Biomedical subjects

D Chopin

Publications and source records attributed to D Chopin.

At least 37 records · Page 2Linked to original sources

PubMed2001

[Treatment of pheochromocytomas with retroperitoneal laparoscopy].

OBJECTIVES: Although laparoscopic adrenalectomy has become one of the techniques of choice for the treatment of adrenal tumours, this technique has not been widely used to treat phaeochromocytoma due to the risks of hypertension before control of the adrenal vein. The authors report their experience of retroperitoneal laparoscopic adrenalectomy for phaeochromocytoma. MATERIAL AND METHODS: From January 1995 to December 1999, 10 (5 right, 5 left) retroperitoneal laparoscopic adrenalectomies were performed for symptomatic phaeochromocytoma, in 4 men and 6 women, aged 40 to 67 years (mean: 51 years). In every case, the phaeochromocytoma had been diagnosed by elevated urinary catecholamines, abdominopelvic CT scan and positive MIBG scintigraphy. RESULTS: There were no conversions to open surgery. The mean operating time was 116 minutes (range: 100 to 140 minutes). Mean blood loss was 180 ml (range: 0 to 550 ml) and none of the patients were transfused. In one case, an injury to the adrenal vein was repaired intraoperatively. The mean length of hospital stay was 3.4 days (range: 1 to 12 days). The mean diameter of the lesion was 38 mm (range: 15 to 110 mm). Postoperative complications occurred in two cases (one haematoma and one incisional hernia repaired one year later). With a mean follow-up of 21.6 months (range: 6 to 46 months), all patients had normal urinary catecholamine levels and 9 had a normal blood pressure with no antihypertensive therapy. CONCLUSION: Retroperitoneal laparoscopic adrenalectomy can be performed for small phaeochromocytomas (less than 5 cm). Retroperitoneal laparoscopy is a direct approach which allows the surgeon to control the adrenal vein first in order to avoid hypertensive crises.

Adrenal Gland Neoplasms↗

PubMed2001

[Retroperitoneal laparoscopic surgery and carcinogenic risk].

OBJECTIVE: To retrospectively evaluate the development of metastasis at trocar sites, local recurrence and distance metastases associated with retroperitoneal laparoscopic surgery performed in the context of a malignant tumour. METHODS: From 1994 to 1999, 228 retroperitoneal laparoscopic surgical operations were performed in our centre. Fifty six operations (24.6%) were performed for malignant tumours and comprised 41 radical nephrectomies and 8 partial nephrectomies for renal tumour and 7 nephro-ureterectomies for upper urinary tract tumours. The pathological stage and surgical margins were correlated with TNM 1997 stage. Postoperative data were obtained by physical and radiological examination performed one month and three months after the operation and then every six months. Metastases at the trocar site, local recurrences and distant metastases were investigated. The specific progression-free survival was calculated according to the Kaplan-Meier method. RESULTS: The mean follow-up was 24.9 +/- 13.85 months. All patients had tumour-free surgical margins. No trocar site metastasis was observed. For retroperitoneal laparoscopic radical nephrectomies: one patient developed a local recurrence with liver metastases 9 months after the operation (pT3G2) and died 19.7 months after the operation. One patient with a pT3G3M+ renal tumour at the time of diagnosis died 23.1 months after radical nephrectomy with no signs of local recurrence. For laparoscopic retroperitoneal nephro-ureterectomies: one patient with a pT3G3 lesion developed a local recurrence at 12.1 months and died 26.6 months after surgery. One patient with a pT1G2 tumour developed bone metastases at 9 months and died 29 months after the operation. The recurrence-free survival at 54 months was 91% for radical nephrectomies, 71% at 30 months for nephro-ureterectomies and 100% at 49 months for partial nephrectomies. CONCLUSION: Malignant tumours of the upper urinary tract can be managed by retroperitoneal laparoscopy. The short-term results suggest that this surgical technique is not associated with an increased risk of trocar site metastases or local recurrence and that recurrence-free survival rates comparable to those reported in series of conventional surgery.

Follow-Up Studies↗

PubMed2001

Experience with retroperitoneal laparoscopic adrenalectomy in 115 procedures.

PURPOSE: Laparoscopic adrenalectomy has become an effective option for removing small adrenal tumors. We evaluated the retroperitoneal approach with regard to operative complications, morbidity and hospital stay. MATERIALS AND METHODS: Between January 1995 and March 2000 we performed a total of 115 laparoscopic adrenalectomies via the retroperitoneal approach, including 70 on the left and 45 on the right side, in 64 women and 42 men 17 to 74 years old (mean age 49.3) with adrenal neoplasms. Average adrenal tumor size was 31 mm. (range 10 to 65). All procedures required 4 trocars and mean operative time was 118 minutes (range 45 to 240). RESULTS: There were no patient deaths. The conversion rate to open surgery was 0.8% and estimated blood loss was 77 ml. (range 0 to 550). At a mean followup of 23.4 months, morbidity was 15.5% with intraoperative vascular injury in 3 cases (3.4%) and postoperative complications in 12.1%, including wound infection, deep hematoma, parietal dehiscence and severe pneumopathy. Average hospital stay was 4 days and mean duration of analgesic requirement was 2 days (range 1 to 5). CONCLUSIONS: The retroperitoneal approach to laparoscopic adrenalectomy appears to be minimally invasive and safe for adrenal tumors not larger than 5 cm.

Adolescent↗

PubMed2001

Early removal of the catheter after laparoscopic radical prostatectomy.

PURPOSE: We prospectively tested the safety of routine removal of the catheter as early as 2 to 4 days after laparoscopic radical prostatectomy. MATERIALS AND METHODS: Between March 1998 and March 2001, 228 patients underwent laparoscopic radical prostatectomy for clinically organ confined prostate cancer. The last 113 consecutive patients were included in a prospective study according to gravitational cystography performed 2 to 4 days postoperatively. If no leak was seen the catheter was removed. If a leak was apparent the catheter was left indwelling for another 6 days and cystography was repeated. RESULTS: Cystography 2 to 4 days postoperatively showed an anastomosis without a leak in 96 (84.9%) patients who subsequently had the catheters removed. There were 28 patients who had the catheter removed on postoperative day 2, 28 day 3 and 40 day 4. In 17 (15.1%) patients an anastomotic leak was observed, and the catheter was not removed at that time. Of the 96 patients in whom the catheter was removed early 10 (10.4%) had urinary retention that necessitated re-catheterization. This procedure was performed without the need for cystoscopy. After the catheter was removed all patients were able to void 24 hours later. Median followup was 7 months (range 1 to 15) and showed continence rates greater than 93%. No anastomotic stricture, pelvic abscess or urinoma developed in any patient. CONCLUSIONS: Patients who undergo laparoscopic radical prostatectomy can have the catheter safely removed 2 to 4 days postoperatively without a higher risk of incontinence, stricture or leak related problems.

Humans↗

PubMed2001

[Tolerance and efficiency of intravesical instillation of Calmette-Guérin in the prophylactic treatment of superficial bladder tumors, using a maintenance treatment].

UNLABELLED: Maintenance treatment with complementary BCG instillations in the prevention of superficial bladder tumour could improve the results of this immunotherapy. This maintenance treatment is limited by accentuation of the adverse effects related to BCG. OBJECTIVES: To evaluate the impact of maintenance treatment on tumour recurrence and progression, and to evaluate the influence of adverse effects on maintenance treatment and the recurrence rate. MATERIAL AND METHODS: 72 patients were treated with six weekly instillations of 81 mg of BCG (Immucyst) followed by three complementary instillations 3, 6, 12, 18, 24, 30 and 36 months later. Adverse effects (AE) were classified into four classes, according to their type, severity and duration, and were recorded prospectively for 518 instillations. An adverse effect score was determined for each patient. RESULTS: 84.9% of patients did not present any recurrence, 12.5% developed recurrence and 2.6% progressed. The instillation regimen was completed by 19% of patients, the dose had to be decreased for 57% of patients and treatment had to be discontinued for 39% of patients. An initial adverse effect score (AESi) greater than 1.5 was associated with an increased risk of discontinuation of treatment or reduction of the dosage during maintenance treatment (p = 0.01). CONCLUSIONS: Maintenance treatment was associated with a very low recurrence and progression rate. We have established and validated an adverse effect severity scale and the consequences of these adverse effects on maintenance treatment. This scale could be used to prospectively define the most appropriate maintenance instillation regimen, by preventively decreasing the doses or deferring instillation.

Adjuvants, Immunologic↗

PubMed2001