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VID.09: Laparoscopic Surgery of Renal Tumour Interaortocava Recurrence
MODERATED VIDEO SESSIONS
producible, and teachable technique that allows one to obviate intra-abdominal complications combining the advantages of minimally invasive laparoscopy and the open retropubic approach. The preliminary results of our series are promising. LPPRP is similar to any other new surgical procedure and as with open surgery we learn and gain experience with each procedure; however, the learning curve is never completely finished. VID.07 Twelve Years of Experience with Transrectal High Intensity Focused Ultrasound (HIFU) at 3 MHZ as Treatment of Prostate Cancer: Hints to a Successful Treatment Thueroff S, Chaussy C Urological Department, Klinikum Harlaching, Muenchen, Germany Introduction and Objectives: Transrectal pulsed high intensity focused ultrasound (HIFU) is robotic surgery. To facilitate an advanced learning curve, specific detailed information for different steps of the procedure has to be known. This video explains the most important parameters for the treatment to new Ablatherm® users in order to avoid problems and to standardize the procedure. Materials and Methods: Twelve years of clinical experience after 2000 treatments is the basis for this video. Since 4 ‘96, we use pulsed transrectal high intensive focused ultrasound (HIFU) as local treatment for all patients with prostate cancers non-suitable for open surgery. Most HIFU treatments are performed in spinal anesthesia and are riskless for any emergency intervention or severe complications. HIFU treatment is therefore especially indicated in patients with significant comorbidity or advanced disease. Results: Curative intention in localized cases, as well as palliative local debulcking show high rates of local cancer destruction proven by control biopsies and by post HIFU PSA per course (-stability). The device used (Ablatherm® EDAP-Lyon) underwent significant changes since ‘96 and presents itself today as a surgical robot, including real time imaging and TRUS scanning procedure for therapy planning. Conclusions: The 8 minute video shows all major failure possibilities and how to avoid them. If a new user pays attention to this topics, if he/she has experience in transrectal ultrasound, TURP, pelvic anatomy and computer handling, he/she should be able to integrate transrectal HIFU into his/her armentarium after approximately 15 treatments.
S108
VID.08 Radical Prostatectomy for Locally Advanced Prostate Cancer Claessens M, Joniau S, Van Poppel H University Hospital Leuven, Department of Urology, Leuven, Belgium Introduction and Objectives: The value of surgery as monotherapy in clinical stage T3 prostate cancer (cT3 PCa) is still subject to debate. We performed a study to examine the technical feasibility and here we describe our technique of radical retropubic prostatectomy (RRP) for cT3 PCa. Material and Methods: We reviewed the records of 139 patients who underwent a RRP with extended lymphadenectomy for cT3 PCa. Briefly, the operative procedure consists of an extended lymphadenectomy up to the bifurcation of the common iliac artery. Afterwards, we incise the endopelvic fascia and perform the lateral dissection. The puboprostatic ligaments are divided and the dorsal vein complex is controlled in order to have a complete and clear vision of the apex, the urethra and the neurovascular bundles. The urethra is transsected, as well as the neurovascular bundles, except in well-defined cases. After the posterior release and division of the pedicles the seminal vesicles are completely resected. In most cases, the bladder neck cannot be spared and must be resected as well. A reconstruction is then needed before performing a classical 4-point anastomosis. The files were critically reviewed and all data related to surgical and peri-operative complications were collected. Comparison was made to series of RRP in patients with clinically localised disease. Results: There was no peri-operative mortality. No ureteral or large vessel injury occurred. Rectal injury and injury of the obturator nerve occurred both in 0.7% of cases. No serious in-hospital complications were noted and no reintervention was needed. Lymphorrhea was noted in 2.2% of patients and 1.4% experienced prolonged drainage of urine. In 7.2%, wound related problems occurred. Anastomotic stricture occurred in 2.9%. At 12 months, complete continence was 87.8%. Erectile function fully recovered in 10% of patients who underwent a unilateral nervesparing procedure. Positive surgical margin rate was only 13.7%. Cancer specific 10 year survival was 91.6% with a clinical progression free survival after 10 years of 85.4%. Conclusions: In cT3 PCa, RRP is technically feasible with morbidity comparable to RRP in clinically localised PCa and with
a very high cancer specific and clinical progression free survival after 10 years. VID.09 Laparoscopic Surgery of Renal Tumour Interaortocava Recurrence Pen ˜ a J, Monllau V, Ballestero R, Rengifo D, Palou J, Villavicencio H Fundacio ´ Puigvert, Barcelona, Spain Introduction and Objectives: The surgical approach remains the only alternative with curative intent to treat the recurrence of kidney tumours. The indications of laparoscopic surgery in oncology have increased dramatically in recent years, offering less postoperative pain, less bleeding and shorter hospital stays. Materials and Methods: We present the case of a 72-year-old patient who underwent left radical nephrectomy in November 2003 (pathology chromophobe renal cell carcinoma. Grade IV. pT3a) with adjuvant radiotherapy of surgical bed. Interaortocava recurrence was objectivated during the follow up. Surgical removal through a transperitoneal laparoscopic approach was decided. We detail in the video the surgical technique. Results: Laparoscopic approach was feasible. The operative time was 235 minutes and bleeding was insignificant. The main technical bother was the access to the mass because of the presence of bowel adhesions. The dissection of the mass was not especially complex as it was not too attached to the cava vein. Prior nephrectomy contralateral access facilitated the surgery. Patient was discharged at day 6. Conclusions: Surgery remains the treatment of choice for the recurrence of renal tumours. The laparoscopic approach is feasible and reduces morbidity secondary to surgery. VID.10 Transperitoneal Laparoscopic Partial Nephrectomy with Hilar Control and Clamping Sanseverino R, Intilla O, Di Mauro U, Napodano G, Realfonso T, Barela A Department of Urology, Umberto I Hospital, Nocera Inferiore, Italy Introduction and Objectives: Laparoscopic partial nephrectomy (LPN) has become a valid alternative to open partial nephrectomy. LPN seems to offer comparable oncologic outcomes but lower morbidity and shorter hospitalization than open partial nephrectomy. However, it remains a technically challenging procedure that requires advanced laparoscopic skills. We report our preliminary experience of LPN.
UROLOGY 72 (Supplement 5A), November 2008
producible, and teachable technique that allows one to obviate intra-abdominal complications combining the advantages of minimally invasive laparoscopy and the open retropubic approach. The preliminary results of our series are promising. LPPRP is similar to any other new surgical procedure and as with open surgery we learn and gain experience with each procedure; however, the learning curve is never completely finished. VID.07 Twelve Years of Experience with Transrectal High Intensity Focused Ultrasound (HIFU) at 3 MHZ as Treatment of Prostate Cancer: Hints to a Successful Treatment Thueroff S, Chaussy C Urological Department, Klinikum Harlaching, Muenchen, Germany Introduction and Objectives: Transrectal pulsed high intensity focused ultrasound (HIFU) is robotic surgery. To facilitate an advanced learning curve, specific detailed information for different steps of the procedure has to be known. This video explains the most important parameters for the treatment to new Ablatherm® users in order to avoid problems and to standardize the procedure. Materials and Methods: Twelve years of clinical experience after 2000 treatments is the basis for this video. Since 4 ‘96, we use pulsed transrectal high intensive focused ultrasound (HIFU) as local treatment for all patients with prostate cancers non-suitable for open surgery. Most HIFU treatments are performed in spinal anesthesia and are riskless for any emergency intervention or severe complications. HIFU treatment is therefore especially indicated in patients with significant comorbidity or advanced disease. Results: Curative intention in localized cases, as well as palliative local debulcking show high rates of local cancer destruction proven by control biopsies and by post HIFU PSA per course (-stability). The device used (Ablatherm® EDAP-Lyon) underwent significant changes since ‘96 and presents itself today as a surgical robot, including real time imaging and TRUS scanning procedure for therapy planning. Conclusions: The 8 minute video shows all major failure possibilities and how to avoid them. If a new user pays attention to this topics, if he/she has experience in transrectal ultrasound, TURP, pelvic anatomy and computer handling, he/she should be able to integrate transrectal HIFU into his/her armentarium after approximately 15 treatments.
S108
VID.08 Radical Prostatectomy for Locally Advanced Prostate Cancer Claessens M, Joniau S, Van Poppel H University Hospital Leuven, Department of Urology, Leuven, Belgium Introduction and Objectives: The value of surgery as monotherapy in clinical stage T3 prostate cancer (cT3 PCa) is still subject to debate. We performed a study to examine the technical feasibility and here we describe our technique of radical retropubic prostatectomy (RRP) for cT3 PCa. Material and Methods: We reviewed the records of 139 patients who underwent a RRP with extended lymphadenectomy for cT3 PCa. Briefly, the operative procedure consists of an extended lymphadenectomy up to the bifurcation of the common iliac artery. Afterwards, we incise the endopelvic fascia and perform the lateral dissection. The puboprostatic ligaments are divided and the dorsal vein complex is controlled in order to have a complete and clear vision of the apex, the urethra and the neurovascular bundles. The urethra is transsected, as well as the neurovascular bundles, except in well-defined cases. After the posterior release and division of the pedicles the seminal vesicles are completely resected. In most cases, the bladder neck cannot be spared and must be resected as well. A reconstruction is then needed before performing a classical 4-point anastomosis. The files were critically reviewed and all data related to surgical and peri-operative complications were collected. Comparison was made to series of RRP in patients with clinically localised disease. Results: There was no peri-operative mortality. No ureteral or large vessel injury occurred. Rectal injury and injury of the obturator nerve occurred both in 0.7% of cases. No serious in-hospital complications were noted and no reintervention was needed. Lymphorrhea was noted in 2.2% of patients and 1.4% experienced prolonged drainage of urine. In 7.2%, wound related problems occurred. Anastomotic stricture occurred in 2.9%. At 12 months, complete continence was 87.8%. Erectile function fully recovered in 10% of patients who underwent a unilateral nervesparing procedure. Positive surgical margin rate was only 13.7%. Cancer specific 10 year survival was 91.6% with a clinical progression free survival after 10 years of 85.4%. Conclusions: In cT3 PCa, RRP is technically feasible with morbidity comparable to RRP in clinically localised PCa and with
a very high cancer specific and clinical progression free survival after 10 years. VID.09 Laparoscopic Surgery of Renal Tumour Interaortocava Recurrence Pen ˜ a J, Monllau V, Ballestero R, Rengifo D, Palou J, Villavicencio H Fundacio ´ Puigvert, Barcelona, Spain Introduction and Objectives: The surgical approach remains the only alternative with curative intent to treat the recurrence of kidney tumours. The indications of laparoscopic surgery in oncology have increased dramatically in recent years, offering less postoperative pain, less bleeding and shorter hospital stays. Materials and Methods: We present the case of a 72-year-old patient who underwent left radical nephrectomy in November 2003 (pathology chromophobe renal cell carcinoma. Grade IV. pT3a) with adjuvant radiotherapy of surgical bed. Interaortocava recurrence was objectivated during the follow up. Surgical removal through a transperitoneal laparoscopic approach was decided. We detail in the video the surgical technique. Results: Laparoscopic approach was feasible. The operative time was 235 minutes and bleeding was insignificant. The main technical bother was the access to the mass because of the presence of bowel adhesions. The dissection of the mass was not especially complex as it was not too attached to the cava vein. Prior nephrectomy contralateral access facilitated the surgery. Patient was discharged at day 6. Conclusions: Surgery remains the treatment of choice for the recurrence of renal tumours. The laparoscopic approach is feasible and reduces morbidity secondary to surgery. VID.10 Transperitoneal Laparoscopic Partial Nephrectomy with Hilar Control and Clamping Sanseverino R, Intilla O, Di Mauro U, Napodano G, Realfonso T, Barela A Department of Urology, Umberto I Hospital, Nocera Inferiore, Italy Introduction and Objectives: Laparoscopic partial nephrectomy (LPN) has become a valid alternative to open partial nephrectomy. LPN seems to offer comparable oncologic outcomes but lower morbidity and shorter hospitalization than open partial nephrectomy. However, it remains a technically challenging procedure that requires advanced laparoscopic skills. We report our preliminary experience of LPN.
UROLOGY 72 (Supplement 5A), November 2008