Navegando por Autor "Britto, Cesar Araujo"

Agora exibindo 1 - 9 de 9

Laparoendoscopic single-site repair of retrocaval ureter without any special devices
(International Braz J Urol, 2013-01) Rebouças, Rafael B.; Britto, Cesar Araujo; Monteiro, Rodrigo C.; Medeiros Júnior, Porfírio F. de; Madruga Neto, Antônio C.; Soares Junior, Marcos M.; Guedes, Camila N.; Moura, Rícia N. P.; Camilo Neto, Geraldo; Alencar, Gustavo M. C. de; Souza, Giácomo F.
The retrocaval ureter is a rare congenital anomaly. The extrinsic compression may be responsible for obstruction and pain symptoms. The laparoscopic approach has been used with good results and less morbidity than the open surgery. Herein we describe a case of retrocaval ureter treated with LESS. To our knowledge, this represents the second such case reported in the literature, and the first without using any special devices, such as, single port or bended instruments. PRESENTATION Female, 23 years, complaining of right low back pain for a long time and recurrent urinary tract infection. Renal ultrasound demonstrated right-sided hydronephrosis and intravenous urography suggested the presence of retrocaval ureter. DTPA renal scintigraphy confirms delay in the elimination of contrast through the right kidney. A laparoendoscopic single-site repair was planned. The patient was placed in rightside-up modified flank position. A semicircular intra-umbilical incision was made and the conventional trocars (one 10 mm and two 5 mm) were inserted through the same incision on different points of the aponeurosis. The colon was dissected medially and the proximal ureter lateral to the vena cava was identified and dissected. An extra corporeal repair with Vycril 2-0 was used to facilitate the ureteral dissection and the anastomosis. A segment of ureter was ressected due to the tortuosity. Two 4-0 Vycril sutures were used to perform a running anastomosis. An ureteral stent was placed after the posterior layer on an antegrade fashion. A suction drain was left through the umbilicus. RESULTS The total operative time was 145 min. The blood loss was minimal. The patient was discharged on the third postoperative day and resumed total activity about 10 days after surgery. The double J was removed within 4 weeks. DISCUSSION Albeit technically challenging, LESS repair for retrocaval ureter might represent a feasible new treatment option for this rare anatomic anomaly. Special devices could help on the procedure, however they are not essencials.
Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination
(International Braz J Urol, 2014-03) Rebouças, Rafael B.; Monteiro, Rodrigo C.; Souza, Thiago N. S. de; Burity, Camila R. T.; Lisboa, João B. R. M.; Pequeno, Giovanna B. M.; Figueiredo, Luciano G. de; Silva, Emanuel R. M.; Britto, Cesar Araujo
Inroduction Acquired bladder diverticula are herniations of the bladder mucosa through detrusor muscle. Due to the ineffective emptying of the bladder diverticulum, urine accumulation may lead to urinary tract infection, stone disease, and lower urinary tract malignancy in the diverticulum (1). The symptomatic bladder diverticula may require surgical treatment. Surgical approaches include open operation via an extravesical or a transvesical approach for large diverticula or endoscopically with transurethral fulguration for small diverticula (2). Herein, we present a video of a Laparoscopic Bladder Diverticulectomy for recurrent urinary tract infection, aided by concurrent cystoscopy. Materials and methods Female patient, 37 years old, complaining of recurrent urinary tract infection for three years. A bladder diverticulum was found on ultrasonography. Cystoscopy revealed a posterior right-side diverticulum next to the ipsilateral ureteral ostium. A laparoscopic bladder diverticulectomy with the aid of intraoperative cystoscopy was proposed. Surgical Technique Under general anesthesia, the patient was placed in lithotomy and Trendelenburg position. An umbilical incision was used for pneumoperitoneum creation and insertion of a 10mm trocar. Three other 5mm trocars were inserted at positions equidistant between the navel and the pubis, and between the umbilicus and the iliac crests bilaterally. Concomitant cystoscopy was performed for location of the diverticulum by transillumination and help to identify the diverticular neck. The diverticulum was dissected both sharply and bluntly until the whole diverticulum was freed. After completion the ressection, a catheter was inserted in the right ureter near the diverticulum to assess inadvertent lesions. The mouth of the diverticulum was closed by 2-0 double-layered absorbable running suture and a suction drain was placed through a lateral 5mm port. RESULTS The surgery was uneventful. The operative time was 120 minutes with minimal blood loss. There was no postoperative leakage, the drain was removed after 24 hours and the patient discharged. The indwelling catheter was removed after 7 days and the patient progresses without voiding complaints or new infectious episodes in a follow-up of 10 months. Conclusions Laparoscopic diverticulectomy is technically feasible and safe. The concomitant use of cystoscopy facilitates the identification and location of the diverticulum, thereby minimizing dissection of the bladder and decreasing operative time. Cystoscopy may also be useful in the delineation of margins in cases of neoplasia within the diverticulum.
Laparoscopic transplant nephrectomy for failed renal allograft
(Lippincott, Williams & Wilkins, 2018-07) Medeiros, Paulo; Silva, Rodolfo A.; Silva Junior, Mauricio F; Dantas Junior, José Hipolito; Paiva, Rodrigo Trigueiro Morais de; Britto, Cesar Araujo
Traditionally, transplant nephrectomy for a failed renal allograft is performed using open surgery. This approach is associated with bleeding during surgery or infected hematoma, postoperatively. Minimally invasive surgery for removal of a failed renal allograft has previously been reported using robotic technique. These procedures are challenging due to the substantial fibrosis that forms around a retroperitoneal allograft. We report our experience with two cases, using laparoscopic approach. A 47-year-old female lost function of his deceased donor allograft after 1,5 year due rejection and infection, presented with fever, pain in renal fossa and hematuria. The operation was performed intra-abdominally using the laparoscopic with four trocars. The total operative time was 300 min and the estimated blood loss was 250 cm. A 46 year old female patient lost function of his deceased donor allograft after 2 year due atypical hemolytic uremic syndrome. The operative time was 340 min, intraoperative blood loss -150 ml. There were no peri-operative complications observed and the patients were discharged to home in 4 days postoperatively. This method is technically demanding and surgeon needs considerable laparoscopic experience to try this approach.
Pure laparoscopic augmentation Ileocystoplasty
(International Braz J Urol, 2014-11) Rebouças, Rafael Batista; Britto, Cesar Araujo; Monteiro, Rodrigo C.; Souza, Thiago N. S. de; Aragão, Augusto J. de; Burity, Camila R. T.; Nóbrega, Júlio C. de A.; Oliveira, Natália S. C. de; Abrantes, Ramon B.; Dantas Júnior, Luiz B.; Cartaxo Filho, Ricardo; Negromonte, Gustavo R. P.; Sampaio, Rafael da C. R.
Introduction Guillain-Barre syndrome is an acute neuropathy that rarely compromises bladder function. Conservative management including clean intermittent catheterization and pharmacotherapy is the primary approach for hypocompliant contracted bladder. Surgical treatment may be used in refractory cases to improve bladder compliance and capacity in order to protect the upper urinary tract. We describe a case of pure laparoscopic augmentation ileocystoplasty in a patient affected by Guillain-Barre syndrome. Presentation A 15-year-old female, complaining of voiding dysfunction, recurrent urinary tract infection and worsening renal function for three months. A previous history of Guillain-Barre syndrome on childhood was related. A voiding cystourethrography showed a pine-cone bladder with moderate post-void residual urine. The urodynamic demonstrated a hypocompliant bladder and small bladder capacity (190mL) with high detrusor pressure (54 cmH2O). Nonsurgical treatments were attempted, however unsuccessfully. The patient was placed in the exaggerated Trendelenburg position. A four-port transperitoneal technique was used. A segment of ileum approximately 15-20cm was selected and divided with its pedicle. The ileal anastomosis and creation of ileal U-shaped plate were performed laparoscopically, without staplers. Bladder mobilization and longidutinal cystotomy were performed. Enterovesical anastomosis was done with continuous running suture. A suprapubic cystostomy was placed through a 5mm trocar. Results The total operative time was 335 min. The blood loss was minimal. The patient developed ileus in the early days, diet acceptance after the fourth day and was discharged on the seventh postoperative day. The urethral catheter was removed after 2 weeks. At 6-month follow-up, a cystogram showed a significant improvement in bladder capacity. The patient adhered well to clean intermittent self-catheterization and there was no report for febrile infections or worsening of renal function. We did not experience any complication related to the intestinal anastomosis fully prepared intracorporeally. Conclusions Albeit technically challenging, pure laparoscopic enterocystoplasty was feasible and safe. Preparing the enteral anastomosis and the pouch intracoporeally may prolong surgical time and contribute to postoperative ileus. Surgical staplers can assist in the procedure, however they are not essential.
Pure laparoscopic radical heminephrectomy for a large renal-cell carcinoma in a horseshoe kidney
(International Braz J Urol, 2013-07) Rebouças, Rafael Batista; Monteiro, Rodrigo C.; Souza, Thiago N.; Barbosa, Paulyana F.; Pereira, George G.; Britto, Cesar Araujo
Introduction Horseshoe Kidneys are the most common renal fusion anomaly. When surgery is contemplated for renal-cell carcinoma in such kidneys, aberrant vasculature and isthmusectomy are the major issues to consider. We describe a case of a pure laparoscopic radical heminephrectomy with hand-sewn management of the isthmus for a 11 cm tumour in a horseshoe kidney. Presentation A 47-year-old man complaining of palpable left flank mass for two months. Magnetic resonance of the abdomen revealed a 11 cm renal mass arising from the left moiety of an incidentally discovered horseshoe kidney. Preoperative CT angiography revealed a dominant anterior renal artery feeding the upper and midpole, with two other arteries feeding the lower pole and isthmus. The patient was placed in a modified flank position. A four-port transperitoneal technique was used, the colon was reflected. Renal pedicle was dissected and the renal arteries and renal vein were secured with polymer clips. The kidney was fully mobilized and a Satinsky clamp was placed on the isthmus for its division. A running 2-0 vicryl hand-sewn was used for parenchyma hemostasis. The specimen was extracted intact in a plastic bag through an inguinal incision. Results The operative time was 220 minutes, and the estimated blood loss was 200 mL. There were no immediate or delayed complications. The patient resumed oral intake on postoperative day 1 and was discharged on postoperative day 2. Pathologic examination of the specimen confirmed a 11 cm organ-confined chromophobe renal-cell carcinoma, with negative margins. Discussion Laparoscopic oncologic surgery in patients with horseshoe kidneys can be technically challenging. The presence of a large cancer in a horseshoe kidney should not preclude a purely laparoscopic approach. With the aid of a Satinsky clamp, the isthmus can be sharply divided and sutured in a fashion similar to the open technique. To our knowledge, this report represents the largest cancer (11 cm) removed laparoscopically in the context of a horseshoe kidney.
The pubovesical complex-sparing technique on laparoscopic radical prostatectomy
(International Braz J Urol, 2008-07) Rebouças, Rafael Batista; Monteiro, Rodrigo Campos; Lima, João Paulo Pereira; Almeida, Filipe de Pádua B. F.; Britto, Cesar Araujo; Machado, Marcos Tobias; Passerotti, Carlo
Introduction: Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution. Presentation: A 61-year-old male patient with a diagnosis of prostate cancer, with PSA 6.54ng/ml, DRE: T1C and Gleason 6 (3+3) 1/12 fragments. All therapeutic possibilities were discussed, including active surveillance. The patient opted for surgical treatment. A transperitoneal technique was used. We started the dissection on the left side, in the limit between the detrusor and the base of the prostate. The left seminal vesicle was dissected and left neurovascular bundle released by a high anterior dissection. We repeated the same procedure on the right side. The urethra was then divided, prostatic apex was laterally drawn and PVC was released. The bladder neck was divided and an urethrovesical anastomosis was achieved. A pelvic drain was placed. Results: The total operative time was 150 minutes. The estimated blood loss was 300mL. The drain was removed on the 1st postoperative day and the patient was discharged. The Foley catheter was removed after 7 days and the patient remained completely dry. Hystopathology revealed adenocarcinoma Gleason 6, negative margins. PSA after 30 days was <0.04ng/mL, and the patient reported partial penile erection. Conclusion: The Pubovesical Complex-Sparing Technique on Laparoscopic Radical Prostatectomy was feasible and safe. Further adequately designed studies are needed to confirm whether this technique enhances early functional outcomes.
Ureteral replacement using segment of Ileum: an approach totally intracorporeal
(Videourology, 2013-06) Britto, Cesar Araujo; Figueiredo, Fellipe Rodrigo Gomes; Carvalho, Pedro Sales Lima de; Medeiros, Filipe Correia Lima Rodrigues de; Nóbrega, Artur; Cavalcante, Vinicius Matias Monteiro; Cunha, Diego Rebouças; Marques, Andre Frederico Nogueira; Formiga, Cipriano Cruz; Medeiros, Paulo Jose
Introduction: The ureteral avulsion during ureteroscopic procedures is a rare complication (incidence 0%–2%).1 Surgical options in this situation include ileal ureter replacement, autotransplantation, or nephrectomy.2 We present a video of a pure laparoscopic-assisted ileal ureter replacement for a scabbard avulsion ureter. Case Report: A 37-year-old man, allergic to iodine, body mass index (BMI) 31, referred to our clinic after a right ureteral avulsion, occurred one month ago, during a semirigid ureteroscopic management of 8 mm ureteral calculi, located at proximal ureter. An open nephrostomy was performed. MRI showed ureteral damage at the right ureteropyelic (UPJ) and nephrostomy tube. We performed on pure laparoscopic ileal ureter replacement, using five trocars. During dissection, severe fibrosis was observed at the renal hilum. The bladder was fixed at the psoas muscle. A segment of ileum (20 cm) was isolated, 20 cm proximal to the ileocecal valve. Intestinal reconstruction was made using the Godoy's technique (Eudes Paiva de Godoy, MD, personal communication). The ileal segment was placed in an isoperistaltic position and a proximal pyeloileal and a distal ileovesical anastomosis was performed, with continuous suture. No stapler was used. A Double-J catheter was introduced using a nephrostomy tube. The operative time was 347 minutes, blood loss was 200 mL, the drain was removed on the third postoperative day (PD), and the patient was discharged on the fifth PD. Double-J removed with 30 days. In the third month of follow-up, the patient was asymptomatic, with normal renal function and no obstruction was detected by ultrasound and renal scintigraphy. Discussion: A patient with a solitary kidney and urinary lithiasis has a risk to develop ureteral obstruction and acute renal failure, throughout the life. Therefore, as we faced a ureteral injury, we need to preserve the kidney, making nephrectomy, the last option of treatment. Autotransplantation is another option of treatment, performing the nephrectomy by the laparoscopic technique.3,4 In this case, severe fibrosis of the renal hilum, associated with a short renal vein, motivated us to avoid this procedure. The ileal ureter replacement has advantages, preserving the renal function, and facilitates the removal of calculi, which may be formed later. This procedure was first described by Shoemaker, in 1906 and popularized by Goodwin.5 Most recently, laparoscopy has advanced the field of reconstructive urology and urologists have reproduced the traditional procedures. Gill et al. described the first laparoscopic ileal ureter replacement, using a small open incision to intestinal reconstruction.6 The exposure of the bowel by small incision can lead tension and compression of the mesenteric vessels, especially in obese patients, with thick abdominal wall.7,8 Performing the procedure completely inside the body, this theoretical risk, and any complications related to the incision, can be avoided.9 The risk of neoplasia at the bowel's segment incorporated into the urinary tract is low, especially in patients without immunosuppression, and a strict follow-up will not be necessary.10,11 Conclusion: The ileal ureter replacement allows preservation of the kidney in complex ureteral injuries. When performed laparoscopically, reduces morbidity, avoiding large incision with associated protracted recovery. We describe a case of pure laparoscopic ileal ureter replacement duplicating the open technique, including intestinal reconstruction.
V5-01 totally laparoscopic radical nephrectomy with thrombectomy level IV
(Journal of Urology, 2015-04-01) Britto, Cesar Araujo; Anselmo, Christophe; Costa, Paulo Renato; Oliveira, Daniel; Lima, Ronnie; Grossi, Thiago; Gadelha Junior, Hernani de Paiva; Duarte, Stefferson; Coelho, Rafael; Medeiros, Paulo Jose de
Since the first laparo scopic nephrectomy performed by Clayman, in 1991, urological surgery has changed the paradigm for minimally invasive surgery. Every day, more diseases are being treated laparoscopically. Now, we describe a radical nephrectomy with thrombectomy level IV, performed totally laparoscopic, with deep hypothermia and circulatory arrest. To our knowledge, this clinical approach was not reported before. METHODS: A 38-year-old man presented with left lumbar pain, hematuria and palpable mass. Magnetic resonance imaging showed a 14 x11cm left renal mass with and thrombus extending to supra-diaphrag matic inferior vena cava. The patient accepted a minimally invasive sur gical approach. A left laparoscopic radical nephrectomy was performed with the patient in right lateral decubitus, using 4 trocars. Renal artery was clipped and divided. The kidney was completely dissected but remained attached to the thrombotic vein. The patient was repositioned in left lateral decubitus. Vena cava and right renal vessels were dissected and repaired using 5 trocars. Then, repositioned the patient to modified dorsal decu bitus. The cardiovascular surgery team initiated a minimally invasive Cardiopulmonary Bypass (CPB) with deep hypothermic and circulatory arrest. Immediately, vena cava was clamped with laparoscopic Satinski clams. Cavotomy was made and thrombectomy performed. Then, vena cava was closed. Atriotomy was closed. The patient was rewarmed to 37oC and coming off CPB. Thoracic and abdominal cavities were drained. The specimen was removed through a Pfannenstiel incision. RESULTS: Operative time was 765 minutes. Estimated blood loss was 1500 ml and he received blood transfusion (1200ml) intraoperatively. Circulatory arrest time was 43 minutes, but only 8 without cerebral circu lation. Postoperatively showed no neurological complication. The patient developed pneumonia and sepsis related to mechanical ventilation. Remained 21 days in the ICU and was discharged in postoperative day 36. Histology revealed chromophobe renal tumor with free margins. CONCLUSIONS: Laparoscopy has been progressively gaining acceptance in the urologic field, almost all the open surgery has been reproduced by laparoscopy, except radical nephrectomy with thrombec tomy level IV. With this report, the last frontier in urologic laparoscopy was overcome. This case has shown that laparoscopic approach in the treatment of renal cell carcinoma with level IV vena cava thrombus is feasible and challenging and requires advanced laparoscopic skills.
Video-assisted left inguinal lymphadenectomy for penile cancer
(International Braz J Urol, 2012-04) Britto, Cesar Araujo; Rebouças, Rafael Batista; Lopes, Tassilo Rodrigo Araujo; Costa, Thiago Silva da; Leite, Rodrigo de Carvalho Holanda; Carvalho, Pedro Sales Lima de
Penile cancer is a rare disease, most commonly encountered in developing countries. It constitutes 0.4% of cancers in U.S. men and 2.1% in Brazil, with the highest prevalence in the North and Northeast regions. Inguinal lymph node metastasis of penile cancer occurs in 20 to 40% of patients and is an important predictor of cancer-specific mortality. The preferred diagnostic and therapeutic tool to assess the regional lymph nodes is a lymphadenectomy which can, in addition to establishing staging, offers curative potential. MATERIALS AND METHODS: A 44 years old man, previously to underwent a partial penectomy for penile cancer, whose pathology showed a moderately differentiated squamous cell carcinoma with neural and angiolymphatic invasion and negative surgical margins. The pathologic stage of the primary tumor was pT3NxMx. Following a one month course of oral antibiotics, the patient underwent a video-assisted bilateral inguinal lymphadenectomy. In the present video, we highlight the left video-assisted inguinal lymphadenectomy. RESULTS: Seventeen lymph nodes were dissected on the left side, two of them positive for cancer without extracapsular extension. On the right side, fourteen lymph nodes were dissected and one was positive for cancer with extracapsular extension, and the patient underwent based on these pathological findings a pelvic lymphadenectomy, which was similarly conducted using a video-assisted laparoscopic approach. CONCLUSIONS: The conventional open lymphadenectomy has a morbidity that can approach 50% in the current series, despite on the refinements in technique. The video-assisted endoscopy is a recent technique aiming to decrease this inherent complication rate promoting a lymph node resection rate which may be equivalent to the open procedure. This video confirms its feasibility, reduced morbidity, and cancer control efficacy.

SIGAA

Navegando por Autor "Britto, Cesar Araujo"