Potential risk and safety measures in laparoscopy in COVID-19 positive patients

Background. During the COVID-19 pandemic the question arises if laparoscopy, as an aerosol forming procedure, poses a potential risk for viral transmission of SARS-CoV-2 to healthcare workers. Methods. A literature search was conducted using PubMed, Embase and MEDLINE. Articles reporting information regarding COVID-19 or other relevant viruses and laparoscopy, surgical smoke, aerosols and viral transmission were included. Results. Although aerosols produced during laparoscopy do not originate from the respiratory tract, the main transmission route of SARS-CoV-2, research did show SARS-CoV-2 to be present in other body fluids. The transmission risk via this route is however considered very low. As previous research showed potential viral transmission during laparoscopy for viruses that spread through contaminated body fluids, there might be a potential risk of SARS-CoV-2 transmission during laparoscopy, albeit considered very small. Conclusion. Due to the small risk compared to widely known benefits of laparoscopy, there is no reason to replace laparoscopy by laparotomy due to COVID-19 infection. To avoid the potential small risk of viral transmission, additional safety measures are advised.Gynecolog

Small renal mass cryosurgery: Imaging and vascular changes

The combined use of a fluorescent casting technique, cryomicrotome imaging, and 3-D computer analysis as a new static method for visualizing and reconstructing the vascular anatomy in a porcine renal model was studied. The arterial blood supply in 3-D at a resolution of up to 50μm of the whole could be visualized. This method could be used to visualize the process following parenchymal cryoablation injury and establish a microvascular diameter threshold of 180μm for acute vascular damage. However, the branching structures of larger arteries remained anatomically intact. In an in vivo study we quantified temporary vascular changes after cryosurgery. Some anatomically arterial vessels were still present after 2 days but after one week the vascular structures in the ablation crater had disappeared completely. We investigated the impact of the RENAL and PADUA nephrometry indices on the assessment of intraoperative (IOC) and postoperative complications in patients with primary renal tumors treated with laparoscopic cryoablation (LCA). The domains "diameter" of both indices were significantly correlated with the risk for IOC. The threshold tumor diameter of 35mm was found to be predictive for an increased risk for IOC performing LCA. The observation that the standard follow-up, using contrast-enhanced computed tomography, in patients treated with cryoablation for a small renal mass runs the risk of jeopardizing the renal function led to the study of alternative imaging methods. The studies show that Contrast Enhanced UltraSonography can be used to describe the perfusion characteristics and 18F-FDG PET-CT could be used to discriminate for metabolic activity of cryoablation lesions

Holmium:YAG laser for treatment of strictures of vesicourethral anastomosis after radical prostatectomy.

Contains fulltext : 47725.pdf (publisher's version ) (Open Access)BACKGROUND AND PURPOSE: Strictures of the vesicourethral anastomosis (VUA) following radical prostatectomy tend to recur. We used the holmium:YAG laser for treatment of recurrent stricture of the VUA. We evaluated the technique and its efficacy. PATIENTS AND METHODS: In 10 patients, the Ho:YAG laser was used with a 365-mum fiber at a setting of 2 J and frequency 10 to 20 Hz, creating a deep incision of the scar tissue at the 6 o'clock position. This was followed by a vaporizing resection of the remaining scar tissue between 3 and 9 o'clock. We aimed to vaporize up to well-vascularized surrounding tissue. Retrospectively, the charts were reviewed for hospital stay, voiding complaints, recurrence of stenosis, complications, and flow rates. The mean follow-up was 18 months. RESULTS: There were no operative complications. After removal of the catheter, all patients could void without difficulty. No re-treatment was needed for recurrent stenosis. Any existing irritative voiding complaints or incontinence did not change after treatment. In all patients, the flow pattern improved: the mean maximum flow rate increased, and the mean postvoiding residual volume decreased. CONCLUSION: The Ho:YAG laser seems to be a safe and effective treatment for first or recurrent strictures of the VUA after radical prostatectomy

Ultrasonography of renal masses using contrast pulse sequence imaging : a pilot study

Background and Purpose: The use of contrast-enhanced ultrasonography for imaging of renal masses was first described in 1994. Since then, many new techniques for visualization of the effect of microbubble contrast agents have been developed. In this pilot study, a small number of patients was investigated with contrast pulse sequence imaging (CPS), and the characteristics of this perfusion imaging technique were evaluated subjectively and judged against the clinical diagnosis and histology findings when available. The purpose of this pilot study was to describe CPS imaging in several cases. Patients and Methods: Eighteen patients with 20 previously identified renal masses were examined with CPS. Perfusion imaging was compared with clinical diagnosis and with histologic findings when available. Results: Nineteen masses were visible. Various enhancement patterns could be observed, and interpretations of CPS characteristics are described. In carcinomas, inhomogeneous enhancement patterns were observed, and areas without enhancement inside the inhomogeneous lesions corresponded to necrotic areas in histologic specimens. All simple cysts and complex benign cysts showed absence of enhancement inside or in the wall of the lesion and a regular shape. Conclusion: To our knowledge, this is the first study in which the characteristics of CPS imaging of renal masses have been related to clinical diagnoses and histologic features. From the results of this pilot project, we conclude that CPS is a promising technique to determine perfusion patterns in the kidney

Cryotherapy for renal-cell cancer : diagnosis, treatment, and contrast-enhanced ultrasonography for follow-up

Cryotherapy is a curative treatment option for patients with small

Contrast-enhanced ultrasonography in the follow-up of cryoablation of renal tumours : a feasibility study

OBJECTIVE To determine whether evaluating perfusion patterns with contrast-enhanced ultrasonography using contrast-pulse sequence imaging (CPS; a new imaging method that enables selective visualization of perfusion) is possible at different times after cryoablation of renal tumours, and to describe the characteristics of CPS in a small group of patients. PATIENTS AND METHODS The efficacy of renal cryoablation is mainly judged using imaging. Seven randomly selected patients, each at a different time after laparoscopically assisted cryoablation of a renal tumour, were investigated with CPS and a microbubble-contrast agent. The perfusion characteristics in the lesions were scored by two investigators and described, and the lesions were measured. RESULTS In the seven patients treated with cryoablation for small renal tumours, eight CPS studies were performed. Five lesions showed no enhancement and one lesion, investigated 18 months after treatment was not recognized. In one patient, no enhancement was seen after 1 month but 7 months later, there were minimal contrast signals inside the treated area. The lesions could be measured with a mean standard deviation of 1.1 mm and a mean difference between the two investigators of 0.7 mm. CONCLUSION Our first experiences with CPS imaging for the follow-up of renal cryoablation show that this technique can be used to characterize perfusion defects at different times after cryoablation