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Intraoperative laparoscopic complications for urological cancer procedures

World Journal of Clinical Cases 2015年第5期3卷 450-456页

作者： sergio fernández-pello montes Ivan Gonzalez Rodríguez Rodrigo Gil Ugarteburu Luis Rodríguez Villamil Begoa Diaz Mendez Patricio Suarez Gil Javier Mosquera Madera Urology Department Cabueñes Hospital33203 GijónAsturiasSpain

AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications. RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery(radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery(radical prostatectomy and radical cystectomy).CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications.

关键词： Intraoperative complications Laparoscopy Surgical complication Urology Cancer

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Efficacy of different doses of sugammadex after continuous infusion of rocuronium

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World Journal of Clinical Cases 2015年第4期3卷 360-367页

作者： Diego Soto Mesa Mounir Fayad Fayad Laura Pérez Arviza Verónica Del Valle Ruiz fernando Cosío Carreño Luis Arguelles Tamargo Manuel Amorín Díaz sergio fernández-pello montes Department of Anaesthesiology Hospital of Cabueñes33394 GijónSpain Department of Neurology Hospital of JoveEduardo Castro s/n33290 GijónSpain Department of Urology Hospital of Cabueñes33394 GijónSpain

AIM: To evaluate the effects of two different doses of sugammadex after maintenance anesthesia with sevofluorane and remifentanil and deep rocuroniuminduced neuromuscular blockade(NMB).METHODS: Patients between 20 and 65 years of age, with American Society of Anesthesiologists physical status classification Ⅰ-Ⅱ, undergoing gynecological surgery were included in a prospective, comparative and randomized study. NMB was induced with an injection of 0.6 mg/kg of rocuronium followed by continuous infusion of 0.3-0.6 mg/kg per hour to maintain a deep block. Anesthesia was maintained with sevofluorane and remifentanil. Finally, when surgery was finished, a bolus of 2 mg/kg(group A) or 4 mg/kg(group B) of sugammadex was applied when the NMB first response in the train-of-four was reached. The primary clinical endpoint was time to recovery to a train-of-four ratio of 0.9. Other variables recorded were the time until recovery of train-of-four ratio of 0.7, 0.8, hemodynamic variables(arterial blood pressure and heart rate at baseline, starting sugammadex, and minutes 2, 5 and 10) and adverse events were presented after one hour in the post-anesthesia care ***: Thirty-two patients were included in the study: 16 patients in group A and 16 patients in group B. Only 14 patients each group were recorded because arterial pressure values were lost in two patients from each group in minute 10. The two groups were comparable. Median recovery time from starting of sugammadex administration to a train-of-four ratio of 0.9 in group A and B was 129 and 110 s, *** estimated difference in recovery time between groups was 24 s(95%CI: 0 to 45 s, Hodges-Lehmann estimator), entirely within the predefined equivalence interval. Times to recovery to train-of-four ratios of 0.8(group A: 101 s; group B: 82.5 s) and 0.7(group A: 90 s; group B: 65 s) from start of sugammadex administration were not equivalent between groups. There was not a significant variation in the arterial pr

关键词： Rocuronium Sugammadex Neuromuscular block antagonism Monitoring neuromuscular function Neuromuscular block rocuronium

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Pyonephrosis as a sign of sarcomatoid carcinoma of the renal pelvis

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World Journal of Clinical Cases 2014年第6期2卷 215-218页

作者： sergio fernández-pello Victoria Venta Iván González Rodrigo Gil Carmen Luz Menéndez Department of Urology Cabuenes Hospital33394 GijonSpain Department of Pathology Cabuenes Hospital33394 GijonSpain

We report the case of an urgent nephrectomy because of a pyonephrosis and sepsis due to an unsuspected sarcomatoid transitional cell carcinoma, an infrequent subtype with a bad oncological prognosis. We present a 58-year-old man assessed by internal medicine for a general syndrome and weakness many months previously. A pyonephrotic kidney was observed at abdominal computed tomography in the context of septic shock, without suspecting the underlying cause. The pathology report described a sarcomatoid transitional cell carcinoma. Sarcomatoid transitional cell carcinoma is an invasive and infrequent subtype of urothelial tumors. The symptoms are often the same as other renal masses; however, in this case, sepsis and pyonephrosis were the rare initial symptoms.

关键词： Urothelial carcinoma Renal pelvis Sarcomatoid

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Lymph node non-Hodgkin's lymphoma incidentally discovered during a nephrectomy for renal cell carcinoma

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World Journal of Clinical Cases 2013年第3期1卷 121-123页

作者： sergio fernandez-pello Luis Rodriguez Villamil Ivan Gonzalez Rodriguez Victoria Venta Javier Cuervo Carmen Luz Menéndez Urology Department Cabuenes Hospital33203 GijónSpain Pathology Department Cabuenes Hospital33203 GijónSpain

We report the case of a left laparoscopic nephroureterectomy with the incidental discovery of a non-Hodgkin's lymphoma in one of the lymph nodes of the renal hilum. A laparoscopic nephroureterectomy was decided on for a 64-year-old man. Renal cell carcinoma in the kidney and one lymph node of the renal hilum with non-Hodgkin's lymphoma was found. Chemotherapy was not started for the lymphoma discovery. There are no signs of relapse after two years of follow up. Coexistence in the same patient is an extremely rare condition. We review the literature about this issue to clarify this association.

关键词： Renal cell carcinoma Lymphoma Nephrectomy

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