Modified Lithotomy Position Research Articles

Impact of patient positioning during surgery on neuropathies after robot-assisted laparoscopic radical prostatectomy: a randomised controlled trial.

To investigate whether ankle braces or shoulder support used for fixation during robot-assisted radical prostatectomy (RARP), where patients are commonly positioned in the head-down Trendelenburg position, differ in their potential to cause peripheral nerve injury. A prospective, double-blind, randomised controlled trial was conducted on patients undergoing RARP for prostate cancer between May 2020 and September 2021 using the da Vinci® Si system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Patients were randomly assigned to either the shoulder or ankle brace fixation group and were positioned in a modified lithotomy position. Neurological examinations were performed pre- and postoperatively. The primary endpoint was the prevalence of any peripheral neuropathy on the first postoperative day. A total of 98 patients were treated using the da Vinci Si system: 46 in the lithotomy lower fixation group and 52 in the lithotomy upper fixation group. Both groups mainly recorded neuropathies in the lower extremity, with a total incidence of 6.9% for lower neuropathies and 3.9% for upper neuropathies. All neuropathies were sensory, with one exception in the upper fixation group presenting a motor deficit. Over a median follow-up of 12 months, no neuropathies persisted. Neuropathy on the first postoperative day was observed in 15% of patients in the upper fixation group and 6.5% in the lower fixation group (P = 0.2). We observed neuropathies in a clinically relevant proportion of men undergoing RARP. We were not able to demonstrate a significant difference regarding postoperative neuropathies between ankle braces or shoulder support during RARP.

"Modified Lithotomy Position RIRS For Infectious Staghorn Renal Calculi in a Patient at Extremely High Risk of Thrombosis: A Case Report"

"Modified Lithotomy Position RIRS For Infectious Staghorn Renal Calculi in a Patient at Extremely High Risk of Thrombosis: A Case Report"

Using Remotely Operated Suction Irrigation System in da Vinci SP Submucosal Dissection.

Submucosal dissection using the da Vinci SP® system (Intuitive Surgical, Sunnyvale, CA, USA) is an emerging approach for treating premalignant lesions in the colon and rectum. The endoluminal space is tight and small, and during the procedure, this tight space is accessed by the 40 mm GelPOINT® Path transanal platform (Applied Medical, Rancho Santa Margarita, CA, USA). Most of the trocar space is occupied by the 25 mm port of the da Vinci SP® system. There is limited space for an additional trocar, and the full mobility of this trocar is restricted; hence there is a need for an effective suction irrigator during these procedures. Although the da Vinci SP® system has four instrument capabilities, it does not have a suction irrigation instrument. To address this issue, we tested a Remotely Operated Suction Irrigation System (ROSI™) (VTI, Nashua, NH, USA) in three patients undergoing da Vinci SP® submucosal dissection. The impact of innovation is the evaluation of a flexible suction irrigator during endorobotic submucosal dissection (ERSD), addressing space constraints and enhancing surgical precision. This was a single-center retrospective observational study involving three patients who underwent ERSD, between February 2023 and May 2023. ROSI™ was used selectively for rectal lesions. The first patient was a 67-year-old male with a 30 mm tubulovillous adenoma found in the rectum at 4 cm. The second patient was a 49-year-old female, referred after a screening colonoscopy, with a 40 mm rectal mass 12 cm from the anal verge. A biopsy revealed a tubular adenoma without dysplasia. The last patient was a 66-year-old male with a 25 mm tubulovillous adenoma with a focal high-grade dysplasia at 10 cm. There was no evidence of invasive carcinoma or lymph node metastasis on MRI in any of the patients. The patients were placed in a modified lithotomy position, and the GelPOINT® Path was inserted. A silk suture was attached at the proximal end of ROSI™ to facilitate tubing manipulation. ROSI™ was freely passed into the endoluminal space through the gel using a surgical clamp. Any bleeding during the operation was aspirated and irrigated using ROSI™ with the assistance of bipolar forceps. All surgeries were completed without complications and the patients were discharged on the same day. ROSI™ is a flexible foot pedal-controlled suction irrigator that can facilitate da Vinci SP® submucosal dissection. The flexibility and controllability of ROSI in the surgeon's hand may qualify it as an essential tool for performing ERSD and possibly other TAMIS procedures.

The relationship between stone-free and patient position in retrograde intrarenal surgery: a randomized prospective study

PurposeResidual fragments not removed with urinary stone surgery may become symptomatic. In this context, this study was carried out to investigate the effect of performing retrograde intrarenal surgery, which is conventionally performed in the lithotomy position, in the modified lithotomy position (Trend-side) on stone-free rates following the surgery.MethodsThis prospective study consisted of 100 patients with a single kidney stone smaller than 2 cm between 2021 and 2023. These patients were randomized into two groups of 50 patients each to be operated on in the conventional lithotomy and Trend-side positions. Variables were compared using independent t test for continuous variables and chi-square test for categorical variables.ResultsThere was no significant difference between the lithotomy and Trend-side position groups in terms of preoperative size, density, location of the stone, and hydronephrosis degree. Stone-free rate was 72% (n = 36) in the lithotomy group and 92% (n = 46) in the Trend-side group. Hence, there was a significant difference between the groups in the stone-free rate in favor of the Trend-side group (p = 0.009). Fragmentation time was statistically significantly shorter in the Trend-side group than in the lithotomy group (34 ± 17 min vs. 43 ± 14 min; p = 0.006). There was no significant difference between the groups in postoperative complication rates.ConclusionPerforming retrograde intrarenal surgery in the Trend-side position shortened the duration of fragmentation compared to the lithotomy position and was associated with higher stone-free rates. In conclusion, the Trend-side position can be safely preferred in patients undergoing retrograde intrarenal surgery due to kidney stones.

7693 Deep Infiltrating Endometriosis: Laparoscopic Treatment with Discal Resection

<h3>Study Objective</h3> To show how deep intestinal endometriosis can be managed safely and effectively with laparoscopic discoid resection. <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> The surgical management of deep endometriosis infiltrating the rectum employs either colorectal segmental resection or conservative techniques, i.e., shaving and discoid resection. When the nodule measures less than 3 cm in diameter, the discoid resection is applicable as an alternative to segmental colorectal resection. For surgery, the patient was placed in a dorsal modified lithotomy position. The surgeon was on the patient's left side, the first assistant on the right, and the second assistant between the patient's legs. <h3>Patients or Participants</h3> A 32-year-old patient presented to our center with dysmenorrhea, dyspareunia, dyschezia and chronic pelvic pain. On physical examination, in the pouch of Douglas, a painful nodule of approximately 2 cm was palpable, involving the left uterosacral ligament. In the MRI, it can be observed in the sagittal section T2 a hypointense nodule that obliterates the pouch of Douglas and involves the anterior wall of the rectum. The nodule contacts with the anterior wall of the rectum with a 27 mm expansion and a 9 mm maximal invasion. The distance between the nodule and the anal margin is 8 cm. <h3>Interventions</h3> Laparoscopic approach with discal resection to treat deep infiltrating endometriosis. Step-by-step demonstration of the surgery with the key points through a narrated video. <h3>Measurements and Main Results</h3> Patient evolves favorably in post operative care. Hospital discharge is given 48hs after the intervention. At 6-month follow-up, the patient reported resolution of all initial symptoms. <h3>Conclusion</h3> Discoid resection is an effective and safe alternative for trained surgeons with the aim of better preserving rectal function and reducing the risk of low anterior rectal resection syndrome that can be generated with bowel resection.

Laparoscopic Repair of a Deep Cesarean Scar Defect Guided by Hysteroscopy: Surgical Technique

<h3>Study Objective</h3> To show a uterus-preserving surgical technique in a patient with a deep cesarean scar defect. <h3>Design</h3> A technical video showing a laparoscopic isthmoplasty guided by hysteroscopy. <h3>Setting</h3> A tertiary referral hospital. For surgery, the patient was placed in dorsal modified lithotomy position. The surgeon was on the patient's left side, the first assistant on the right, and the second assistant between the patient's legs to perform the hysteroscopy. <h3>Patients or Participants</h3> A 41-year-old woman, with a history of two cesarean sections, was referred to our gynecological department for symptomatic isthmocele with abnormal uterine bleeding and abdominal pain. At MRI examination, it was identified a cesarean scar defect of 34 mm length x 34mm depth x 48mm of transverse diameter, with a residual myometrial thickness of 1.7 mm. <h3>Interventions</h3> The procedure started with the resection of adhesions between the uterus and the abdominal wall, followed by cautious mobilization of the bladder below the external cervical os. The cesarean scar was excised until healthy myometrium was identified, guided by transillumination with hysteroscopy. Afterwards, an hysterometer was used to facilitate the myometrial repair, which was performed with two layers of interrupted 2-0 absorbable multifilament suture. An hysteroscopic control was done, using physiological solution with methylene blue as distensor media, which ensured, with a laparoscopic view, that there were no leaks. Finally, the uterine plastic was covered by a peritoneal flap. <h3>Measurements and Main Results</h3> Operating time was of 140 minutes. The postoperative course was uneventful, and the patient was discharged on the first postoperative day. The patient reported resolution of postmenstrual spotting and abdominal pain. <h3>Conclusion</h3> Laparoscopic repair of a deep cesarean scar defect guided by hysteroscopy, is a feasible surgery and it should be considered as an alternative to hysterectomy in women who want to preserve the uterus.

Single-Port Endorobotic Rectal Mucosa Harvest For Urethral Reconstruction.

Colorectal mucosal grafts for substitution urethroplasty are alternatives for patients when buccal mucosa is not adequate for long urethral strictures. This study presents the first cases of single-port endorobotic rectal mucosa harvesting for urethral reconstruction. The patients are 43- and 57-year-old men with medical histories of lichen sclerosis. The urethrograms demonstrated panurethral strictures requiring long mucosal grafts. The single-port robot was docked under general anesthesia in the modified lithotomy position. The procedure began with a submucosal injection of a lifting agent. After achieving an adequate lift of the mucosa, the dissection was started 2 cm proximal to the sphincter complex with a hook and continued cephalad. The semiflexible robotic platform eased and facilitated the dissection providing the required traction and counter traction. The injecting needle and aspiration device were directed with the help of a silk knot at the tip of the tools to create a handle for robot arms. The procedure was continued with a spatula tip thinner than the hook, which delivers less energy to the dissection field and creates a precise cut. The harvested graft was provided to the urology team after pinning it for measurement. The urologists prepared and completed the reconstruction of the urethra with the autograft. The patient had no complications related to his rectal mucosa harvest. We report the first 2 cases of single-port robotic rectal mucosal harvesting for long panurethral strictures with single-port endorobotic submucosal dissection technique. The technique seems promising to facilitate the precise submucosal dissection with meticulous control of traction and delivered energy.

Single-Port, Robot-Assisted Transanal Harvest of Rectal Mucosa Grafts for Substitution Urethroplasty

ObjectiveTo describe a novel single-port, endorobotic technique for harvesting rectal mucosa grafts (RMGs) for urethral reconstruction. MethodsA 57-year-old man with prior transurethral procedures developed recurrent obstructive voiding symptoms. Urethrography revealed a panurethral stricture, meatus to the bulbomembranous junction. It was decided to proceed with surgical repair. Owing to the stricture's length, available oral mucosa would require additional material, and repair with a single rectal mucosa graft was offered instead. Single-port (SP) endorobotic approach offered ideal access for transanal harvest. With the patient placed in a modified lithotomy position, a GELPOINT Path transanal access platform was inserted through the anal canal. Pneumorectum was established at 12 mmHg with an AirSeal CO2 insufflator. A Da Vinci SP surgical system was docked, equipped with Maryland bipolar forceps and a monopolar spatula. After injection of ORISE gel, endorobotic submucosal dissection began posteriorly proximal to the dentate line. ResultsProceeding cranially through the rectal submucosa, a 21 ✕ 3 cm strip of mucosa was obtained with appropriate hemostasis. The resulting graft was thoroughly thinned. The robot was undocked, and the patient repositioned to high lithotomy. The patient underwent a penis-inverting, dorsolateral approach augmentation urethroplasty. With an indwelling catheter placed, the patient was discharged on postoperative day 2 with no postoperative complications. ConclusionTransanal rectal mucosal dissection with a single-port endorobotic approach can be an enticing and minimally invasive harvesting technique to provide substitution grafts for long-segment urethral reconstruction.

Analysis of the Effect of Modified Lithotomy Position in Patients Undergoing Laparoscopic Rectal Resection

Analysis of the Effect of Modified Lithotomy Position in Patients Undergoing Laparoscopic Rectal Resection

A novel tattooing technique for ureteric strictures in robotic ureteroureterostomy: a non-inferiority analysis.

A novel tattooing technique for ureteric strictures in robotic ureteroureterostomy: a non-inferiority analysis.

Uterine Transposition after Radical Trachelectomy for Fertility Preservation: Step By Step of the Surgical Technique.

<h3>Study Objective</h3> To demonstrate the technique of a laparoscopic uterine transposition for fertility preservation in a patient with a previous radical trachelectomy. <h3>Design</h3> A technical video showing step-by-step a laparoscopic uterine transposition. <h3>Setting</h3> A tertiary referral hospital in Argentina. For surgery, the patient was placed in a dorsal modified lithotomy position. During the pelvic part of the procedure, the surgeon was on the patient's left side, the first assistant on the right, and the second assistant between the patient's legs. When working in the upper abdomen the surgeon moved to the patient's right side, the first assistant was between the patient's legs, and the second assistant to the left side. <h3>Patients or Participants</h3> A 27-year-old woman with a FIGO stage IB1 squamous cell cervical carcinoma who had had a radical trachelectomy, and after histopathological assessment fulfilled the criteria for pelvic external radiation therapy. <h3>Interventions</h3> This intervention for fertility preservation consists of three main steps. During the first one, a minimally invasive surgery is performed to detach the uterus and adnexa from the vagina and to place them in the right upper abdomen, out of the pelvic radiation field. Afterwards, the patient is able to start the radiotherapy without delays, and after finishing it, the last step is to reposition the uterus and adnexa in the pelvis with a laparoscopic approach. <h3>Measurements and Main Results</h3> Two months after surgery, the patient has regular uterine bleeding with oral contraceptives. A transvaginal doppler ultrasound shows normal blood flow to the uterus, and the cervix exhibits a normal appearance on physical examination. <h3>Conclusion</h3> Uterine transposition is a feasible surgery, and it should be considered as an alternative for fertility preservation in women who have a pelvic tumor and require pelvic radiation therapy.

Percutaneous Nephrolithotomy in Supine versus Prone Position in Tertiary Hospital in Mysore: A Prospective Cohort Study

Introduction: Percutaneous Nephrolithotomy (PCNL) is a procedure of choice for large renal calculi. It is a common urological procedure. PCNL can be performed in various positions. Aim: To determine the surgical outcomes in patients undergoing PCNL in supine and prone positions. Materials and Methods: A cohort study was conducted on patients with renal and upper ureteral stones who underwent PCNL in either prone or supine position between August 2019 to August 2020 at Urology Department, JSS Hospital, Mysuru. Supine PCNL was done in the flank Free Oblique Supine Modified Lithotomy (FOSML) position. All the procedures were performed under fluoroscopy guidance. Surgical outcomes including operative time, length of hospital stay, Stone Free Rate (SFR), radiation dose, and postoperative complications were evaluated. The collected data was tabulated and frequency (n) and percentage (%) analysis was performed. The Chi-square test was used to find the level of significance. Results: A total of 70 patients were included in the study and out of which 35 patients were in the supine (46.37±14.73 years, 28 males and 7 females) and 35 patients (47.54±12.45 years, 23 males and 12 females) were in the prone PCNL groups. Statistically significant difference was observed in the mean operating time in the supine and prone PCNL groups (81.43 vs 127.71 minutes; p-value=0.001), with a higher stone-free rate (94.29% vs 91.43%; p-value=0.643) observed in the supine PCNL group. One patient in supine group had postoperative sepsis and one patient in prone group had bleeding requiring transfusion. The Visual Analog Scale (VAS) score in supine PCNL was (5.08±0.32) less than in prone group (8.03±0.40) (p-value &lt;0.001). Conclusion: PCNL in the supine position compared with the prone position demonstrates significantly lower operative time with similar SFR and lower VAS score.

Flank Free Oblique Supine Modified Lithotomy Position (FOSML) for Simultaneous Anterograde and Retrograde Endourological Access. Single Centre Experience

Flank Free Oblique Supine Modified Lithotomy Position (FOSML) for Simultaneous Anterograde and Retrograde Endourological Access. Single Centre Experience

The Modified Lithotomy: A Surgical Position for Lower Extremity Wound Care Procedures in Super Morbidly Obese Patients. A Case Study

The purpose of this case study was to describe a modified lithotomy operative positioning technique that has helped the authors improve care of these patients. Double-layer, foam padding at least 4 inches thick is secured to the top and sides of 2 small rolling preparation tables using 3-inch silk tape to create "lithotomy" leg holders, the operating table is raised appropriately, the abducted legs are placed onto the padded prep tables, and the footboard is carefully lowered to provide access to the groin and medial thighs. A super morbidly obese (body mass index 74), 47-year-old African American man with a history of hypertension and type 2 diabetes controlled on oral medications presented to the authors' wound care clinic with 2 large, medial left thigh lymphedema masses requiring resection. Both procedures were successfully completed using the modified lithotomy position. No adverse events occurred. The modified lithotomy is easy to implement, does not require unique equipment, improves access to the surgical site, and may reduce the risk of complications. Larger and longer-term follow-up studies are needed to monitor the outcomes of this positioning technique.

An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study

BackgroundA recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery.MethodsThe Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes.DiscussionThe IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study.Trial registrationClinicalTrials.gov, NCT02773173. Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016.

A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study.

While guidelines for laparoscopic abdominal surgery advise using the lowest possible intra-abdominal pressure, commonly a standard pressure is used. We evaluated the feasibility of a predefined multifaceted individualized pneumoperitoneum strategy aiming at the lowest possible intra-abdominal pressure during laparoscopic colorectal surgery. Multicenter prospective study in patients scheduled for laparoscopic colorectal surgery. The strategy consisted of ventilation with low tidal volume, a modified lithotomy position, deep neuromuscular blockade, pre-stretching of the abdominal wall, and individualized intra-abdominal pressure titration; the effect was blindly evaluated by the surgeon. The primary endpoint was the proportion of surgical procedures completed at each individualized intra-abdominal pressure level. Secondary endpoints were the respiratory system driving pressure, and the estimated volume of insufflated CO2 gas needed to perform the surgical procedure. Ninety-two patients were enrolled in the study. Fourteen cases were converted to open surgery for reasons not related to the strategy. The intervention was feasible in all patients and well-accepted by all surgeons. In 61 out of 78 patients (78%), surgery was performed and completed at the lowest possible IAP, 8mmHg. In 17 patients, IAP was raised up to 12mmHg. The relationship between IAP and driving pressure was almost linear. The mean estimated intra-abdominal CO2 volume at which surgery was performed was 3.2L. A multifaceted individualized pneumoperitoneum strategy during laparoscopic colorectal surgery was feasible and resulted in an adequate working space in most patients at lower intra-abdominal pressure and lower respiratory driving pressure. ClinicalTrials.gov (Trial Identifier: NCT03000465).

V06-04 ROBOT ASSISTED INFERIOR VENA CAVOSCOPY

You have accessJournal of UrologyAdrenal, Testis, UTUC Oncology & More1 Apr 2018V06-04 ROBOT ASSISTED INFERIOR VENA CAVOSCOPY Haidar Abdul-Muhsin, Anthony Chau, Richard Fowl, and Erik Castle Haidar Abdul-MuhsinHaidar Abdul-Muhsin More articles by this author , Anthony ChauAnthony Chau More articles by this author , Richard FowlRichard Fowl More articles by this author , and Erik CastleErik Castle More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1583AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conventional therapy of inferior vena cava tumor invasion (IVC) retroperitoneal malignancies involves caval resection with or without vascular grafting. Assessment of the extent of tumor invasion relies on preoperative (CT and MRI) and intraoperative (US) imaging. However, these imaging modalities cannot differentiate between bland and tumor thrombi. In this video we are presenting a technique for direct visualization of the IVC lumen to assess for tumor invasion during a robot assisted retroperitoneal lymph node dissection for testicular cancer. METHODS A 29 year old male patient with metastatic non-seminomatous mixed germ cell tumor was found to have a persistent metastatic retroperitoneal lymph node mass following four cycles of BEP chemotherapy. Preoperative imaging demonstrated a 6 cm interaortocaval mass with adjacent filling defect in the IVC. Preoperative imaging could not differentiate between tumor invasion vs bland thrombus. RESULTS After induction of general anesthesia, the patient was placed in a modified lithotomy position. Following port placement and robot docking, the small bowel was retracted cephalad and to the left upper quadrant. The retroperitoneal space was developed. Retroperitoneal lymph node dissection was started in a regular manner. The large mass was encountered in the interaortocaval region and was adherent to the IVC wall. It was dissected free from all attachments except the IVC wall. Proximal and distal control was obtained with vessel loops. A small venotomy was made on the IVC anterior wall just distal to the mass. A flexible cystoscope was introduced through one of the assistant ports and into the IVC lumen. Examination of the IVC showed multiple synechiae and vascular webs consistent with organized and recanalized bland thrombus with no evidence of tumor invasion. Given these findings no caval resection was needed. These webs were excised and the remaining part of the wall reconstructed, preserving more than 50% of the IVC circumference. The remaining part of the dissection was completed in the conventional manner. Operative time was 383 min, EBL was 150 ml, and LOS was one day. Postoperatively patient had smooth recovery with no postoperative complication. Postoperative pathology was consistent with a bland thrombus. Follow up imaging showed preserved IVC circumference and no filling defects. CONCLUSIONS Direct visualization of the IVC lumen is feasible using conventional endoscopic instruments and robotic approach. This helps avoid a large venotomy or graft placement and completion of the retroperitoneal lymph node dissection in a minimally invasive manner. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e662 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Haidar Abdul-Muhsin More articles by this author Anthony Chau More articles by this author Richard Fowl More articles by this author Erik Castle More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Supine PCNL in Flank-Free Oblique Supine Modified Lithotomy (FOSML) Position: Our Point of Technique

Supine PCNL in Flank-Free Oblique Supine Modified Lithotomy (FOSML) Position: Our Point of Technique

Clinical efficacy of laparoscopic extralevator abdominoperineal excision for low rectal cancer without turning position

Objective To explore the clinical efficacy of laparoscopic extralevator abdominoperineal excision (laparoscopic ELAPE) for low rectal cancer with modified Lloyd-Davies lithotomy position and without turning position. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 27 patients with low rectal cancer who underwent laparoscopic ELAPE without turning position in the West China Hospital of Sichuan University from September 2013 to January 2015 were collected. The modified Lloyd-Davies lithotomy position was used in perineal resection. Observation indicators: (1) surgical situation; (2) postoperative recovery situation; (3) postoperative pathological examination situation; (4) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications, survival of patients and tumor recurrence or metastasis up to March 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). Results (1) Surgical situation: A total of 27 patients received laparoscopic ELAPE without turning position, and operation time and volume of intraoperative blood loss were (198±51)minutes and (85±66)mL. Among 5 of 27 patients with intraoperative complications, 1 with intestinal perforation received successful intraoperative repair, 1 with presacral haemorrhage received successful hemostasis by intraoperative gauze pressing, 1 with left and right pelvic plexus injury didn′t receive special treatment, 1 with left pelvic plexus injury + left internal iliac vein injury didn′t receive special treatment and were repaired in vascular injury repair, 1 with right neurovascular bundle injury didn′t receive special treatment of nerve injury and received successful hemostasis by ultrasonic scalpel. There was no perforation in the site of the tumor. Number of lymph node dissected was 14 (range, 9-22), and number of lymph node dissected ≥12 and 100 mL) and 7 in Clavien-DindoⅡ (3 with pulmonary infection, 2 with chylous fistula, 1 with perineal incision infection and 1 with hematuria). There was no death within 30 days postoperatively. The median duration of hospital stay of 27 patients was 7 days (range, 6-8 days). (3) Postoperative pathological examination situation: of 27 patients, 1 and 26 had respectively positive and negative circumferential margins and median distance of circumferential margin was 0.7 cm (range, 0.1-1.1 cm). T stage: 14, 12 and 1 patients were respectively detected in T2, T3 and T4. N stage: 18, 6 and 3 patients were respectively found in N0, N1 and N2. (4) Follow-up and survival situations: 25 of 27 patients were followed up for 2-32 months, with a median time of 24 months. During the follow-up, 5 had complications after discharge from hospital. Of 5 patients, 2 with persistent anal pain didn′t receive special treatment and were not relieved, and 3 with sexual dysfunction didn′t receive special treatment and were followed up or observed. Of 25 patients, 2 died of tumor-related diseases, 1 died of non-tumor-related disease and other 22 had survival. No local tumor recurrence was detected. Eight patients had tumor distant metastases, including 4 with pulmonary metastases, 3 with hepatic metastases and 1 with brain metastasis. Conclusion Laparoscopic ELAPE by modified Lloyd-Davies lithotomy position without turning position is safe and feasible, with closing pelvic floor peritoneum in stage Ⅰ. Key words: Rectal neoplasms, low; Extralevator abdominoperineal excision; Laparoscopy; Position

V6-12 TRANSVESCICOSCOPIC BLADDER CUFF EXCISION IN LAPAROSCOPIC NEPHROURETERECTOMY

You have accessJournal of UrologyMisc. GU Oncology and Transplant1 Apr 2017V6-12 TRANSVESCICOSCOPIC BLADDER CUFF EXCISION IN LAPAROSCOPIC NEPHROURETERECTOMY Young Eun Yoon, Sang Woon Kim, Hyung Ho Lee, Jang He Han, Seung Hwan Lee, Won Sik Ham, Koon Ho Rha, and Woong Kyu Han Young Eun YoonYoung Eun Yoon More articles by this author , Sang Woon KimSang Woon Kim More articles by this author , Hyung Ho LeeHyung Ho Lee More articles by this author , Jang He HanJang He Han More articles by this author , Seung Hwan LeeSeung Hwan Lee More articles by this author , Won Sik HamWon Sik Ham More articles by this author , Koon Ho RhaKoon Ho Rha More articles by this author , and Woong Kyu HanWoong Kyu Han More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1587AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To describe the management of the distal ureter during laparoscopic radical nephroureterectomy with the transvesical laparoscopic approach. METHODS The patient was placed in the modified lithotomy position with abducted thighs. The procedure started with cystoscopic examination of the bladder and ureteral orifices. After a small skin incision, a 5-mm-diameter trocar was introduced into the bladder dome. The anterior bladder wall was suspended to the abdominal wall to prevent the trocar from slipping out and 2 more 3-mm-diameter trocars were placed. The ureter was mobilized with hook electrocautery and dissected ureteral end was placed in extravesical space. Bladder was repaired with 4-0 vicryl. Then patient was placed in lateral position and conventional laparoscopic radical nephroureterectomy was performed. While dissection of distal ureter, the distal end of ureter was smoothly removed from perivesical space without any difficulty. RESULTS The patient was a 61-year-old female. The patient's CT scan showed right proximal ureteral mass and the result of previously performed ureteroscopic biopsy was transitional cell carcinoma, low grade. The operation time of transvesical bladder cuff excision was 50 minutes, and laparoscopic nephroureterectomy was performed for 120 minutes. Estimated blood loss of whole procedure was 300ml and there was no intraoperative or postoperative complication. Foley catheter was removed at 1 week. After 6 months postoperatively, there's no evidence of recurrence or metastasis. CONCLUSIONS Our initial experience with transvesicoscopic bladder cuff excision in laparoscopic radical nephroureterectomy demonstrated that the procedure is feasible and safe. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e682 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Young Eun Yoon More articles by this author Sang Woon Kim More articles by this author Hyung Ho Lee More articles by this author Jang He Han More articles by this author Seung Hwan Lee More articles by this author Won Sik Ham More articles by this author Koon Ho Rha More articles by this author Woong Kyu Han More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...