Biomedical subjects

Xavier Cathelineau

Publications and source records attributed to Xavier Cathelineau.

At least 19 recordsLinked to original sources

PubMed2006

Robot-assisted versus pure laparoscopic radical prostatectomy.

The aim of this study is to report the relative advantages and disadvantages of the radical prostatectomy with a laparoscopic (LRP) and a robotic (RALP) approach. A medline search was performed. Published data regarding perioperative parameters, complications, oncological results, functional results were analyzed. Shorter learning curves have been reported with the RALP. Intra-operative and post-operative outcomes appear to be comparable between the two approaches. The average time for LRP is 234 min (151-453) versus 182 min (141-250) for RALP. Estimated blood loss for the LRP averages 482 ml (185-850) versus 234 ml (75-500) for the RALP. Complication rates in single institution studies are similar. Long-term outcomes data on PSA progression is not yet available for LRP or RALP due to their relatively short existence. RALP appears to offer a significant benefit to the laparoscopically naïve surgeon with respect to learning curve when compared to LRP. This, however, comes at an increased cost. Intra-operative and post-operative outcomes appear to be similar. Longer follow-up data is necessary to compare oncological and functional outcomes.

Humans↗

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↗

PubMed2006

[Place of laparoscopic nephroureterectomy in the treatment of upper urinary tract transitional cell carcinoma].

The current reference treatment for upper urinary tract transitional cell carcinoma is open nephroureterectomy via a lumbar incision and an iliac incision with resection of a large bladder cuff: Since the first laparoscopic nephroureterectomy performed in 1991, several teams have studied this approach for the treatment of urinary tract tumours. Laparoscopy has the advantage of decreased morbidity for the patient and allows early return to work. Recent published series do not demonstrate any difference in terms of cancer control between open and laparoscopic nephroureterectomy. However, the follow-up of laparoscopic nephroureterectomy is still limited and the safety of this technique has not been fully demonstrated. It therefore appears preferable to limit the indications for laparoscopic nephroureterectomy to small and/or low-grade tumours to avoid excessive manipulation of large transitional cell carcinomas in a gaseous atmosphere that can predispose to dissemination during dissection. Diagnostic ureteroscopy has therefore become a useful tool in the preoperative assessment. Biopsies can determine the tumour grade and guide the surgeon's choice of surgical approach.

Carcinoma, Transitional Cell↗

PubMed2005

[Laparoscopic treatment of urological malignancies].

This literature review highlights the laparoscopic prostatectomy, partial and total nephrectomy, nephroureterectomy, and total cystectomy. The indications, operative technique, complications and outcomes of each are discussed.

Cystectomy↗

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↗

PubMed2005

Extraperitoneal laparoscopic radical prostatectomy: a prospective evaluation of 600 cases.

PURPOSE: We report our experience with the extraperitoneal approach to laparoscopic radical prostatectomy. We describe the technique, clinical and oncological results, and functional outcome. MATERIALS AND METHODS: From February 2002, to March 2004, 600 laparoscopic radical prostatectomies were performed by an extraperitoneal approach and evaluated prospectively. RESULTS: A total of 599 extraperitoneal procedures were performed successfully. Mean operative time was 173 minutes. Mean operative blood loss was 380 cc. The transfusion rate was 1.2%. The major and minor complications rate was 2.3% and 9.2%, respectively. The reoperation rate was 1.7%. Mean hospital stay was 6.3 days. Pathological stage was pT2 and pT3 in 72% and 28% of cases, respectively. Mean Gleason score was 7. The overall positive margin rate was 17.7% (14.6% and 25.6% of pT2 and pT3 tumors, respectively). Median followup was 12 months. Of the patients 95% had prostate specific antigen less than 0.2 ng/ml. Patients were evaluated by a self-questionnaire sent by mail before and after surgery (International Continence Society and International Index of Erectile Function-5). At a median followup of 12 months 84% of the patients were continent (no pad), 7% used 1 precautionary pad and 7% needed 1 pad routinely. At a median followup of 6 months in preoperatively potent patients (International Index of Erectile Function-5 greater than 20) the postoperative erection and intercourse rate was 64% and 43%, respectively, in those with bilateral nerve bundle preservation. CONCLUSIONS: The extraperitoneal technique is a reliable approach to laparoscopic radical prostatectomy.

Aged↗

PubMed2005

[Robotic surgery: toy or tool?].

Telemanipulation has been developed for industrial purposes since the 1970s. More recently, telemanipulated arms entered the operating room. This paper briefly describes the history of surgical robotics and discusses the advantages and disadvantages for both patients and surgeons. The authors advocate the development of robotic surgery, as it facilitates the training of young surgeons and can be useful during certain phases of an operation. Thus, robotic surgery is more a promising tool than a simple toy.

Humans↗

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

Robotic radical prostatectomy: the European experience.

Radical prostatectomy is standard treatment for localized prostate cancer in young patients. The shortcomings of the laparoscopic approach have led to the use of robots to improve the precision and accuracy of anatomic dissection. The feasibility of using a remote-controlled robot to perform urologic procedures is established, especially for radical prostatectomy. This article reviews the European experience with robotic radical prostatectomy.

Europe↗

PubMed2004

Impact of learning curve in laparoscopic radical prostatectomy on margin status: prospective study of first 100 procedures performed by one surgeon.

PURPOSE: To describe the experience of a single surgeon with his first 100 laparoscopic radical prostatectomies and determine the impact of the learning curve on the surgical margin status according to the rate of nervesparing procedures. PATIENTS AND METHODS: Between December 2000 and April 2002, 100 laparoscopic radical prostatectomies were performed by one surgeon without any selection of patients and without the help of any other surgeon. The procedures were divided in four groups of 25 consecutive cases. There was no significant difference among the groups in terms of age, clinical and pathological stage, or Gleason score. Nerve-sparing (NS) dissection was performed when the procedure was easy. Positive surgical margins (SM+) were measured and classified according to their location. RESULTS: The overall rate of SM+ was 12.8% in pT2 and 31.8% in pT3 tumors. The SM+ rate was not significantly different among the groups. In contrast, the number of NS dissections (49 patients) increased from group 1 to group 4. Both the positive margin length and the rate of multiple positive margins were significantly lower in the 50 most recent patients. CONCLUSION: Nerve-sparing surgery was performed with increasing frequency during this learning curve without compromising the surgical margins. The results suggest that experience could lead to a decrease of both the positive margin length and the rate of multiple positive margins. The impact on cancer control and potency is under evaluation.

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↗

PubMed2004

Transrectal focused ultrasound combined with transurethral resection of the prostate for the treatment of localized prostate cancer: feasibility study.

PURPOSE: We studied the feasibility of combined treatment with high intensity focused ultrasound (HIFU) and transurethral resection or incision of the prostate for localized prostate cancer to decrease the risk of posttreatment prolonged urinary retention. MATERIALS AND METHODS: Included in this feasibility study were 30 patients fulfilling certain criteria, namely localized prostate cancer indicated for HIFU, age 60 years or older, prostate volume 45 cc or less, no more than 4 positive samples at sextant biopsy, baseline prostate specific antigen (PSA) 10 ng/ml or less and no evidence of cancer extension. They received the combined treatment under general anesthesia using an Ablatherm HIFU device (EDAP SA, Lyon, France). RESULTS: The enrolled patients were a mean of 72 years old and presented with a median prostate volume of 30 cc. Median Gleason score was 6, median PSA was 7 ng/ml and pretreatment sextant biopsies provided a median of 2 positive samples. Mean operative time was 2 hours 48 minutes, including resection and HIFU. An average of 616 HIFU shots were delivered. The urinary catheter was removed at day 2 after treatment. Median hospital stay was 3 days. Only a few complications were observed. In regard to the oncological aspects at a mean of 20 months of followup 86% of the patients had negative biopsies after HIFU. Median PSA was 0.9 ng/ml. At 1 year of followup the mean International Prostate Symptom Score was 8. Regarding sexual function, 73% of previously potent patients reported preserved sexual activity. CONCLUSIONS: The combination of endoscopic resection or incision of the prostate with HIFU treatment decreases urinary catheterization time and improves posttreatment urinary status without additional morbidity.

Aged↗

PubMed2004

Impact of margin size on the incidence of local residual tumor after laparoscopic radical prostatectomy.

PURPOSE: Since October 2001 we have performed intraoperative frozen section (IFS) on the posterolateral areas of the radical prostatectomy specimen with bilateral nerve sparing. In cases of positive surgical margin (SMs) the corresponding neurovascular bundle (NVB) was resected. We evaluated the impact of several biological and pathological parameters on the incidence of local residual tumor in the NVB. MATERIALS AND METHODS: A total of 487 laparoscopic radical prostatectomies with bilateral nerve sparing and IFS were performed between October 2001 and December 2003. When IFS was positive, the whole NVB was removed and analyzed after fixation in serial sections. The size of the positive SM was measured in its largest dimension. The association of NVB residual tumor with positive SM size, preoperative prostate specific antigen, pathological stage and Gleason score was analyzed using the t and chi-square tests, and logistic regression. RESULTS: Of the 487 patients 84 had a positive SM on IFS. In 25 of the 84 additionally resected NVBs we found residual tumor. On univariate and multivariate analysis the only predictor of residual tumor was positive SM size (p<0.001). In all cases of a positive SM of 0.1 cm or less we found no residual tumor cells in the NVB. CONCLUSIONS: In case of a positive SM in the posterolateral area of the prostatectomy specimen margin size is predictive of the incidence of residual tumor in the corresponding NVB. This finding could help management and the decision about local adjuvant treatment.

Adult↗

PubMed2004

[Laparoscopic surgery for renal cancers].

327 patients with renal adenocarcinoma underwent laparoscopic radical nephrectomy (n=123), radical open nephrectomy (n=113), laparoscopic partialnephrectomy (n=47) or partial open nephrectomy (n=20) for stage T1 disease. Eighteen patients underwent open radical nephrectomy and six laparoscopic radical nephrectomy for stage T2 and T3 disease. Median tumor size was 9.6 cm after open surgery and 4.1 cm after laparoscopic surgery (p<0.01). Intraoperative blood loss was 254 ml during laparoscopy and 460 ml during open surgery (p<0.01). The hospital stay lasted 4.5 days after laparoscopic surgery and 10 days after open surgery (p<0.01). Complications were the same in the two groups, affecting 21.5 and 27.5% of patients, respectively (NS). Oncological results: stage for stage, the results were identical in the open and laparoscopic groups. The specific actuarial recurrence-free survival rate at 5 years among patients with stage PT1 disease was 97% after open radical nephrectomy and 96.8% after laparoscopic surgery; the corresponding rates were 100% after partial open surgery and 100% after laparoscopic partial surgery. Thus, laparoscopic surgery for renal adenocarcinoma offers identical oncological results to open surgery for patients with non metastatic tumors measuring less than 7 cm. Partial laparoscopic surgery offers the same results as partial open nephrectomy.

Adenocarcinoma↗

PubMed2004

[The surgical management of recurrent urological malignancies after primary ablative therapy].

This literature review highlights the surgical management of recurrent urological malignancies after primary ablative therapy. In particular, recurrent nonseminomatous germ cell tumours (NSGCT) post-chemotherapy, recurrent bladder cancer post-cystectomy, loco-regional recurrence of prostate cancer after radiotherapy, and loco-regional recurrence of renal cell carcinoma after radical nephrectomy. The indications, operative technique, complications and outcomes of each malignancy are discussed.

Female↗

PubMed2003

In vitro training program to improve ambidextrous skill and reduce physical fatigue during laparoscopic surgery: preliminary experience.

PURPOSE: We illustrate the preliminary experience with our planned intensive in vitro training program focused on the nondominant hand and reducing physical fatigue. Apart from this, we tried to calculate how much training is required for a novice urologist to master laparoscopic freehand suturing with the dominant and nondominant hands. MATERIALS AND METHODS: Between December 2001 and May 2002, one trainee worked on a Pelvi-trainer, first with the dominant (right) hand and then with the left hand, practicing intracorporeal suturing and cutting and improving physical endurance by gradually increasing the duration of each training session. Along with the Pelvi-trainer, he worked on left-handed writing to improve wrist movements. Before starting this training, he did not have any laparoscopic experience as assistant or primary surgeon. The progress was stored in the computer prospectively to compare the results with those obtained at the end of the training. RESULTS: For the dominant hand, 30 hours over 2 months was required to master laparoscopic suturing skills. After training of the right hand, the nondominant hand required 40 hours of Pelvi-trainer work and 20 hours of handwriting during 2 months. Physical endurance for suturing in the Pelvi-trainer increased from 15 minutes to 150 minutes over 3 months. The main improvement was in the degree of pain over the right shoulder (because of the abducted position) and backache. CONCLUSION: Incorporation of sufficient in vitro training to improve nondominant hand functioning and reduce physical fatigue can make adaptation to laparoscopic surgery easier.

Clinical Competence↗