117 research outputs found
Open versus laparoscopic radical prostatectomy
No full textRadical prostatectomy (RP) is a curative treatment for localized prostate cancer that involves removing the prostate and seminal vesicles. The primary goals of RP include ensuring oncologic control and maintaining the preoperative status of continence and potency. This report focuses on the outcomes and the keys to success for both open retropubic and laparoscopic RP. Both surgical volume and the surgeon are directly related to postoperative erectile function in men. The preoperative status of the patients is also of importance because it significantly affects postoperative functional outcomes. Surgical steps, which are keys to success following the open procedure, include incision of the endopelvic fascia, control of the Santorini plexus, and nerve-sparing procedures. Similarly, the key surgical steps of laparoscopic prostatectomy are described and a comparison between the transperitoneal and extraperitoneal route is made. Oncologic and functional outcomes observed following the two-procedures are discussed. This report then briefly introduces the robotic surgical system and summarizes the related panel discussion. In conclusion, the difference between one surgeon's performance and that of another seems to count for more than any difference between procedures. Whilst postoperative functional outcomes are hard to evaluate, they seem to be comparable following the two different approaches. (c) 2006 Published by Elsevier B.V
Laparoscopic partial adrenalectomy for bilateral pheochromocytomas in a boy with von Hippel-Lindau disease
No full textObjectives: In adults, increasing numbers of adrenalectomies for pheochromocytomas are performed laparoscopically. We report for the first time laparoscopic bilateral subtotal adrenalectomy for pheochromocytomas in an 8-year-old boy with von Hippel-Lindau disease. Methods, In July 1998, an 8-year-old boy with von Hippel-Lindau disease underwent laparoscopic adrenal-sparing surgery for bilateral pheochromocytomas. The boy presented with severe hypertension and two pheochromocytomas on both sides. Results: The child could be solely treated with laparoscopic adrenal-sparing surgery. The procedure was completed as planned. There were absolutely no intraoperative or postoperative complications. Postoperatively, catecholamine levels and hypertension went back to normal. At follow-up no residual tumor could be detected and no steroid replacement therapy was necessary. Conclusions: In experienced hands, laparoscopic adrenal-sparing surgery for pheochromocytomas is feasible and safe. Moreover, this minimal invasive approach represents an exceptional improvement in life quality, especially in children with von Hippel-Lindau disease since surgery will probably be necessary again and again in their future life. Copyright (C) 2000 S. Karger AG, Basel
Indocyanine greenfluorescence-guidedsentinel lymph node identification in urologic cancers: A systematic review and meta-analysis
No full textINTRODUCTION: To date, bilateral pelvic lymph node dissection (PLND) represents the most accurate and reliable staging procedure for the detection of lymph node invasion in prostate cancer and bladder cancer. However, the procedure is not devoid of complications. In this field, Indocyanine green fluorescence-guided sentinel lymph node (SLN) identification is an emerging and promising technique, as accurate staging of urologic cancer could be enhanced by a thorough evaluation of the sentinel lymph nodes. Aim of the present review is to analyze available evidence and perform a metanalysis on ICG-guided SLN detection for urologic malignancies.EVIDENCE ACQUISITION: A systematic review to assess the clinical value of Indocyanine green for the identification of sentinel lymphatic drainage for bladder, prostate, kidney and penile cancers was undertaken, with a meta-analysis to generate pooled detection rate concerning patients (clinical sensitivity) and nodes basin (technical sensitivity) separately. Studies reporting on the use of Indocyanine green for the detection of SLNs from the bladder, prostate and penile cancers were included.EVIDENCE SYNTHESIS: A total of 10 clinical trials were included. Using the fixed effects model and the random effects model, the pooled patient detection rates and their 95% confidence intervals (95% CI) were 0.88 (0.82-0.92) and 0.92 (0.84-0.96), respectively. The pooled nodes detection rates were 0.71 (95% CI: 0.68-0.74) using the fixed effect model and 0.75 (95% CI: 0.56-0.87) using the random effect model. Significant heterogeneities existed among studies for patients and for nodes (I-2=0.66, P<0.001 and I-2=0.96, P<0.001, respectively). Significant publication bias was found in patient detection rate (P<0.001) and in nodes detection rate (P<0.001).CONCLUSIONS: SLN mapping in bladder and prostate cancer is a method with a high detection rate, although its specificity to predict LN invasion remains poor. Large, well-constructed trails are needed to assess the impact of ICG-fluorescence guided SLN dissection on uro-oncologic surgery
Re: Five Year Biochemical Recurrence Free Survival for Intermediate Risk Prostate Cancer After Radical Prostatectomy, External Beam Radiation Therapy or Permanent Seed Implantation
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