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ABSTRACT Background Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is associated with significant morbidity and mortality. We present an alternative technique that preserves the complete mesenteric vascularization during the isolation of the intestinal segment used in ICUD, including distal vessels. This approach aims to minimize the risk of ischemia in both the ileal anastomosis and the isolated loop at the diversion site. Methods This cohort study included 31 patients, both male and female, who underwent RARC with ICUD from February 2018 to November 2023, performed by a single surgeon. Intraoperative and postoperative complications data were retrieved for analysis, employing our proposed mesentery-sparing technique in all cases. The primary endpoint was the incidence of intraoperative and postoperative complications directly attributable to the mesentery-sparing approach in ICUD. Secondary endpoints included other postoperative variables not directly related to mesentery preservation, such as the incidence of postoperative ileus requiring parenteral nutrition and the duration of hospitalization. Results None of the patients experienced intraoperative or postoperative complications directly related to mesentery-sparing, such as intestinal fistulae or internal hernias. The median duration of hospitalization was 6 days, and postoperative ileus necessitating total parenteral nutrition occurred in 19% of the patients. Minor complications (Clavien–Dindo grades I-II) accounted for 27.6% of the cases and major complications (grades III-V) accounted for 20.6%. Conclusion The mesentery-sparing technique outlined herein offers an alternative method for preserving the vascularization of intestinal segments and reducing the risk of intestinal complications in ICUD during RARC. Roboticassisted Robotic assisted (RARC (ICUD mortality vessels site 3 female 201 2023 surgeon analysis mesenterysparing sparing preservation mesenterysparing, sparing, hernias days 19 Clavien–Dindo ClavienDindo Clavien Dindo III I II I-II 276 27 27.6 IIIV V III-V 206 20 20.6% 202 1 2 27. 20.6 20.

https://doi.org/10.1590/s1677-5538.ibju.2024.0153

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer Longterm Long term VEIL (VEIL
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Tobias-Machado, Marcos

; Ornellas, Antonio A.

; Hidaka, Alexandre K.

; Medina, Luis G.

; Mattos, Pablo A. L.

; Besio, Ruben S.

; Abreu, Diego

; Castro, Pedro R.

; Nishimoto, Ricardo H.

; Astigueta, Juan

; Dourado, Aurus

; Machado, Roberto D.

; Magnabosco, Wesley J.

; Corona-Montes, Victor

; Villoldo, Gustavo M.

; Zampolli, Hamilton C.

; Taha, Anis

; Auad, Pericles R.

; Faria, Eliney F.

; Arantes, Paulo B. O.

; Tavares, Alessandro

; Nascimento, Francisco S. M. S.

; Brazão Jr., Eder S.

; Rocha, Maurício M.

; Costa, Walter H.

; Panico, Vinicius

; Reis, Leonardo O.

; Almeida-Carrera, Roberto J.

; Silva, Rafael C.

; Zequi, Stênio C.

; Calixto, José R. R.

; Sotelo, Rene

International braz j urol

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Oct 2023, Volumen 49 Nº 5 Paginas 580 - 589

Resumen: En | Texto: En | PDF: En

ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer. Objective VEIL. . (VEIL) Methods 2 CoalitionLatin Coalition Latin PeCLA PeC LA (PeC-LA technique intermediate/highrisk intermediatehighrisk intermediate/high risk intermediate high nonfixed non fixed diameter range Results 200 2020 5 4568 45 68 (45-68 old 9 60120. 60120 60 120 (60-120) 1 616. 616 6 16 (6-16) 157 15 7 15.7% 19 1.9 86 8 8. 48 4.8 respectively 267 26 26.7 nonpalpable 28 2.8 10y y 742 74 74.2 848 84 84.8% pN0 pN pN1 100 100% 824 82 82.4% 727 72 72.7 91 9.1% Conclusion morbidity noninvasive invasive biopsy nonbulky bulky (VEIL highrisk intermediatehigh 20 202 456 (45-6 6012 12 (60-120 61 (6-16 15.7 1. 4. 26. 2. 74. 84.8 82.4 72. 9.1 (45- 601 (60-12 (6-1 15. 84. 82. 9. (45 (60-1 (6- (4 (60- (6 ( (60

https://doi.org/10.1590/s1677-5538.ibju.2023.0065

Salvage Retzius sparing robotic assisted radical prostatectomy: the first brazilian experience
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Nunes-Silva, Igor

; Hidaka, Alexandre Kyoshi

; Monti, Carlos Roberto

; Tobias-Machado, Marcos

; Zampolli, Hamilton de Campos

International braz j urol

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Dic 2021, Volumen 47 Nº 6 Paginas 1279 - 1280

Resumen: En | Texto: En | PDF: En

ABSTRACT Introduction: Salvage Radical Prostatectomy after radiation therapy is challenging and associated with high rates of serious complications (1, 2). The novel Retzius-Sparing RARP (RS-RARP) approach has shown excellent continence outcomes (3, 4). Purpose: To describe step-by-step our Salvage Retzius-Sparing RARP (sRS-RARP) operative technique and report feasibility, safety and the preliminary oncological and continence outcomes in the post-radiation scenario. Materials and Methods: Twelve males presenting local prostate cancer recurrence after radiotherapy that underwent sRS-RARP were included. All patients performed preoperative multiparametric MRI and PSMA-PET. Surgical technique: 7cm peritoneum opening at Douglas pouch, Recto-prostatic space development, Seminal vesicles and vas deferens isolation and section, Extra-fascial dissection through peri-prostatic fat, Neurovascular bundle control, Bladder neck total preservation and opening, Anterior dissection at Santorini plexus plane, Apex dissection with urethra preservation and section, Prostate release, Vesicouretral modified Van Velthoveen anastomosis, Rocco Stitch, Oncological and continence outcomes reported with minimum 1-year follow-up. Results: Ten patients had previously received external beam radiation (EBR) whereas two received previous brachytherapy plus EBR. At 1, 3 and 12 months after surgery, 25%, 75% and 91.6% of the men used one safety pad or less, respectively. No major complications or blood transfusions were reported. Final pathology reported pT2b 41.6%, pT2c 33.3% and pT3a 25%, positive surgical margins 25%, positive lymph nodes were not found, biochemical recurrence 16.6%. Conclusion: Salvage Retzius-Sparing Robotic Assisted Radical Prostatectomy approach appears to be technically feasible and oncologically safe with potential to provide better continence outcomes.

https://doi.org/10.1590/s1677-5538.ibju.2021.0260 86 descargas

Role of salvage lymph node dissection in patients previously treated for prostate cancer: systematic review
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Fantin, João Paulo Pretti

; Furst, Maria Claudia Bicudo

; Tobias-Machado, Marcos

; Muller, Roberto Lodeiro

; Machado, Roberto Dias

; Santos, Alexandre Cesar

; Magnabosco, Wesley Justino

; Alcantara-Quispe, Cinthia

; Faria, Eliney Ferreira

International braz j urol

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Jun 2021, Volumen 47 Nº 3 Paginas 484 - 494

Resumen: En | Texto: En | PDF: En

ABSTRACT Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.

https://doi.org/10.1590/s1677-5538.ibju.2020.0051 450 descargas

Robotic parastomal hernia repair
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Tobias-Machado, Marcos

; Gomes, Daniel Coser

; Faria, Eliney Ferreira

; Zampolli, Hamilton de Campos

International braz j urol

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Mar 2021, Volumen 47 Nº 2 Paginas 857 - 858

Resumen: En | Texto: En | PDF: En

ABSTRACT Introduction and Objective: Annually, more than one hundred thousand new stomas are created in the United States and near 30-50% of those will develop parastomal hernia (1). Occasionally parastomal hernias may result in life threatening complications such as bowel obstruction or strangulation requiring urgent surgical intervention (2). The minimally invasive surgery for these hernias are preferred, specially when the primary case was either laparoscopic or robot-assisted. Our objective is to demonstrate a step-by-step robotic approach with and without mesh placement and their outcomes in two different scenarios: elective and emergency. Materials and Methods: We present two cases, a 56-year-old male with three years prior robot-assisted radical cystectomy with ileal conduit and a 82-year-old male with five year post operation of laparoscopic radical cystectomy with bilateral ureterostomies. Both of them had parastomal hernia, the first case was an urgency due to bowel obstruction while the second case was an elective procedure. Using three portals, we choose the primary repair for the first case and placement of a biological mesh within the keyhole technique (3) for the second one. Results: In the first case we had an operative time of 110min, total blood loss of 40cc and for the second case an operative time of 140min with total blood loss of 20cc. Both patients were discharged within 24h and had a follow-up of 2 years with no recurrence. Conclusions: The capability for complex sutures and dissection of intracorporeal structures makes the robotic platform a powerful ally (4) and we believe in its superiority over conventional laparoscopy. Although further studies are required, our initial series suggests that the robotic parastomal hernia repair is feasible and reproducible, with or without mesh placement and could be demonstrated its use for either elective or emergency situations.

https://doi.org/10.1590/s1677-5538.ibju.2020.0347 397 descargas

Vaginal sparing in laparoscopic radical cystectomy for females: feasibility and technical notes
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Alcántara-Quispe, Cinthia

; Faria, Eliney Ferreira

; Santos, Alexandre Cesar

; Magnabosco, Wesley Justino

; Fantin, João

; Tobias-Machado, Marcos

; Machado, Roberto Dias

International braz j urol

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Dic 2020, Volumen 46 Nº 6 Paginas 1109 - 1110

Resumen: En | Texto: En | PDF: En

https://doi.org/10.1590/s1677-5538.ibju.2019.0021 343 descargas

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group
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Garza-Gangemi, Adrián M.

; Castillejos-Molina, Ricardo A.

; Gueglio, Guillermo

; Tobia-Gonzalez, Ignacio P.

; Jurado, Alberto M.

; Meza-Montoya, Luis

; Scorticati, Carlos H.

; Henriques-da-Costa, Walter

; Yandian, Juan

; Ubillos, Luis

; Glina, Sidney

; Tobias-Machado, Marcos

; Rodríguez-Faba, Oscar

; Ameri, Carlos

; Nolazco, Alejandro

; Martinez, Pablo

; Franco Carvalhal, Gustavo

; Bengio, Ruben G.

; Arribillaga, Leandro Cristian

; Langenhin, Raúl

; Muguruza, Diego

; Campos-Salcedo, José G.

; Bravo-Castro, Edgar I.

; Mingote, Pablo A.

; Ginestar, Nicolás

; Autran-Gomez, Ana M.

; Puente, Roberto

; Decia, Ricardo

; Cardoso-Guimarães, Gustavo

; Palou-Redorta, Joan

; Abreu-Clavijo, Diego

; Cassio-Zequi, Stenio de

; Rodriguez-Covarrubias, Francisco T.

Revista de investigación clínica

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Oct 2020, Volumen 72 Nº 5 Paginas 308 - 315

Resumen: En | Texto: En | PDF: En

Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs. ≥75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

https://doi.org/10.24875/ric.20000018 141 descargas

Initial experience of video endoscopic inguinal Lymphadenectomy in a center located at northeast brazilian region
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Meneses, Aurus Dourado

; Mattos, Pablo Aloisio Lima

; Eulálio Filho, Walberto Monteiro Neiva

; Fé, Taíla Sousa de Moura

; Rodrigues, Rodolfo Myronn de Melo

; Tobias-Machado, Marcos

International braz j urol

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Abr 2019, Volumen 45 Nº 2 Paginas 325 - 331

Resumen: En | Texto: En | PDF: En

ABSTRACT Introduction: Video endoscopic inguinal lymphadenectomy – VEIL – has emerged as an alternative to reduce post-surgical complications (PSC) in patients with penile cancer submitted to inguinal lymphadenectomy (IL). In some series, these PSC are observed in more than 50% of patients. The objectives of the present study are to describe the initial experience of VEIL in a Hospital in Teresina, PI, Brazil, and to analyze PSC incidence. Material and Methods: Retrospective descriptive study of patients submitted to VEIL from March 2014 to November 2015. Data were collected regarding surgical time, bleeding, complications, lymph node number, conversion, global complications, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time. Results: 20 lower limbs of 11 patients were operated. Mean age was 51.4 (24-72) years. Mean surgical time was 85 (60-120) minutes. No patient showed intrasurgical complications, bleeding > 50 mL or conversion. Three surgeries evolved with lower limb edema, 2 with lymphoceles and one patient had cutaneous necrosis and another bulging of surgical wound. Mean time of hospitalization was 4 (2-11) days. A mean of 5.8 (1-12) lymph nodes were dissected in each surgery. Conclusion: VEIL is a safe and easy technique with lower incidence of PSC that can be reproduced in small centers.

https://doi.org/10.1590/s1677-5538.ibju.2018.0521 736 descargas

Prospective evaluation of Chondroitin sulfate, Heparan sulfate and Hyaluronic acid in prostate cancer
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Silva, Matheus N. Ribeiro da

; Mendes, Aline

; Martins, João R. Maciel

; Tobias-Machado, Marcos

; Pinhal, Maria Aparecida da Silva

International braz j urol

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Dic 2018, Volumen 44 Nº 6 Paginas 1139 - 1146

Resumen: En | Texto: En | PDF: En

ABSTRACT Purpose: The present study evaluates chondroitin sulfate (CS) and heparan sulfate (HS) in the urine and hyaluronic acid (HA) in the plasma of patients with prostate cancer before and after treatment compared to a control group. Materials and Methods: Plasma samples were used for HA dosage and urine for quantification of CS and HS from forty-four cancer patients and fourteen controls. Clinical, laboratory and radiological information were correlated with glycosaminoglycan quantification by statistical analysis. Results: Serum HA was significantly increased in cancer patients (39.68 ± 30.00 ng/ mL) compared to control group (15.04 ± 7.11 ng/mL; p=0.004) and was further increased in high-risk prostate cancer patients when compared to lower risk patients (p = 0.0214). Also, surgically treated individuals had a significant decrease in seric levels of heparan sulfate after surgical treatment, 31.05 ± 21.01 μg/mL (before surgery) and 23.14 ± 11.1 μg/mL (after surgery; p=0.029). There was no difference in the urinary CS and HS between prostate cancer patients and control group. Urinary CS in cancer patients was 27.32 ± 25.99 μg/mg creatinine while in the men unaffected by cancer it was 31.37 ± 28.37 μg/mg creatinine (p=0.4768). Urinary HS was 39.58 ± 32.81 μg/ mg creatinine and 35.29 ± 28.11 μg/mg creatinine, respectively, in cancer patients and control group (p=0.6252). Conclusions: Serum HA may be a useful biomarker for the diagnosis and prognosis of prostate cancer. However, urinary CS and HS did not altered in the present evaluation. Further studies are necessary to confirm these preliminary findings.

https://doi.org/10.1590/s1677-5538.ibju.2017.0569 738 descargas

10.

Synchronous abdominal tumors: is combined laparoscopic surgery in a single approach a safe option?
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Cartapatti, Marcelo

; Machado, Roberto Dias

; Muller, Roberto Lodeiro

; Magnabosco, Wesley J.

; Santos, Alexandre César

; Chapin, Brian Francis

; Melani, Armando

; Talvane, Antonio

; Tobias-Machado, Marcos

; Faria, Eliney Ferreira

International braz j urol

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Jun 2018, Volumen 44 Nº 3 Paginas 483 - 490

Resumen: En | Texto: En | PDF: En

ABSTRACT Background and Purpose: Recent advances in cancer treatment have resulted in bet- ter prognosis with impact on patient's survival, allowing an increase in incidence of a second primary neoplasm. The development of minimally invasive surgery has provided similar outcomes in comparison to open surgery with potentially less mor- bidity. Consequently, this technique has been used as a safe option to simultaneously treat synchronous abdominal malignancies during a single operating room visit. The objective of this study is to describe the experience of two tertiary cancer hospitals in Brazil, in the minimally invasive treatment of synchronous abdominal neoplasms and to evaluate its feasibility and peri-operative results. Materials and Methods: We retrospectively reviewed the data from patients who were submitted to combined laparoscopic procedures performed in two tertiary hospitals in Brazil from May 2009 to February 2015. Results: A total of 12 patients (9 males and 3 females) with a mean age of 58.83 years (range: 33 to 76 years) underwent combined laparoscopic surgeries for the treatment of at least one urological disease. The total average duration of surgery was 339.8 minutes (range: 210 to 480 min). The average amount of intraoperative bleeding was 276.6mL (range: 70 to 550mL) and length of hospitalization was 5.08 days (range: 3 to 10 days). Two patients suffered minor complications regarding Clavien system during the immediate postoperative period. Conclusions: Combined laparoscopic surgery for the treatment of synchronous tumors is feasible, viable and safe. In our study, there was a low risk of postoperative morbidity.

https://doi.org/10.1590/s1677-5538.ibju.2017.0429 501 descargas

11.

A safe teaching protocol of LRP (Laparoscopic Radical Prostatectomy)
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Tobias-Machado, Marcos

; Pazeto, Cristiano Linck

; Neves-Neto, Oseas Castro

; Nunes-Silva, Igor

; Zampolli, Hamilton de Campos

International braz j urol

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Abr 2018, Volumen 44 Nº 2 Paginas 273 - 279

Resumen: En | Texto: En | PDF: En

ABSTRACT Purpose The LRP has a steep learning curve to obtain proficiency during which patient safety may be compromised. We present an adapted modular training system which purpose to optimize the learning curve and perform a safe surgery. Materials and Methods A retrospective analysis of the LRP safe learning protocol applied during a fellowship program over eight years (2008-2015). The surgery was divided in 12 steps and 5 levels of difficulty. A maximum time interval was stipulated in 240 minutes. After an adaptation, the fellows had 120 minutes to perform all the corresponding modules to its accumulated skill. The participants gradually and safely pass through the steps and difficulty levels. Surgeries performed by fellows were analyzed as a single group and compared to a prior series performed by tutor. Results In eight years, 250 LRP were performed (25 per apprentice) during fellowship program and 150 procedures after completion. The baseline characteristics were comparable. Most cases operated were of intermediate risk. Mean operative time was longer in the fellow group when compared to the tutor (150 min). Mean estimated blood loss were similar among the groups. Functional and oncological outcomes were better in the Tutor's group. No conversion to open surgery was performed. Conclusions The LRP safe learning protocol proved to be an effective method to optimize the learning curve and perform safe surgery. However, the tutor's functional and oncological results were better, showing that this is a procedure with a steep learning curve and proficiency demands more than 25 cases.

https://doi.org/10.1590/s1677-5538.ibju.2017.0137 594 descargas

12.

Laparoscopic resection of prescral and obturator fossa schwannoma
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Tobias-Machado, Marcos

; Hidaka, Alexandre Kiyoshi

; Sato, Letícia Lumy Kanawa

; Silva, Igor Nunes

; Mattos, Pablo Aloisio Lima

; Pompeo, Antonio Carlos Lima

International braz j urol

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Jun 2017, Volumen 43 Nº 3 Paginas 566 - 566

Resumen: En | Texto: En | PDF: En

ABSTRACT Introduction Pelvic Schwannoma is an extremely rare event. Laparoscopic approach for radical resection on pelvic region already has been described in the literature. However, with better image quality provided by optic in the laparoscopy we can assure an improvement in this kind of approach for tumor resection. Objective Our goal is to describe and evaluate the results of one laparoscopic resection of presacral and obturator fossa tumor. Materials and Methods We present a case of a 60-year-old man with progressive congestion in the right inferior member and CT scan revealing a mass with miscellaneous content located behind of the right iliac vessels and right obturator nerve. Exploratory transperitoneal laparoscopy was indicated. During laparoscopy it was possible to see the mass between the spermatic cord and external iliac artery. We made the identification and preservation of iliac vessels and obturator nerve. Resection of the tumor was performed carefully, allowing the safe removal of the specimen with complete preservation of the iliac vessels and obturator nerve. Results Mean operative time of 150 minutes. No perioperative complications occurred. Two days of hospital stay. Posterior histopathological exam confirmed that the mass was a Schwannoma. Conclusion The maximization of the image in the laparoscopic surgery offers dexterity and capacity of dissection required for complex mass dissection on pelvic region.

https://doi.org/10.1590/s1677-5538.ibju.2015.0091 568 descargas

13.

Nutcracker Syndrome: laparoscopic external stenting of the renal vein (“the shield technique”)
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Korkes, Fernando

; Silveira, Marcel

; Neves-Neto, Oseas Castro

; Brandão, Luiz Franco

; Tobias-Machado, Marcos

; Wolosker, Nelson

; Nasser, Felipe

; Maurano, Alexandre

International braz j urol

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Abr 2017, Volumen 43 Nº 2 Paginas 373 - 373

Resumen: En | Texto: En | PDF: En

ABSTRACT Nutcracker syndrome refers to the complex of clinical symptoms caused by the compression of the left renal vein (LRV) between the abdominal aorta and the superior mesenteric artery, leading to stenosis of the aortomesenteric portion of the LRV and dilatation of the distal portion. Hematuria, proteinuria, flank pain, varicocele and pelvic congestion may occur, occurring more frequently in young adults. Conservative management, might be the option whenever it is possible. When surgical treatment is required, classically open surgery have been performed, with major surgeries as LRV transposition or bypass techniques. The main caveats regards the fact that these are large and risky surgeries. Endovascular surgery with venous stent placement has gained some space as it is minimally invasive alternative. However, venous stents are associated with a high number of trombotic complications and in many cases requirement of life-long anticoagulants. External stenting of the LRV with this “shield technique” is a minimally invasive alternative, with good medium term results. We herein demonstrate our second experience with the technique of this surgery in a patient with 12 months of follow up and excellent results.

https://doi.org/10.1590/s1677-5538.ibju.2015.0666 728 descargas

14.

One wire tubeless ureteral reimplant: preliminary experience and step-by-step technique
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Tobias-Machado, Marcos

; Hidaka, Alexandre Kyoshi

; Sato, Leticia Lumy Kanawa

; Almeida-Carrera, Roberto Javier

; Faria, Eliney Ferreira

; Zampolli, Hamilton

MedicalExpress

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Feb 2017, Volumen 4 Nº 1 elocation M170106

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

JUSTIFICATIVA E OBJETIVOS: O reimplante ureteral é comumente utilizado em cirurgia pediátrica e ginecológica. A maioria das técnicas exigem um cirurgião experiente e dura 2-3 horas. Não há consenso sobre a técnica preferida até hoje. Relatamos uma modificação simples do Taguchi para reduzir sua duração e torná-lo mais adequado para a abordagem laparoscópica. MÉTODO: Três pacientes foram submetidos a reimplante ureteral distal, com base na técnica de abordagem minimamente invasiva de Taguchi modificada. Cistografia e ultra-sonografia foram realizadas no 30º, 90º e 180º dias de pós-operatório para monitorização dos rins; um acompanhamento de um ano para recorrência ou sintomas clínicos também foi realizado. RESULTADOS: O tempo operatório para o reimplante ureteral utilizando a nossa técnica foi de 15-25 minutos. Os resultados dos exames realizados nos dias pós-operatórios mostraram rins normais sem hidronefrose. No seguimento de um ano não houve sinais de recorrência ou sintomas clínicos. CONCLUSÃO: Nossas modificações permitiram um manejo mais rápido e fácil do reimplante ureteral distal, com excelentes resultados peri- e pós-operatórios. Tanto quanto sabemos, esta é a primeira descrição detalhada desta técnica através de abordagem minimamente invasiva. No entanto, estudos adicionais e um acompanhamento mais longo serão necessários para confirmar os resultados a longo prazo e os benefícios clínicos da técnica proposta.

BACKGROUND AND OBJECTIVES: Ureteral Reimplant is commonly used in pediatric and gyne-cologic surgery. Most techniques demand an experienced surgeon and lasts 2-3 hours. There is no consensus about the preferred technique until today. We report a simple modification of the Taguchi to reduce duration and make it more suitable for laparoscopic approach. METHOD: Three patients underwent distal ureteral reimplant, based on our modified Taguchi minimally invasive approach technique. Cystography and ultrasonography were performed on the 30th, 90th and 180th postoperative days to monitor kidneys; a one-year follow-up for recurrence or clinical symptoms was also performed. RESULTS: Operative time for ureteral reimplant using our technique was 15-25 minutes. The results of the performed exams on postoperative days showed normal kidneys without hydro-nephrosis. At the one-year follow-up no signs of recurrence or clinical symptoms were present. CONCLUSION: Our modifications allowed a faster and easier management of distal ureteral reimplant, with excellent perioperative and post-operative outcomes. To our knowledge this is the first detailed description of this technique through minimally invasive approach. However, further studies and a longer follow up will be necessaries to confirm the long-term outcomes and clinical benefits of our technical proposal.

https://doi.org/10.5935/medicalexpress.2017.01.06 996 descargas

15.

Retzus-sparing robotic-assisted laparoscopic radical prostatectomy: a step–by-step technique description of this first brazilian experience
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Tobias-Machado, Marcos

; Nunes-Silva, Igor

; Hidaka, Alexandre Kiyoshi

; Sato, Leticia Lumy Kanawa

; Almeida, Roberto

; Colombo Jr., Jose Roberto

; Zampolli, Hamilton de Campos

; Pompeo, Antonio Carlos Lima

International braz j urol

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Dic 2016, Volumen 42 Nº 6 Paginas 1250 - 1250

Resumen: En | Texto: En | PDF: En

Abstract Introduction: Retzus-sparing robotic-assisted radical prostatectomy(RARP) is a newly approach that preserve the Retzus structures and provide better recovery of continence and erectile function. In Brazil, this approach has not yet been previously reported. Objective: Our goal is to describe Step-by-Step the Retzus-sparing RARP surgical technique and report our first Brazilian experience. Methods: We present a case of a 60-year-old white man with low risk prostate cancer. Surgical materials were four arms Da Vinci robotic platform system, six transperitoneal portals, two prolene wires and Polymer Clips. This surgical technique was step-by-step described according to Galfano et al. One additional step was added as a modification of Galfano et al. Primary technique description: The closure of the Denovellier fascia. Results: We have operated one patient with this technique. The operative time was 180minutes, console time was135 min, the blood loss was 150ml, none perioperative or postoperative complications was found, hospital stay of 01 day. The anatomopathological classification revealed a pT2aN0M0 specimen with free surgical margins. The patient achieved continence immediately after bladder stent retrieval. Full erection reported after 30 days of surgery. Conclusion: Retzus-sparing RARP approach is feasible and reproducible. However, further comparative studies are necessary to demonstrate potential benefits in continence and sexual outcomes over the standard approaches.

https://doi.org/10.1590/s1677-5538.ibju.2015.0348 684 descargas

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