Laparoscopic Urologic Surgery Research Articles

A systematic review and meta-analysis compared the safety and effectiveness of the AirSeal system with traditional pneumoperitoneum systems in robot-assisted laparoscopic urologic surgery.

This study aimed to analyze perioperative results in robot-assisted laparoscopic urological surgeries, comparing the AirSeal system with traditional pneumoperitoneum systems. This study adhered to the PRISMA guidelines for conducting systematic reviews and meta-analyses. Extensive searches were conducted in PubMed, EMBASE, and Google Scholar, including randomized controlled trials (RCTs) and cohort studies up to June 15, 2024. A combined examination of the studies found that the AirSeal system had superior results in terms of surgery duration, end-tidal carbon dioxide levels, and tidal volume compared to the traditional pneumoperitoneum system. During robotic-assisted partial nephrectomy, the AirSeal team experienced a notable decrease in surgical time, ETCO2, and VT. In addition, the occurrence of SCE was lower in the AirSeal group. However, there were no significant differences observed between the groups regarding EBL, LOHS, overall complications, and major complications. Compared to conventional pneumoperitoneum systems, the AirSeal system offers several advantages in robot-assisted laparoscopic urological surgery: reduced operative time, lower end-tidal CO2 pressure, and decreased tidal volume. Furthermore, implementing the AirSeal system does not lead to higher rates of complications, estimated blood loss, or lengthier hospital stays.

Association between postoperative shoulder pain and left-side laparoscopic urologic surgery: a single-center retrospective cohort study.

Postoperative shoulder pain is a common problem after laparoscopic surgery. This study aimed to investigate the association between operative side and postoperative shoulder pain following urologic laparoscopic surgery performed in the lateral recumbent position. This was a retrospective cohort study conducted at a single tertiary care center. A total of 506 patients who underwent urologic laparoscopic surgery (including adrenalectomy, radical nephrectomy, partial nephrectomy, and pyeloplasty) between January 2010 and December 2019 were included. Patients who underwent total nephroureterectomy or resection of other organs were excluded. The primary outcome was the incidence of postoperative shoulder pain. A multivariable logistic regression analysis investigated the association between the operative side and postoperative shoulder pain. Among the 506 included patients, there were an equal number of surgeries on the left and right sides. Eighty-eight patients had postoperative shoulder pain. The incidence of postoperative shoulder pain in the left-side group was significantly higher than that in the right-side group (21.3% [54/253] versus 13.4% [34/253], crude odds ratio = 1.75, 95% confidence interval [CI] 1.07-2.89). After adjustment for potential confounders (age, sex, body mass index, operation duration, operative technique, epidural block, peripheral nerve block, American Society of Anesthesiologists physical status classification, and intraoperative rocuronium dose), the left operative side was found to be associated with postoperative shoulder pain (adjusted odds ratio = 1.89, 95% CI 1.15-3.09). The left operative side is associated with an increased incidence of postoperative shoulder pain after urologic laparoscopic surgery performed in the lateral recumbent position.

Our initial experiences with laparoscopic urologic surgery in a peripheral hospital in Central Java, Indonesia

Introduction: Nowadays, laparoscopic surgery in urology is widely adopted as a surgical technique for almost all cases, rendering the traditional open surgery approach obsolete. The increased use of laparoscopic surgical procedures has significantly contributed to progress in many urology areas. This study evaluates the initial experience with laparoscopic urology surgery in Banyumas General Hospital, a peripheral hospital in Indonesia. Method: Between May 2023 and October 2023, laparoscopic urologic surgery was performed on 36 patients. The patient’s demographic characteristics, pre-operative diagnosis, type of laparoscopic approach, and intraoperative and post-treatment results were gathered and analyzed retrospectively. Result: The mean patient age is 58.69±13.52 years, with 12 (33.33%) female patients and 24 (66.67%) male patients. While 20 had ureterolithotomy, 3 had pyelolithotomy, 5 had radical cystectomy, 2 patients received unroofing renal cyst, 1 had pyeloplasty, 1 had ureteral Anastomosis, and 1 had radical nephroureterectomy, 1 had a simple nephrectomy, 1 had diverticulectomy, and 1 had orchidopexy. 2 (5,56%) of the 36 patients must be converted to open surgery. The mean duration of surgery for procedures we did was as follows: ureterolithotomy 86.25 ± 7.23 minutes, pyelolithotomy 96.67 ± 7.64, radical cystectomy 418± 64.09 min, unroofing renal cyst 57.5 ± 10.61 minutes, pyeloplasty 130 minutes, ureteral anastomosis 220 minutes, radical nephroureterectomy 210 minutes, simple nephrectomy 140 minutes, diverticulectomy 215 minutes, and orchidopexy 125 minutes. The mean hospital stay was 4.39 ± 2.28 (2-11) days. There are major complications, but no mortality was encountered. Conclusion: Laparoscopic surgery is an effective technique with excellent outcomes, a safe and feasible alternative to open surgery in urology.

Characteristics of robotic urological surgeries at Hospital Eugenio Espejo (November 2021 to March 2023)

Introduction: Minimally invasive urologic surgery employs extracorporeal, endoscopic and laparoscopic techniques. Robotic assistance has significantly modified urologic laparoscopic surgery in the last decade. This technology is available at the Hospital de Especialidades Eugenio Espejo (HEEE) in the city of Quito - Ecuador, since November 2021, being one of the few public hospitals in Latin America that provides this service to the community. Methods: Observational, retrospective and descriptive study, with case series design. All patients undergoing robotic surgery in the Urology Department of the HEE between November 2021 and March 2023 were included. Results: In the 28 months of the study, 98 surgical procedures were performed. Of the 91 adult patients, 67% were men. The main preoperative diagnoses were malignant prostate tumor, malignant kidney tumor, hydronephrosis, adrenal tumor, malignant bladder tumor and lithiasis. The procedures performed were radical prostatectomy, nephrectomy, ureterolysis and adrenalectomy. The mean operative time was 169.2±3 min; with a Dokin time of 12.7±5.2 min. There were 1.1% of non-fatal complications. The median hospital stay was 4 days (range 2 to 18 days). In the 7 younger patients with a mean age of 8.3 years operated on, the most common procedure was ureteral reimplantation. There were two cases of non-fatal complications. Surgical time was 255.7±29.2 min and Dokin time was 9.5±5.3 min. Conclusion: In the Hospital de Especialidades Eugenio Espejo, urological robotic surgery has been used mainly for the surgical treatment of neoplasias in adults and urinary tract alterations in children, being the experience for other procedures still incipient. Surgical times have been longer in children due to the complexity of reconstructive surgeries, but with excellent results and early recovery.

Novel Robotic Platforms for Robot-Assisted Laparoscopic Surgery in Urology: A Narrative Review.

Robot-assisted surgery (RAS) has been integrated into clinical practice to overcome several limitations of conventional open or laparoscopic surgery. After the expiration of the long key patent period of Intuitive Surgical, various robotic systems (RSs) have been developed aiming at improving certain characteristics of the first robotic platform, the Da Vinci RS. This narrative review provides an overview of the current RSs used in urology along with the initial results from their application in urologic procedures. Nine robotic platforms are being analyzed regarding their unique characteristics as well as their efficacy, safety, feasibility, and outcomes in urologic, oncological, or non-oncological operations. The main barrier to the wide application of RAS has been the increased cost that refers to both acquisition and maintenance costs. Besides, the health inequality resulting from the lack of expert robotic surgeons and the difficulty of performing robot-assisted procedures in provincial hospitals should be overcome. However, large properly designed comparative studies are required to establish the role of newly introduced RSs. In addition, urologists should keep abreast of new developments and research in robot-assisted urologic procedures.

Assessment of the Quality of YouTube Educational Videos on Laparoscopic Right Adrenalectomy and Laparoscopic Partial Nephrectomy Surgeries.

Introduction: Despite the considerable studies conducted on the quality of YouTube surgical videos as an educational resource in other surgical fields, there have been no such studies in the field of laparoscopic urology so far. Considering the great sensitivity in these procedures and the necessity of identifying the mistakes in these videos, we aimed to evaluate the quality of YouTube educational videos on laparoscopic right adrenalectomy and laparoscopic partial nephrectomy surgeries. Materials and Methods: In this descriptive cross-sectional study, 131 YouTube educational videos on laparoscopic right adrenalectomy and laparoscopic partial nephrectomy surgeries were reviewed. Two researchers familiar with laparoscopic urological surgery reviewed the videos based on the LAP-VEGaS checklist. A third professor reviewed the videos on which there were disagreements. Results: In the majority of the videos, the title was chosen accordingly and the surgeon was introduced appropriately. Furthermore, in most of the videos, patient anonymity was respected. The mean score of the videos was equal to 74.3 ± 5.4, the maximum score being 17 and the minimum 1. The average score of the partial nephrectomy videos was obtained as 98.3 ± 5.74, whereas the average score for adrenalectomy videos was 47.3 ± 4.5. The overall average score of the studied videos was 74.3 ± 5.40. Conclusion: The results of our study suggest that most of YouTube videos on laparoscopic right adrenalectomy and laparoscopic partial nephrectomy surgeries are used for educational purpose. These YouTube videos are suboptimal in educational aspect and students should be advised to use them with caution.

Comment on: "A Historical Perspective of the Evolution of Laparoscopic Surgeries in Urology" by Soputro et al.

Dear Editor: I would like to congratulate Dr. Soputro and collaborators for their fine article entitled "A Historical Perspective of the Evolution of Laparoscopic Surgeries" in the Journal of Endourology; Volume 36, Number 10, October 20221 and, in particular, thank them for mentioning us as authors of the first laparoscopic radical cystectomy, performed in 1993. However, it is notable that they fail to cite the first laparoscopic operative procedure in urology, i.e., the laparoscopic varicocelectomy published in 1988 and later in 1990 in the Journal of Endourology.2,3 Especially considering that this soon became the procedure of choice in adolescents4 and for years was the most performed laparoscopic surgery in urology, along with lymphadenectomy, followed by nephrectomy, because, among other things, at that time these were the only techniques in use5 (Fig. 1). In fact, we presented the technique for the first time at a congress in 1986, but we received so much criticism that we were discouraged and did not publish it until 1988. We were told that it had the serious drawback of breaking the peritoneal barrier with the serious risk that this entailed, and that we had in fact been able to convert something easy into something very complicated. Nevertheless, this technique demonstrated that urological surgery, as conceived at the time, could be done in a very different way.

Effect of the new video laryngeal mask airway SaCoVLM on airway management in lateral laparoscopic urological surgery: A single center randomized controlled trial

There are few pertinent studies about the application of laryngeal mask airways (LMAs) in lateral decubitus surgery. Therefore, the aim of our study was to evaluate the effects of lateral position and pneumoperitoneum on oropharyngeal leak pressure (OLP) and ventilation efficiency for the LMA SaCoVLM. Patients undergoing elective retroperitoneal laparoscopic urological surgery were randomized 1:1 to the Supreme group or SaCoVLM group. The primary outcome was the OLP with LMA insertion. The secondary outcomes were the first-attempt success rate, insertion time, adjustment times, gastric tube success rate, LMA alignment accuracy, LMA removal time, regurgitation or aspiration, LMA blood staining, and incidence of adverse events 24 h after surgery. We recruited 70 patients to complete the study. Regardless of lateral position and pneumoperitoneum, the OLP was greater in the SaCoVLM group (n = 35) than in the Supreme group (n = 35), with a median difference of 4–7 cmH2O. The first-attempt success rate of the SaCoVLM group was higher than that of the Supreme group (91.4% vs. 77.1%, risk ratio (RR): 1.19; 95% CI 0.96 to 1.46, P = 0.188). Thus, in the lateral position with pneumoperitoneum, although the new video LMA SaCoVLM has a higher OLP than the LMA Supreme, both devices provide sufficient ventilation efficiency.

Robotic-assisted laparoscopic surgeries in functional and reconstructive urology

The adoption of robotic-assisted laparoscopic surgery in urology is becoming increasingly frequent. Initially, its use was essentially limited to oncological surgery, such as radical prostatectomy. Its success lies in the enhanced dexterity, the three-dimensional vision, and the ability to easily suture intracorporeally. All these advantages have enabled many pioneer surgeons to develop techniques in the field of functional surgery, such as artificial urinary sphincter implantation and sacrocolpopexy, and as for reconstructive surgery, ureteral reconstructions and enterocystoplasties. This article provides a brief yet rich review of the recently innovated techniques and the now minimally invasive feasibility of previously highly complex procedures in conventional laparoscopy.

Index of consciousness monitoring during general anesthesia may effectively enhance rehabilitation in elderly patients undergoing laparoscopic urological surgery: a randomized controlled clinical trial

BackgroundBased on electroencephalogram (EEG) analysis, index of consciousness (IoC) monitoring is a new technique for monitoring anesthesia depth. IoC is divided into IoC1 (depth of sedation) and IoC2 (depth of analgesia). The potential for concurrent monitoring of IoC1 and IoC2 to expedite postoperative convalescence remains to be elucidated. We investigated whether combined monitoring of IoC1 and IoC2 can effectively enhances postoperative recovery compared with bispectral index (BIS) in elderly patients undergoing laparoscopic urological surgery under general anesthesia.MethodsIn this prospective, controlled, double-blinded trail, 120 patients aged 65 years or older were arbitrarily assigned to either the IoC group or the control group (BIS monitoring). All patients underwent blood gas analysis at T1 (before anesthesia induction) and T2 (the end of operation). The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered to all patients at T0 (1 day before surgery) and T4 (7 days after surgery). Serum concentrations of C-reactive protein (CRP) and glial fibrillary acid protein (GFAP) were assessed at T1, T2, and T3 (24 h after surgery). Postoperative complications and the duration of hospitalization were subjected to comparative evaluation.ResultsThe incidence of postoperative cognitive dysfunction (POCD) was notably lower in the IoC group (10%) than in the control group (31.7%) (P = 0.003). Postoperative serum CRP and GFAP concentrations exhibited significant differences at time points T2 (CRP: P = 0.000; GFAP: P = 0.000) and T3 (CRP: P = 0.003; GFAP: P = 0.008). Postoperative blood glucose levels (P = 0.000) and the overall rate of complications (P = 0.037) were significantly lower in Group IoC than in Group control.ConclusionThe employment of IoC monitoring for the management of elderly surgical patients can accelerate postoperative convalescence by mitigating intraoperative stress and reducing peripheral and central inflammatory injury.Trial registrationChinese Clinical Trial Registry Identifier: ChiCTR1900025241 (17/08/2019).

Perioperative Renal Ultrasonography of Arterio-to-Venous Coupling Predicts Postoperative Complications after Major Laparoscopic Urologic Surgery.

Point-of-care ultrasonography (POCUS) with concomitant venous and arterial Doppler assessment enables clinicians to assess organ-specific blood supply. To date, no studies have investigated the usefulness of including a comprehensive perioperative POCUS assessment of patients undergoing major laparoscopic surgery. The primary aim of the present study was to evaluate whether the combined venous and arterial renal flow evaluation, measured at different time points of perioperative period, may represent a clinically useful non-invasive method to predict postoperative acute kidney injury (AKI) after major laparoscopic urologic surgery. The secondary outcome was represented by the development of any postoperative complication at day 7. We included 173 patients, subsequently divided for analysis depending on whether they did (n = 55) or did not (n = 118) develop postoperative AKI or any complications within the first 7 days. The main results of the present study were that: (1) the combination of arterial hypoperfusion and moderate-to-severe venous congestion inferred by POCUS were associated with worst outcomes (respectively, HR: 2.993, 95% CI: 1.522-5.884 and HR: 8.124, 95% CI: 3.542-18, p < 0.001); (2) high intra-operative abdominal pressure represents the only independent determinant of postoperative severe venous congestion (OR: 1.354, 95% CI: 1.017-1.804, p = 0.038); (3) the overall number of complications relies on the balance between arterial inflow and venous outflow in order to ensure the adequacy of peripheral perfusion; and (4) the overall reliability of splanchnic perfusion assessment by Doppler is high with a strong inter-rater reliability (ICC: 0.844, 95% CI: 0.792-0.844). The concomitant assessment of arterial and venous Doppler patterns predicts postoperative complications after major laparoscopic urologic surgery and may be considered a useful ultrasonographic biomarker to stratify vulnerable patients at risk for development of postoperative complications.

Fragility of statistically significant findings from randomized trials in comparing laparoscopic versus robotic abdominopelvic surgeries.

Utility of robotic over laparoscopic approach has been an area of debate across all surgical specialties over the past decade. The fragility index (FI) is a metric that evaluates the frailty of randomized controlled trials (RCTs) findings by altering the status of patients from an event to non-event until significance is lost. This study aims to evaluate the robustness of RCTs comparing laparoscopic and robotic abdominopelvic surgeries through the FI. A search was conducted in MEDLINE and EMBASE for RCTs with dichotomous outcomes comparing laparoscopic and robot-assisted surgery in general surgery, gynecology, and urology. The FI and reverse fragility Index (RFI) metrics were used to assess the strength of findings reported by RCTs, and bivariate correlation was conducted to analyze relationships between FI and trial characteristics. A total of 21 RCTs were included, with a median sample size of 89 participants (Interquartile range [IQR] 62-126). The median FI was 2 (IQR 0-15) and median RFI 5.5 (IQR 4-8.5). The median FI was 3 (IQR 1-15) for general surgery (n = 7), 2 (0.5-3.5) for gynecology (n = 4), and 0 (IQR 0-8.5) for urology RCTs (n = 4). Correlation was found between increasing FI and decreasing p-value, but not sample size, number of outcome events, journal impact factor, loss to follow-up, or risk of bias. RCTs comparing laparoscopic and robotic abdominal surgery did not prove to be very robust. While possible advantages of robotic surgery may be emphasized, it remains novel and requires further concrete RCT data.

Electric impedance tomography and protective mechanical ventilation in elective robotic-assisted laparoscopy surgery with steep Trendelenburg position: a randomized controlled study

Electrical impedance tomography (EIT) reconstructs functional lung images and evaluates the variations of impedance during the breathing cycle. The aim of this study was to evaluate the effect of protective mechanical ventilation on ventilation distributions recorded by the EIT during elective robotic-assisted laparoscopy surgery with steep Trendelenburg position. This prospective, randomized single center study included patients with healthy lungs undergoing elective robot-assisted laparoscopic urological surgery in general anesthesia. Patients were randomly assigned to either protective lung ventilation or conventional ventilation. In the protective ventilation group, tidal volume (TV) was set at 6 ml/Kg predicted body weight (PBW), with PEEP 6 cmH2O, and recruitment maneuvers (RM) as needed. In the conventional ventilation group, TV was set at 9 ml/Kg PBW, with PEEP 2 cmH2O and RM only as needed. Ventilation distribution was assessed using an EIT device. This study included 40 patients in the functional image analysis. Significant differences were found in ventilation distribution in the region of interest (p < 0.05). Driving pressure was significantly lower in protective ventilation group (p < 0.05). Peak and plateau pressures were not different between the groups while statical significance was found in tidal volume and respiratory rate. EIT may be a valuable tool for monitoring lung function during general anesthesia. During elective robotic-assisted laparoscopy surgery with steep Trendelenburg position, protective mechanical ventilation may have a more homogenous distribution of intraoperative and postoperative ventilation. Larger sample size and long-term evaluation are needed in future studies to assess the benefit of EIT monitoring in operation room.Clinical trial registration ClinicalTrials.gov Identifier: NCT04194177 registered at 11th December 2019.

Low Intra-Abdominal Pressure with Complete Neuromuscular Blockage Reduces Post-Operative Complications in Major Laparoscopic Urologic Surgery: A before-after Study.

Most urological interventions are now performed with minimally invasive surgery techniques such as laparoscopic surgery. Combining ERAS protocols with minimally invasive surgery techniques may be the best option to reduce hospital length-of-stay and post-operative complications. We designed this study to test the hypothesis that using low intra-abdominal pressures (IAP) during laparoscopy may reduce post-operative complications, especially those related to reduced intra-operative splanchnic perfusion or increased splanchnic congestion. We applied a complete neuromuscular blockade (NMB) to maintain an optimal space and surgical view. We compared 115 patients treated with standard IAP and moderate NMB with 148 patients treated with low IAP and complete NMB undergoing major urologic surgery. Low IAP in combination with complete NMB was associated with fewer total post-operative complications than standard IAP with moderate NMB (22.3% vs. 41.2%, p < 0.001), with a reduction in all medical post-operative complications (17 vs. 34, p < 0.001). The post-operative complications mostly reduced were acute kidney injury (15.5% vs. 30.4%, p = 0.004), anemia (6.8% vs. 16.5%, p = 0.049) and reoperation (2% vs. 7.8%, p = 0.035). The intra-operative management of laparoscopic interventions for major urologic surgeries with low IAP and complete NMB is feasible without hindering surgical conditions and might reduce most medical post-operative complications.

Dynamic Indices for the Prediction of Fluid Responsiveness in Laparoscopic Urologic Surgery under General Anaesthesia: An Interventional Study

Objective: This study aims to evaluate the ability of stroke volume variation (SVV), pulse pressure variation (PPV), and change in PVV and SVV after tidal volume challenge testing (ΔPPV and ΔSVV) aiming to predict fluid responsiveness in patients undergoing laparoscopic urologic surgery. Material and Methods: A prospective interventional study was performed with 23 patients undergoing urologic surgery while they were placed in Trendelenburg positions. A Vigileo/FloTrac system was used for the analysis. Hemodynamic data such as: arterial pressure (MAP), heart rate (HR), peak airway pressure (PIP), stroke volume (SV), cardiac output (CO), SVV, and PPV were recorded at the tidal volume settings of 8 mL/kg and 12 mL/kg before, and after a fluid challenge (FC). Fluid responsiveness was defined as an increase in SV(ΔSV) ≥15.0%. Results: After tidal volume challenge tests, there were significant increases in PIP in both groups. PPV increased only in the responders, as opposed to SVV, which increased significantly only in non-responders after tidal volume challenge test. After fluid challenge, PVV and SVV decreased gradually and significantly in both groups. The area under the ROC curves of patients undergoing laparoscopic urologic surgery was 0.872 (95% CI: 0.57-0.96) for ΔPPV, this change was the highest compared to other parameters. The threshold of the ΔPPV of patients undergoing laparoscopic urologic surgery was 4% with a sensitivity at 0.75 and specificity at 0.93. Conclusion: Change in PPV after the tidal volume challenge test from 8 mL/kg to 12 mL/kg can be used as an effective indicator to monitor fluid responsiveness in regards to patients undergoing urologic surgery.

BUBBLING OVER: A CASE OF SUBCONJUNCTIVAL EMPHYSEMA AND PNEUMOMEDIASTINUM FOLLOWING LAPAROSCOPIC PROSTATECTOMY

BUBBLING OVER: A CASE OF SUBCONJUNCTIVAL EMPHYSEMA AND PNEUMOMEDIASTINUM FOLLOWING LAPAROSCOPIC PROSTATECTOMY

Effects of intravenous clonidine on hemodynamics and plasma cortisol level during laparoscopic urological surgeries in a tertiary care hospital

Background: Laparoscopic urologic surgeries causes rise in Blood pressure and heart rate. Maintenance of hemodynamics is an essential part of anaesthetic management. Aims and Objectives: The aim of the study was to observe the effects of intravenous clonidine on heart rate (HR) and mean arterial pressure (MAP) and plasma cortisol level during laparoscopic surgeries. Materials and Methods: In this ethical committee approved double-blind prospective interventional study, 50 adult patients of both sexes with ASA I and II were randomly allocated to two groups: Group C (3 mcg/kg Clonidine in 20 ml of Normal saline) and Group P (20 ml Normal saline). HR and MAP were recorded at different time intervals and blood samples were drawn before induction and after reversal from general anesthesia. Results: In Group P there was a significant increase in variables during intubation, pneumoperitoneum and release of gas from the abdomen (P&lt;0.001). In Group C mean plasma cortisol level increased from 19.36±1.49 (before induction) to 28.60±1.21 (after reversal) and in Group P from 19.33±1.30 to 32.28±1.66. Conclusion: Clonidine may be a suitable and safe medication to attenuate hemodynamic stress response during laparoscopic surgeries.

A Historical Perspective of the Evolution of Laparoscopic Surgeries in Urology.

Recent decades have seen the rapid progression of minimally invasive surgery in urology with continuing developments in robotic technology paving ways into a new era. In addition to these technological innovations, interests from urologists in developing and embracing new techniques have become a forefront in the ongoing evolution of the field allowing for improvement in intraoperative experience as well as morbidity and mortality outcomes. This article aims to provide an overview of the historical development of laparoscopic surgery in urology while also providing a brief look into its future.

Dexmedetomidine in the Program of Multimodal Low-opioid Anesthesia During Laparoscopic Surgery in Urology

Dexmedetomidine, a highly selective α2-adrenergic agonist, has become a valuable component of low-opioid multimodal anesthesia, providing sedative, anxiolytic and analgesic effects. The objective: to evaluate the effectiveness of using dexmedetomidine in a multimodal low opioid anesthesia program for laparoscopic renal surgery. Materials and methods. 55 patients who underwent laparoscopic renal surgery under two types of general anesthesia were included. All patients underwent surgery under general anesthesia with tracheal intubation. Induction: intravenous propofol 2 mg/kg, fentanyl 1.5–2 μg/kg, atracurium 0.6 mg/kg. Anesthesia maintenance: sevoflurane (MAC – 1.44±0.25 vol.%). In group 1 analgesia was provided with fentanyl 3.89±2.1 μg/kg/h. Multimodal low-opioid anesthesia with fentanyl 2.38±1.01 μg/kg/h combined with dexmedetomidine 0.7 μg/kg/h was used in group 2. The efficacy of antinociceptive protection was assessed by the dynamics of changes in the levels of stress hormones, hemodynamic parameters, and blood glucose concentrations. Results. The total average doses of fentanyl used during the entire period of anesthesia were: 369.23±16.42 μg in group 1, 272.41±10,98 μg in group 2 (p&lt;0.001). In patients of the control group 1, an increase in the plasma concentration of adrenocorticotropic hormone by 111.86% (p&lt;0.01) from 25.7±2.1 pg/ml to 54.45±5.43 pg/ml was recorded (the study was conducted before the start of surgery and after the end of the operation), which was accompanied by a statistically significant increase cortisol concentration from 371.0±32.32 nmol/l to 562.72±45.37 nmol/l (by 51.67%) (p&lt;0.01). In patients of the second group (dexmedetomidine group), an intraoperative increase in the plasma concentration of adrenocorticotropic hormone was recorded from 26.25±2.3 pg/l to 46.88±2.36 pg/l (by 78.59%) (p&lt;0.01), which was accompanied by a statistically insignificant intraoperative increase in cortisol concentration from 393.51±25.0 nmol/l to 436.37±34.92 nmol/l – only by 10.89% (p&gt;0.05). Blood glucose concentrations in the early postoperative period in the both groups were 6.79±0.31 mmol/l and 6.29±0.24 mmol/l, respectively (p&gt;0.05). Hemodynamic parameters and BIS, which was maintained within 44±6.4%, indicated the adequacy of anesthesia and analgesia in both groups. Conclusions. The use of dexmedetomidine in multimodal low-opioid anesthesia for laparoscopic renal surgery provides the greatest antinociceptive protection and reduces the stress response to surgery.

Urological laparoscopic procedures and results performed by a single urologist in a secondary state hospital

Amaç: İkinci basamak devlet hastanesinde tek ürolog tarafından gerçekleştirilen ürolojik laparoskopik operasyonların sonuçlarını irdelemek.Gereç ve Yöntem: Ocak 2018 – Ocak 2021 yılları arasında Şanlıurfa Eğitim ve Araştırma Hastanesi’nde ürolojik laparoskopik cerrahi geçiren 30 hastanın verileri retrospektif olarak incelendi. Operasyon tipi, ameliyat süreleri, taraf, dren süreleri, hastanede kalış süreleri ve komplikasyonları not edildi. Bulgular: Tüm hastalara transperitoneal yolla laparoskopi yapıldı. On beş hastaya laparoskopik nefrektomi, 4 hastaya dismembred piyeloplasti, 8 hastaya üreterolitotomi, 3 hastaya ise kist eksizyonu uygulandı. Ortalama hasta yaşı 40,43 + 16,72 (14-76) saptandı. Erkek/kadın oranı 13/17 olmak üzere %43,3 erkek ve %56,7 kadın saptandı. Operasyon sürelerine bakıldığında nefrektomi 173,26 (120-240) dk. piyeloplasti 240 ± (210-270) dk. üreterolitotomi 110,75 (75-180) dk. kist eksizyonu 112,66 (100-138) dk. saptandı. Tüm hastaların drenaj miktarları eser miktarda (&amp;lt;50ml) idi. Dren çekilme süresi nefrektomi 2,26 (1-4) gün, piyeloplasti 3,5 (2-4) gün, üreterolitotomi 2,62 (2-4) gün, kist eksizyonu 1 (1) gün saptandı. Hastanede kalış süresi nefrektomi 3,46 (2-7) gün, piyeloplasti 4.5 (3-5) gün, üreterolitotomi 3.5 (2-7) gün, kist eksizyou 1,67 (1-2) gün saptandı. Toplam 30 vakanın 3’ünde (%10) açık prosedüre geçildi. Sadece internal iliak ven yaralanması olan bir hastaya 2 ünite kan transfüzyonu yapıldı. Komplikasyonlar Clavien-Dindo sınıflamasına göre değerlendirildiğinde internal iliak ven yaralanması sonrası açık onarım yapılan hasta Clavien-Dindo grade 3b, post-operatif atelektazi gelişen 3 hasta ise Clavien-Dindo grade 1 olarak kaydedildi. Sonuç: Laparoskopik operasyonlar ülkemizde üniversite hastaneleri ve eğitim klinikleri başta olmak üzere birçok merkezde açık operasyonların yerini almaktadır. Cerrahın yeteneğine ve tecrübesine göre değişkenlik göstermekle birlikte laparoskopik operasyonlar uzun öğrenme eğrisi gerektirmektedir. Günümüzde laparoskopik vakaların artışına sekonder asistanların deneyimlerinde de artış söz konusu olmaktadır. Laparoskopik operasyonlar; laparoskopi eğitimi almış ve deneyimleme fırsatı olmuş ürologlar tarafından uygun hasta seçimi ve doğru planlama ile ikinci basamak hastanelerde güvenle yapılabilir.