Endoscopic enucleation of the prostate with Thulium Fiber Laser (ThuFLEP). A retrospective single-center study

Purpose: The aim of the present, retrospective study was to describe our initial experience and early outcomes of Thulium Fiber Laser enucleation of the prostate (ThuFLEP) with the use of the FiberDust™ (Quanta System, Samarate, Italy) in patients with benign prostate hyperplasia. Methods: From June 2022 to April 2023, all patients who underwent endoscopic enucleation of the prostate at Urology Department of the University Hospital of Patras were included. A single surgeon utilizing the same standardized operative technique performed all the surgeries. The primary endpoints included the uneventful completion of the operation, the surgical time and any minor or major complication observed intra- or post-operatively. Results: Twenty patients with benign prostate hyperplasia were treated with ThuFLEP. All the surgeries were completed successfully and uneventfully. The enucleation phase of the operation was completed in a mean time of 45 ± 9.1 min, while the average time needed for the morcellation was 17.65 ± 3.42 min. No significant complications were observed intra- or post-operatively. The average hemoglobin drop was calculated to be 0.94 ± 0.71 g/dL. Conclusions: All the operations were successfully and efficiently completed with the use of the FiberDust™ (Quanta System, Samarate, Italy) in ThuFLEP. Significant blood loss or major complications were not observed

Feasibility study of a novel robotic system for transperitoneal partial nephrectomy: An in vivo experimental animal study

Purpose: To evaluate the safety and feasibility of partial nephrectomy with the use of the novel robotic system in an in vivo animal model. Methods: Right partial nephrectomy was performed in female pigs by a surgical team consisting of one surgeon and one bedside assistant. Both were experienced in laparoscopic surgery and trained in the use of the novel robotic system. The partial nephrectomies were performed using four trocars (three trocars for the robotic arms and one as an assistant trocar). The completion of the operations, set-up time, operation time, warm ischemia time (WIT) and complication events were recorded. The decrease in all variables between the first and last operation was calculated. Results: In total, eight partial nephrectomies were performed in eight female pigs. All operations were successfully completed. The median set-up time was 19.5 (range, 15-30) minutes, while the estimated median operative time was 80.5 minutes (range, 59-114). The median WIT was 23.5 minutes (range, 17-32) and intra- or postoperative complications were not observed. All variables decreased in consecutive operations. More precisely, the decrease in the set-up time was calculated to 15 minutes between the first and third attempts. The operative time was reduced by 55 minutes between the first and last operation, while the WIT was decreased by 15 minutes during the consecutive attempts. No complications were noticed in any operation. Conclusions: Using the newly introduced robotic system, all the advantages of robotic surgery are optimized and incorporated, and partial nephrectomies can be performed in a safe and effective manner

The effect of permissive hypotension in combined traumatic brain injury and blunt abdominal trauma: an experimental study in swines

BACKGROUND. Optimal hemodynamic resuscitation strategy of the trauma patient with uncontrolled hemorrhage and severe head injury in the pre-hospital setting remains a special challenge. Permissive hypotension prior to definite surgical hemostasis promotes coagulation, decreases blood loss and favors survival. However hypotension is associated with poor outcome in severe head injury. The purpose of this experimental animal study was to assess the impact of permissive hypotension on survival, hemodynamic profile and brain oxygenation parameters before and/or after definite surgical haemostasis. MATERIALS AND METHODS. Six-week-old pigs (n=12) underwent general anesthesia and brain injury was produced by the fluid percussion model. Animals were instrumented to measure hemodynamic parameters and cerebral blood flow. All animals (n=12) were subjected to laparotomy and a surgical knot was placed through the abdominal aorta wall. Uncontrolled hemorrhage was simulated by pulling out the intentionally left protruding free ends of the suture (goal MAP=30 mmHg). Animals were randomly divided into two groups; group A (n=6) was subjected to aggressive fluid resuscitation (goal SAP>80 mmHg) and group B (n=6) was left hypotensive (permissive hypotension). Animals who survived one hour of hypotensive shock underwent definite surgical haemostasis and were resuscitated for one hour. We measured survival, hemodynamic and brain oxygenation parameters at different time points before and after surgical haemostasis. RESULTS. All animals from Group A and 50% from Group B died before surgical haemostasis. In surviving animals (Group B, 50%, p=0.033), MAP, CO, rCBF, SjO2 and AVDO2 were restored to pre-procedural levels. CONCLUSIONS. Permissive hypotension by delaying fluid resuscitation up to definite surgical haemostasis improves survival, hemodynamics and allows restoration of cerebral oxygenation in severe head injury.Εισαγωγή : Η ιδανική στρατηγική αναζωογόνησης ενός πολυτραυματία με ανεξέλεγκτη εσωτερική αιμορραγία και κρανιοεγκεφαλική κάκωση, κατά την προνοσοκομειακή περίοδο, αποτελεί μια πρόκληση. Η εφαρμογή της υποτασικής αναζωογόνησης πριν την χειρουργική αποκατάσταση της αιμορραγίας προάγει την πηκτικότητα, μειώνει την απώλεια αίματος και αυξάνει την επιβίωση. Η υπόταση από την άλλη πλευρά συνδέεται με κακή έκβαση στις κρανιοεγκεφαλικές κακώσεις. Ο σκοπός της παρούσας μελέτης είναι να αξιολογηθεί η επίδραση της υποτασικής αναζωογόνησης (επιτρεπόμενης υπότασης) στην επιβίωση, καθώς και στην αιμοδυναμική εικόνα και τις παραμέτρους οξυγόνωσης του εγκεφάλου πριν και μετά την χειρουργική αποκατάσταση της αιμορραγίας. Υλικό και μέθοδος . Σε (n=12) θηλυκούς χοίρους πραγματοποιήθηκε, υπό γενική αναισθησία, κρανιοεγκεφαλική κάκωση με βάση το μοντέλο πρόσκρουσης μέσω υγρού. Τα πειραματόζωα καθετηριάστηκαν για να μετρηθούν αιμοδυναμικές παράμετροι και η εγκεφαλική αιματική ροή. Σε όλα τα πειραματόζωα (n=12) πραγματοποιήθηκε λαπαροτομία και τοποθετήθηκε ένας χειρουργικός κόμπος ολικού πάχους στο πρόσθιο τοίχωμα της κοιλιακής αορτής. Η ανεξέλεγκτη αιμορραγία προκλήθηκε από την εκούσια έλξη των ελεύθερων άκρων των ραμμάτων του χειρουργικού κόμπου (στόχος MAP=30 mmHg). Τα πειραματόζωα χωρίστηκαν τυχαία σε δύο ομάδες ; ομάδα A (n=6) στην οποία εφαρμόστηκε επιθετική αναζωογόνηση με υγρά (στόχος SAP>80 mmHg) και ομάδα B (n=6) στην οποία δεν έγινε αναζωογόνηση (υποτασική αναζωογόνηση). Όσα πειραματόζωα επιβίωσαν ύστερα από μία ώρα αιμορραγικής καταπληξίας υποβλήθηκαν σε χειρουργική αιμόσταση και στην συνέχεια αναζωογονήθηκαν για μία ώρα. Μετρήσαμε την επιβίωση, αιμοδυναμικές παραμέτρους καθώς και παραμέτρους οξυγόνωσης του εγκεφάλου σε διαφορετικά χρονικά σημεία πριν και μετά την χειρουργική αιμόσταση. ΑΠΟΤΕΛΕΣΜΑΤΑ: όλα τα πειραματόζωα της ομάδας A και το 50% της ομάδας B πέθαναν πριν την χειρουργική αιμόσταση. Στην ομάδα των επιζώντων (ομάδα B, 50%, p=0.033), MAP, CO, rCBF, SjO2 και AVDO2 αποκαταστάθηκαν στα προ της κάκωσης επίπεδα. ΣΥΜΠΕΡΑΣΜΑΤΑ. Η υποτασική αναζωογόνηση και η καθυστερημένη αναζωογόνηση με υγρά, μέχρι την χειρουργική αποκατάσταση της αιμορραγίας, βελτιώνει την επιβίωση και την αιμοδυναμική εικόνα και επιτρέπει την αποκατάσταση της οξυγόνωσης του εγκεφάλου σε μια βαριά κρανιοεγκεφαλική κάκωση

Non-papillary percutaneous nephrolithotomy for treatment of staghorn stones

BACKGROUND: To evaluate the non-papillary puncture for Percutaneous Nephrolithotomy (PCNL) for the treatment of staghorn stones in terms of safety and efficacy.METHODS: Data of 53 patients undergoing PCNL for staghorn stones were retrospectively collected from January 2015 to December 2019. A non-papillary puncture was performed with a two- step track dilation technique up to 30Fr. A 26 Fr semirigid nephroscope and an ultrasonic lithotripter with integrated suction (Swiss Lithoclast master, EMS S.A, Switzerland) were used for the treatment. Demographics and perioperative data were retrospectively gathered from an institutional board approved database.RESULTS: The average stone size was 60.1±16.1 mm. Mean operative time was 54.57±14.83 minutes, while mean time using fluoroscopy was 2.67±1.02 minutes. Mean number of accesses was 1.2 (a total of 64 accesses). Flexible nephroscope was never used. Primary stone-free rate after PCNL was 81.1% (43 patients). Mean hemoglobin drop was 1.6±1.86 gr/dl. Overall patient stay was 3.94±0.82 days, while overall complication rate was 20.7% (11 patients), with only one patient requiring blood transfusion due to pseudoaneurysm.CONCLUSIONS: The use of non-papillary access for PCNL in the treatment of staghorn stones resulted in promising results in terms of stone-free rate, operating time, complication rate, hemoglobin drop and reduced the number of percutaneous tracts. These parameters of the current investigation were directly comparable to current literature. The safety and efficacy of a non-papillary approach for the treatment of staghorn stones could be advocated

Effect of patient positioning on anesthesiologic risk in endourological procedures

Objective: The objective is to compare supine and prone positions in terms of arterial blood gas during lithotripsy endourology procedures in different stages. Material and Methods: Cases of during lithotripsy endourology procedures in our department from March to September 2020 were included prospectively. The variables registered were body mass index, age, the American Society of Anesthesiologists (ASA) score, diabetes mellitus, positive end-expiratory pressure (PEEP), FiO2, stone size, stone location, procedural type, position, procedure duration, PaO2, SaO2, PaCO2, pH, and dynamic compliance. PaO2, SaO2, PaCO2, pH, and dynamic compliance were recorded at the beginning of the procedure, 5 min later, 15 min later, and at the end of the procedure. Results: Thirty patients in prone position and 30 in lithotomy position were included in this study. Patients in prone position underwent percutaneous nephrolithotomy, and patients in supine/lithotomy underwent retrograde intrarenal surgery or ureteroscopy. Statistically significant differences were found in PEEP, duration, PaO2 at the beginning, SaO2 at the beginning and at the end of the procedure, PaCO2 at the beginning and at minute 5 and pH at the beginning of the surgery. The saturation PaO2 increased significantly on prone position and was statistically significantly better at the end of the surgery. Conclusions: Both prone and supine positions were safe regarding anesthesiologic risk and had no clinically relevant differences in terms of individual comparisons in arterial blood gas parameters in static moments of the procedure. Prone position was related to an increase in PaO2 and a drop in PaCO2 gradually from the beginning to the end of the surgery