Safety and efficacy of inferoposterior access approach to the renal pedicle during transperitoneal laparoscopic radical nephrectomy: A retrospective comparative analysis at a single institution

2020 ◽  
pp. 205141582094553
Author(s):  
Xiao-Bao Cheng ◽  
Wayne Lam ◽  
Zhen-Quan Lu ◽  
Richard Lo
Keyword(s):  
Comparative Analysis ◽  
Radical Nephrectomy ◽  
Anterior Approach ◽  
Operative Time ◽  
Renal Vasculature ◽  
Safety And Efficacy ◽  
Laparoscopic Radical Nephrectomy ◽  
Renal Pedicle ◽  
Significant Difference ◽  
Approach Group

Purpose To assess the safety and efficacy of transperitoneal laparoscopic radical nephrectomy using an inferoposterior approach to the renal pedicle. Materials and methods A retrospective review of 89 patients who underwent transperitoneal laparoscopic radical nephrectomy by a single surgeon between June 2014 and December 2019 at a single urological unit was carried out. Access to the renal pedicle was via the inferoposterior approach in 48 cases (study group) and 41 were approached via the conventional anterior approach (control group). Patient demographics, intra-operative anatomical findings, and procedural details including operative time on renal pedicles and post-operative outcomes were recorded. Post-operative complications were recorded and classified according to the Clavien-Dindo classification. A comparative analysis between the two groups was performed using Chi-square test and t-test. Results The inferoposterior approach group had a shorter operative time (132.85±26.65 min vs 153.46±39.94 min; p<0.01), which could be attributed to the shorter time spent operating on the renal vasculature (46.31±6.16 min vs 64.46±7.64 min; p<0.01). Lower average blood loss was also observed in the inferoposterior approach group (42 ml vs 62 ml; p<0.05). No significant difference was identified concerning the mean patient age, body mass index, tumor size, number of renal vessels identified, and post-operative length of stay between the two groups. None of the patients required conversion to open. Conclusion Inferoposterior approach to access the renal pedicle during transperitoneal laparoscopic radical nephrectomy is a safe and effective technique, which shortens the operative time when compared to the conventional anterior approach. Level of evidence: Level 3b.

scholarly journals Superficial and Deep Infections Rate in Primary Total Ankle Replacement through Anterior Approach versus Lateral Transfibular Approach

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003 ◽  
Author(s):  
Federico Giuseppe Usuelli ◽  
Cristian Indino ◽  
Luigi Manzi ◽  
Camilla Maccario ◽  
Ettore Vulcano
Keyword(s):  
Anterior Approach ◽  
Operative Time ◽  
Deep Infection ◽  
Lateral Approach ◽  
Trabecular Metal ◽  
Ankle Replacement ◽  
Group A ◽  
Group B ◽  
Approach Group

Category: Ankle, Ankle Arthritis, Periprosthetic Infections Introduction/Purpose: Periprosthetic joint infections represent a relatively infrequent complication following total ankle replacement (TAR), with reported incidence ranging from 2% to 8,6%. Early treatment of any wound infection is the key to prevent disastrous outcomes. One of the most recent TARs (Zimmer Trabecular Metal Total Ankle, Zimmer Biomet, Warsaw, IN) requires implantation through a lateral transfibular approach. Potential advantages of this approach include the supposed decreased risk of wound complications, thanks to a preservation of the distal leg angiosomes. The purpose of this study is to retrospectively compare the rate of superficial and deep infections between TARs performed through an anterior approach and TARs performed through a lateral transfibular approach at 12-months follow-up. Methods: This study included 150 consecutive primary TARs performed between May 2011 and July 2015 with at least 1-year follow up. The 3-component uncemented Hintegra implant (Newdeal SA, Lyon, France) was used in 81 TARs (54.0%) through an anterior approach (group A). The 2-component uncemented Zimmer Trabecular Metal Total Ankle prosthesis, was implanted in 69 TARs (46.0%) through a lateral transfibular approach (Group B). Operative time, tourniquet time and superficial and deep infections were recorded up to 1-year follow-up. All patients were clinically and radiologically evaluated postoperatively at two, six and twelve months. Superficial wound infections were classified as dehiscence, eschar, or wound drainage according to criteria of the Centers for Disease Control and Prevention for surgical wound infection. Deep infections were classified according to Fitzgerald’s classification: acute postoperative, deep late infections, late hematogenous infections. We compared the incidence of superficial and deep infections as well as the operative time. Results: In group A there were 4 (4.9%) superficial infections. Two of these patients developed a deep infection. Overall, there were 3 (3.7%) deep infections in group A that required: intravenous antibiotics and vacuum assisted closure; replacement of the tibial component and polyethylene liner; polyethylene exchange and VAC treatment. In group B, there were 2 (2.9%) superficial infections. One of these patients developed the only deep infection (1.4%) that was treated with antibiotic-impregnated cement spacer. There was no statistically significant difference in terms of superficial (P= 0.687) and deep infections (P= 0.625). The mean operative time in group A was 115.2 minutes (65-150) and 179.5 minutes (105-333) in group B. Operative time was statistically different between group A and group B (P <0.001). Conclusion: This study demonstrates a lower superficial and deep infection rate in the lateral transfibular approach group compared to the anterior approach group. Nonetheless, this difference was not statistically significant. The significantly longer operative time in the lateral approach group did not seem to affect the infection rates. In conclusion, TARs performed through a lateral approach appear to be as safe as TARs done through an anterior approach in terms of the infection rate within the first postoperative year. Further studies on larger cohorts and longer follow-up are essential to validate the findings from this study.

Safety and Efficacy of Laparoscopic Liver Resection for Colorectal Liver Metastasis With Obesity

2020 ◽  
pp. 000313482095244
Author(s):  
Yoshihiro Inoue ◽  
Masatsugu Ishii ◽  
Kensuke Fujii ◽  
Kentaro Nihei ◽  
Yusuke Suzuki ◽  
...  
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Laparoscopic Liver Resection ◽  
Operative Time ◽  
Surgical Site Infections ◽  
Obese Patients ◽  
Visceral Fat Area ◽  
Safety And Efficacy ◽  
Estimated Blood Loss ◽  
Significant Difference

Introduction Laparoscopic liver resection (LLR) in obese patients has been reported to be particularly challenging owing to technical difficulties and various comorbidities. Methods The safety and efficacy outcomes in 314 patients who underwent laparoscopic or open nonanatomical liver resection for colorectal liver metastases (CRLM) were analyzed retrospectively with respect to the patients’ body mass index (BMI) and visceral fat area (VFA). Results Two hundred and four patients underwent LLR, and 110 patients underwent open liver resection (OLR). The rate of conversion from LLR to OLR was 4.4%, with no significant difference between the BMI and VFA groups ( P = .647 and .136, respectively). In addition, there were no significant differences in terms of operative time and estimated blood loss in LLR ( P = .226 and .368; .772 and .489, respectively). The incidence of Clavien-Dindo grade IIIa or higher complications was not significantly different between the BMI and VFA groups of LLR ( P = .877 and .726, respectively). In obese patients, the operative time and estimated blood loss were significantly shorter and lower, respectively, in LLR than in OLR ( P = .003 and < .001; < .001 and < .001, respectively). There was a significant difference in the incidence of postoperative complications, organ/space surgical site infections, and postoperative bile leakage between the LLR and OLR groups ( P = .017, < .001, and < .001, respectively). Conclusion LLR for obese patients with CRLM can be performed safely using various surgical devices with no major difference in outcomes compared to those in nonobese patients. Moreover, LLR has better safety outcomes than OLR in obese patients.

scholarly journals Middle calyx access in complete supine percutaneous nephrolithotomy

2013 ◽  
Vol 7 (5-6) ◽  
pp. 306 ◽  
Author(s):  
Siavash Falahatkar ◽  
Ehsan Kazemnezhad ◽  
Keivan Gholamjani Moghaddam ◽  
Majid Kazemzadeh ◽  
Ahmad Asadollahzade ◽  
...  
Keyword(s):  
Operative Time ◽  
P Value ◽  
Inclusion Criteria ◽  
Renal Anomalies ◽  
Safety And Efficacy ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Hemoglobin Drop ◽  
Free Rate ◽  
Staghorn Stones

Background: Middle calyx access has been underused in percutaneousnephrolithotomy (PCNL), especially in the supine position.We compared the safety and efficacy outcomes between middlecalyx and lower calyx accesses in the complete supine PCNL in anon-randomized single-surgeon clinical study.Methods: Between February 2008 and October 2011, 170 patientsunderwent posterior subcostal single tract complete supine PCNLwith one-shot dilation and middle calyx (n = 48) and lower calyx(n = 122) accesses. Stone location and surgeon decision determinedtarget calyx for access. Inclusion criteria were pelvis stones,staghorn stones and multiple location stones. Exclusion criteriawere renal anomalies, only upper calyx stones, only middle calyxstones and only lower calyx stones. Important parameters werecompared between the two groups. A p value of <0.05 was consideredsignificant.Results: Two groups were similar in important patient- and stonerelatedparameters. Mean operative time (60.7 minutes), meanpostoperative hospital stay (1.84 days) and mean hemoglobin drop(0.67 g/dL) in the middle calyx group were significantly lesser thanin the lower calyx group (80.1 minutes, 2.19 days, 1.36 g/dL). Themiddle calyx group (89.6%; 79.6%) had a higher stone-free rate(p = 0.054) and efficiency quotient than the lower calyx group(76.2%; 61.6%). In the middle calyx group (10.4%; 2.1%), complicationand transfusion rates were lesser (p > 0.05) than lowercalyx group (14.8%; 7.4%). No significant difference (p = 0.40)was seen between two groups using the modified Clavien classificationof complications.Interpretation: Middle calyx can be an optimal access in PCNLwith the complete supine position for many of upper urinary tractstones due to its superior outcomes.

Transperitoneal Laparoscopic Radical Nephrectomy for a 12 cm Renal Mass

2009 ◽  
Vol 76 (2) ◽  
pp. 150-152
Author(s):  
P. Parma ◽  
A. Samuelli ◽  
S. Guatelli ◽  
M. Luciano ◽  
B. Dall'Oglio ◽  
...  
Keyword(s):  
Radical Nephrectomy ◽  
Renal Mass ◽  
Renal Carcinoma ◽  
Operative Time ◽  
Standard Of Care ◽  
Laparoscopic Technique ◽  
Laparoscopic Radical Nephrectomy ◽  
Nephron Sparing ◽  
Operative Complications ◽  
The Right

Laparoscopic radical nephrectomy is now considered a standard of care for patients with T1 renal carcinoma not suitable for nephron-sparing surgery. In the hands of experienced laparoscopic urological surgeons also T2 renal cell carcinoma can be approached through the laparoscopic technique. We present the video of a radical laparoscopic nephrectomy in a patient with a 12cm renal mass of the right kidney. We chose the transperitoneal approach; the operative time was 240 minutes. There were neither intra- nor post-operative complications. The patient was discharged at day 4 postoperatively.

Posterior approach for accessory-suprascapular nerve transfer: an electrophysiological outcomes study

2012 ◽  
Vol 38 (3) ◽  
pp. 242-247 ◽  
Author(s):  
J. Rui ◽  
X. Zhao ◽  
Y. Zhu ◽  
Y. Gu ◽  
J. Lao
Keyword(s):  
Anterior Approach ◽  
Posterior Approach ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Significant Difference ◽  
Potential Alternative ◽  
Motor Unit Action ◽  
Low Incidence ◽  
Electrophysiological Examination ◽  
Approach Group

The aim of this study was to retrospectively investigate the electrophysiological results obtained after employing the posterior approach for spinal accessory nerve-suprascapular nerve (SAN-SSN) transfer, and to compare this with the traditional anterior approach. SAN-SSN transfer was performed in 74 patients with brachial plexus injury. The posterior approach was used in 35 patients and the anterior approach was used in 39 patients. Electrophysiological examination was conducted and analyzed postoperatively. There was no significant difference between approaches in the time it took for the infraspinatus to show low-incidence motor unit action potentials (MUAPs) and an incomplete interference pattern. In addition, the final ratio of patients that showed regeneration potential of the infraspinatus was not significantly different between the approaches. Furthermore, latency and wave amplitude showed a linear regression with post-operative time in the posterior approach group. In the posterior approach group, the final abduction of the shoulder was positively correlated with the amplitude. The posterior approach for SAN-SSN is an effective potential alternative technique that may be appropriate for some clinical situations.

Safety and Efficacy of Laparoscopic Radical Nephrectomy with Manual Specimen Morcellation for Stage cT1 Renal-Cell Carcinoma

2008 ◽  
Vol 22 (6) ◽  
pp. 1257-1260 ◽  
Author(s):  
O. A. Lesani ◽  
Lee C. Zhao ◽  
Justin Han ◽  
Onisuru Okotie ◽  
Naresh V. Desireddi ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Safety And Efficacy ◽  
Laparoscopic Radical Nephrectomy
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