Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus.

Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure.

Minimally invasive treatment of vesicourethral leak after laparoscopic radical prostatectomy.

Objective: to describe our experience with a minimally invasive approach for persistent vesicourethral anastomotic leak (PVAL) after Laparoscopic Radical Prostatectomy (LRP).

Methods: from 2004 to 2011, two surgeons performed LRP in 620 patients. Ten patients had PVAL, with initially indicated conservative treatment, to no avail.

Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

Background: Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience.

Impact of a low-volume laparoscopic radical prostatectomy learning curve on perioperative outcomes: is it acceptable?

Objective: The reproducibility of high-volume published series of laparoscopic radical prostatectomy (LRP) is still debatable. Many questions about its implementation, safety, and number of procedures required to achieve competence and improvement of outcomes with the technique remain unclear, and a learning curve study is crucial to investigate the acceptable performance of this advanced, minimally invasive procedure.

Subjects And Methods: Between 2004 and 2011, 240 consecutive patients underwent an LRP performed by a single surgeon and were divided into the first, second, and third groups of 80 patients each.

Long-term outcome of laparoscopic pyeloplasty: multicentric comparative study of techniques and accesses.

Purpose: The aim of the present study was to analyze long-term follow up (18-108 months) of different techniques and routes for laparoscopic repair of uretero-pelvic junction obstruction comparing efficacy and results.

Materials And Methods: A retrospective analyses of 133 laparoscopic pyeloplasties in 132 patients (mean age 35 years) between August 1995 and November 2008 was performed. Transperitoneal route was performed in 114 patients, and retroperitoneal route was performed in 19 patients.

Laparoscopic partial nephrectomy in the presence of multiple renal arteries.

Objectives: As experience with laparoscopic partial nephrectomy (LPN) expands, inevitably tumor-bearing kidneys with anomalous renal vasculature will be subjected to LPN. We evaluated LPN in kidneys with multiple arteries and compared those outcomes with the LPN outcomes in patients with conventional renal arterial anatomy.

Methods: Since September 1999, we have performed LPN for tumors in 333 patients.

Stereological study of collagen and elastic system in the detrusor muscle of bladders from controls and patients with infravesical obstruction.

Objective: Compare detrusor muscle of normal and patients with infravesical obstruction, quantifying the collagen and elastic system fibers.

Materials And Methods: We studied samples taken from bladders of 10 patients whose ages ranged from 45 to 75 years (mean = 60 years), who underwent transvesical prostatectomy for treatment of BPH. Control material was composed of 10 vesical specimens, removed during autopsies performed in cadavers of accident victims, with ages between 18 and 35 years (mean = 26 years).

Energy sources for laparoscopic partial nephrectomy--critical appraisal.

Laparoscopic partial nephrectomy (LPN) has emerged as a viable alternative for the conventional open nephron-sparing surgery (NSS). So far, an adequate renal parenchymal cutting and hemostasis, as well as caliceal repair remains technically challenging. Numerous investigators have developed techniques using different energy sources to simplify the technically demanding LPN.

Laparoscopic surgery in urological oncology: brief overview.

The authors report the experience of a high-volume center with laparoscopic surgery in urological oncology, as well as a review of other relevant series. Laparoscopic outcomes in the treatment of adrenal, kidney, upper tract transitional cell carcinoma, bladder, prostate, and testicular malignancy are described in this review. Specific considerations as complications and port-site recurrence are also addressed.

Laparoscopic partial nephrectomy for centrally located renal tumors.

Purpose: LPN is frequently reserved for small, peripherally located tumors. Centrally located tumors typically require complex intracorporeal suturing and reconstruction with hilar clamping, which is a laparoscopically advanced maneuver given the constraints of renal ischemia. We retrospectively compared our experience with central vs peripheral tumors treated with LPN.

Use of titanium knot placement device (TK-5) to secure dorsal vein complex during laparoscopic radical prostatectomy and cystoprostatectomy.

Introduction: We evaluated the feasibility and describe the surgical technique of using the Ti-Knot device TK-5 to secure the dorsal vein complex (DVC) during 20 consecutive cases of laparoscopic radical prostatectomy and cystoprostatectomy.

Technical Considerations: Bloodless DVC ligation and transection was successfully achieved in 19 (95.03%) of 20 cases.

Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy.

Purpose: We report a prospective, randomized comparison of transperitoneal laparoscopic adrenalectomy (TLA) vs retroperitoneal laparoscopic adrenalectomy (RLA) for adrenal lesions with long-term followup.

Materials And Methods: Between December 1997 and November 1999, 57 consecutive eligible patients with surgical adrenal disease were prospectively randomized to undergo TLA (25) or RLA (32). Study exclusion criteria were patient age greater than 80 years, body mass index greater than 40, bilateral adrenalectomy and significant prior abdominal surgery in the quadrant of interest.

Outpatient laparoscopic pyeloplasty.

Objectives: To assess the feasibility of ambulatory laparoscopic pyeloplasty. Laparoscopic pyeloplasty aims to reproduce the excellent functional outcomes of open pyeloplasty while diminishing procedural morbidity.

Methods: Six patients fulfilled specific inclusion criteria for outpatient laparoscopic pyeloplasty: informed consent, body mass index of 40 kg/m2 or less, primary ureteropelvic junction obstruction, uncomplicated laparoscopic surgery completed by 12:00 pm, and postoperative pain control by oral analgesics.

Laparoscopic partial nephrectomy for cancer: techniques and outcomes.

Open partial nephrectomy is the gold standard nephron-sparing treatment for small renal tumors. Technical aspects of laparoscopic partial nephrectomy have evolved considerably, and the technique is approaching established status at our institution. Over the past 4 years, the senior author has performed more than 400 laparoscopic partial nephrectomies at the Cleveland Clinic.

Lateral pedicle control during laparoscopic radical prostatectomy: refined technique.

Objectives: To report a technique of lateral pedicle control during laparoscopic radical prostatectomy that completely eliminates any form of electrocautery, ultrasonic thermal energy, clips, or bioadhesives.

Methods: The technique was used in 25 men undergoing nerve-sparing laparoscopic radical prostatectomy. Our antegrade technique involves transient control of the lateral prostate pedicles with an atraumatic vascular bulldog clamp.

[Obstructive urinary symptoms associated with giant cyst of seminal vesicle].

Objective: Seminal vesicle cysts are rare diseases and frequently cause no symptoms. An acquired giant seminal vesicle cyst in a 73-year-old man is presented. Bladder outlet obstruction was the main complaint, mimicking that arising from the prostate.