Flexible Ureterorenoscopy under Spinal Anesthesia: Focus on Technique, Results, Complications, and Patients’ Satisfaction from a Large Series

2021 ◽  
pp. 1-6
Author(s):  
Andrea Bosio ◽  
Eugenio Alessandria ◽  
Federico Vitiello ◽  
Eugenia Vercelli ◽  
Simone Agosti ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Renal Stones ◽  
Flexible Ureterorenoscopy ◽  
Patients Satisfaction ◽  
Stone Burden ◽  
Unfit Patients ◽  
Technical Details ◽  
Very High

<b><i>Introduction:</i></b> Although spinal anesthesia (SA) may reduce postoperative morbidity, most urologists perform flexible ureterorenoscopy (fURS) under general anesthesia (GA). The objective of our study is to provide technical details, results, complications, and patients’ satisfaction with fURS performed under exclusive SA. <b><i>Methods:</i></b> We analyzed all consecutive fURS performed under SA to treat renal stones from March 2011 to February 2017. Details of technique, operative time, outcomes, need for further treatments, complications, and patients’ satisfaction were evaluated. <b><i>Results:</i></b> Two hundred thirty-four fURS under SA were considered. SA was performed through L2-L3 vertebral interspace in 64.1%. Patients were discharged the same day of surgery. Mean stone burden was 13.5 ± 6.6 mm and mean operative time 76.9 ± 34.6 min. Single-procedure SFR was 69.7%. Further treatments were performed in 22.8%. 96.6% had no anesthesia-related complications. No Clavien-Dindo grade ≥ IIIb complications were noticed. 99.6% of patients were satisfied with SA. No cases of conversion from SA to GA occurred. <b><i>Conclusion:</i></b> fURS can be performed safely and efficiently under SA, taking into account a few details of the technique. Patients’ satisfaction with SA is very high, and complications are rare. Although SA is usually adopted in unfit patients for GA, it may be considered as a viable alternative in fit patients.

scholarly journals Initial Experience of Percutaneous Nephrolithotomy at Lumbini Medical College

2013 ◽  
Vol 1 (1) ◽  
pp. 35
Author(s):  
Prakash Sapkota ◽  
Y B Tambey ◽  
Sunil Thapa ◽  
Rajan Shakya
Keyword(s):  
Prospective Study ◽  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Renal Stones ◽  
Invasive Approach ◽  
Medical College ◽  
Stone Burden ◽  
Estimated Blood Loss ◽  
The Mean

  Introduction: Renal stone disease is a challenging problem in urologic practice especially in our locality because of large stone burden and recurrence. Since ,the early 1980s when percutaneous nephrolithotomy (PCNL) was established for management of renal stones, open surgical procedures have virtually been replaced. PCNL is a safe, effective and minimally invasive approach compared to open surgery for patients with large single, multiple or staghorn stones. The aim of this prospective study was to evaluate and to review our experience with PCNL in management of renal and upper ureteric stones.   Methods: Prospective study carried out at Lumbini Medical College and Teaching Hospital during 1stJanuary 2011 to 31st October 2011. Sixty patients were evaluated and subjected to PCNL. After clinical investigations like ultrasonography (USG) and intravenous urography (IVU), once patients were found to have renal or upper ureteric stones they were informed and explained about PCNL, its likely complications, probable hospital stay, the cost of treatment and data were recorded along with the operative time, estimated blood loss, stone burden, stone-free rate, length of hospitalization and complications .Patients were followed up after three months to rule out recurrence of stones by plain abdominal x-ray of kidney, ureter and bladder and USG.   Results: Out of 60 patients 35 were male and 25 were female (M: F=1.4:1) with mean age of 37 years and were subjected to PCNL monotherapy. With the average stone size of 3.26cm, the mean operative time was 78 minutes. Complete stone removal achieved by PCNL alone in 60 cases, with insignificant residual small stones we achieved 97% stone clearance rate. The mean hospital stay was 3.7 days. No Serious complications were encountered, 9 (15%) patients required blood transfusion and 3 (5%) patients developed transient post-operative pyrexia.   Conclusion: PCNL is the first line treatment option for management of large renal stones which as monotherapy has advantages in removal of renal and upper ureteric stones and achieving excellent results with minimal morbidity.

scholarly journals Effectiveness of Flexible Ureterorenoscopy and Laser Lithotripsy for Multiple Unilateral Intrarenal Stones Smaller Than 2 cm

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Erdal Alkan ◽  
Oguz Ozkanli ◽  
Egemen Avci ◽  
Mirac Turan ◽  
M. Murad Başar ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Operative Time ◽  
Laser Lithotripsy ◽  
High Grade ◽  
Effective Treatment Option ◽  
High Grade Fever ◽  
Flexible Ureterorenoscopy ◽  
Safety And Efficacy ◽  
Stone Burden

Purpose. To evaluate the safety and efficacy of RIRS for the treatment of multiple unilateral intrarenal stones smaller than 20 mm.Methods. Between March 2007 and April 2013, patients with multiple intrarenal stones smaller than 20 mm were treated with RIRS and evaluated retrospectively. Each patient was evaluated for stone number, stone burden (cumulative stone length), operative time, SFRs, and complications.Results. 173 intrarenal stones in 48 patients were included. Mean age, mean number of stones per patient, mean stone burden, and mean operative time were40.2±10.9years (23–63),3.6±3.0(2–18),22.2±8.4 mm (12–45), and60.3±22.0minutes (30–130), respectively. The overall SFR was 91.7%. SFRs for patients with a stone burden less and greater than 20 mm were 100% (23/23) and 84% (21/25), respectively (χ2=26.022,P<0.001). Complications occurred in six (12.5%–6/48) patients, including urinary tract infection or high-grade fever >38.5°C in three cases, prolonged hematuria in two cases, and ureteral perforation in one case, all of whom were treated conservatively. No major complications occurred.Conclusions. RIRS is an effective treatment option in patients with multiple unilateral intrarenal stones especially when the total stone burden is less than 20 mm.

scholarly journals Operative Time, Age, and Serum Albumin Predict Surgical Morbidity After Laparoscopic Liver Surgery

2021 ◽  
pp. 155335062199122
Author(s):  
Daniel Heise ◽  
Jan Bednarsch ◽  
Andreas Kroh ◽  
Sandra Schipper ◽  
Roman Eickhoff ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Operation Time ◽  
Laparoscopic Liver Surgery ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Preoperative Albumin

Background. Laparoscopic liver resection (LLR) has emerged as a considerable alternative to conventional liver surgery. However, the increasing complexity of liver resection raises the incidence of postoperative complications. The aim of this study was to identify risk factors for postoperative morbidity in a monocentric cohort of patients undergoing LLR. Methods. All consecutive patients who underwent LLR between 2015 and 2019 at our institution were analyzed for associations between complications with demographics and clinical and operative characteristics by multivariable logistic regression analyses. Results. Our cohort comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years. General complications and major perioperative morbidity were observed in 19.9% and 9.6% of the patients, respectively. Multivariable analysis identified age>65 years (HR = 2.56; P = .028) and operation time>180 minutes (HR = 4.44; P = .001) as significant predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR = 3.66; P = .033) and also operative time (HR = 23.72; P = .003) were identified as predictors of major postoperative morbidity (Clavien ≥3). Conclusion. Surgical morbidity is based on patient- (age and preoperative albumin) and procedure-related (operative time) characteristics. Careful patient selection is key to improve postoperative outcomes after LLR.

Comparison between different techniques for management of renal stones in horseshoe kidneys

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Abdel Fattah Mohammed Aggour ◽  
Mohamed Kotb Ahmed Tolba ◽  
Abdelrahman nazmy abbas hatata
Keyword(s):  
Horseshoe Kidney ◽  
Renal Stones ◽  
Operative Management ◽  
Flexible Ureteroscopy ◽  
Stone Clearance ◽  
Stone Burden ◽  
Laparoscopic Pyelolithotomy ◽  
Almost All ◽  
Laparoscopic Assisted ◽  
Operating Surgeon

Abstract Objective To report the operative management , intra and post operative complications and subsequent stone-free rates of patients with urolithiasis in a horseshoe kidneys. Materials and Methods We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 20-year period. The stone burden, surgical management, complications and stone clearance rates were recorded. Results In all, 80 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 28 patients. 12 patients had laparoscopic assisted PCNL , 8 had flexible ureteroscopy and 18 had laparoscopic pyelolithotomy . PCNL was used for large stones = (mean digitized surface area= 614.32 mm 2 ) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures. only 33% of patients treated with flexible ureteroscopy was cleared from stones in one session and surprisingly, 89% of patients treated with laparoscopic pyelolithotomy was stone free after one session Complications were minimal, with 15% minor and 3% major complications in the PCNL group only.. Conclusions Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.

scholarly journals Cytoreductive Surgery for Peritoneal Carcinomatosis from Gastric Cancer: Technical Details

2021 ◽  
Vol 10 (22) ◽  
pp. 5263
Author(s):  
Thomas Boerner ◽  
Pompiliu Piso
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Postoperative Morbidity ◽  
Current Knowledge ◽  
Treatment Options ◽  
Treatment Modalities ◽  
Locoregional Treatment ◽  
Surgical Expertise ◽  
Technical Details

Due to limited systemic treatment options, peritoneal carcinomatosis of gastric origin is still associated with a dismal outcome and is claimed a terminal disease. In the past, surgery had not been considered as a potential treatment option. However, there is emerging evidence that in selected patients, locoregional treatment modalities including cytoreductive surgery of peritoneal carcinomatosis can improve survival in patients with gastric cancer. These operative procedures are complex and challenging, and a high surgical expertise of the treating physician is necessary to prevent major postoperative morbidity and mortality with a delay of further systemic therapy. This review summarizes our current knowledge and personal experience regarding the techniques of cytoreductive surgery for peritoneal metastasis of gastric origin.

scholarly journals Retrograde Intrarenal surgery- Our experience

2020 ◽  
Vol 3 (1) ◽  
pp. 88-92
Author(s):  
Nand Kumar B. Madhekar ◽  
A. Nischal Prasad
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Tertiary Care ◽  
Renal Stones ◽  
Tertiary Care Centre ◽  
Renal Surgery ◽  
Retrograde Intrarenal Surgery ◽  
Residual Stone ◽  
Stone Clearance ◽  
Residual Stones

Background: RIRS has become an important treatment option for kidney stones in pediatric patients with the development of new-generation ureteroscopy and holmium laser. The present study was conducted to assess cases of retrograde intrarenal surgery. Subjects and Methods: The present study was conducted in a tertiary care centre over a period of one year on 120 cases of retrograde intra renal surgery (RIRS) performed in both genders. Renal stone location and stone clearance, laterality, stone size, operative time, hematuria, postoperative pain & fever, urosepsis, hospital stay, residual stones and need of an adjunctive procedure to achieve residual stone clearance. Results: Out of 120 patients, males were 70 and females were 50. Stones were detected in upper calyx in 50 cases, middle calyx in 40, lower calyx in 20 and pelvis in 10 cases. The mean size of stones was 8.1 mm, operative time was 62.1 minutes, hospital stay was 3.6 days, clinically insignificant radiological fragments were seen in 35 cases and residual stones were seen in 20 cases. Maximum cases of CIRF were seen in middle calyx (15) and residual stones were seen in lower calyx (7). The difference was significant (P< 0.05). Common complications were fever in 7, hematuria in 3, flank pain in 4 and urosepsis in 2 cases. Conclusion: Authors found that retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal stones.

scholarly journals Incidence of Post-spinal Hypotension during Cesarean Section in Paropakar Maternity and Women’s Hospital

2018 ◽  
Vol 13 (3) ◽  
pp. 43-47
Author(s):  
Sangeeta Shrestha ◽  
Tara Gurung ◽  
Ritu Pradhan ◽  
Amir Babu Shrestha
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Demographic Data ◽  
Loss Of Consciousness ◽  
Cardiovascular Collapse ◽  
Prophylactic Measures ◽  
The Mean ◽  
Spinal Hypotension ◽  
Record Section ◽  
Very High

Aims: Spinal anesthesia is the choice of anesthesia in parturient for cesarean section. This procedure is frequently associated with hypotension and the incidence varies from 70% to 80%. Maternal hypotension causes very unpleasant sign and symptoms such as nausea, vomiting, dyspnoea and sense of impending doom. Prolonged episodes of hypotension lead to organ ischemia, loss of consciousness, cardiovascular collapse and uteroplacental hypoperfusion. The aim of this study is to find out the proper data of the incidence of hypotension in parturient undergoing cesarean section in our hospital as only the estimated data is present. Methods: We retrospectively reviewed the intraoperative anesthesia record form of all the patients who underwent cesarean section under spinal anesthesia from the hospital record section from 13th April 2016 to 12th April 2017. The detailed parameters of patient’s demographic data were collected and recorded. Results: A total of 3814 parturients were included in this study. The mean age was 25.76 ± 4.74 years and mean gestational age was 39.23 ± 1.54 weeks. Post spinal hypotension was seen in 947 patients out of 3814. Thus the incidence of hypotension was 24.8%. Conclusions: The incidence of maternal hypotension is very high if prophylactic measures are not taken. The fluid preloading or coloading, left lateral uterine displacement and prophylactic vasopressors have shown to be effective in preventing postspinal hypotension.

scholarly journals Effect of Preoperative Internal Biliary Drainage on Postoperative Outcome Following Pancreaticoduodenectomy for Periampullary Carcinoma

KYAMC Journal ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 196-201
Author(s):  
Munsur Miah ◽  
M Fardil Hossain Faisal ◽  
Bidhan C Das ◽  
Md Manir Hossain Khan ◽  
Md Nahid Reza ◽  
...  
Keyword(s):  
Blood Loss ◽  
Wound Infection ◽  
Biliary Drainage ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Postoperative Outcome ◽  
Preoperative Biliary Drainage ◽  
Eligibility Criteria ◽  
High Incidence ◽  
Hepatobiliary And Pancreatic Surgery

Background: Preoperative biliary drainage before pancreaticoduodenectomy is a controversial issue. Proponents are in favor of preoperative biliary drainage by ERCP with stent to reduce surgical jaundice with an anticipation of better surgical outcome. Objective: Compare the outcome with or without pre-operative biliary drainage before pancreaticoduodenectomy. Materials and Methods: This observational comparative study was conducted in department of Surgery and Hepatobiliary and pancreatic surgery of BSMMU. Twenty three patients presented with obstructive jaundice due to periampulary carcinoma who subsequently underwent pancreaticoduodenectomy were selected by purposive sampling and finalized by eligibility criteria. Results: Patients with preoperative biliary drainage (PBD) group required a longer operative time (mean 4.12 hours versus 3.83 hours) and had more intra-operative blood loss (mean 662 mL versus 495 mL) compared with non PBD group (P=0.009 and 0.010). No differences were found with respect to operative mortality (4.3%) and incidence of pancreatic leakage (P=0.281). PBD was significantly associated with positive bile culture (P=0.019) and high incidence of wound infection (p=0.029). Conclusion: Preoperative biliary drainage did not increase major postoperative morbidity and mortality but associated with increased operative time, intraoperative blood loss, and incidence of wound infection. Preoperative biliary drainage should be used selectively in patients undergoing pancreaticoduodenectomy. KYAMC Journal Vol. 10, No.-4, January 2020, Page 196-201

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