Avaliação das pieloplastias videolaparoscópicas realizadas pela técnica de Anderson-Hynes por residentes em um hospital escola do Sul do Brasil

Introdução: Diversas tecnologias foram introduzidas no tratamento da estenose de JUP nas últimas três décadas. No entanto, o princípio da pieloplastia desmembrada, apresentado por Anderson e Hynes, ainda é válido e amplamente utilizado. O conceito desta técnica cirúrgica foi incorporado com sucesso para a abordagem laparoscópica e posteriormente robótica. Até o momento, poucos estudos analisaram a pieloplastia desmembrada laparoscópica realizada por residentes e se é possível atingir proficiência na realização dessa técnica cirúrgica durante o período de formação. Objetivo: Analisar os desfechos das pieloplastias desmembradas laparoscópicas realizadas pelos residentes do último ano de um Serviço de Urologia. O objetivo principal foi avaliar o tempo cirúrgico, as taxas de conversão e de sucesso clínico, em pacientes com pelo menos 6 meses de seguimento. Método: Estudo transversal retrospectivo, com todos os pacientes com diagnóstico de estenose da JUP submetidos à pieloplastia laparoscópica. Foram revisados os prontuários dos pacientes operados entre maio de 2006 a junho de 2019 pelos residentes do terceiro ano. Para análise, foram divididos em 3 grupos de acordo com o quadrimestre do último ano de residência. As análises foram realizadas no software IBM SPSS Statistics v.25. O nível de significância adotado foi 0,05. As análises gráficas foram realizadas no Excel® 2013. Resultados: Foram analisados 124 pacientes, com idade média de 30,9 anos e seguimento médio de 29 meses (6-146). O tempo médio de internação foi de 4,79 dias (1-33). A maioria eram homens (n=72 - 58,1%), e em 60 casos (48,4%) havia a presença de vaso anômalo. O tempo operatório foi de 197,5 min, 188,5 min, 182,5 min, nos grupos 1, 2 e 3 respectivamente. A taxa de complicação pós-operatória foi de 12,09% (n=15), sendo que 7 pacientes (46,7%) apresentaram complicações importantes (IIIb e IVa de Clavien-Dindo). A taxa de conversão foi de 5,64% (n=7). A taxa de sucesso clínico foi de 92,7% (n=115). Entre os 9 (7,2%) pacientes que não apresentaram melhora clínica, dois (22,2%) necessitaram nova cirurgia. Conclusão: Mesmo quando realizada por urologistas em treinamento durante o período da residência, a pieloplastia desmembrada laparoscópica apresenta taxas de sucesso, de conversão e de complicações comparáveis às realizadas por grandes centros.Introduction: Several technologies have been introduced in the treatment of UPJ stenosis in the last three decades. However, the dismembered pyeloplasty principle, presented by Anderson and Hynes, is still valid and widely used. The concept of this surgical technique was successfully incorporated into the laparoscopic and subsequently robotic approaches. Until now, few studies have analyzed the laparoscopic dismembered pyeloplasty performed by residents and whether proficiency in performing this surgical technique can be achieved during the training period. Objective: To analyze the outcomes of laparoscopic dismembered pyeloplasty performed by senior residents of a Urology Service. The main objective was to evaluate surgical time, conversion rates and clinical success rates in patients with at least 6 months of follow-up. Materials and Methods: We performed a retrospective cross-sectional study with patients diagnosed with UPJ stenosis undergoing laparoscopic pyeloplasty. Medical records of all patients operated by fifth-year residents from May 2006 to June 2019 were reviewed. The patients were divided into 3 groups according to the 4-month period of the residency year. Analyzes were performed using IBM SPSS Statistics v.25 software. The significance level adopted was 0.05. Graphical analyses were performed in Excel® 2013. Results: A total of 124 patients were analyzed, with a mean age of 30.9 years and a mean follow-up of 29 months (6-146). The average length of stay was 4.79 days (1-33). Most patients were men (n = 72 - 58.1%), and in 60 cases (48.4%) there was an anomalous vessel. The operative time was 197.5 min, 188.5 min, 182.5 min, in groups 1, 2 and 3 respectively. The postoperative complication rate was 12.09% (n = 15), of which 7 patients (46.7%) had significant complications (Clavien-Dindo IIIb and IVa). The conversion rate was 5.64% (n = 7). The clinical success rate was 92.7% (n=115). Among the 9 (7.2%) patients who showed no clinical improvement, two (22.2%) required further surgery. Conclusion: Even when performed by urologists in training during the residency period, laparoscopic dismembered pyeloplasty has success, conversion, and complication rates comparable to those performed by large centers

Laparoscopic pyeloplasty proficiency during a residency program after adoption of a standardized simulation training program is maintained during the COVID pandemic despite reduced surgery volume

ABSTRACT Purpose: To evaluate the effect of the standardized laparoscopic simulation training program in pyeloplasty, following its implementation and during the COVID-19 pandemic. Material and Methods: A retrospective chart review was performed at Hospital de Clínicas de Porto Alegre, a tertiary referral center in south Brazil, in which 151 patients underwent laparoscopic pyeloplasty performed by residents between 2006-2021. They were divided into three groups: before and after adoption of a standardized laparoscopic simulation training program and during the COVID-19 pandemic. The main outcome was a combined negative outcome of conversion to open surgery, major postoperative complications (Clavien-Dindo III or higher) or unsuccessful procedure, defined as need for redo pyeloplasty. Results: There was a significant reduction in the combined negative outcome (21.1% vs 6.3%), surgical time (mean 200.0 min vs 177.4 min) and length of stay (median 5 days vs 3 days) after the adoption of simulation training program. These results were maintained during the COVID-19 pandemic (combined negative outcome of 6.3%, mean surgical time of 160.1 min and median length of stay of 3 days) despite a reduction in 55.4% of the surgical volume. Conclusion: A structured laparoscopic simulation program can improve outcomes of laparoscopic pyeloplasty during the learning curve

Avaliação das pieloplastias videolaparoscópicas realizadas pela técnica de Anderson-Hynes por residentes em um hospital escola do Sul do Brasil

Introdução: Diversas tecnologias foram introduzidas no tratamento da estenose de JUP nas últimas três décadas. No entanto, o princípio da pieloplastia desmembrada, apresentado por Anderson e Hynes, ainda é válido e amplamente utilizado. O conceito desta técnica cirúrgica foi incorporado com sucesso para a abordagem laparoscópica e posteriormente robótica. Até o momento, poucos estudos analisaram a pieloplastia desmembrada laparoscópica realizada por residentes e se é possível atingir proficiência na realização dessa técnica cirúrgica durante o período de formação. Objetivo: Analisar os desfechos das pieloplastias desmembradas laparoscópicas realizadas pelos residentes do último ano de um Serviço de Urologia. O objetivo principal foi avaliar o tempo cirúrgico, as taxas de conversão e de sucesso clínico, em pacientes com pelo menos 6 meses de seguimento. Método: Estudo transversal retrospectivo, com todos os pacientes com diagnóstico de estenose da JUP submetidos à pieloplastia laparoscópica. Foram revisados os prontuários dos pacientes operados entre maio de 2006 a junho de 2019 pelos residentes do terceiro ano. Para análise, foram divididos em 3 grupos de acordo com o quadrimestre do último ano de residência. As análises foram realizadas no software IBM SPSS Statistics v.25. O nível de significância adotado foi 0,05. As análises gráficas foram realizadas no Excel® 2013. Resultados: Foram analisados 124 pacientes, com idade média de 30,9 anos e seguimento médio de 29 meses (6-146). O tempo médio de internação foi de 4,79 dias (1-33). A maioria eram homens (n=72 - 58,1%), e em 60 casos (48,4%) havia a presença de vaso anômalo. O tempo operatório foi de 197,5 min, 188,5 min, 182,5 min, nos grupos 1, 2 e 3 respectivamente. A taxa de complicação pós-operatória foi de 12,09% (n=15), sendo que 7 pacientes (46,7%) apresentaram complicações importantes (IIIb e IVa de Clavien-Dindo). A taxa de conversão foi de 5,64% (n=7). A taxa de sucesso clínico foi de 92,7% (n=115). Entre os 9 (7,2%) pacientes que não apresentaram melhora clínica, dois (22,2%) necessitaram nova cirurgia. Conclusão: Mesmo quando realizada por urologistas em treinamento durante o período da residência, a pieloplastia desmembrada laparoscópica apresenta taxas de sucesso, de conversão e de complicações comparáveis às realizadas por grandes centros.Introduction: Several technologies have been introduced in the treatment of UPJ stenosis in the last three decades. However, the dismembered pyeloplasty principle, presented by Anderson and Hynes, is still valid and widely used. The concept of this surgical technique was successfully incorporated into the laparoscopic and subsequently robotic approaches. Until now, few studies have analyzed the laparoscopic dismembered pyeloplasty performed by residents and whether proficiency in performing this surgical technique can be achieved during the training period. Objective: To analyze the outcomes of laparoscopic dismembered pyeloplasty performed by senior residents of a Urology Service. The main objective was to evaluate surgical time, conversion rates and clinical success rates in patients with at least 6 months of follow-up. Materials and Methods: We performed a retrospective cross-sectional study with patients diagnosed with UPJ stenosis undergoing laparoscopic pyeloplasty. Medical records of all patients operated by fifth-year residents from May 2006 to June 2019 were reviewed. The patients were divided into 3 groups according to the 4-month period of the residency year. Analyzes were performed using IBM SPSS Statistics v.25 software. The significance level adopted was 0.05. Graphical analyses were performed in Excel® 2013. Results: A total of 124 patients were analyzed, with a mean age of 30.9 years and a mean follow-up of 29 months (6-146). The average length of stay was 4.79 days (1-33). Most patients were men (n = 72 - 58.1%), and in 60 cases (48.4%) there was an anomalous vessel. The operative time was 197.5 min, 188.5 min, 182.5 min, in groups 1, 2 and 3 respectively. The postoperative complication rate was 12.09% (n = 15), of which 7 patients (46.7%) had significant complications (Clavien-Dindo IIIb and IVa). The conversion rate was 5.64% (n = 7). The clinical success rate was 92.7% (n=115). Among the 9 (7.2%) patients who showed no clinical improvement, two (22.2%) required further surgery. Conclusion: Even when performed by urologists in training during the residency period, laparoscopic dismembered pyeloplasty has success, conversion, and complication rates comparable to those performed by large centers

Robotic assisted laparoscopic excision of a retroperitoneal Ganglioneuroma

ABSTRACT Introduction: Ganglioneuromas are rare benign neoplasms of the sympathetic nervous system. We describe the case of an incidentally found ganglioneuroma in a woman. To our knowledge this is the first described case of robotic excision of a retroperitoneal ganglioneuroma. Case: A 41-year-old female had an incidental retroperitoneal mass found during a routine US. CT scan and MRI showed an 8.3cm homogeneous mass, adjacent to left kidney upper pole, with peripheral contrast enhancement. Metabolic tests were normal. Patient was positioned in a left flank position and five ports were introduced transperitoneally. A 4-arm Da Vinci SI was docked at a 45° angle to the table. Lesion was dissected along with left adrenal gland, beginning at the left renal hilum and proceeding cephalad. Results: Operating time was 325min and blood loss was 50ml. Patient was discharged after 72hours. There were no postoperative complications. Pathology showed ganglionic cells with neural tissue, and normal adrenal. Discussion: Ganglioneuromas rare benign tumors originating from neural crest and typically affect young adults. Most frequent locations are posterior mediastinum, retroperitoneum and adrenal gland. As in this case, ganglioneuromas are usually silent, slow growing tumors discovered incidentally or by mass effect. US and CT imaging may suggest the diagnosis while MRI findings can be specific for ganglioneuroma. Percutaneous biopsy is an option. Although benign, usually requires surgical excision for treatment. Conclusions: Our case shows that a robotic approach is feasible and allows for meticulous and safe dissection of vascular structures, facilitating adequate hemostasis while maintaining oncological principles

Step by step male to female transsexual surgery

ABSTRACT Introduction After the diagnosis of transsexualism is confirmed therapy commences with psychotherapeutic preparation for the conversion, and after conversion, long-term patient rehabilitation is maintained for at least two years. The indication for surgery is chronic discomfort caused by discord with the patient's natural gender, intense dislike of developing secondary sex characteristics and the onset of puberty. The surgical conversion of transsexuals is the main step in the complex care of these problematic patients (1). This surgery was first described by Benjamin H, using a flap of inverted penile skin (2) and is considered the gold standard since then. Male-to-female transsexual surgical techniques are well defined and give good cosmetic and functional results. Sex reassignment surgery promotes the improvement of psychological aspects and social relationships as shown in the World Health Organization Quality of Life Assessment applied in the patients submitted to this procedure (3). Techniques include the creation of a normal appearing female introitus, a vaginoplasty allowing sexual intercourse and the capability of clitoral orgasm (4). Various methods for neovaginoplasty have been described and can be classified into five categories, i.e. pedicled intestinal transplants, penile skin grafts, penile skin flaps, non-genital skin flaps and non-genital skin grafts (5). In our Hospital, we use penile and scrotal skin flaps. Until now, 174 procedures have been performed by our team using this technique with high rates of satisfaction (3). Patients and methods We present a step-by-step male to female transsexual surgery. Conclusion Surgical gender reassignment of male transsexuals resulted in replicas of female genitalia which enabled coitus with orgasm (1). With this video we show step by step that a surgery using penile skin flaps is able to be performed with good cosmetic results