Laparoscopic Heminephrectomy of a Horseshoe Kidney

These authors suggest that laparoscopic heminephrectomy is a feasible option in the surgical management of diseases of the horseshoe kidney and can be performed safely using a transperitoneal or retroperitoneal approach

Incremento del IVA a telefonía móvil

El pasado primero de marzo de 2012, el presidente de la Asociación de la Industria Móvil de Colombia Asomóvil, Rodrigo Lara Restrepo, explicó que las empresas que prestan servicios de telefonía móvil en Colombia, permanecen a la espera de la publicación de la sentencia por parte de la Corte Constitucional, la cual reduciría 4 puntos del IVA al servicio de telefonía celular y pasaría del 20% a la tarifa general. Este impuesto había sido incrementado Mediante la Ley No. 788 del 27 de diciembre de 2002, la cual expide normas en materia tributaria y penal del orden nacional y territorial, en su artículo No. 35, parágrafo 2, la cual se incluye un aumento en el impuesto al valor agregado aplicado a la telefonía celular, la cual pasa del 16% al 20% y comienza a regir a partir del 1º de enero de 2003.Pregrad

Diagnostic accuracy of image guided biopsies in small (<4cm) renal masses with implications for active surveillance:A systematic review of the evidence

The objective of this study was to determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only < 4cm using a 3 x 2 table intention-to-diagnose approach. The 3 x 2 table approach examines indeterminate results as a separate category, rather than pushing these through traditional a 2 x 2 table (four-cell matrix) approach. A highly sensitive search was performed in the Cochrane Library Database of Abstracts of Reviews of Effects, MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966 to 2016). The search sought the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM < 4cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using a conventional 2 x 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 x 2 table for pooled estimates of the sensitivity and specificity. A total of twenty studies were included, with a total sample size of 974. The pooled estimates for sensitivity and specificity of RTB based upon univariate analysis using a 2 x 2 table observed sensitivity 0.952 (confidence interval (CI) 0.908-0.979) and specificity 0.824 (CI 0.566-0.962). Using the 3 x 2 table and intention-to-diagnose principle, sensitivity 0.947 (CI 0.925-0.965) and specificity 0.609 (CI 0.385-0.803) decreased. In conclusion, renal tumour biopsy in SRMs < 4cm is associated with a high diagnostic sensitivity, but poor specificity when non-diagnostic results are included by a 3 x 2 table for analysis (intention-to-diagnose approach). The risk of non-diagnostic results and poor quality of research need addressing through future studies, preferably by a well-designed prospective study, appropriately powered for diagnostic accuracy using valid reference standards

Global Assessment of Urological Endoscopic Skills (GAUES):development and validation of a novel assessment tool to evaluate endourological skills

Objective: To develop and evaluate an assessment tool for endourological skills during simulation including cystoscopy, ureteroscopy (URS) and transurethral resection (TUR) procedures. Methods: We designed a Global Assessment of Urological Endoscopic Skills (GAUES) tool, comprised of nine endourology task-specific and two global-rating skills items. The tool was developed through two rounds of the Delphi process. The GAUES tool was used to assess acquisition of URS and TUR skills of novices (Year 2 core surgical trainees, CT2) and intermediate level trainees (residents at the start of the UK higher surgical training programme in Urology, Speciality Trainee Year 3, ST3) at the Urology Simulation Boot Camp (USBC) between 2016 and 2018. Validity was evaluated by comparing scores between trainees with different levels of urological experience. Inter-rater reliability was also assessed. Results: We evaluated 130 residents, 52% of trainees were at an intermediate stage of training and 39% were novices. In all, 9% of the anonymous forms were missing demographics. The completion rate of the GAUES tool during the USBC for URS and TUR was 85% and 89%, respectively. Our analysis demonstrated a significant difference in all domains between intermediates and novices at assessment in URS, except for one domain more suited to clinical assessment (P\ua0=\ua00.226). There was excellent intraclass correlation (ICC) overall between the two experts’ judgements, ICC\ua0=\ua00.841 (95% confidence interval 0.767–0.893; P\ua

Carcinoma in situ is significantly underdetected by prenephroureterectomy ureteroscopy in the management of upper tract urothelial cancers

Objective. Diagnostic reliability of prenephroureterectomy ureteroscopy (PNU) for the detection of upper tract carcinoma in situ (CIS) remains unproven in particular and underreported in general. Methods. Patients who underwent radical nephroureterectomy (RNU) in a large multicentre retrospective study for upper tract transitional cell carcinoma (UT-TCC) between January 2002 and December 2013 were identified from our hospitals databases. PNU appearances, stage, and grade of ureteroscopic biopsy were compared with final histology results of RNU to assess the diagnostic reliability of PNU for carcinoma in situ (CIS). Results. Three hundred patients underwent RNU for UT-TCC. 106 (106/300; 35.3%) of the cohort had PNU using white light with biopsies taken in most (92/106; 86.7%). Postnephroureterectomy histology of the cohort showed CIS in 65 (65/300; 21.6%) patients. Thirty nine of patients with CIS (39/65; 60%) had prenephroureterectomy ureteroscopy biopsies. Out of ten patients with CIS on ureteroscopic biopsies, six did not show CIS on final histopathology (6/10; 60%). Moreover, grading and staging on PNU biopsies of obvious tumours showed a significant nonconcordance with final histopathology of RNU specimen (P=0.02). Overall survival was also shorter in patients with CIS compared with those without; this showed strong statistical significance (P=0.004). Conclusions. There is a high incidence of CIS in upper tract with significant underdetection and discordance rate between the histopathology of biopsy samples obtained by white light PNU and resected specimen of radical nephroureterectomy. The presence of concomitant CIS and high stage disease in the upper tract TCC carried a poor prognosis following radical nephroureterectomy

Innovation in gastrointestinal surgery: the evolution of minimally invasive surgery—a narrative review

Background Minimally invasive (MI) surgery has revolutionised surgery, becoming the standard of care in many countries around the globe. Observed benefits over traditional open surgery include reduced pain, shorter hospital stay, and decreased recovery time. Gastrointestinal surgery in particular was an early adaptor to both laparoscopic and robotic surgery. Within this review, we provide a comprehensive overview of the evolution of minimally invasive gastrointestinal surgery and a critical outlook on the evidence surrounding its effectiveness and safety. Methods A literature review was conducted to identify relevant articles for the topic of this review. The literature search was performed using Medical Subject Heading terms on PubMed. The methodology for evidence synthesis was in line with the four steps for narrative reviews outlined in current literature. The key words used were minimally invasive, robotic, laparoscopic colorectal, colon, rectal surgery. Conclusion The introduction of minimally surgery has revolutionised patient care. Despite the evidence supporting this technique in gastrointestinal surgery, several controversies remain. Here we discuss some of them; the lack of high level evidence regarding the oncological outcomes of TaTME and lack of supporting evidence for robotic colorectalrectal surgery and upper GI surgery. These controversies open pathways for future research opportunities with RCTs focusing on comparing robotic to laparoscopic with different primary outcomes including ergonomics and surgeon comfort