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C G Eden

Publications and source records attributed to C G Eden.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic pyeloplasty: evolution of a new gold standard.

OBJECTIVES: To report our series of laparoscopic dismembered pyeloplasty for the treatment of primary and secondary ureteropelvic junction obstruction and to review the current status of this procedure. METHODS: A total of 170 consecutive cases of laparoscopic pyeloplasty (156 for primary and 14 for secondary ureteropelvic junction obstruction) were performed or supervised by a single surgeon (C.G.E). A four-port extraperitoneal approach was used in all but 3 cases, which were performed transperitoneally. RESULTS: The median operative time was 140 minutes. The complication rate was 7.1%, and the conversion rate was 0.6%, with no conversion in the last 161 cases. The median postoperative hospital stay was 3 nights. Crossing vessels were encountered in 42% of cases, and in 11 patients, coexisting renal calculi were successfully removed. At a median follow-up of 12 months, the success rate was 96.2%. CONCLUSIONS: Laparoscopic dismembered pyeloplasty produces functional results comparable to that of open surgery with the advantages of a minimally invasive procedure. Our results are consistent with previous series and support the view that laparoscopic pyeloplasty is moving rapidly toward replacing open surgery as the gold standard in the treatment of ureteropelvic junction obstruction.

Adolescent↗
PubMed2005

The impact of prostate size in laparoscopic radical prostatectomy.

OBJECTIVES: Large prostates can be challenging to remove during open or laparoscopic radical prostatectomy (LRP). Our objective was to critically analyse the impact of prostate volume in LRP. METHODS: 400 cases of LRP were performed. Three hundred and fourteen patients had a small prostate (weight < 75 g) and 86 patients had a large prostate (weight > or = 75 g) on final histology. The following outcomes were assessed: operative time; estimated blood loss (EBL); transfusion rate; length of hospital stay (LOS); length of catheterisation; perioperative and postoperative complications (including incontinence and erectile dysfunction); surgical margin status; and early biochemical recurrence rates. RESULTS: Patients' age, PSA, Gleason sum and clinical stage were all similar. Larger prostates were associated with a 14 minutes longer mean operating time (p < 0.001), but fewer positive surgical margins (p = 0.01). Blood loss, blood transfusion rate, length of hospital stay, length of catheterisation and complication rate were all similar in both groups. CONCLUSIONS: Prostate size should not be a factor determining a patient's suitability for LRP. Further follow-up is needed to assess the effect of prostate size on long-term functional and oncological results.

Adenocarcinoma↗
PubMed2004

Transperitoneal or extraperitoneal laparoscopic radical prostatectomy: does the approach matter?

PURPOSE: : The greater accuracy of apical dissection and reconstruction in our first 100 patients undergoing transperitoneal laparoscopic radical prostatectomy (TLRP) was not matched by a proportionate increase in the rate of return to normal continence compared with our prior open prostatectomy experience. We postulated that greater bladder dysfunction due to the almost total bladder dissection mandated by TLRP might be responsible and this might be rectified by the adoption of laparoscopic radical prostatectomy using an extraperitoneal approach (ELRP). MATERIALS AND METHODS: : A total of 100 patients undergoing TLRP were compared with 100 undergoing ELRP. The groups were subdivided into halves to investigate the influence of any learning curve effect. All patients had clinical stage T3aN0M0 or less prostate cancer and they were operated on by a single surgeon. RESULTS: : Mean operative time (238.9 vs 190.6 minutes), blood loss (310.5 vs 201.5 ml), postoperative hospitalization (3.8 vs 2.6 nights) and catheterization duration (11.3 vs 10.1 days) were significantly greater in the TLRP group. After the first 50 cases were excluded in each group statistical significance persisted only for operative time (218.3 vs 184.2 minutes) and hospitalization (3.5 vs 2.5 nights). The pad-free rate was significantly lower 3 months following ELRP (80% vs 56%, p = 0.02). The overall 12-month pad-free rate for TLRP and ELRP was 90% and 96%, respectively. The overall 12-month erection rate for TLRP and ELRP was 61% and 82%, respectively. CONCLUSIONS: : ELRP is superior to TLRP with respect to operative time, hospitalization and early continence.

Adenocarcinoma↗
PubMed2002

Laparoscopic radical prostatectomy: the initial UK series.

OBJECTIVE: To test the reproducibility of other series of laparoscopic radical prostatectomy (LRP) for safety, efficacy and early oncological and functional results. PATIENTS AND METHODS: One hundred consenting patients with clinically localized adenocarcinoma of the prostate and a Gleason sum of < or = 8 opting for surgery underwent LRP undertaken by one surgeon. Their mean (range) age was 62.2 (52-72) years, weight 78.8 (65-100) kg, prostate specific antigen (PSA) level 8.0 (2-32) ng/mL, and Gleason sum 6.0 (4-8). A five-port antegrade transperitoneal technique was used in all cases. RESULTS: The mean (range) operative duration was 245 (145-600) min, blood loss 313 (50-1300) mL, parenteral morphine sulphate administration 20.2 (0-160) mg and hospital stay after LRP 4.2 (3-13) nights. Bilateral neurovascular bundle preservation was attempted in 58% of patients. The transfusion rate was 3%. The conversion and re-intervention rates were 1% and 2%, respectively. There were eight complications, six of which were in the initial 26 cases, i.e. bladder neck stenosis (two), and rectal injury, laparotomy for bleeding, premature drain removal leading to urinary peritonitis, ulnar nerve neuropraxia, port-site hernia and paralytic ileus in one each. The positive surgical margin rate was 16%. All patients had a PSA level of < or = 0.1 ng/mL at 3 months. By 1 year 90% of patients were pad-free and 62% operated on using a bilateral nerve-sparing technique had erections. There were no biochemical failures. The mean (range) follow-up was 9.8 (1-24) months. CONCLUSION: The present results are similar to those reported by other centres with greater experience and confirm that LRP is an effective, safe and precise technique. Once intial experience has been gained it offers advantages over open surgery in the form of a dry and magnified operative site, and a lower likelihood of blood transfusion, in addition to the generic advantages of laparoscopy.

Adenocarcinoma↗
PubMed2002

Big-screen laparoscopic surgery.

Significant advances in fiberoptic and digital technology for laparoscopic surgery have been made over the past decade. One area that appears to be overlooked in this field is the advancement in the display of the image during laparoscopic surgery. The authors describe the use of digital video-cinema equipment as a simple and effective technique that enhances the projection of the surgical view. This method has been found to be visually more comfortable, aiding the surgical procedure, and extremely useful as a teaching tool.

Humans↗
PubMed2001

Laparoscopic dismembered pyeloplasty: 50 consecutive cases.

OBJECTIVE: To test the hypothesis that laparoscopic dismembered pyeloplasty offers the same good results as open pyeloplasty, but without the disadvantages of the loin incision (which is painful, prolongs hospitalization and prevents a return to normal activities for several weeks) in the treatment of pelvi-ureteric junction (PUJ) obstruction. PATIENTS AND METHODS: Fifty consecutive consenting patients presenting with PUJ obstruction underwent laparoscopic dismembered pyeloplasty carried out by one surgeon using an extraperitoneal approach. RESULTS: Two (4%) procedures were converted to open surgery. The mean (range) operative duration was 164 (120-240) min. Fifteen (30%) of the patients had their ureter transposed anterior to a crossing lower-pole vessel; 22 (44%) patients had a separate renal pelvic suture line. The mean (range) postoperative parenteral analgesic requirement was 19.1 (0-111) mg of morphine sulphate. The mean (range) hospitalization was 2.6 (2-7) days. Two (4%) patients had complications. After a mean (range) follow-up of 18.8 (3-72) months all but one patient, who had failed endopyelotomy, had a normal renogram and were symptom-free. CONCLUSION: These results suggest that a loin wound is not necessary for a successful outcome after dismembered pyeloplasty, and that in expert hands laparoscopic dismembered pyeloplasty should now be considered the standard of care.

Adolescent↗
PubMed1998

Intracorporeal or extracorporeal lithotripsy for distal ureteral calculi? Effect of stone size and multiplicity on success rates.

Over a period of 57 months, 404 patients with distal ureteral calculi were treated by in situ SWL on a Storz Modulith SL 20 lithotripter and 163 by ureteroscopy (URS) and Swiss Lithoclast stone fragmentation. The case notes on these patients were reviewed for comparison of the initial stone number and individual length and for the calculation of the stone-free, treatment, retreatment, secondary procedure, and complication rates. Complete data were available on 447 patients. The median stone length was 7.0 (range 4-25) mm in the SWL group and 8.0 (range 5-13) mm in the URS group. The single-treatment stone-free rates for the SWL and URS groups were 74.8% and 89.7%, respectively, for single stones and 50.0% and 88.9%, respectively, for multiple (>1) stones. The mean treatment rates for the SWL and URS groups were 1.97 and 1.03, respectively, for single stones and 2.83 and 1.00, respectively, for multiple stones. The mean treatment rate for single stones subjected to SWL increased with increasing stone length (1.57 for stones <8 mm and 2.38 for stones >8 mm), whereas this was not the case for patients submitted to URS (1.20 and 1.27, respectively). The re-treatment rate for each group showed a reciprocal trend. Of the SWL group, 25.9% of the patients eventually required URS to render them stone-free. Nearly all (96%) of the patients undergoing SWL were treated as outpatients. The mean hospitalization in the URS group was 1.1 days. Three patients who underwent URS sustained a ureteral perforation, which was managed successfully by double-J stent insertion. The ideal primary treatment for small (<8 mm) distal ureteral calculi is in situ SWL, with URS plus Lithoclast fragmentation being reserved for failed SWL, single stones >8 mm in length, and multiple stones.

Adolescent↗
PubMed1997

Extraperitoneal laparoscopic dismembered fibrin-glued pyeloplasty: medium-term results.

OBJECTIVE: To assess the feasibility and results of performing retroperitoneoscopic dismembered fibrin-glued pyeloplasty in a clinical series of patients with pelvi-ureteric junction (PUJ) obstruction. PATIENTS AND METHODS: A balloon-dissecting four-port extraperitoneal laparoscopic approach was used in each of nine patients (aged 21-60 years) to dismember the PUJ over a previously placed double-pigtail stent, insert stay sutures to appose the urothelium and complete the pelvi-ureteric anastomosis using fibrin glue. Anastomoses were assessed by diuresis renography 3 months after surgery and at yearly intervals thereafter. RESULTS: Eight of the nine attempted procedures were completed successfully in a median (range) operating time of 180 (150-230) min. The median (range) post-operative parenteral opiate requirement was 0 (0-80) mg morphine sulphate and the post-operative hospitalization was 2 (2-4) nights. A shortened fibrotic ureter prevented the laparoscopic completion of the second case, which was converted to an open procedure. Follow-up imaging after 1-2 years showed satisfactory upper tract drainage in those cases completed successfully. One patient developed a renal pelvic calculus that was treated by extracorporeal shock wave lithotripsy. CONCLUSION: This technique is associated with a significantly shorter operating time than historical laparoscopic controls, and with a significantly lower post-operative opiate analgesic requirement and shorter post-operative hospitalization than in a contemporaneous series of patients undergoing open pyeloplasty. However, longer term follow-up is needed to fully assess the performance of these anastomoses.

Adult↗
PubMed1996

Assessment of alternative tissue approximation techniques for laparoscopy.

OBJECTIVE: To investigate the feasibility and results of applying alternative techniques of tissue approximation for experimental urothelial re-anastomosis in an open and laparoscopic setting. MATERIALS AND METHODS: The study was carried out in two phases; in phase 1, an open porcine ureteric re-anastomosis was performed using gelatin/resorcin/ formaldehyde (GRF) glue, fibrin glue or potassiumtitanyl-phosphate laser tissue-welding with a fluorescein-doped human albumin solder. The anastomoses were assessed both immediately, by leak pressure, and by the operating time, upper tract urodynamic studies and light and scanning electron microscopy, 6 weeks after surgery. In phase 2 the best technique from phase 1 was compared with sutured controls for porcine retroperitoneoscopic dismembered pyeloplasty, using the same assessment criteria. RESULTS: In phase 1, GRF glue produced adhesion which was insufficiently flexible to withstand rotation of the anastomosis and this technique was therefore abandoned. Fibrin-glued anastomoses withstood leak pressures equal to those from laser-welding (P = 0.91) and gave similar changes in maximum pressure with a Whitaker test at 6 weeks (P = 0.30), but were superior in requiring a shorter operating time (P = 0.02) and in their electron and light microscopic appearances. In phase 2, fibrin glue gave similar changes in maximum pressure with a Whitaker test to those from polyglactin 910 sutures (P = 0.51) but withstood higher leak pressures (P = 0.01), had a shorter operating time (P = 0.01) and had superior electron and light microscopic appearances. CONCLUSION: Fibrin glue produced effective experimental laparoscopic pelvi-ureteric anastomoses within less operating time than did sutured controls. Such anastomoses withstood supra-physiological pressures, with no evidence of functional obstruction and with a more favourable histological result after 6 weeks. Laparoscopic evaluation of this modality in a clinical setting is now justified.

Anastomosis, Surgical↗
PubMed1995

Trash penis.

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Aged↗