BACKGROUND Complications associated with stomas—including parastomal hernia(PSH),pro-lapse,mucocutaneous separation,and stoma retraction—provide considerable postoperative challenges for colostomy patients.Selecting...BACKGROUND Complications associated with stomas—including parastomal hernia(PSH),pro-lapse,mucocutaneous separation,and stoma retraction—provide considerable postoperative challenges for colostomy patients.Selecting between extraperi-toneal colostomy(EPC)and transperitoneal colostomy(TPC)pathways is there-fore essential for mitigating these complications.AIM To analyze the existing data regarding the efficacy of EPC compared to TPC in reducing stoma-related complications post-colostomy.METHODS PubMed,Google Scholar,EMBASE,MEDLINE,and the Cochrane Library were adopted to uncover pertinent papers in which EPC and TPC approaches were compared.We then conducted a meta-analysis using RevMan 5.4.1.RESULTS Both laparoscopic(Lap)and open approaches showed a reduced incidence of PSH in EPC relative to TPC(P<0.00001 and P=0.02 respectively).In addition,Lap EPC depicted a lesser incidence of prolapse,mucocutaneous separation,and stoma retraction(P=0.007,P=0.03,and P=0.01,respectively)compared to Lap TPC.However,EPC and TPC did not differ with respect to operation time,blood loss,edema,ischemia,necrosis,or infection after the LAP approach.CONCLUSION The extraperitoneal approach may provide benefits in minimizing some stoma-related problems such as PSH,pro-lapse,mucocutaneous separation,and stoma retraction after colostomy surgery.展开更多
Approximately 5%of patients with renal cancer present with synchronous bilateral renal masses(SBRM).1,2 Bilateral renal tumors associated with hereditary syndromes often exhibit more aggressive biological behaviors co...Approximately 5%of patients with renal cancer present with synchronous bilateral renal masses(SBRM).1,2 Bilateral renal tumors associated with hereditary syndromes often exhibit more aggressive biological behaviors compared to sporadic SBRM cases.3,4 Notably,the prognosis for sporadic cases,in terms of cancerspecific and distant metastasis-free survival,is comparable to that of unilateral renal masses.展开更多
Objective To review published literatures comparing the safety and effectiveness of retroperitoneal laparoscopic partial nephrectomy(RLPN) with transperitoneal laparoscopic partial nephrectomy(TLPN) and provide refere...Objective To review published literatures comparing the safety and effectiveness of retroperitoneal laparoscopic partial nephrectomy(RLPN) with transperitoneal laparoscopic partial nephrectomy(TLPN) and provide reference for clinical work. Methods The search strategy was performed to identify relevant papers from the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, Google Scholar, China Hospital Knowledge Database, Wangfang Chinese Periodical Database, and VIP Chinese Periodical Database. All papers comparing RLPN with TLPN were included from 2000 to 2015. Two to three reviewers independently screened, evaluated, and extracted the included papers. A Meta-analysis was executed by using Review Manager 5.3 software. The interesting outcomes were tumor size, operating time, estimated blood loss, warm ischaemia time, length of hospital stay, positive margin rate, open conversion rate, overall complication rate, and recurrence rate. Results The literature search obtained 378 papers, then 10 of them were ultimately met the inclusion criteria and included in the systematic review. Finally, 6 of the 10 papers were included in the Meta-analysis. RLPN had significantly less operating time [P = 0.01, mean difference(MD)=-33.68, 95% confidence interval(CI) within(-60.35,-7.01)] and shorter length of hospital stay [P < 0.0001, MD=-1.47, 95% CI within(-2.18,-0.76)] than TLPN. Significant differences were not found between RLPN and TLPN in other outcomes. Conclusions RLPN may be equally safe and be faster than TLPN. Each center can choose a modality according to your own operating habits and experience.展开更多
BACKGROUND B-mode-ultrasound-guided percutaneous cholecystostomy(PC)may be performed by a transhepatic or transperitoneal approach,called percutaneous transhepatic gallbladder drainage(PHGD)and percutaneous transperit...BACKGROUND B-mode-ultrasound-guided percutaneous cholecystostomy(PC)may be performed by a transhepatic or transperitoneal approach,called percutaneous transhepatic gallbladder drainage(PHGD)and percutaneous transperitoneal gallbladder drainage(PPGD),respectively.We compared the impact of PC related to the route of catheter placement on subsequent laparoscopic cholecystectomy(LC).AIM To compare the impact of PC related to the route of catheter placement on subsequent LC.METHODS We retrospectively studied 103 patients with acute calculous cholecystitis who underwent scheduled LC after PC between January 2010 and January 2019.Group I included 58 patients who underwent scheduled LC after PHGD.Group II included 45 patients who underwent scheduled LC after PPGD.Clinical outcomes were analyzed according to each group.RESULTS Baseline demographic characteristics did not differ significantly between both groups(P>0.05).Both PHGD and PPGD were able to quickly resolve cholecystitis sepsis.Group I showed significantly higher efficacy than group II in terms of lower pain score during puncture(3.1 vs 4.5;P=0.001)and at 12 h follow-up(1.5 vs 2.2;P=0.001),lower rate of fever within 24 h after PC(13.8%vs 42.2%;P=0.001),shorted operation duration(118.3 vs 139.6 min;P=0.001),lower amount of intraoperative bleeding(72.1 vs 109.4 mL;P=0.001)and shorter length of hospital stay(14.3 d vs 18.0 d;P=0.001).However,group II had significantly lower rate of local bleeding at the PC site(2.2%vs 20.7%;P=0.005)and lower rate of severe adhesion(33.5%vs 55.2%;P=0.048).No significant differences were noted between both groups regarding the conversion rate to laparotomy,rate of subtotal cholecystectomy,complications and pathology.CONCLUSION B-mode-ultrasound-guided PHGD is superior to PPGD followed by LC for treatment of acute calculous cholecystitis,with shorter operating time,minimal amount of intraoperative bleeding and short length of hospital stay.展开更多
BACKGROUND Horseshoe kidney(HK)with renal stones is challenging for urologists.Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports,the therapeutic outcome ...BACKGROUND Horseshoe kidney(HK)with renal stones is challenging for urologists.Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports,the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.AIM To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.METHODS This was a retrospective study of 12 patients with HK and a limited number(n≤3)of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy(June 2012 to May 2019).The perioperative data of both groups were compared including operation time,estimated blood loss,postoperative fasting time,perioperative complications and stone-free rate(SFR).RESULTS No significant difference was observed for age,gender,preoperative symptoms,body mass index,preoperative infection,hydronephrosis degree,largest stone diameter,stone number and isthmus thickness.The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29±0.49 and 2.40±0.89 d,respectively(P=0.019).There was no significant difference in operation time(194.29±102.48 min vs 151.40±39.54 min,P=0.399),estimated blood loss(48.57±31.85 m L vs 72.00±41.47 m L,P=0.292)and length of hospital stay(12.14±2.61 d vs 12.40±3.21 d,P=0.881)between the retroperitoneal and transperitoneal groups.All patients in both groups had a complete SFR and postoperative renal function was within the normal range.The change in estimated glomerular filtration rate(e GFR)from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was-3.86±0.69 and-2.20±2.17 m L/(min·1.73 m2),respectively(P=0.176).From the preoperative stage to the 3-mo follow-up,the absolute change in e GFR values for patients in the retroperitoneal group and the transperitoneal group was-3.29±1.11 and-2.40±2.07 m L/(min·1.73 m2),respectively(P=0.581).CONCLUSION Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.展开更多
Recurrent thrombotic occlusions are one major problem in patients with thrombosis of the inferior vena cava. Due to this, we report a new surgical strategy for the construction of aorto-caval (mesenteric-caval) fistul...Recurrent thrombotic occlusions are one major problem in patients with thrombosis of the inferior vena cava. Due to this, we report a new surgical strategy for the construction of aorto-caval (mesenteric-caval) fistula in a patient with homozygous Antithrombin III (ATIII)-Deficiency. The patient survived postoperatively and only surgical complications grade I and II (Clavien-Dindo classification) were reported after short-term and one year follow-up. After one year, the CT-angiography did not show any caval thrombosis or stenosis and no restriction or occlusion of the fistula. Thus, the mesenteric-caval fistula could be safely performed and resulted in a satisfactory patency.展开更多
Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with ages ranging from 51 to 73 years fr...Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with ages ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg /L and展开更多
Background:Laparoscopic transperitoneal donor nephrectomy(LTDN)is currently the standard procedure for renal donation from living donors.Only a handful of clinical studies have compared the outcomes of retroperitoneos...Background:Laparoscopic transperitoneal donor nephrectomy(LTDN)is currently the standard procedure for renal donation from living donors.Only a handful of clinical studies have compared the outcomes of retroperitoneoscopic donor nephrectomy(RDN)and LTDN.More robust data and systematic comparative analyses of the outcomes and complications of these 2 techniques are needed.This study aimed to elucidate the noninferiority of RDN to LTDN.Materials and methods:All live renal donors who underwent either RDN or LTDN at our institution during the period of January 2015 to March 2021 were considered subjects,excluding those who refused to participate in the study.This was a bidirectional cohort study.Demographic and clinical data were collected and analyzed using standard statisticalmethods.Statistical significance was set at p<0.05.Results:Our study included 89 subjects:40 in the LTDN group and 49 in the RDN group.The RDN group had significantly shorter warm ischemia time(2.85 vs.6.04 minutes),a lower fall in hemoglobin on postoperative day(POD)-1(1.73 vs.2.24 g/dL),lower estimated blood loss(601.93 vs.797.27 mL),and lower pain on POD-1(0.78 vs.1.28).The improvement in recipient’s estimated glomerular filtration rate on POD-30 was significantly higher in the RDN group(79.98 vs.63.73 mL/min/1.73 m^(2)).There was a significantly higher fall in estimated glomerular filtration rate of donor after nephrectomy in RDN group on POD-30(35.53 vs.30.60 mL/min/1.73 m^(2)).However,there were no significant differences in other parameters.Conclusions:Our study,conducted in India,showed that themajority of RDN outcomes were better than those of LTDN.Hence,RDN is clearly non-inferior to the gold standard LTDN.A well-designed randomized controlled study is required to elucidate the statistical superiority of one approach over another.展开更多
The laparoscopic radical prostatectomy （LRP） is a developing technique for treatment of localizedprostate cancer, while the extraperitoneal approach has been highlighted recently.1 From May 2003 to April 2006, we pe...The laparoscopic radical prostatectomy （LRP） is a developing technique for treatment of localizedprostate cancer, while the extraperitoneal approach has been highlighted recently.1 From May 2003 to April 2006, we performed laparoscopic radical prostatectomy by transperitoneal or extraperitoneal approaches in 31 patients with localized prostate cancer. Some parameters of these patients are compared in this article.展开更多
Pyeloplasty is a standard therapy for ureteropelvic junction obstruction witha success rate of over 90% for all types of repair. In 1993 the first cases of laparoscopic repairof ureteropelvic junction obstruction via ...Pyeloplasty is a standard therapy for ureteropelvic junction obstruction witha success rate of over 90% for all types of repair. In 1993 the first cases of laparoscopic repairof ureteropelvic junction obstruction via the transperitoneal approach were described. In the lastfew decades open pyeloplasty has been a standard for surgical treatment with a long-term successrate of more than 90%. The results have shown the feasibility of Anderson-Hynes dismemberedpyeloplasty. In this report, we present our experience with transperitoneal laparoscopicdismembered pyeloplasty in 18 patients with ureteropelvic junction obstruction ( UP JO ) at ourhospital between October 2001 and October 2002. All the operations were successful and the resultssatisfactory.展开更多
AIM: To evaluate outcomes of robotic-assisted laparoscopic partial nephrectomy performed for posterior renal tumors via a transperitoneal or retroperitoneal approach.METHODS: Retrospective review was performed for pat...AIM: To evaluate outcomes of robotic-assisted laparoscopic partial nephrectomy performed for posterior renal tumors via a transperitoneal or retroperitoneal approach.METHODS: Retrospective review was performed for patients who underwent robotic-assisted laparoscopic partial nephrectomy(RALPN) for a posterior renal tumor between 2009-2015. Patient demographic characteristics, operative factors, pathology, oncologic outcomes, renal function, and tumor complexity were obtained. Radius of the tumor, exophytic/endophytic properties of the tumor, nearness of tumor to the collecting system, anterior/posterior position, location relative to the polar line(RENAL) nephrometry scores were calculated. nephrometry scores were calculated. The operative approach was determined by the primary surgeon. RESULTS: A total of 91 patients were identified who underwent RALPN for a posterior renal tumor. Fifty-four procedures were performed via the retroperitoneal(RP) approach, and 37 via the transperitoneal(TP) approach. There were no significant differences in patient factors(race, sex, age and body mass index), RENAL nephrometry scores, tumor size, conversion rates, or margin status. Among procedures performed on-clamp, therewas no significant difference in warm ischemia times. Total operative time(180.7 min for RP vs 227.8 min for TP, P < 0.001), robotic console time(126.9 min for RP vs 164.3 min for TP, P < 0.001), and median estimated blood loss(32.5 m L for RP vs 150 mL for TP, P < 0.001) were significantly lower via the RP approach. Off-clamp RALPN was performed for 31(57.4%) of RP procedures vs 9(24.3%) of TP procedures. Oncologic and renal functional outcomes were equivalent.CONCLUSION: The RP approach to RALPN for posterior renal tumors is superior with regard to operative time and blood loss and the ability to be performed off-clamp.展开更多
文摘BACKGROUND Complications associated with stomas—including parastomal hernia(PSH),pro-lapse,mucocutaneous separation,and stoma retraction—provide considerable postoperative challenges for colostomy patients.Selecting between extraperi-toneal colostomy(EPC)and transperitoneal colostomy(TPC)pathways is there-fore essential for mitigating these complications.AIM To analyze the existing data regarding the efficacy of EPC compared to TPC in reducing stoma-related complications post-colostomy.METHODS PubMed,Google Scholar,EMBASE,MEDLINE,and the Cochrane Library were adopted to uncover pertinent papers in which EPC and TPC approaches were compared.We then conducted a meta-analysis using RevMan 5.4.1.RESULTS Both laparoscopic(Lap)and open approaches showed a reduced incidence of PSH in EPC relative to TPC(P<0.00001 and P=0.02 respectively).In addition,Lap EPC depicted a lesser incidence of prolapse,mucocutaneous separation,and stoma retraction(P=0.007,P=0.03,and P=0.01,respectively)compared to Lap TPC.However,EPC and TPC did not differ with respect to operation time,blood loss,edema,ischemia,necrosis,or infection after the LAP approach.CONCLUSION The extraperitoneal approach may provide benefits in minimizing some stoma-related problems such as PSH,pro-lapse,mucocutaneous separation,and stoma retraction after colostomy surgery.
文摘Approximately 5%of patients with renal cancer present with synchronous bilateral renal masses(SBRM).1,2 Bilateral renal tumors associated with hereditary syndromes often exhibit more aggressive biological behaviors compared to sporadic SBRM cases.3,4 Notably,the prognosis for sporadic cases,in terms of cancerspecific and distant metastasis-free survival,is comparable to that of unilateral renal masses.
基金Supported by the Science and Technology Plans of Shaoxing Science and Technology Bureau,China(2010D10014)
文摘Objective To review published literatures comparing the safety and effectiveness of retroperitoneal laparoscopic partial nephrectomy(RLPN) with transperitoneal laparoscopic partial nephrectomy(TLPN) and provide reference for clinical work. Methods The search strategy was performed to identify relevant papers from the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, Google Scholar, China Hospital Knowledge Database, Wangfang Chinese Periodical Database, and VIP Chinese Periodical Database. All papers comparing RLPN with TLPN were included from 2000 to 2015. Two to three reviewers independently screened, evaluated, and extracted the included papers. A Meta-analysis was executed by using Review Manager 5.3 software. The interesting outcomes were tumor size, operating time, estimated blood loss, warm ischaemia time, length of hospital stay, positive margin rate, open conversion rate, overall complication rate, and recurrence rate. Results The literature search obtained 378 papers, then 10 of them were ultimately met the inclusion criteria and included in the systematic review. Finally, 6 of the 10 papers were included in the Meta-analysis. RLPN had significantly less operating time [P = 0.01, mean difference(MD)=-33.68, 95% confidence interval(CI) within(-60.35,-7.01)] and shorter length of hospital stay [P < 0.0001, MD=-1.47, 95% CI within(-2.18,-0.76)] than TLPN. Significant differences were not found between RLPN and TLPN in other outcomes. Conclusions RLPN may be equally safe and be faster than TLPN. Each center can choose a modality according to your own operating habits and experience.
文摘BACKGROUND B-mode-ultrasound-guided percutaneous cholecystostomy(PC)may be performed by a transhepatic or transperitoneal approach,called percutaneous transhepatic gallbladder drainage(PHGD)and percutaneous transperitoneal gallbladder drainage(PPGD),respectively.We compared the impact of PC related to the route of catheter placement on subsequent laparoscopic cholecystectomy(LC).AIM To compare the impact of PC related to the route of catheter placement on subsequent LC.METHODS We retrospectively studied 103 patients with acute calculous cholecystitis who underwent scheduled LC after PC between January 2010 and January 2019.Group I included 58 patients who underwent scheduled LC after PHGD.Group II included 45 patients who underwent scheduled LC after PPGD.Clinical outcomes were analyzed according to each group.RESULTS Baseline demographic characteristics did not differ significantly between both groups(P>0.05).Both PHGD and PPGD were able to quickly resolve cholecystitis sepsis.Group I showed significantly higher efficacy than group II in terms of lower pain score during puncture(3.1 vs 4.5;P=0.001)and at 12 h follow-up(1.5 vs 2.2;P=0.001),lower rate of fever within 24 h after PC(13.8%vs 42.2%;P=0.001),shorted operation duration(118.3 vs 139.6 min;P=0.001),lower amount of intraoperative bleeding(72.1 vs 109.4 mL;P=0.001)and shorter length of hospital stay(14.3 d vs 18.0 d;P=0.001).However,group II had significantly lower rate of local bleeding at the PC site(2.2%vs 20.7%;P=0.005)and lower rate of severe adhesion(33.5%vs 55.2%;P=0.048).No significant differences were noted between both groups regarding the conversion rate to laparotomy,rate of subtotal cholecystectomy,complications and pathology.CONCLUSION B-mode-ultrasound-guided PHGD is superior to PPGD followed by LC for treatment of acute calculous cholecystitis,with shorter operating time,minimal amount of intraoperative bleeding and short length of hospital stay.
基金the National Natural Science Foundation of China,No.81572507。
文摘BACKGROUND Horseshoe kidney(HK)with renal stones is challenging for urologists.Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports,the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.AIM To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.METHODS This was a retrospective study of 12 patients with HK and a limited number(n≤3)of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy(June 2012 to May 2019).The perioperative data of both groups were compared including operation time,estimated blood loss,postoperative fasting time,perioperative complications and stone-free rate(SFR).RESULTS No significant difference was observed for age,gender,preoperative symptoms,body mass index,preoperative infection,hydronephrosis degree,largest stone diameter,stone number and isthmus thickness.The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29±0.49 and 2.40±0.89 d,respectively(P=0.019).There was no significant difference in operation time(194.29±102.48 min vs 151.40±39.54 min,P=0.399),estimated blood loss(48.57±31.85 m L vs 72.00±41.47 m L,P=0.292)and length of hospital stay(12.14±2.61 d vs 12.40±3.21 d,P=0.881)between the retroperitoneal and transperitoneal groups.All patients in both groups had a complete SFR and postoperative renal function was within the normal range.The change in estimated glomerular filtration rate(e GFR)from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was-3.86±0.69 and-2.20±2.17 m L/(min·1.73 m2),respectively(P=0.176).From the preoperative stage to the 3-mo follow-up,the absolute change in e GFR values for patients in the retroperitoneal group and the transperitoneal group was-3.29±1.11 and-2.40±2.07 m L/(min·1.73 m2),respectively(P=0.581).CONCLUSION Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.
文摘Recurrent thrombotic occlusions are one major problem in patients with thrombosis of the inferior vena cava. Due to this, we report a new surgical strategy for the construction of aorto-caval (mesenteric-caval) fistula in a patient with homozygous Antithrombin III (ATIII)-Deficiency. The patient survived postoperatively and only surgical complications grade I and II (Clavien-Dindo classification) were reported after short-term and one year follow-up. After one year, the CT-angiography did not show any caval thrombosis or stenosis and no restriction or occlusion of the fistula. Thus, the mesenteric-caval fistula could be safely performed and resulted in a satisfactory patency.
文摘Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with ages ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg /L and
文摘Background:Laparoscopic transperitoneal donor nephrectomy(LTDN)is currently the standard procedure for renal donation from living donors.Only a handful of clinical studies have compared the outcomes of retroperitoneoscopic donor nephrectomy(RDN)and LTDN.More robust data and systematic comparative analyses of the outcomes and complications of these 2 techniques are needed.This study aimed to elucidate the noninferiority of RDN to LTDN.Materials and methods:All live renal donors who underwent either RDN or LTDN at our institution during the period of January 2015 to March 2021 were considered subjects,excluding those who refused to participate in the study.This was a bidirectional cohort study.Demographic and clinical data were collected and analyzed using standard statisticalmethods.Statistical significance was set at p<0.05.Results:Our study included 89 subjects:40 in the LTDN group and 49 in the RDN group.The RDN group had significantly shorter warm ischemia time(2.85 vs.6.04 minutes),a lower fall in hemoglobin on postoperative day(POD)-1(1.73 vs.2.24 g/dL),lower estimated blood loss(601.93 vs.797.27 mL),and lower pain on POD-1(0.78 vs.1.28).The improvement in recipient’s estimated glomerular filtration rate on POD-30 was significantly higher in the RDN group(79.98 vs.63.73 mL/min/1.73 m^(2)).There was a significantly higher fall in estimated glomerular filtration rate of donor after nephrectomy in RDN group on POD-30(35.53 vs.30.60 mL/min/1.73 m^(2)).However,there were no significant differences in other parameters.Conclusions:Our study,conducted in India,showed that themajority of RDN outcomes were better than those of LTDN.Hence,RDN is clearly non-inferior to the gold standard LTDN.A well-designed randomized controlled study is required to elucidate the statistical superiority of one approach over another.
文摘The laparoscopic radical prostatectomy （LRP） is a developing technique for treatment of localizedprostate cancer, while the extraperitoneal approach has been highlighted recently.1 From May 2003 to April 2006, we performed laparoscopic radical prostatectomy by transperitoneal or extraperitoneal approaches in 31 patients with localized prostate cancer. Some parameters of these patients are compared in this article.
文摘Pyeloplasty is a standard therapy for ureteropelvic junction obstruction witha success rate of over 90% for all types of repair. In 1993 the first cases of laparoscopic repairof ureteropelvic junction obstruction via the transperitoneal approach were described. In the lastfew decades open pyeloplasty has been a standard for surgical treatment with a long-term successrate of more than 90%. The results have shown the feasibility of Anderson-Hynes dismemberedpyeloplasty. In this report, we present our experience with transperitoneal laparoscopicdismembered pyeloplasty in 18 patients with ureteropelvic junction obstruction ( UP JO ) at ourhospital between October 2001 and October 2002. All the operations were successful and the resultssatisfactory.
文摘AIM: To evaluate outcomes of robotic-assisted laparoscopic partial nephrectomy performed for posterior renal tumors via a transperitoneal or retroperitoneal approach.METHODS: Retrospective review was performed for patients who underwent robotic-assisted laparoscopic partial nephrectomy(RALPN) for a posterior renal tumor between 2009-2015. Patient demographic characteristics, operative factors, pathology, oncologic outcomes, renal function, and tumor complexity were obtained. Radius of the tumor, exophytic/endophytic properties of the tumor, nearness of tumor to the collecting system, anterior/posterior position, location relative to the polar line(RENAL) nephrometry scores were calculated. nephrometry scores were calculated. The operative approach was determined by the primary surgeon. RESULTS: A total of 91 patients were identified who underwent RALPN for a posterior renal tumor. Fifty-four procedures were performed via the retroperitoneal(RP) approach, and 37 via the transperitoneal(TP) approach. There were no significant differences in patient factors(race, sex, age and body mass index), RENAL nephrometry scores, tumor size, conversion rates, or margin status. Among procedures performed on-clamp, therewas no significant difference in warm ischemia times. Total operative time(180.7 min for RP vs 227.8 min for TP, P < 0.001), robotic console time(126.9 min for RP vs 164.3 min for TP, P < 0.001), and median estimated blood loss(32.5 m L for RP vs 150 mL for TP, P < 0.001) were significantly lower via the RP approach. Off-clamp RALPN was performed for 31(57.4%) of RP procedures vs 9(24.3%) of TP procedures. Oncologic and renal functional outcomes were equivalent.CONCLUSION: The RP approach to RALPN for posterior renal tumors is superior with regard to operative time and blood loss and the ability to be performed off-clamp.
