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UP-02.055 No-Clamp, No-Stop Watch Pure Laparo-Endoscopic Single-site Surgery (LESS) Partial Nephrectomy
UNMODERATED POSTER SESSIONS
UP-02.055, Table 1. Case 1 2 3 4
Age/ sex 76/F 33/F 51/M 24/M
Warm ischaemia time/min 0 0 0 0
Operation Time/min 270 540 540 360
rameters, complications, size of stones, hospital stay, site and number of tracts were recorded. All operations were done by standard PCNL and the irrigation fluid was reversed osmosis 24-26 centigrade still water. Result: There were 28 males and 20 females with the range of 12 month to 13 years old (mean 7.7⫾4.5 years). There were 33 PCNL done on the right and 21 on the left. Mean stone size was 2.85⫾0.9cm, mean Hb drop was 1.2⫾0.55 g/dl, mean hospital stay was 3.6⫾1.7 days, stone free rate in monotherapy with PCNL was 76%and 85% in combined with SWL. The amplatz size of 30, 26 and 24F were used in 41.7 and 7 renal units respectively. Eight cases had intercostal access (11th intercostal space) without any adverse effect. The most common complication was fever and this result in prolonged hospitalization. Only 1 patient transfused and none of them had organ injury. No hypothermia or hyponatremia was seen. Conclusion: Although it is ideal to use small size instrument for children PCNL, but we can use adult size instrument with acceptable complication even when we perform it tubeless.
UP-02.054 Effect of Patient-Centered Goal on Postoperative Satisfaction in Patients with HoLEP Surgery Nam J, Kim T, Park C Pusan National University School of Medicine, Yangsan, South Korea Introduction and Objective: To evaluate the effect of patient-centered goal on postoperative patient satisfaction and quality of life (QoL) in patients who underwent HoLEP (Homium Laser Enucleation of the Prostate) for benign prostate hyperplasia (BPH). Materials and Methods: From April 2009 to June 2010, 230 consecutive patients were enrolled in this study who had received HoLEP for BPH. The participants visited our clinic before surgery and asked to make his patient-centered goals for surgery. In this follow-up study, participants were asked to indicate the level of goal
S278
Blood loss/mL 100 2000 1800 600
Histology Oncocytoma (negative margins) Chronic pyelonephritis and stone Clear Cell RCC (negative Margins) Chronic pyelonephritis and stone
attainment (goal attainment scale, GAS; ⫺2⫽not at all, ⫹2⫽completely), postoperative satisfaction expressed as a percentage of 100% satisfied (0-100%), and quality of life (IPSS QoL). Goal achievement was defines as GAS ⫹1 and ⫹2. Results: Of the 230 study participants, 182 (79.1%) completed this study. Preoperative patient-centered goals were loss of weak stream (n⫽114, 62.6%), loss of residual urine sense (n⫽30, 16.5%), loss of dysuria (n⫽18, 9.9%), loss of frequency (n⫽9, 4.9%), loss of nocturia (n⫽5, 2.8%), and so on. Mean GAS was 0.8⫾0.8 and preoperative goals were achieved in 140 patients (76.9%). Mean postoperative patient satisfaction rate was 74.6⫾19.5% (0-100%) and mean QoL scale was 1.8⫾1.1 (0-6). Postoperative satisfaction and QoL were statistically significantly correlated to GAS (r⫽0.775, p⬍0.001 and r⫽⫺0.725, p⬍0.001, respectively). Conclusions: Patients underwent HoLEP surgery showed high satisfaction scores. Also, attainment of preoperative patientcentered goals was significantly correlated to postoperative satisfaction and QoL.
UP-02.055 No-Clamp, No-Stop Watch Pure Laparo-Endoscopic Single-site Surgery (LESS) Partial Nephrectomy Rao A, Nemade H, Rouse P, Brown C, Kooiman G, Grange P Kings College Hospital NHS Foundation Trust, London, UK Introduction and Objectives: Partial Nephrectomy is considered the standard of care for small renal masses and symptomatic non-functioning renal polar moieties. Laparoscopic partial nephrectomy is well established in terms of oncological and functional outcome. Clamping of the renal hilum causing renal ischaemia during tumour / renal excision can be detrimental to the future function of the kidney. LESS partial nephrectomy is technically challenging resulting in only a small number of cases reported in the literature. We report our series of pure LESS partial nephrectomy using a no clamp technique. Materials and Methods: Four selected
Change in Hb/g/dL 0 ⫺3.0 ⫺6.6 ⫺4.0
Change in eGFR/mL/min ⫺10 (90 to 80) ⫺20 (90 to 70) 1 (77-76) 0 (90 to 90)
Length of stay/days 7 8 4 4
patients with low BMI and no previous abdominal surgery underwent the technique. Arterial phase 3D CT reconstruction was used pre-operatively to identify the polar and segmental arterial anatomy. Quad/Triport (Olympus™) transperitoneal access, a flexible tip HD camera (LTF-VP EndoEYE Video Laparoscope™) and a robotic camera holder (Freehand, Prosurgics™) was used in all cases. Dissection was carried out using the Harmonic ACE™ and a long bariatric curved suction device to avoid internal and external instrument clashes. Intra-hilar dissection was carried out to expose both arteries and veins supplying the target area of the kidney which were then suture ligated. Partial nephrectomy was then carried out along the line of ischaemic demarcation using the Harmonic ACE™. Methylene blue was injected into the ureter via a catheter to identify significant breaches in the collecting system. The cut surface of the kidney was sutured to control haemorrhage and urine leaks using our innovative single port spaghetti knot technique. Results: There were no postoperative complications and no blood transfusions were given. Conclusion: No clamp LESS partial nephrectomy is feasible in selected patients. Avoiding warm ischaemia helps to maintain renal function. Hilar dissection with ligation of vessels supplying the target area produces an ischaemic zone which aids renal incision. Development of a complete intra-corporeal suturing and knotting technique avoids the use of additional ports making pure LESS procedure technically achievable.
UP-02.056 Efficacy of Early Salvage Radiotherapy After Radical Prostatectomy in Patients With Rising PSA Levels Below the Conventional Threshold of 0.2ng/ mL Jarolim L1, Vesely S1, Babjuk M1, Schmidt M1, Dusek P1, Malinova B2 1 Dept. of Urology, 2Dept. of Oncology and Radiotherapy, Charles University, Prague, Czech Republic
UROLOGY 78 (Supplement 3A), September 2011
UP-02.055, Table 1. Case 1 2 3 4
Age/ sex 76/F 33/F 51/M 24/M
Warm ischaemia time/min 0 0 0 0
Operation Time/min 270 540 540 360
rameters, complications, size of stones, hospital stay, site and number of tracts were recorded. All operations were done by standard PCNL and the irrigation fluid was reversed osmosis 24-26 centigrade still water. Result: There were 28 males and 20 females with the range of 12 month to 13 years old (mean 7.7⫾4.5 years). There were 33 PCNL done on the right and 21 on the left. Mean stone size was 2.85⫾0.9cm, mean Hb drop was 1.2⫾0.55 g/dl, mean hospital stay was 3.6⫾1.7 days, stone free rate in monotherapy with PCNL was 76%and 85% in combined with SWL. The amplatz size of 30, 26 and 24F were used in 41.7 and 7 renal units respectively. Eight cases had intercostal access (11th intercostal space) without any adverse effect. The most common complication was fever and this result in prolonged hospitalization. Only 1 patient transfused and none of them had organ injury. No hypothermia or hyponatremia was seen. Conclusion: Although it is ideal to use small size instrument for children PCNL, but we can use adult size instrument with acceptable complication even when we perform it tubeless.
UP-02.054 Effect of Patient-Centered Goal on Postoperative Satisfaction in Patients with HoLEP Surgery Nam J, Kim T, Park C Pusan National University School of Medicine, Yangsan, South Korea Introduction and Objective: To evaluate the effect of patient-centered goal on postoperative patient satisfaction and quality of life (QoL) in patients who underwent HoLEP (Homium Laser Enucleation of the Prostate) for benign prostate hyperplasia (BPH). Materials and Methods: From April 2009 to June 2010, 230 consecutive patients were enrolled in this study who had received HoLEP for BPH. The participants visited our clinic before surgery and asked to make his patient-centered goals for surgery. In this follow-up study, participants were asked to indicate the level of goal
S278
Blood loss/mL 100 2000 1800 600
Histology Oncocytoma (negative margins) Chronic pyelonephritis and stone Clear Cell RCC (negative Margins) Chronic pyelonephritis and stone
attainment (goal attainment scale, GAS; ⫺2⫽not at all, ⫹2⫽completely), postoperative satisfaction expressed as a percentage of 100% satisfied (0-100%), and quality of life (IPSS QoL). Goal achievement was defines as GAS ⫹1 and ⫹2. Results: Of the 230 study participants, 182 (79.1%) completed this study. Preoperative patient-centered goals were loss of weak stream (n⫽114, 62.6%), loss of residual urine sense (n⫽30, 16.5%), loss of dysuria (n⫽18, 9.9%), loss of frequency (n⫽9, 4.9%), loss of nocturia (n⫽5, 2.8%), and so on. Mean GAS was 0.8⫾0.8 and preoperative goals were achieved in 140 patients (76.9%). Mean postoperative patient satisfaction rate was 74.6⫾19.5% (0-100%) and mean QoL scale was 1.8⫾1.1 (0-6). Postoperative satisfaction and QoL were statistically significantly correlated to GAS (r⫽0.775, p⬍0.001 and r⫽⫺0.725, p⬍0.001, respectively). Conclusions: Patients underwent HoLEP surgery showed high satisfaction scores. Also, attainment of preoperative patientcentered goals was significantly correlated to postoperative satisfaction and QoL.
UP-02.055 No-Clamp, No-Stop Watch Pure Laparo-Endoscopic Single-site Surgery (LESS) Partial Nephrectomy Rao A, Nemade H, Rouse P, Brown C, Kooiman G, Grange P Kings College Hospital NHS Foundation Trust, London, UK Introduction and Objectives: Partial Nephrectomy is considered the standard of care for small renal masses and symptomatic non-functioning renal polar moieties. Laparoscopic partial nephrectomy is well established in terms of oncological and functional outcome. Clamping of the renal hilum causing renal ischaemia during tumour / renal excision can be detrimental to the future function of the kidney. LESS partial nephrectomy is technically challenging resulting in only a small number of cases reported in the literature. We report our series of pure LESS partial nephrectomy using a no clamp technique. Materials and Methods: Four selected
Change in Hb/g/dL 0 ⫺3.0 ⫺6.6 ⫺4.0
Change in eGFR/mL/min ⫺10 (90 to 80) ⫺20 (90 to 70) 1 (77-76) 0 (90 to 90)
Length of stay/days 7 8 4 4
patients with low BMI and no previous abdominal surgery underwent the technique. Arterial phase 3D CT reconstruction was used pre-operatively to identify the polar and segmental arterial anatomy. Quad/Triport (Olympus™) transperitoneal access, a flexible tip HD camera (LTF-VP EndoEYE Video Laparoscope™) and a robotic camera holder (Freehand, Prosurgics™) was used in all cases. Dissection was carried out using the Harmonic ACE™ and a long bariatric curved suction device to avoid internal and external instrument clashes. Intra-hilar dissection was carried out to expose both arteries and veins supplying the target area of the kidney which were then suture ligated. Partial nephrectomy was then carried out along the line of ischaemic demarcation using the Harmonic ACE™. Methylene blue was injected into the ureter via a catheter to identify significant breaches in the collecting system. The cut surface of the kidney was sutured to control haemorrhage and urine leaks using our innovative single port spaghetti knot technique. Results: There were no postoperative complications and no blood transfusions were given. Conclusion: No clamp LESS partial nephrectomy is feasible in selected patients. Avoiding warm ischaemia helps to maintain renal function. Hilar dissection with ligation of vessels supplying the target area produces an ischaemic zone which aids renal incision. Development of a complete intra-corporeal suturing and knotting technique avoids the use of additional ports making pure LESS procedure technically achievable.
UP-02.056 Efficacy of Early Salvage Radiotherapy After Radical Prostatectomy in Patients With Rising PSA Levels Below the Conventional Threshold of 0.2ng/ mL Jarolim L1, Vesely S1, Babjuk M1, Schmidt M1, Dusek P1, Malinova B2 1 Dept. of Urology, 2Dept. of Oncology and Radiotherapy, Charles University, Prague, Czech Republic
UROLOGY 78 (Supplement 3A), September 2011