Laparoscopic Urologic Surgery Outcome Assessment

Abstract

Laparoscopic surgery is an evolving technique that began to be applied widely in urology in the early 1990s. We have conducted an ongoing multicenter study of laparoscopic urologic surgery to identify any changes in utilization, complications, and short- and long-term outcomes. Laparoscopic urologic surgical procedures were assessed in three successive phases: retrospective initial experience [P1] (before 1991), and prospectively, an intermediate phase [P2] (1991-1992) and a late phase [P3] (1993-1994). The late phase group was followed for 1 year through 1995 to identify any delayed complications. In the P1 group, 114 patients are included; 105 underwent laparoscopic pelvic lymph node dissection (LPLND), 7 underwent laparoscopic variocele ligation (LVL), and 2 underwent other procedures. The complication rates in P1 are 21% (total): 10.5% (major) and 10.5% (minor). The P2 group includes 148 patients; 132 underwent LPLND, 10 underwent LVL, and 6 underwent other procedures. The complication rates decreased to 16.2% (total): 6% (major) and 10.1% (minor). The latest group (P3) includes 326 subjects; 245 had LPLND, 39 had LVL, and 42 had other procedures. More improvement in outcome is shown in this phase with a 7.98% total complication rate: 0.92% major and 7.05% minor. In addition, other parameters such as operative time and hospital stay show improvement through the successive phases. There were no significant long-term complications in the latest study group. This study demonstrates a continual improvement in outcome and changes in utilization patterns as urologists become more experienced with laparoscopic surgery. The complexity of the procedures performed has increased with a decrease in the complication rates overall.

Magnetic resonance imaging‐guided laser thermal ablation of renal tumours

“…RCCs are poorly responsive to radiotherapy or chemotherapy; although interferon-a improves the survival of patients with metastatic RCC by a median of 2.5 months, this improvement needs to be balanced against the toxic effects of this drug [5]. Other alternatives to radical nephrectomy include nephron-sparing surgery, including tumour enucleation [6], laparoscopic nephrectomy [7,8] embolization with alcohol or other embolic material [9][10][11][12], percutaneous or laparoscopic cryotherapy [13], focused ultrasound (FUS) [14], radiofrequency ablation (RFA) [15,16], and cystoscopic or percutaneous laser thermal ablation (LTA) [17].…”

Should laparoscopy be the standard approach used for pelvic lymph node dissection?

“…Third, this shift toward less invasive procedures leads to shorter hospitalization and overall lower costs. Furthermore, a multicenter outcome assessment was conducted to evaluate laparoscopic urologic procedures, and there is a continual improvement in outcome and changes in usage patterns with increased experience in laparoscopic surgery [29]. Although laparoscopy is well established in the field of urology, the application in the community setting may be somewhat limited [30].…”

Retroperitoneal laparoscopy

“…While early reports enthusiastically supported the use of laparoscopy in urology, significant complications, e.g. bowel or vascular injuries, can occur with the transperitoneal approach [ 1–3].…”

“…In an effort to reduce the risk of complications, retroperitoneal laparoscopy, also known as retroperitoneoscopy, has been described for a variety of procedures, including pelvic lymph node dissection [ 2, 4–7], ureterolithotomy [ 8–11], bladder neck suspension [ 12] and a variety of renal procedures [ 13–18]. Several factors support the retroperitoneal approach.…”