Laparoscopic Urologic Procedures Research Articles

Analysis of Various Laparoscopic Pediatric Urology Surgeries: Five-Year Experience of a Single Institution.

Background In this study, we aim to report our single-center experience with laparoscopic pediatric urological surgeries. We aim to determine the feasibility of various urological and urogenital laparoscopic procedures and the tricks that increase surgical success. Methodology Data from 98 patients who underwent laparoscopic urological and/or urogenital procedures for diagnostic and therapeutic purposes in our clinic between June 2018 and February 2023 were retrospectively analyzed. All surgeries were performed by the same surgical team. Laparoscopic procedures included orchidopexy, gonadectomy, vaginoplasty, hysterectomy, pyeloplasty, nephrectomy/partial nephrectomy, ureteroneocystostomy, bladder diverticulum excision, renal cyst excision, proximal ureter stone removal, oophorectomy, ovarian detorsion, oophoropexy, and lymph node excision for diagnostic purposes. The surgical planning of the patients was based on the decisions of the pediatric nephrology, pediatric endocrinology, and pediatric oncology departments and the multidisciplinary council. Demographic characteristics of the patients, surgical indications, and intraoperative data, as well as postoperative pathological diagnoses and complications, were recorded. All patients underwent a transperitoneal approach. The duration of the operation was obtained from anesthesia records and defined as the time from the beginning of the surgical incision to the closure of the skin incision. Results Of the patients, 54 were males and 44 were females. The median age was 7.8 years. No complications other than grade 1 according to the Clavien-Dindo classification were observed in our patients. As different types of surgeries were analyzed, the mean operative duration was estimated. Conclusions The laparoscopic method should be performed by surgeons experienced in advanced surgeries in pediatric urology. It is critical to consider the difference in the size of pediatric patients in preparation for laparoscopic surgery to minimize technical and ergonomic problems. We believe that each surgery has its specific tricks and that these should be a part of laparoscopy training. Moreover, developing and sharing this information would be very useful for pediatric urologists.

324 The Learning Curves of Major Laparoscopic and Robotic Procedures in Urology: A Systematic Review

Abstract Aim Urology has been at the forefront of adopting laparoscopic and robot-assisted techniques to improve patient outcomes. Defining the learning curves for these procedures enables assessment of trainee performances relative to expected progress and has important implications in research. This systematic review aimed to examine the literature relating to the learning curves of major urological robotic and laparoscopic procedures. Method In accordance with PRISMA guidelines, a systematic literature search strategy was employed across PubMed, EMBASE, and the Cochrane Library from inception to December 2021 for eligible studies alongside a search of the grey literature. Two independent reviewers completed the article screening and data extraction stages, using the Newcastle-Ottawa Scale (NOS) to then undertake quality assessment of the included articles. The review was reported in accordance with AMSTAR guidelines. Results Of 3702 records identified, 97 eligible studies were included for narrative synthesis. 39 studies evaluated robot-assisted laparoscopic prostatectomy (RALP) with the learning curve identified as 10-250 cases for operative time and 250-300 for potency. The shortest learning curve was reported for hand-assisted laparoscopic nephrectomy, involving 4-10 cases. There was considerable variation in the study designs, outcome measures and prior experience of surgeons, with all studies scoring either 5 or 6 on the NOS. Conclusions Standardised reporting of outcomes and performance measures is required to reduce heterogeneity and enable the undertaking of a meta-analysis. Future studies should use multiple surgeons and large sample sizes of cases to identify the currently undefined learning curves for laparoscopic radical cystectomy and for robotic and laparoscopic retroperitoneal lymph node dissection.

Analysis of Complications of Laparoscopic Procedures in Urology

Introduction: Laparoscopic procedures have revolutionized the field of urology by offering minimally invasive alternatives to traditional open surgeries. Objectives: The main objective of the study is to find the complications of laparoscopic procedures in urology Material and methods: This retrospective observational study was conducted at institute of kidney disease Hayatabad Peshawar, to comprehensively analyze the complications arising from laparoscopic procedures in urology conducted between the years 2022 and 2023. Results: A total of 320 patients who underwent laparoscopic urological procedures between 2022 and 2023 were included in the study. The mean age of the cohort was 54.8 years (± 10.2), with a range of 28 to 76 years. Of the participants, 215 (67.2%) were male and 105 (32.8%) were female.Postoperative complications occurred in 92 patients (28.8%). The Clavien-Dindo classification was utilized to categorize the severity of complications. Grade I complications, defined as any deviation from the normal postoperative course without the need for pharmacological treatment or surgical intervention, were observed in 34 cases (10.6%). Practical Implication: This study will help in intraoperative and postoperative issues emphasize the need for precise techniques and vigilant postoperative care. Conclusion: It is concluded that varying rates of intraoperative and postoperative issues emphasize the need for precise techniques and vigilant postoperative care. Tailored approaches based on surgical techniques and patient age can enhance outcomes, reinforcing the importance of thorough evaluation and comprehensive management. Keywords: Postoperative, Patients, Laparoscopic, Urology, Procedures, Operative

Health Information Technology Usability Evaluation Scale (Health-ITUES) and User-Experience Questionnaire (UEQ) for 3D Intraoperative Cognitive Navigation (ICON3DTM) System for Urological Procedures

Backgound and objectives: In recent years, the adoption of 3D models for surgical planning and intraoperative guidance has gained a wide diffusion. The aim of this study was to evaluate the surgeons' perception and usability of ICON3DTM platform for robotic and laparoscopic urological surgical procedures. Materials and Methods: During the 10th edition of the Techno-Urology Meeting, surgeons and attendees had the opportunity to test the new ICON3DTM platform. The capability of the user to manipulate the model with hands/mouse, the software usability, the quality of the 3D model's reproduction, and the quality of its use during the surgery were evaluated with the Health Information Technology Usability Evaluation Scale (Health-ITUES) and the User-Experience Questionnaire (UEQ). Results: Fifty-three participants responded to the questionnaires. Based on the answers to the Health-ITUES questionnaire, ICON3DTM resulted to have a positive additional value in presurgical/surgical planning with 43.4% and 39.6% of responders that rated 4 (agree) and 5 (strongly agree), respectively. Regarding the UEQ questionnaire, both mouse and infrared hand-tracking system resulted to be easy to use for 99% of the responders, while the software resulted to be easy to use for 93.4% of the responders. Conclusions: In conclusion, ICON3DTM has been widely appreciated by urologists thanks to its various applications, from preoperative planning to its support for intraoperative decision-making in both robot-assisted and laparoscopic settings.

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 (<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.

Inguinal hernia TAPP repair using Senhance® robotic platform: first multicenter report from the TRUST registry.

The purpose of this article was to provide feasibility and safety results of robotic transabdominal preperitoneal inguinal hernia repair (Robotic TAPP). We included 271 cases of robotic inguinal hernia TAPP repair using the Senhance® robotic platform from four different centers between March 2017 and March 2020. Key data points were intraoperative and postoperative complication rate, operating time, length of hospital stay, postoperative pain score and time required to get back to a daily routine that were inserted in the TransEnterix European Patient Registry for Robotic assisted Laparoscopic Procedures in Urology, Abdominal Surgery, Thoracic and Gynecologic Surgery (TRUST). We report 203 cases of unilateral and 68 cases of bilateral inguinal hernia repairs. Mean operative time was 74 ± 35min (range 32-265min), postoperative complications occurred in five (1.85%) cases, the intraoperative complication rate was five (1.85%). The average subjective patient-related pain score after the procedure was 3 ± 1.9 (range 1-9), length of hospital stay was 39 ± 28h (range 4-288h), and recovery time was 9.65 ± 8days (range 1-36days). Robotic inguinal hernia TAPP repair shows inspiring results. It is a safe and doable procedure. However, cost analysis should be performed in future to show the superiority over other techniques.

Urology residency training in Greece. Results from the first national resident survey

Background and objectivesThis is the first national survey assessing Greek Urology residency programs. The main objective of this study is to assess the level of confidence and perception of Greek Urology residents regarding their educational program and detect areas of improvement. Material and methodsA 51-question survey was developed via an electronic platform and answered by 91 out of 104 Greek residents from March 2019 until May 2019. Fisher's exact test, chi-squared test and Kruskal–Wallis test were used with statistical significance set at p = .05. ResultsThe median overall satisfaction regarding surgical training was 6/10 regardless of working schedule, working in a University Department, PGY or number of residents in clinic. Most residents have not performed any scrotal ultrasound or pressure-flow-studies; however, they are more familiar with KUB ultrasound. Double-J stent insertion and cystoscopy were common procedures for residents. Bureaucracy was reported as a major issue by 70.4% of residents. ESWL has not been performed by 80.2% of residents, 58.2% residents performed less than 10 ureteroscopies, and only the last year trainees performed more than 10 TURBT and TURP. Most residents mentioned to rarely perform basic steps in many open or laparoscopic urological procedures. Surprisingly, 59.3% of residents have not published any study in peer-reviewed journals. Regarding satisfaction, 44% rarely feel satisfied at work and 59.3% sometimes suffer from burnout. Response rate reached 87.5%. ConclusionsConsidering the results from this survey, regulatory authorities should join forces to establish a structured curriculum of clinical, surgical and research training in Urology across Europe.

Complications of upper urinary system laparoscopic surgery: a single center experience with 942 cases

Objectives: Since the introduction of laparoscopic nephrectomies, laparoscopic surgeries in the field of urology have become increasingly popular. Laparoscopic surgery has its advantages but carries the risk of complications like all interventions. In our study, we aimed to discuss our complication rates according to difficulty level by presenting our experiences with urological laparoscopic procedures for the upper urinary system. Methods: This retrospective study includes 942 laparoscopic urological procedures performed by a single surgeon. The procedures divided into three groups according to the European Scoring System (ESS) Classification. The complication rate of each group was calculated separately. Results: A total of 127 (13.4%) complications were observed. Partial nephrectomy, nephroureterectomy and ureterolithotomy had the highest complication rates. Renal cyst excision, simple nephrectomy and radical nephrectomy had the lowest complication rates. According to the Clavien Complication Classification, the distributions of Grade 1, 2 and 3 complications were 29.1% (n =37), 57.4% (n = 73) and 13.3% (n = 17); respectively. The open conversion rate was 0.84%. When procedures were classified as “easy”, “difficult” and “very difficult” according to the ESS classification; complication rates were found 7.3% in the easy group, 13.3% in the difficult group and 16.6% in the very difficult group. There was no significant difference between the three groups in terms of complication rates (p = 0.329). Conclusions: Performing easier operations according to ESS in the first years of the learning curve is beneficial in preventing complications. With increasing experience, more complicated procedures can be performed with similar complication rates.

The First National Resident Survey Assessing the Greek Urology Residency Training Programs

Background and Objectives: This is the first national survey regarding Greek Urology residency programs. The main objective of this study is to assess the level of confidence and perception of Greek Urology residents regarding their educational program and detect areas that necessitate improvement. Materials and Methods: A 51-question survey was developed via an electronic platform and 87.5% of residents (91 out of 104) participated from March 2019 until May 2019. Fisher's exact test, Chi-square test, and Kruskal–Wallis test were used with statistical significance set at P = 0.05. Results: The median overall satisfaction from surgical training was 6/10, and was independent of working schedule, working in a University Department, postgraduate years or number of residents in clinic. Among diagnostic and therapeutic procedures, kidney-ureter-bladder ultrasound, cystoscopy, and double-J stent insertion were common for trainees. On the other hand, most residents have not performed any scrotal ultrasound or pressure-flow studies. About 70.4% of residents reported bureaucracy as a major issue. 80.2% have not performed any ESWL, while 58.2% of residents performed <10 ureteroscopies and only the last year trainees performed more than 10 TURBT and transurethral resection of prostate. Most of the participants mentioned to rarely perform basic steps in many open or laparoscopic urological procedures. Surprisingly, 59.3% of residents have not published any study in peer-reviewed journals. 44% rarely feel satisfied from their work and 59.3% sometimes suffer from burnout. Conclusions: Considering the results from this survey regulatory authorities should join forces to establish a structured curriculum of clinical, surgical, and research training in Urology across Europe.

Formación de la residencia de Urología en Grecia. Resultados de la primera encuesta nacional

Background and objectivesThis is the first national survey assessing Greek Urology residency programs. The main objective of this study is to assess the level of confidence and perception of Greek Urology residents regarding their educational program and detect areas of improvement. Material and methodsA 51-question survey was developed via an electronic platform and answered by 91 out of 104 Greek residents from March 2019 until May 2019. Fisher's exact test, chi-squared test and Kruskal–Wallis test were used with statistical significance set at p=.05. ResultsThe median overall satisfaction regarding surgical training was 6/10 regardless of working schedule, working in a University Department, PGY or number of residents in clinic. Most residents have not performed any scrotal ultrasound or pressure-flow-studies; however, they are more familiar with KUB ultrasound. Double-J stent insertion and cystoscopy were common procedures for residents. Bureaucracy was reported as a major issue by 70.4% of residents. ESWL has not been performed by 80.2% of residents, 58.2% residents performed less than 10 ureteroscopies, and only the last year trainees performed more than 10 TURBT and TURP. Most residents mentioned to rarely perform basic steps in many open or laparoscopic urological procedures. Surprisingly, 59.3% of residents have not published any study in peer-reviewed journals. Regarding satisfaction, 44% rarely feel satisfied at work and 59.3% sometimes suffer from burnout. Response rate reached 87.5%. ConclusionsConsidering the results from this survey, regulatory authorities should join forces to establish a structured curriculum of clinical, surgical and research training in Urology across Europe.

Management of major vascular injury in laparoscopic urology

ObjectiveDuring the past three decades, laparoscopy has played a significant role in the management of urological disorders. This study aims to standardize the management of major vascular injury, which is a life-threatening complication in the laparoscopic urological procedures. MethodsA total of 8210 patients with the urological disorder, who underwent laparoscopic surgery at Sir Run Run Shaw Hospital from January 2000 to December 2018, were included in this retrospective study. Patients’ data of the laparoscopic major vascular injury were collected and analyzed, and the basic principles of the procedure were summarized. ResultsA total of 15 (0.18%) cases of major vascular injury were found among the 8210 patients, and 2 of them were converted to open surgery. Although the type of laparoscopic surgery, causes, and management of major vascular injury among the patients were diverse, the main management strategies of major vascular injury in laparoscopic surgery were to keep the vision clear, control bleeding rapidly by clamping and compression, make full preparation for possibly needed liquid resuscitation, and try best to repair under laparoscope. If necessary, converse to open surgery. ConclusionAlthough the reported incidence of major vascular injury in laparoscopic urological surgery is extremely low, such injury can result in high morbidity and mortality. It is important to rapidly identify the cause and strictly follow the standardized management for better outcomes.

Cost, training and simulation models for robotic-assisted surgery in pediatric urology.

Laparoscopic procedures in pediatric urology have been shown to be safe and effective over the last number of years. Coupled with this is the technological trend to provide minimally invasive options for even the most complex pediatric patients. Whilst robotic platforms continue to try to demonstrate superior patient outcomes in adults with mixed results, the utilization of robotic platforms for pediatric urology is increasing. A review of the current literature was undertaken to assess the evidence for training models and cost-effectiveness of robotic-assisted pediatric urology. A growing body of evidence in this field has demonstrated that robotic platforms are safe and effective in children and can provide additional reconstructive benefits due to motion scaling, magnification, stereoscopic views, instrument dexterity and tremor reduction. The main drawbacks remain the financial implications associated with this platform through purchase, maintenance, and disposable costs. This review addresses some of the addresses issues pertaining to cost, training and simulation for robotic-assisted surgery in pediatric urology.

Lessons learned from a single-surgeon series of paediatric robot-assisted laparoscopic urological procedures: predictors of high-grade postoperative complications.

To describe postoperative complications after robot-assisted laparoscopic urological surgery in children, and identify potential predictors of these complications by analysing the outcomes of a large-volume single-surgeon experience. We reviewed our institutional database to identify all robot-assisted laparoscopy (RAL) cases performed between December 2007 and December 2017. Patients were grouped into three cohorts based on the anatomical location of the procedure: upper urinary tract (kidney and renal pelvis); lower urinary tract (ureter); and lower urinary tract reconstruction with bowel (bladder reconstruction). A descriptive analysis of baseline characteristics, intra-operative variables and postoperative outcomes was carried out. All complications were graded using the Clavien-Dindo scale, and grouped based on type and time of occurrence (<30, 30-90, >90days). Multivariable logistic regression analysis was performed to identify predictors of high-grade complications (Clavien-Dindo grade ≥ III). We also measured complication rates based on year of surgery and surgical caseload. Our database included a total of 326 patients, of whom 57% (n = 186) underwent upper urinary tract procedures, 30% (n = 97) ureteric procedures, and 13% bladder reconstruction. The median follow-up for each procedure was 13, 11 and 57months, respectively. Of the total, 10 cases were converted to an open approach and excluded from further analysis. The most common types of complication in all groups were infections (urinary tract infections) and urinary complications (urine leaks and urolithiasis). Bladder reconstructive procedures, which require the use of bowel, presented the highest rate of high-grade complications (32%). Length of hospital stay (LOS; odds ratio [OR] 1.33, confidence interval [CI] 1.16-1.53), estimated blood loss (EBL) in surgery (OR 1.01, CI 1.002-1.019) and operating time (OR 1.004, CI 1.002-1.006) were all associatedwith increased odds of high-grade complications on multivariate analysis (P < 0.05). In this single-surgeon series, we have described the most commonly encountered complications after RAL in paediatric urology, finding rates similar to the complication rates reported in the current literature on other surgical approaches. In addition, LOS, operating time and EBL, which are probable surrogates of case complexity, were associated with increased odds of high-grade complications.

Robotic versus laparoscopic urological surgery: incidence of reoperation and complications

Objective: To report the introduction of minimum invasive surgery in Denmark with focus on the reoperation and complication rates.Materials and methods: Data were prospectively collected at the national UroLap database. The database was established in 2003 in Denmark to register all laparoscopic urological procedures as well as their peri- and post-operative outcomes. In the period from 2009–2014, 10,843 patients were registered with the database, of which 10,546 (97%) had a complete Clavien-Dindo score within the first 30 postoperative days.Results: The mean age of patients was 60.5 years (S.D. = 16.2), and 415 patients (4%) were under the age of 17 years. The male-to-female ratio was 4:1. At the end of 2010, 25% of surgeries used the robotic technique, but the frequency of robotic surgeries increased to 56% in 2014. No complications were reported in 74.6% of the urological procedures. The mortality rate was reported at only 0.27% of all patients. Patients who underwent a urological procedure performed by consultant urologists had a lower rate of complication compared to procedures performed by trainees (p = 0.03) but not staff doctors (p = 0.9). There were no significant differences in complication rates between staff doctors and trainee (p = 0.2).Conclusion: Robotic and laparoscopic urological procedures are associated with low serious complication rates. Postoperative complications were more common among surgeries performed by trainees. The robotic approach is associated with a shorter L.O.S. compared to the laparoscopic approach and linked to lower reoperation rates.

Comparison of opioid-based and opioid-free TIVA for laparoscopic urological procedures in obese patients.

Background and Aims:Perioperative pain management in an obese patient is challenging. The incidence of respiratory depression is higher in obese patients and is exaggerated with opioids. We evaluated the efficacy of opioid-free anesthesia with propofol, dexmedetomidine, lignocaine, and ketamine in obese patients undergoing urological laparoscopic procedures with reference to postoperative analgesic consumption, hemodynamic stability, and respiratory depression.Material and Methods:In this prospective, randomized, blinded controlled study, patients were randomized to receive either opioid-based (opioid group) or opioid-free (opioid-free group) anesthesia. Postoperative pain was assessed using visual analog score (VAS) 30 min after recovery, hourly for 2 h and every 4 hourly for 24 h. The primary outcomes studied were respiratory depression, mean analgesic consumption and time to rescue analgesia. Intraoperative hemodynamic parameters, mean SpO2, respiratory rate and postanesthesia care unit (PACU) discharge time were secondary objectives.Results:There were no differences in the demographic and intraoperative hemodynamic profile between the groups. Incidence of respiratory depression, defined as fall in saturation, was more in opioid-based group. Postoperative analgesic requirement (225 ± 48.4 vs 63.6 ± 68.5 mg of tramadol with P value of <0.001) and PACU discharge times (18.1 ± 5.4 vs 11.7 ± 4.3 hours with P value of <0.001) were significantly less in the opioid-free group.Conclusions:Opioid-free anesthesia is a safer and better form of anesthesia in obese patients undergoing laparoscopic urological procedures as there is a lower requirement of postoperative analgesia.

Three-dimensional laparoscopy in urology: Initial experience after 100 cases

To evaluate the efficacy of three-dimensional (3D) laparoscopy in urological procedures in a cohort study compared to two-dimensional (2D) laparoscopy. From October 2016 to August 2017, 100 patients underwent various urological procedures with 3D laparoscopy performed by a single experienced surgeon at the University Medical Centre of Ho Chi Minh City. The surgeon's subjective assessment of image quality, depth perception, ease of intra-corporeal suturing and knotting was recorded. The State-Trait Anxiety Inventory for Adults (STAI-6) short version was used to quantify aspects of stress experienced during each operative procedure. A subgroup of 73 complicated 3D laparoscopic procedures (nephron sparing nephrectomy, nephrectomy, adrenalectomy, pyeloplasty and ureterolithotomy) was compared to the same clinical parameter group of 74 two-dimensional laparoscopic procedures, performed by the same surgeon in the year before to define the differencesin operative time, blood loss and time taken for critical surgical steps during the procedures. Mean time of operation was 112.8min±14.5 (range 45-210min). Mean estimated blood loss was 54.7mL±8.2 (range 20-100mL). The surgeon's subjective assessment of image quality, depth perception, operative strain, ease of intra-corporeal suturing, and knotting, and hand-eye coordination was considered as good in 100% of cases. Mean score of STAI-6 was 11.6±2.17 (range 10-22). Subgroup data analysis was all statistically better for 3D compared to 2D. The use of 3D systems in laparoscopic urologic procedures resulted in better image quality and better surgeon performance with lower stress.

Oncological and functional outcomes of 244 laparoscopic urological procedures: Cumhuriyet University experience

Objective: Presenting short-term oncological and functional outcomes of laparoscopic procedures performed in the past two years in the Urology Department of Cumhuriyet University Health Services Training and Research Hospital. Method: Clinical data of a total of 244 patients, including 13 pediatric patients, who underwent laparoscopic surgery between May 2015 and February 2018 were evaluated retrospectively. Results: Of the patients who underwent laparoscopic surgery, 139 (57%) were male and 105 (43%) were female, 13 (5%) were pediatric and the mean age of the patients was 52.6 ± 17.6 (1-83). Radical nephrectomy was performed in 47 patients, radical prostatectomy was performed in 46 patients, simple nephrectomy was performed in 37 patients, renal cyst excision was performed in 35 patients, partial nephrectomy was performed in 26 patients, dismembered pyeloplasty was performed in 25 patients 13 of whom were pediatric, adrenalectomy was performed in 15 patients, ureterolithotomy was performed in 8 patients, pyelolithotomy was performed in 2 patients, sacrocolpopexy was performed in 2 patients, and due to undescended testicle diagnosis, laparoscopy was performed in 1 patient. The mean duration of operation was 101.9 ± 62.7 (20-270) minutes and the mean amount of bleeding was found as 154.3 ± 138.7 (5-800) ml. Transperitoneal approach was preferred in all other cases except extraperitoneal radical prostatectomy. Blood transfusion was required in twenty-six cases, fourteen of which were laparoscopic radical prostatectomy in perioperative and / or postoperative periods. There was no need for initiating intraoperative open surgery except one case. In one case, laparotomy was required due to bleeding on the 4th postoperative day. In six cases, superficial wound site infection developed. The mean duration of postoperative hospitalization was 3.8 ± 2.7 days (1-8 days). The mean follow-up period of our patients was 16.5 (0-33) months. Conclusions: Laparoscopic urological surgeries are frequently preferred as minimally invasive procedures being technically well-defined, with good oncological and functional outcomes, as well as with short hospitalization periods and cosmetic advantages.

Complications of 411 laparoscopic urological procedures: A single surgeon experience.

Objectives:The aim of this study is to review the complications of laparoscopic urological procedures performed using a single surgeon during a 12-year period.Materials and Methods:From June 2004 to May 2017, a total of 411 abdominal urological procedures were performed using the author. They included 250 varicocele ligations, 94 nephrectomies (simple, partial, radical, and nephroureterectomy), 34 adrenalectomies, 22 renal cyst ablation, and 11 pelvic lymph node dissections. Operative and postoperative complications were reviewed and analyzed. The results were analyzed using Chi-squared tests for statistical analysis.Results:A total of 55 complications out of 411 procedures occurred in 26 patients with a total complication rate of 13.4%, 19 were major (4.6%), and 36 were minor (8.8%). Mortality occurred in two patients (0.5%). Conversion to open surgery was done in 5 patients (1.2%) to manage uncontrolled bleeding. Major intraoperative complications included vascular injuries (2.2%), injuries to the diaphragm (0.5%), bowel (0.7%), and pancreas (0.5%). Major postoperative complications included urine leak (0.2%) and pelvic lymphocele (0.2%). Minor intraoperative complications included bleeding during trocar access (4.4%) and subcutaneous emphysema (0.7%), whereas minor postoperative complications included atelectasis (1.2%) and ileus (2.2%).Conclusions:Even though the complications rate in this series was comparable to those of other studies in the literature, yet it remains higher than that of open surgery. The continuing advances in laparoscopic techniques will reduce the complication rate and will pave the way for laparoscopy to replace most currently practiced open surgical urological procedures.

Use of the radiofrequency Caiman® Aesculap® Grasper in three different laparoscopic urologic procedures with video

Use of the radiofrequency Caiman® Aesculap® Grasper in three different laparoscopic urologic procedures with video

Preliminary results of using a voice-controlled robotic camera driver during 3D laparoscopic radical prostatectomy.

IntroductionDuring laparoscopic procedures, the surgeon's control on target field visualization as well as optimal and steady vision can be achieved by using a camera holder. The article presents our preliminary experience with the use of a voice controlled robotic camera holder during 3D laparoscopic radical prostatectomy (3D LRP).Material and methodThirty patients were prospectively enrolled and underwent either 3D LRP with the use of a voice controlled robotic camera holder (study group) or 3D LRP with the surgeon holding the camera (control group). Oncological, demographic data and surgical parameters were evaluated.ResultsVoice-controlled 3D LPR produces a more stable visual field that subjectively decreases the surgeon's fatigue, enables precise preparation, especially along big vessels during lymphadenectomy, urethral stump preparation and urethro-vesical anastomosis. In the fifteen cases analyzed, voice-controlled 3D LRP saved 47 hours of surgeon's time.ConclusionsIn this study, the preliminary experience with a robotic arm for camera positioning revealed that the positioner is effective, easy to use and provides a steady and reliable visual field for laparoscopic urological procedures.