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PubMed1997

[Experiences with endoscopic surgery in treatment of carpal tunnel syndrome. Preliminary results of a prospective study].

Endoscopic carpal tunnel release is a new technique for treatment of carpal tunnel syndrome. The benefits of this procedure are a small skin wound with less local pain, the fact that the hand can quickly be used again, and earlier return to work or other activities. We present the preliminary results of the 3-month follow-up of 88 patients out of a prospective study of 100 patients. All patients were operated on using the one-port technique. Six additional decompressions had to be abandoned and open release was performed. Of the patients with pain, 73.6% (68/88) were completely pain-free and in 13.2% (9/68) pain improved in more than 50%. Subjective symptoms like paresthesia and numbness of the hand disappeared completely in 77.2% (64/83). Sensory deficits disappeared in 50% (33/66). Ten of 17 patients with preoperative paresis of the abductor pollicis brevis muscle and 11/14 with paresis of the opponens pollicis muscle had normal motor function 3 months after the operation. The complication rate concerning nerve lesions was 2.3%. The return to work time was 21 days (range 3-49 days). According to clinical symptoms, our preliminary results do not seem to have any benefits compared to the conventional open technique, and the costs for the endoscopic procedure are markedly higher. The complication rate after the learning curve period is approximately the same as open carpal tunnel release.

Adult↗

PubMed2003

[Sonography of the hand and wrist].

In the recent years US has gained wide diffusion as a useful imaging tool in the evaluation of musculoskeletal disorders. Recognized advantages of US over the other imaging modalities are low costs, non-invasiveness, possibility to perform a dynamic examination and readiness. Unfortunately, US has a long learning curve and allows good results only when performed by well-trained and experienced examiners. Specifically, utilization of the recent small transducers allows to perform dynamic examination of the hand during flexion-extension movements of the fingers, while their high frequency (till 15 MHz) have increased the possibility to evaluate small anatomic structures of the hand and wrist as well as to detect subtle pathologic changes. The purpose of this article is to present first the normal basic anatomy and US appearance. Then the main pathological conditions including joint and tendon disorders, foreign bodies and other traumatic lesions, entrapment neuropathies and expansible lesions will be presented.

Arthritis, Rheumatoid↗

PubMed2002

[Robot-assisted laparoscopy in urology. Radical prostatectomy and reconstructive retroperitoneal interventions].

Complex reconstructive laparoscopic procedures in the field of urology such as radical prostatectomy and pyeloplasty have attracted increased attention in the past 2 years. However, extensive laparoscopic experience is required to master these procedures. Therefore, it remains questionable whether these techniques, which have been shown to be of profit to the patient in the hands of a specialist, will achieve widespread distribution. We have employed computer technology to bridge the gap between open surgery and laparoscopic access and used the daVinci Surgical System to establish laparoscopic radical prostatectomy as well as pyeloplasty and other retroperitoneal procedures at our institution. With experience of more than 70 procedures, we find that with the assistance of the daVinci Surgical System both radical prostatectomy and retroperiteoneal procedures can be easily translated from open to minimally invasive procedures with a considerably shorter learning curve and without compromising patient safety. We expect that large incisions will be soon a thing of the past in urologic surgery. Computer technology, together with mechanical engineering, will play a major role in enabling us to achieve better results despite minimal invasiveness.

Female↗

PubMed2002

[Results of comprehensive data collection concerning urologic laparoscopy].

To evaluate the current status of laparoscopy, the "Working Group Laparoscopy" of the German Urological Association performed a questionnaire among urologists in Germany. Of 300 questionnaires 183 were returned and analyzed (61%): 54% of the departments already performed laparoscopy and another 50% are planning to introduce this technique. The major concerns are economical (70%), long learning curve (92%), investment (53%), and lack of scientific data (76%). Simple nephrectomy, cryptorchism, and varicoceles are treated by 66, 59, and 58 of the 96 departments laparoscopically (of 183 resp.). Laparoscopic surgery for radical prostatectomy and tumor nephrectomy is done by 32 and 34 of 96 departments. Only a minority of the centers performs more than 40 laparoscopies per year and indication. Compared to a survey conducted in 1995, the acceptance level of this technique has increased (100% vs 48%). Only a minority of the departments performs more than 40 laparoscopic interventions per year for one indication.

Attitude of Health Personnel↗

PubMed2003

[Laparoscopic radical nephrectomy: indications, techniques, and oncological outcome].

Renal cell carcinoma is likely to become one of the most important indications for laparoscopic surgery worldwide. The laparoscopic technique combines the benefits of the minimally invasive approach with established surgical principles. In our institution the laparoscopic transperitoneal approach with intact specimen extraction has become the standard technique for radical nephrectomies. We report the indications, techniques, and oncological outcome in a single center experience in 100 cases. The mean tumor size was 5.9 cm (range: 2-11 cm), the blood loss was 220 ml, and the mean surgical time was 211 min, including the learning curves of five surgeons. Histological findings were pT1 in 66 (66%), pT2 in 11 (11%), and pT3 in 19 (19%) patients with an increasing tumor size according to the experience of the surgeons. In four cases (4%) histology did not prove malignant disease. Positive lymph nodes were detected in three cases (3%) and surgical margins were negative for tumor in all patients. To date 61 patients were available for follow-up; patients with primary metastatic disease were excluded from this analysis. Follow-up was between 1 and 30 months with an average of 12.9 months. Progressive disease occurred in two cases in patients with pT3G3 tumors. No cases of local recurrence or port metastasis occurred during observation. Laparoscopic radical nephrectomy is a routine, effective treatment for patients with renal cell carcinoma. Our follow-up data up to 30 months confirm the effectiveness of laparoscopic radical nephrectomy in terms of surgical principles and oncological outcome.

Adult↗

PubMed2004

[Endoscopic extraperitoneal radical prostatectomy. Results after 300 procedures].

During the last decade laparoscopy has become the standard technique in the urologist's armamentarium due to constant technological advancements and refinements. Laparoscopic radical prostatectomy (LRPE), although technically demanding and associated with a considerable learning curve, has become the operative procedure of choice for patients with clinically localized prostate cancer in selected and specialized urologic centers around the globe. However, a major drawback of LRPE is the transperitoneal route of access to the extraperitoneal organ of the prostate. The principal disadvantages of LRPE are potential intraperitoneal complications. Endoscopic extraperitoneal radical prostatectomy (EERPE) is a further advancement of minimally invasive surgery as it overcomes the limitations of LRPE by the strictly extraperitoneal route of access. Based on our growing experience with this procedure we introduce several technical modifications, improvements, and refinements including a nerve-sparing, potency-preserving approach (nEERPE) in an effort to further improve this minimally invasive procedure. We report our short-term follow-up results after 300 procedures. The mean operative times were 115 min without and 150 min with lymph node dissection, in total 140 min (range: 60-260 min). There was no conversion and the transfusion rate was 1.3%. There were three early reinterventions (two bleeding and one hematoma) and five late reinterventions (four symptomatic lymphoceles and one colostomy due to a rectal fistula). Pathological stage was pT2a in 54 patients (18%), pT2b in 87 patients (29%), pT3a in 115 patients (38.3%), pT3b in 40 patients (13.3%), and pT4 in 4 patients (1.3%). Positive surgical margins were found in 9.2% (13/141) of patients with pT2 tumor and 30.3% (47/155) of patients with pT3 tumor. The mean catheterization time was 6.9 days. Six and twelve months postoperatively 86.3 and 89.6% of the patients were completely continent; 9.2% of patients needed 1-2 pads per day and 4.5 and 1.2% of patients needed more than 2 pads per day, respectively. Short-term oncological and functional results of EERPE are at least as favorable as in LRPE while operative times are shorter and complication rates are low. EERPE is a technical advancement because it combines the advantages of a totally extraperitoneal access with the advantages of a minimally invasive procedure.

Adult↗

PubMed2004

[Transurethral resection of bladder tumours in sodium chloride solution].

BACKGROUND: Electrical transurethral resection is a well established and developed procedure. It is performed using high frequency current in a nonconductive irrigation medium. Due to these features this procedure is compromised by two possible complications: (1) spontaneous contractions of adductors caused by electrical stimulation of the obturator nerve may lead to bladder perforation, and (2) excessive flushing of the irrigation medium into the circulation can cause TUR syndrome. We present our initial experiences with a new system for transurethral resection which has overcome these potential sources of complications. The system, developed by Olympus, works with a modified guided high frequency current in 0.9% saline as irrigant. It is called TURIS (transurethral resection in saline). METHODS: A total of 35 resections of bladder tumors were performed using the TURIS technique. The operations were carried out under intravenous anaesthesia without relaxation or nerve block. During resection high frequency current passes through and active electrode (resection loop) to the sheath electrode. About 90% of the current flows through the saline to the sheath of the resectoscope, only a small amount circulates through the body of the patient. The experiences of the surgeons were documented. The resected specimens were histologically examined for artificial thermal changes and compared with a control group of conventionally resected patients. RESULTS: The handling of the TURIS resectoscope is very similar to that of well known instruments. Therefore, no special training was required for the surgeon or the theatre nurse. The control of the cutting was very efficient. Coagulation of bleeding was very good. The lack of carbonisation at the resection ground led to an excellent assessment of the resected areas. The resected tissue did not stick to the resection loop. Contraction due to nerve stimulation was not observed. No complications occurred. Histology showed no significant differences in the quantity or quality of thermal artifacts due to current. CONCLUSIONS: TURIS can be performed safety without a learning curve. Especially in TUR-B, it seems to be advantageous due to the excellent control of the extent of cutting and the lack of nerve stimulation. Quantity and quality of thermal changes in histology are not different from a conventionally resected control group.

Aged↗

PubMed2004

[Retroperitoneal lymph node dissection in testis cancer].

According to the rules of the European Interdisciplinary Consensus, retroperitoneal lymph node dissection (RPLND) will be indicated less frequently in patients with nonseminomatous testis cancer. In clinical stage I it will be done only exceptionally and in stage II A only in marker-negative patients. In all other stages RPLND will be recommended as residual tumor resection and additionally in "growing teratoma syndrome" and in rare situations as "desperation surgery." It will be difficult in future using the minor operations to enter the learning curve. Only advanced situations will have to be managed by urological surgeons. These operations will have to be performed predominantly in specialised centres.

European Union↗

PubMed1996

[Laparoscopic lymphadenectomy in prostate carcinoma. Experiences with 120 patients].

Laparoscopic pelvic lymph node dissection was performed in 120 patients scheduled to undergo either radical perineal prostatectomy or radiation therapy. On average 13 lymph nodes were resected in each patient, and 21 patients were found to have metastatic disease in 1-9 lymph nodes. After an initial learning curve, mean operative time was reduced significantly, allowing laparoscopic lymph node dissection and radical prostatectomy to be performed as a one-stage procedure. The overall complication rate was 10%; open revisions were necessary in only 2 of 120 patients. Postoperative hospital stay was 2 days in patients undergoing laparoscopic lymph node dissection only. This minimally invasive procedure is particularly beneficial to patients with lymph node metastases not undergoing radical prostatectomy, as well as to patients planned to be treated by radiation therapy. The combination of laparoscopic lymph node dissection and radical perineal prostatectomy avoids an abdominal incision and thus shortens both the hospital stay and the period of convalescence.

Adenocarcinoma↗

PubMed1999

[Improved tumor stent for internal palliative urinary diversion].

The disadvantages of high flexible endoureteral stents (DJ) in case of tumorinduced extrinsic ureteral compression are due to an insufficient vertical stability of the used stents leading to stent-compression and consecutive hydro- or pyonephrosis. The new developed tumor-stent used in case of tumor-induced ureteral compression is available from 6 to 8 French in diameter and 24 to 32 cm in length. The corpus consists of a combination of high-stability plastics but is of sufficient elasticity in length. Both ends consist of extremely elastic J-parts guaranteeing an exact fixation. As against common DJ's with the same outside-diameter the new stent has a comparable interior diameter and compared to used "old" tumor stents promises a higher interior flow in case of extrinsic diseases. The application can be undertaken in well-known technique, needs no special instrumentation and no learning-curve. To date 52 stents at our urologic departments were placed without any problems, the latest remaining for 15 months. Tumor-induced compression or a higher rate of encrustation could not be seen. All patients tolerated these stents well. In our opinion the new stabilized endoureteral stent can be seen as a better solution instead of percutaneous nephrostomy or frequent stent changing in patients with tumor induced extrinsic ureteral compression.

Elasticity↗

PubMed1999

[Radical perineal prostatectomy without lymphadenectomy. Patients with cT1 + 2, G1 +2, PSA < or = 10 ng/ml prostate carcinoma].

Pelvic lymphadenectomy in patients with organ confined prostate cancer (PCa) is of no therapeutic value and is questionable in many patients because of the low incidence of metastases. 49 patients with < or = cT2 b, G1 + 2, PSA < or = 10 ng/ml underwent laparocopic pelvine lymphadenectomy and radical perineal prostatectomy. Only 1 patient (2%) had microscopic metastases which were missed on frozen section. Because of these own results and those reported in the literature we then performed in patients with this constellation the radical perineal prostatectomy without lymphadenectomy (n = 32). The differences present in both groups concerning complication rate and morbidity are due to laparoscopic lymphadenectomy and the learning curve in perineal prostatectomy.

Aged↗

PubMed1999

[Transurethral resection of the prostate with the Holmium contact laser. Progress in treatment of benign prostatic hypertrophy?].

After the initial enthusiasm subsided lasercoagulation of the prostate has been criticized because the extent of tissue destruction cannot be controlled and many patients may be expected to have significant postoperative obstructive as well as irritative voiding symptoms which may last for weeks. Thanks to new laservaporization techniques these disadvantages have been largely eliminated. With the Holmium laser a real resection of prostatic tissue is possible allowing the surgeon to see the prostatectomy defect immediately and to assess tissue destruction during the operation ("what you see is what you get"). The postoperative voiding disturbances are diminished and comparable to those after TUR-P. At the Department of Urology of the University of Berne 116 patients were treated with the Holmium laser for benign prostatic hyperplasia (BPH). During the initial learning period 12 patients required a secondary TUR-P due to persistent obstruction and in 12 patients a combined laser/conventional resection was performed due to underestimated prostate size. 5 patients were lost to follow-up. In the remaining 87 patients the median duration of catheterization was 2 days. 10/87 patients required postoperative treatment for urinary tract infection. There were no significant perioperative decreases in hemoglobin and no cases of TUR syndrome. 66 patients have been followed for 6 months and 30 patients have been followed for 12 months. The maximum urinary flow improved from 7 ml/s preoperatively to 15 ml/s at 6 months and 14 ml/s at 12 months. The volume of residual urine decreased from a median of 120 ml preoperatively to 24 ml at 6 and 12 months. The IPSS decreased from a median of 20 preoperatively to 3 at 6 and 12 months. In 50 patients followed with pressure-flow study pre- and 6 months postoperatively detrusor pressure at maximum flow decreased from 90 cm H2O to 55 cm H2O and linear PURR sank from 2.06 to 0.6. Taking into account the initial learning curve, transurethral Holmium laser resection of the prostate is a promising method of treatment for BPH as shown by the increase in urinary flow and decrease in detrusor pressure. Although it does not yet rank equally with TUR-P, it is a less invasive alternative providing efficient, safe and almost bloodless' treatment of BPH.

Aged↗

PubMed2001

[Laparoscopic radical prostatectomy. Experiences with 145 interventions].

Encouraged by the groups in Paris, we performed 145 laparoscopic radical prostatectomies between June 1999 and the end of November 2000. The indication for laparoscopic prostatectomy is the same as for open surgery: an organ-confined cancer. Previous abdominal surgery, transurethral resection, and/or relative adiposity are not considered to be contraindications for this laparoscopic procedure. The mean operating time was 255 min; the last 60 procedures took an average of 200 min. In no case was it necessary to convert to open surgery. Worthy of note was the low blood loss of 185 ml on average so that in 98% of the patients no blood transfusion was required. After completing the learning curve, the average indwelling catheter time was only 5.5 days. The postoperative complication rate was 11.7%, consisting mainly of minor complications. Also with regard to continence and potency, the results were representative. Postoperatively, 75%, 86%, 92%, and 93% of the patients were continent after 3, 6, 9, and 12 months, respectively. In our opinion, laparoscopic radical prostatectomy is an alternative to open prostatectomy, offering a number of advantages for the patient and surgeon as well.

Aged↗

PubMed2006

[The MIS anterolateral approach for THA].

The MIS anterolateral approach for hip replacement surgery uses the intermuscular plane between gluteus medius and tensor fascia latae. The patient is placed in the lateral position. Retractors with soft tissue friendly profile and an operating table with modified leg support are recommended. The technique provides very good exposure of the acetabulum and femur and preserves muscle integrity so that rehabilitation can be rapid. Currently the experience comprises over 1000 primary cases performed using the MIS anterolateral approach since March 2003. The clinical results including pain, blood loss, range of motion, functional score, Harris Hip Score, and radiographic studies are based on the complete examinations of 48 consecutive patients. There are significant differences with improved clinical results compared with patients after standard approaches. After a fundamental learning curve there is no evidence of increased complications. The anterolateral approach is a standard approach suitable for wide application. The experience includes difficult primary cases like dysplasia, rheumatic disease, and ankylosis and even for revision surgery the technique can be routinely used. Restrictions are not known either in patients' characteristics or in indications.

Adult↗

PubMed2006

[Minimally invasive approach to implantation of a hip endoprosthesis].

Early experiences with the two-incision approach at the hip joint are reported. We started in July 2002 and until now 272 procedures have been performed. Blood loss (292 ml) and the need for rehabilitation are reduced, the patients will achieve a Harris Hip Score of more than 90 points within 6 or 8 weeks. Complications related to the approach primarily include irritation of the lateral femoral cutaneous nerve. During the learning curve when the initial shaft model was used, shaft fractures or fissures occurred in 4% of the cases. This complication was no longer observed with the ML Taper shaft model now employed (n=102). The development and establishment of minimally invasive approaches constitute a valuable and seminal option for implantation of hip endoprostheses. In the medium term, the time spent in rehabilitation could conceivably be reduced. Conventional approaches still represent the gold standard.

Adult↗

PubMed2002

Single-dilator percutaneous tracheostomy: a comparison of PercuTwist and Ciaglia Blue Rhino techniques.

OBJECTIVE: To compare two single-dilator percutaneous tracheostomy techniques, Ciaglia Blue Rhino and the new PercuTwist technique. DESIGN AND SETTING: Randomized, observational clinical trial in patients undergoing elective percutaneous tracheostomy in the intensive care units of a university hospital. PATIENTS: Seventy consecutive, adult patients undergoing either Blue Rhino ( n=35) or PercuTwist tracheostomy ( n=35). INTERVENTIONS: Performance of percutaneous tracheostomy with a novel screwlike dilating device (PercuTwist) or conically shaped, flexible rubber dilator (Blue Rhino). RESULTS: Stoma dilation was successful with the respective device in all patients. While subsequent tracheostomy cannula insertion was uneventful in all but one patients undergoing the Blue Rhino technique, it was difficult or even impossible in eight patients who underwent PercuTwist tracheostomy. Regarding serious and intermediate procedural-related complications, two cases of posterior tracheal wall injury occurred with the PercuTwist technique. No serious or intermediate complications were noted during Blue Rhino tracheostomy. There was no statistical significance between the two techniques in terms of minor and overall complications. CONCLUSIONS: So far the new PercuTwist technique represents an alternative to the established Blue Rhino technique. Nonetheless, the two cases of posterior tracheal wall injury should not be underestimated, on the one hand, but, on the other, may be attributed to a learning curve with a new technique. The new PercuTwist technique should be performed by various teams and in a considerably larger numbers of patients before an ultimate rating can be made.

Aged↗

PubMed2002

Handport-assisted laparoscopic living-donor nephrectomy; initial experience in Taiwan.

The feasibility of handport-assisted laparoscopic living-donor nephrectomy in Taiwan was assessed by comparison with conventional open nephrectomy. Six serial patients undergoing laparoscopic living-donor nephrectomy (LLDN) were compared with six patients undergoing open donor nephrectomy. Body-mass index (BMI), operating time, hospital stay, and short-term graft function were assessed in both groups of patients. Handport-assisted LLDN was successfully attempted in all six patients. Mean ischemic time was 4.5 min in the laparoscopic group. There was no major complication in either group. Short-term graft function was good in all patients, except for one case of chronic rejection with mild azotemia in the open group. The length of stay was significantly longer in the open group, but the operation time of the laparoscopic group was much longer than that of the open group. There was no difference in the resumption of diet and in the use of narcotic analgesics in addition to patient-controlled analgesia. LLDN is a technically demanding approach. With handport assistance, the surgeons could shorten their learning curve. While initial graft function rates are equal to those of the open method, cosmesis and hospital stay are improved by the laparoscopic approach. Longer follow-up and larger patient numbers are needed to confirm these initial results in Taiwan.

Adult↗

PubMed2003

Percutaneous Achilles tendon repair with and without endoscopic control.

One hundred and fifty six patients were treated using the modified double suture technique for percutaneous Achilles tendon repair between 1994 and 1998. Endoscopy was used in 67 cases. The first ten cases were dropped (learning curve), 57 were followed (E-group). Percutaneous suture without endoscopy was performed in 89 patients. Two could not be followed (went abroad), so this group consists of 87 patients (P-group). Mean age: E-group 37.8 (22-60) years, P-group 38.9 (20-68) years. Male-female ratio: E 49/8, P 74/13. There were 54 and 83 athletes in groups E and P respectively. Follow-up period was 12-60 months. Overall re-rupture rate was 6/144 (4.2%). Two total and 3 partial re-ruptures were in the P-group, and 1 partial was in the E-group. Fusiform thickening of the tendon (delayed healing) occurred in 4 cases in each group. The mean plantar flexion strength compared with the non-affected side was 89% in the P-group and 86% in the E-group. The length of time before returning to sports activity ranged from 4 to 6 months after surgery in both groups. Subjective results were excellent to good in 88% (P-group) and in 89% (E-group) of the cases. On the basis of the results, the percutaneous double suture technique proved to be a simple and safe method for Achilles tendon repair with or without the use of an endoscope. The re-rupture rate was lower in the endoscopic controlled group. The basic goal of the endoscopy was to control the adaptation of the tendon ends. This method yielded further operative possibilities and benefits as well.

Achilles Tendon↗