureteral strictures. This technique requires extensive bladder mobilization and complex intracorporeal suturing. This demonstrates a novel laparoscopic bladder dome advancement approach for ureteral reimplantation. This technique obviates the need for bladder pedicle dissection and simplifies the required suturing.

Humans↗

PubMed2005

Complete daVinci versus laparoscopic pyeloplasty: cost analysis.

BACKGROUND AND PURPOSE: Computer-assisted pyeloplasty with the daVinci system is an emerging technique to treat ureteropelvic junction (UPJ) obstruction. A relative cost analysis was performed assessing this technology in comparison with purely laparoscopic pyeloplasty. PATIENTS AND METHODS: Eight patients underwent computer-assisted (daVinci) dismembered pyeloplasty (CP) via a transperitoneal four-port approach. They were compared with 13 patients who underwent purely laparoscopic pyeloplasty (LP). All patients had a primary UPJ obstruction and were matched for age, sex, and body mass index. The cost of equipment and capital depreciation for both procedures, as well as assessment of room set-up time, takedown time, and personnel were analyzed. Surgeons and nursing staff for both groups were experienced in both laparoscopy and daVinci procedures. One- and two-way financial analysis was performed to assess relative costs. RESULTS: The mean set-up and takedown time was 71 minutes for CP and 49 minutes for LP. The mean length of stay was 2.3 days for CP and 2.5 days for LP. The mean operating room (OR) times for CP and LP were 176 and 210 minutes, respectively. There were no complications in either group. One-way cost analysis with an economic model showed that LP is more cost effective than CP at our hospital if LP OR time is <338 minutes. With adjustment to a volume of 500 daVinci cases/year, CP is still not as cost effective as LP. Two-way sensitivity analysis shows that in-room time must still be <130 minutes and yearly cases must be >500 to obtain cost equivalence for CP. CONCLUSIONS: Perioperative parameters for CP are encouraging. However, the costs are a clear disadvantage. In our hospital, it is more cost effective to teach and perform LP than to perform CP.

Adult↗

PubMed2005

Health related quality of life before and after laparoscopic radical prostatectomy.

PURPOSE: The viability of laparoscopic radical prostatectomy (LRP) as a surgical treatment for prostate cancer depends on oncological and health related quality of life (HRQOL) outcomes. We present a prospective assessment of HRQOL in 122 patients before and after LRP using the validated Expanded Prostate Cancer Index Composite (EPIC) questionnaire. MATERIALS AND METHODS: EPIC data were collected preoperatively, and at 3, 6 and 12 months after LRP, and all were normalized to patient preoperative baseline responses. RESULTS: Using traditional single question responses, 93.4% of patients were continent (0 to 1 pads) at postoperative month 12. Of previously potent men who underwent bilateral nerve sparing 78.9% reported engaging in sexual intercourse within postoperative year 1. However, EPIC domain scores provided a more comprehensive assessment of functional outcomes. For the urinary incontinence subdomain, the majority of functional recovery was achieved by postoperative month 6, reaching a 74% return to baseline on average. In contrast, recovery of the sexual function subdomain continued throughout postoperative year 1 (to a mean of 64%). Recovery of sexual function was not significantly affected by age or preoperative potency status, although the extent of nerve sparing was a significant predictor of outcome (mean recovery to 75% of baseline for bilateral vs 36% for no nerve sparing at 12 months, p = 0.005). CONCLUSIONS: Nerve sparing LRP provides satisfactory first year HRQOL outcomes when assessed with a validated instrument. The time course and extent of functional recovery documented in this prospective study may prove useful for patient counseling before LRP.

Humans↗

PubMed2005

Exploring the learning curve, pathological outcomes and perioperative morbidity of laparoscopic partial nephrectomy performed for renal mass.

PURPOSE: We investigated the learning curve, pathological results and perioperative morbidity of laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS: The records of all LPN cases at our institution between January 1999 and March 2004 were reviewed. Of 223 cases 217 (97.3%) were performed for an enhancing renal mass. RESULTS: Mean tumor size was 2.6 cm (range 1 to 10) and 95.4% of patients had a normal contralateral kidney. Transient vascular control was performed in 75.1% of cases. Mean operative time (186 minutes) decreased with surgeon experience (p = 0.003) but was independent of tumor size (p = 0.964). Mean warm ischemia time (27.6 minutes) depended on tumor size (p = 0.005) but not on experience (0.964). Mean blood loss was 385 cc and the perioperative transfusion rate was 6.9%. Postoperative complications occurred in 23 cases (10.6%) with the most common being ileus (1.8%), bleeding (1.8%) and urinary leakage (1.4%). Although the mean serum creatinine change after LPN was a function of tumor size (p <0.001), it was clinically insignificant (0.13 mg/dl). No significant relationship was observed between warm ischemia time and creatinine change (p = 0.262). The final pathological evaluation revealed renal cell carcinoma in 144 patients (66.4%) and the overall positive margin rate was 3.5%. Only 2 renal cell carcinoma recurrences in the operated kidney (1.4%) were identified (mean followup +/- SD 24 +/- 12 months). CONCLUSIONS: LPN is an effective approach for treating small renal masses with low perioperative morbidity. Contrary to previous reports, more than 30% of the enhancing renal lesions excised in this series were found to be benign on final pathological evaluation.

Adult↗

PubMed2005

Classification and trends of perioperative morbidities following laparoscopic radical prostatectomy.

PURPOSE: We classified and assessed trends in the incidence, severity and management of perioperative morbidity following laparoscopic radical prostatectomy (LRP). MATERIALS AND METHODS: We retrospectively reviewed the records of 250 patients with clinically localized prostate cancer who underwent transperitoneal LRP, as performed by 2 surgeons (CPP and LMS), between April 2001 and March 2004. The Clavien classification system was used to grade complications for cases completed laparoscopically. RESULTS: In the 246 cases completed laparoscopically 20 grade II, 12 grade III and 2 grade IV complications were noted during a mean followup of 13.7 months (overall complication rate 13.8%). Median hospital stay was 2 days (range 2 to 8) and median duration of bladder catheterization was 10 days (range 3 to 36). Postoperative ileus that prolonged hospital stay was the most frequent complication and it occurred in 8 patients (3.3%). Seven patients required blood transfusion (2.8%). Bladder neck contracture was observed in 3 patients (1.2%). A total of 11 complications occurred in the first 50 cases, while 12, 6, 8 and 1 occurred in cases 51 to 100, 101 to 150, 151 to 200 and 201 to 250, respectively. CONCLUSIONS: Perioperative complications following LRP are mostly self-limited and grade II or III (94.1%). The incidence of complications and need for conversion to open radical prostatectomy decreased with experience. Uniform reporting and grading of surgical complications via a standardized classification system may permit more meaningful comparisons among different centers and surgical techniques.

Adult↗

PubMed2005

Long-term survival analysis after laparoscopic radical nephrectomy.

PURPOSE: This report assesses the long-term oncological efficacy of laparoscopic radical nephrectomy compared with open radical nephrectomy in patients with clinically localized renal cell carcinoma. MATERIALS AND METHODS: We analyzed the data from 121 patients who underwent radical nephrectomy between 1991 and 1999 for clinical tumor stage T1/2 N0M0. The medical records of all patients were retrospectively reviewed with emphasis on tumor recurrence and survival. Statistical comparison was performed using Kaplan-Meier analysis. RESULTS: The median followup was 73 months for the laparoscopic group and 80 months for the open group. Of the 67 patients who underwent laparoscopic surgery, 53 survived without any recurrence of disease, 2 are currently alive with metastasis, 2 died of metastatic disease in months 12 and 17, and 10 patients died without any disease recurrence. Laparoscopic port site metastasis did not develop in any patients. Of the 54 who underwent open surgery, 34 survived without any recurrence of disease, 1 currently has metastasis, 6 died of metastasis within 17 to 74 months, and 13 died without any disease recurrence. A comparison of the 5 and 10-year disease-free survival rates of the laparoscopic and open groups revealed no significant differences. In addition, the 5 and 10-year cancer specific and actuarial survival rates were not significantly different. CONCLUSIONS: Based on long-term followup, our evaluation confirmed for clinical tumor stage T1/2 N0M0 that laparoscopic radical nephrectomy is oncologically equivalent to open radical nephrectomy.

Carcinoma, Renal Cell↗