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G Vallancien

Publications and source records attributed to G Vallancien.

At least 19 recordsLinked to original sources
PubMed2006

[Vesico-urethral anastomosis during total laparoscopic prostatectomy].

Vesico-urethral anastomosis is the last step of radical prostatectomy. Whatever the approach, radical prostatectomy remains a difficult surgical intervention. The dissection steps are similar whatever the selected access, open or laparostopic. Laparoscopic anastomosis requires specific skills that must be adequately mastered by the surgeon before starting any laparoscopic radical prostatectomy program. Pelvi-trainers allow training on the anastomosis technique, with reproducible results. This chapter presents the key points for laparoscopic vesico-urethral anastomosis.

Anastomosis, Surgical↗
PubMed2006

Age, comorbidity and hypertensive co-medication do not affect cardiovascular tolerability of 10 mg alfuzosin once daily.

PURPOSE: We assessed in real-life practice the impact of age, cardiovascular comorbidity and co-medication on the tolerability and efficacy of 10 mg alfuzosin OD in men with lower urinary tract symptoms suggestive of benign prostatic obstruction. MATERIALS AND METHODS: A total of 6,523 men with a mean age of 64.7 years were enrolled in a 6-month open label study of 10 mg alfuzosin OD. They were stratified by age quartile (younger than 60, 60 to 64, 65 to 70 and older than 70 years), comorbidity (hypertension, ischemic heart disease and diabetes) and antihypertensive co-medication (diuretics, beta-blockers, angiotensin converting enzyme inhibitors, angiotensin II inhibitors and calcium channel antagonists). RESULTS: Alfuzosin was effective and well tolerated. Despite an increased prevalence of cardiovascular comorbidity and antihypertensive co-medication with age changes in blood pressure did not significantly differ among age groups. In controls, ie those with no cardiovascular comorbidity or co-medication, alfuzosin produced minimal decreases in sitting systolic (mean -2.6 to -2.8 mm Hg) and diastolic (mean -1.7 to -1.8 mm Hg) blood pressure. In men with cardiovascular comorbidity mean decreases in systolic (-3.5 to 5.8 mm Hg) and diastolic (-2.0 to -3.3 mm Hg) blood pressure remained marginal. Of the 6,523 exposed patients 19.3% withdrew from the study, mainly for adverse events (6.4%) or a lack of efficacy (5.3%), while 229 (3.5%) experienced serious adverse events and 1,558 (23.9%) reported at least 1 treatment emergent adverse event. The most commonly reported adverse event was dizziness/postural dizziness (4.8%). Hypotension/postural hypotension was uncommon (0.7%). Age, cardiovascular comorbidity and antihypertensive co-medication had no impact on the safety profile of 10 mg alfuzosin OD. CONCLUSIONS: Alfuzosin (10 mg) OD is effective and well tolerated, and it has marginal effects on blood pressure, including in elderly patients and those with hypertension, ischemic heart disease or diabetes and those receiving antihypertensive agents.

Adrenergic alpha-Antagonists↗
PubMed2004

Feedback from operative performance to improve training program of laparoscopic radical prostatectomy.

PURPOSE: We report our preliminary experience identifying factors that contribute to differences in operative performance in laparoscopic radical prostatectomy (LRP) between trainees and experienced laparoscopic urologists based on objective and subjective feedback. MATERIALS AND METHODS: Between December 2001 and May 2002, six trainees at the Institut Montsouris and Ecole Européenne de Chirurgie, Paris, were evaluated to identify the factors contributing to differences in operative performance in LRP between them and experienced laparoscopic urologists, both objectively and subjectively. Objective evaluation was done by an independent observer who was well versed in laparoscopic surgery, while all the trainees evaluated themselves subjectively. All the trainees had in vitro, in vivo, and didactic training sessions during the evaluation period. RESULTS: The following deficiencies were noted objectively in the trainees compared with experienced laparoscopic urologists: (1) lack of perfect knowledge of each step, (2) lack of synchronized movements of the nondominant hand; and (3) easy physical fatigue. The trainees took a long time to dissect the vas deferens, seminal vesicles, and bladder neck because they did not have perfect knowledge of each step. It was difficult for them to pass the needle for ligation of dorsal venous complex because they tried to hold the needle far away from the needle tip at the wrong angle, and the direction of movement was not correct. For the urethrovesical anastomosis, they struggled to find the right angle to pass the needle on the urethral side. CONCLUSION: Lack of synchronized movement of the nondominant hand, easy physical fatigue, and lack of perfect knowledge of operative steps are crucial limitations for live operative performance of trainees in LRP. Incorporation of intensive well-planned in vitro training into the curriculum to correct these deficiencies and feedback from the operative performance can make a significant contribute to shortening the learning curve.

Adult↗
PubMed2004

Transperitoneal or extraperitoneal approach for laparoscopic radical prostatectomy: a false debate over a real challenge.

PURPOSE: With our extensive experience of transperitoneal laparoscopic prostatectomy, we evaluated the advantages and disadvantages of the extraperitoneal approach by comparing 2 consecutive series of each procedure. MATERIALS AND METHODS: We reviewed 200 consecutive procedures performed by 2 surgeons. A total of 100 transperitoneal procedures (designated group 1) were compared to the first 100 extraperitoneal cases (designated group 2). RESULTS: Mean operating time was 173 minutes in group 1 and shorter in group 2 at 163 minutes (p = 0.003). Mean blood loss (360 ml in group 1,375 ml in group 2) and transfusion rates (4% in group 1, 3% in group 2) were equivalent. There were no major complications. Minor complications were 10% in group 1 and 9% in group 2. There was no statistical difference in positive margin rate between groups 1 and 2. CONCLUSIONS: The 2 procedures are equivalent in terms of operative, postoperative and pathological data. Each surgeon has to choose considering personal experience, training and standardization.

Adenocarcinoma↗
PubMed2003

Laparoscopic partial nephrectomy for renal tumor: single center experience comparing clamping and no clamping techniques of the renal vasculature.

PURPOSE: We performed a nonrandomized retrospective comparison of 2 techniques for laparoscopic partial nephrectomy, that is without and with clamping the renal vessels. MATERIALS AND METHODS: Between December 1997 and February 2002, 28 consecutive patients underwent transperitoneal laparoscopic partial nephrectomy for renal tumor. In group 1 (12 patients) partial nephrectomy was performed with ultrasonic shears and bipolar cautery without clamping the renal vessels, while in group 2 (16 patients) the renal pedicle was clamped before tumor excision. In group 2 patients intracorporeal kidney cooling was achieved by a ureteral catheter connected to 4C solution. Intracorporeal freehand suturing techniques were used to close the collecting system when opened and approximate the renal parenchyma. RESULTS: All procedures were successfully completed laparoscopically. Mean renal ischemia time +/- SD was 27.3 +/- 7 minutes (range 15 to 47) in group 2 patients. Mean laparoscopic operating time was 179.1 +/- 86 minutes (range 90 to 390) in group 1 compared with 121.5 +/- 37 minutes (range 60 to 210) in group 2 (p = 0.004). Mean intraoperative blood loss was significantly higher in group 1 than in group 2 (708.3 +/- 569 versus 270.3 +/- 281 ml., p = 0.014). Three patients in group 1 and 2 in group 2 required blood transfusions. Immediately postoperatively mean creatinine was 1.26 +/- 0.36 and 1.45 +/- 0.61 mg./dl. in groups 1 and 2, respectively (p = 0.075). Surgical margins were negative in all specimens. Pathological examination revealed renal cell cancer in 18 cases (stages pT1 in 17 and pT3a in 1), oncocytoma in 4, angiomyolipoma in 5 and renal adenoma in 1. CONCLUSIONS: Laparoscopic partial nephrectomy represents a feasible option for patients with small renal masses. Clamping the renal vessels during tumor resection and suturing the kidney mimics the open technique and seems to be associated with less blood loss and shorter laparoscopic operative time.

Aged↗
PubMed2003

Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases a Montsouris Institute.

PURPOSE: We performed a prospective oncological evaluation of laparoscopic radical prostatectomy in regard to local tumor control and biochemical recurrence. MATERIALS AND METHODS: Between January 1998 and March 2002, 1,000 consecutive patients with a mean age +/- SD of 63 +/- 6.2 years and clinically localized prostate cancer underwent laparoscopic radical prostatectomy at 1 institution. Preoperative 1997 TNM clinical stage was T1a in 6 patients (0.6%), T1b in 3 (0.3%), T1c in 660 (66.5%), T2a in 304 (30.4%) and T2b in 27 (2.7%). Mean preoperative prostate specific antigen (PSA) +/- SD was 10 +/- 6.1 ng./ml. (range 1.5 to 55). Postoperatively, surgical specimens were assessed and positive surgical margins recorded. Factors that could influence the surgical margins status were evaluated. Irrespective of pathological stage or surgical margin status, no adjuvant treatment was proposed before an increasing PSA. PSA recurrence was defined as PSA greater than 0.1 ng./ml. and was confirmed by a second increase. Recurrence time was defined as the time of the first increase in PSA. RESULTS: Postoperative pathological stage was pT2aN0/Nx in 203 patients (20.3%), pT2bN0/Nx in 572 (57.2%), pT3aN0/Nx in 142 (14.2%), pT3bN0/Nx in 77 (7.7%) and pT1-3 N1 in 6 (0.6%). Positive surgical margin rate was 6.9%, 18.6%, 30% and 34% for pathological stages pT2a, pT2b, pT3a and pT3b, respectively (p <0.001). The main predictors of a positive surgical margin were preoperative PSA (p <0.001), clinical stage (p = 0.001), pathological stage (p <0.001) and Gleason score (p = 0.003). The overall actuarial biochemical progression-free survival rate was 90.5% at 3 years. According to the pathological stage, the progression-free survival rate was 91.8% for pT2aN0/Nx, 88% for pT2bN0/Nx, 77% for pT3aN0/Nx, 44% for pT3bN0/Nx and 50% for pT1-3N1 (p <0.001). Of the patients 94% with negative surgical margins and 80% with positive margins had progression-free survival (p <0.001). Preservation of the neurovascular bundles in patients with localized tumors had no significant effect on the subsequent risk of positive surgical margins or progression-free survival. CONCLUSIONS: Based on followup, our evaluation confirms that laparoscopic radical prostatectomy provides satisfactory results in regard to local tumor control and biochemical recurrence.

Actuarial Analysis↗
PubMed2003

Laparoscopic [correction of laproscopic] management of rectal injury during laparoscopic [correction of laproscopic] radical prostatectomy.

PURPOSE: Rectal injury is a potential complication of radical prostatectomy. Because laparoscopic radical prostatectomy is still a challenging procedure, we review the incidence and management of rectal injury in 1,000 cases of consecutive laparoscopic radical prostatectomy performed at our institution. MATERIALS AND METHODS: Of the first 1,000 laparoscopic transperitoneal radical prostatectomies performed between January 1998 and April 2002, 13 (1.3%) were complicated by rectal injury. Mean patient age was 66.5 years (range 58 to 76) and mean prostate specific antigen was 12.9 ng./ml. (range 2.9 to 26). Clinical stage was T1c, T2a and T2b in 5, 7 and 1 patient, respectively. Mean preoperative Gleason score was 5.8 (range 3 to 8). Once recognized the rectal defect was closed laparoscopically in 2 layers and tested for the absence of leakage. Broad-spectrum intravenous antibiotics were given for 7 days. Oral liquids were started the day after surgery with a low residue diet, and a regular diet was started on postoperative day 5. Healing of the vesicourethral anastomosis was confirmed by voiding cystourethrogram on postoperative day 5. RESULTS: All patients underwent a non-nerve sparing procedure except 1 in whom unilateral neurovascular bundle preservation was done. Of 13 injuries 11 were diagnosed and repaired intraoperatively, and 2 were diagnosed postoperatively. Of the 11 cases of intraoperative diagnosis and repair 9 healed primarily without colostomy and peritonitis was diagnosed in the remaining 2 on days 3 and 4, respectively. Of the latter 2 patients 1 required repair of a small rectal defect without colostomy while the other required colostomy. Colostomy was performed in the 2 patients with delayed diagnosis on days 3 and 4 but even then a rectourethral fistula developed in 1, necessitating secondary repair. Average urethral catheterization time was 8.6 days for the 9 patients with an uneventful immediate postoperative course and mean hospital stay was 6.8 days. For the remaining 4 patients urethral catheterization duration was 12, 13, 15 and 120 days, and hospital stay was 7, 16, 21 and 27 days, respectively. There was no perioperative mortality. CONCLUSIONS: Rectal injury during laparoscopic radical prostatectomy requires meticulous intraoperative repair in 2 layers, which allows primary healing without diversion colostomy. For injury prevention scrupulous attention is required during non-nerve sparing radical prostatectomy, particularly at the posterior surface of the prostatic apex.

Aged↗
PubMed2002

Gene expression profiles of bladder cancers: evidence for a striking effect of in vitro cell models on gene patterns.

In order to assess the effect of in vitro models on the expression of key genes known to be implicated in the development or progression of cancer, we quantified by real-time quantitative PCR the expression of 28 key genes in three bladder cancer tissue specimens and in their derived cell lines, studied either as one-dimensional single cell suspensions, two-dimensional monolayers or three-dimensional spheroids. Global analysis of gene expression profiles showed that in vitro models had a dramatic impact upon gene expression. Remarkably, quantitative differences in gene expression of 2-63-fold were observed in 24 out of 28 genes among the cell models. In addition, we observed that the in vitro model which most closely mimicked in vivo mRNA phenotype varied with both the gene and the patient. These results provide evidence that mRNA expression databases based on cancer cell lines, which are studied to provide a rationale for selection of therapy on the basis of molecular characteristics of a patient's tumour, must be carefully interpreted.

Clone Cells↗
PubMed2002

Complications of transperitoneal laparoscopic surgery in urology: review of 1,311 procedures at a single center.

PURPOSE: The development of laparoscopic surgery in urology is increasing rapidly. We describe our experience with complications during and after transperitoneal laparoscopic surgery after 9 years of practice. MATERIALS AND METHODS: A total of 1,311 laparoscopic procedures were performed by 5 senior urologists in the same department since 1992, of which 72% were classified as difficult or very difficult (prostatectomy, nephrectomy for cancer, nephroureterectomy, partial nephrectomy, cystectomy, para-aortic lymph node dissection), 27.5% as moderately difficult (nephrectomy for benign disease, adrenalectomy, genitourinary prolapse, ureteropelvic junction, pelvic and ureteral stones, ureterovesical reimplantation, pelvic lymph node dissection) and 0.5% as easy (lymphocele, renal cyst and so forth). RESULTS: There was no mortality or anesthetic complications. The overall transfusion rate was 2.4%. Complications were serious in 0.7% of cases, all of which required reoperation, intermediate in 1.8% of which 1% required reoperation and minor in 1.1%. The main complications were bowel (1.2%), vascular (0.5%) and ureteral injuries (0.8%). The conversion rate was 1.2% and the reoperation rate was 2.4%. Of the patients 1.2% had to be admitted to the intensive care unit. Postoperative complications were observed in 19% of cases. Laparoscopic surgery is associated with essentially the same complications as open surgery, and they, particularly bowel injuries and bleeding, can be diagnosed and often treated with repeat laparoscopy. CONCLUSIONS: Complications during and after transperitoneal laparoscopy remain low and are not superior to those observed during and after open surgery. As laparoscopy becomes more widely used, urologists wishing to learn this technique must realize that the learning process is long but essential.

Adult↗
PubMed2001

Laparoscopic radical prostatectomy: assessment after 240 procedures.

Radical prostatectomy can be successfully performed by transperitoneal laparoscopy by a urologic team experienced in laparoscopy and radical prostatectomy. Operative and postoperative morbidity rates are low. Postoperative pain is minimal, allowing reduction of the length of hospital stay. The oncologic results seem satisfactory based on short-term follow-up. The improvement of the quality of intraoperative vision related to magnification of the image allows a more precise procedure. This subjective improvement of the quality of dissection should reduce the usual functional sequelae of conventional radical prostatectomy, such as incontinence and impotence. This finding needs to be confirmed by a larger series of patients with longer follow-up. Laparoscopic radical prostatectomy is now performed routinely and is proposed as a first-line surgical treatment for localized prostatic cancer at the authors' center.

Follow-Up Studies↗
PubMed2001

[The future of urology in Europe: a perspective from the European Urology Association].

INTRODUCTION: In order to be able to influence and monitor future developments for urologists, strategies should be promoted in advance to guarantee the future of the speciality and to accommodate the inevitable changes. Faced with this challenge, the EAU, through its Strategy Planning Office (SPO), has prepared a document which is offered, here, in abbreviated form, to the European and international urological communities for general consideration. MATERIAL AND METHODS: A group of subjects, related to the domains and internal consistency of urology as a speciality, were selected and discussed among the members of the SPO and later submitted to open consultation among distinguished members of the urological community. The topics selected for discussion included: what is urology; urology in the university; sub-specialization in urology; training in urology; does kidney transplantation belong to urology, and others. RESULTS: It is shown that urology is going through an exciting and hazardous transition period. Urology has conflicting problems in its traditional domains due to changes in health care policy, and internal identification problems due to its permanent expansion and sub-specialization options. Weaker points are its relation with primary care medicine (shared care options), the presence and role of urology in institutions such as the university, department of surgery, children's hospitals, administration, etc.; the desegregating effect of the sub-specialities; the increasing encroachment of other specialities, and the increasing outpatient effect of technological progress. CONCLUSIONS: An action plan is proposed to confront these changes without losing manpower, internal consistency or social image and improving patient care quality, excellence of training and scientific progress.

Europe↗
PubMed2001

Treatment of lower urinary tract symptoms suggestive of benign prostatic obstruction in real life practice in France.

The objective of this work is to describe the profile of prevalent and incident populations suffering from lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) and to analyse the management of care by 620 general practitioners (GPs) in France in 1997 and 1998. Patient records were extracted from the THALES database. Special attention was given to the use of medical therapy and switch rates (ie change to another or combination with another drug). In real life practice (RLP) French GPs predominantly utilise alpha(1)-adrenoceptor antagonists for the treatment of LUTS. This is in agreement with available evidence from randomised controlled trials (RCTs) with different medical therapies (alpha(1)-adrenoceptor antagonists, finasteride, plant extracts). On the contrary, the relatively high usage of phytotherapy might be explained by traditional and personal preferences. Using purely descriptive statistics, newer alpha(1)-adrenoceptor antagonists, alfuzosin and tamsulosin, seem to be the most frequently prescribed medical therapy for new patients and are, moreover, associated with a low switch rate.Prostate Cancer and Prostatic Diseases (2001) 4, 124-131

Journal Article↗
PubMed2001

Laparoscopic radical prostatectomy: the lessons learned.

PURPOSE: To evaluate the operative, oncologic, and functional results of laparoscopic radical prostatectomy based on an initial series of 350 patients. PATIENTS AND METHODS: Between January 1998 and May 2000, 350 consecutive patients underwent laparoscopic radical prostatectomy according to our technique. The study of operative morbidity was based on all intraoperative and postoperative complications. The oncologic assessment was based on clinical, laboratory, and intraoperative and postoperative pathological data. Postoperative functional results were assessed by the ICS-male self-administered questionnaire. RESULTS: No deaths were observed in this series. Conversion was required in seven cases, exclusively among the first 70 patients. The mean operating time was 217 +/- 59 minutes, including the lymphadenectomy phase that was considered necessary in 21.4% of patients, and 195 +/- 56 minutes for the most recent 200 patients. The mean intraoperative blood loss was 354 +/- 250 mL. The overall transfusion rate was 5.7% and 2.8% in the last 250 patients. Intraoperative complications were reported in 14 patients (4%), and the reoperation rate was 3.7%. The mean postoperative bladder catheterization time was 5.8 +/- 3.3 days, and the catheter could be removed before the 5th day in 41% of patients. The mean hospital stay was 6 +/- 3.9 postoperative days (range 2-33 days). By pathologic stage, the positive surgical margin rate was 3.6% for pT2a specimens (3 patients), 14% for pT2b specimens (29 patients), 33% for pT3a specimens (12 patients), and 43.5% for pT3b specimens (10 patients). In the first 75 patients with pT2N0/Nx negative-margin specimens and a follow-up of >12 months, the PSA concentrations was <0.2 ng/mL in 92% of patients. The continence rate (no protection necessary either during the day or at night) among the first 133 patients was 85.5% and the postoperative erection rate was 59% among 22 selected consecutive patients. CONCLUSIONS: This study confirms the value, in our experience, of the laparoscopic approach to radical prostatectomy, which allows satisfactory cancer control associated with low perioperative morbidity and encouraging functional results in terms both of continence and erectile function.

Aged↗
PubMed2001

Laparoscopic partial nephrectomy in the pig: comparison of three hemostasis techniques.

BACKGROUND AND PURPOSE: Control of intraoperative bleeding is the main technical difficulty encountered during laparoscopic partial nephrectomy. The objective of this study was to compare the efficacy and morbidity of three renal parenchymal hemostasis techniques: high-frequency bipolar electrical current, high-frequency unipolar spray electrical current, and ultrasound during laparoscopic partial nephrectomy performed in pigs without vascular control. MATERIALS AND METHODS: A standardized laparoscopic transperitoneal right lower-pole partial nephrectomy was performed in 27 pigs with a mean weight of 65 +/- 5 kg. The pigs were divided into three groups according to the technology used: Group 1 = bipolar electrical current, Group 2 = unipolar spray electrical current, and Group 3 = ultrasound. Intravenous urography was performed on the 28th day. The kidneys were then removed for histologic examination, and the pigs were sacrificed. The criteria evaluated were intraoperative and postoperative complications, blood loss, renal function, and thickness of the parenchymal lesions induced. The Kruskal-Wallis nonparametric test for comparison of medians was used for statistical analysis of the data (P < 0.05). Data from pigs that died before the end of the study were excluded from the analysis. RESULTS: All partial nephrectomies were performed laparoscopically, and all pigs were alive at the end of the operation. The postoperative complication rate was 11% (N = 3): two pigs died before the end of the study, one from hemorrhage on Day 6 (Group 2), and the other from prolonged reflex ileus with sacrifice of the pig on Day 7 (Group 3). One pig developed an asymptomatic urinoma (Group 2). Blood loss was significantly lower when ultrasound was used (P = 0.026). Global renal function was not significantly altered in the various groups. The median thickness of tissue necrosis and fibrosis detected in the scar zone was 6 mm (range 4-10 mm) and was similar in the three groups. CONCLUSION: Partial nephrectomy can be performed by laparoscopy without vascular control in the pig. Coagulation by ultrasound appears to present an advantage in terms of limitation of blood loss compared with coagulation by bipolar or unipolar spray electrical currents without presenting any benefit in terms of preservation of the renal parenchyma.

Animals↗