ANUAR IBRAHIM MITRE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- Robotic simple prostatectomy: Technical considerations and outcomes(2012) COLOMBO, J. R. Jr.; MITRE, A. I.The open approach has been the gold standard for simple prostatectomy, either through a retropubic enucleation with an anterior transverse prostatic capsulotomy (Millin) or through a suprapubic transvesical access. The simple laparoscopic prostatectomy may be an alternative to open simple prostatectomy with potentially lower morbidity, lower blood loss, faster recovery, shorter hospital stay, and earlier return to normal activities In 2002, Mariano et al.7 first described the technique for laparoscopic simple prostatectomy that was modified by several authors using both transperitoneal and extraperitoneal approaches. The American Urological Association (AUA) and European Association of Urology (EAU) guidelines suggest that open surgery should be the treatment for prostate volume higher than 80 g. Similarly to others procedures, some skilled urologists have replaced the open simple prostatectomy by the laparoscopic counterpart. Robotics brought contributions to laparoscopic simple prostatectomy allowing the enucleation of adenoma without the need for special devices due to the advantages provided by better visualization and robotic-articulated instruments. It also potentially facilitates hemostatic sutures to control the main prostatic vessels, resulting in reduced intraoperative blood loss. The closure of bladder and/or prostatic capsule is easier with robotic assistance. Robotic simple prostatectomy seems to have a shorter learning curve than pure laparoscopic, what would be a real alternative to a larger number of urologists to perform such a procedure with the minimally invasive approach. The drawbacks of robotic simple prostatectomy are the costs and the preferential transperitoneal approach. Although currently literature is scanty on this subject, multicentric studies with larger numbers of subjects are expected to compare the open, laparoscopic, and robotic simple prostatectomy. © Springer-Verlag London Limited 2012.
- Comparison beetwen open and laparoscopic radical cistectomy in a latin american reference center: perioperative and oncological results(2015) TOBIAS-MACHADO, Marcos; SAID, Danniel Frade; MITRE, Anuar Ibrahim; POMPEO, Alexandre; POMPEO, Antonio Carlos LimaObjectives: To evaluate the differences of peri-operatory and oncological outcomes between Laparoscopic Radical Cystectomy and Open Radical Cystectomy in our center. Materials and Methods: Overall, 50 patients were included in this non randomized match-pair analysis: 25 patients who had undergone Laparoscopic Radical Cystectomy for invasive bladder cancer (Group-1) and 25 patients with similar characteristics who had undergone Open Radical Cystectomy (Group-2). The patients were operated from January 2005 to December 2012 in a single Institution. Results: Mean operative time for groups 1 and 2 were 350 and 280 minutes (p=0.03) respectively. Mean blood loss was 330 mL for group 1 and 580 mL for group 2 (p=0.04). Intraoperative transfusion rate was 0% and 36% for groups 1 and 2 respectively (p=0.005). Perioperative complication rate was similar between groups. Mean time to oral intake was 2 days for group 1 and 3 days for group 2 (p=0.08). Median hospital stay was 7 days for group 1 and 13 for group 2 (p=0.04). There were no differences in positive surgical margins and overall survival, between groups. Conclusions: In a reference center with pelvic laparoscopic expertise, Laparoscopic Radical Cystectomy may be considered a safe procedure with similar complication rate of Open Radical Cystectomy. Laparoscopic Radical Cystectomy is more time consuming, with reduced bleeding and transfusion rate. Hospital stay seems to be shorter. Oncologically no difference was observed in our mid-term follow-up.
- Specific training for LESS surgery results from a prospective study in the animal model(2016) MARCHINI, Giovannni Scala; JUNIORI, Italo D. Fioravanti; HORTA, Leonardo V.; TORRICELLI, Fabio C. M.; MITRE, Anuar Ibrahim; ARAP, Marco AntonioObjective: to prospectively evaluate the ability of post-graduate students enrolled in a laparoscopy program of the Institute for Teaching and Research to complete single port total nephrectomies. Materials and Methods: 15 post-graduate students were enrolled in the study, which was performed using the SILS (TM) port system for single-port procedures. All participants were already proficient in total nephrectomies in animal models and performed a left followed by a right nephrectomy. Analyzed data comprised incision size, complications, and the time taken to complete each part of the procedure. Statistical significance was set at p<0.05. Results: All students successfully finished the procedure using the single-port system. A total of 30 nephrectomies were analyzed. Mean incision size was 3.61 cm, mean time to trocar insertion was 9.61 min and to dissect the renal hilum was 25.3 min. Mean time to dissect the kidney was 5.18 min and to complete the whole procedure was 39.4 min. Total renal hilum and operative time was 45.8% (p<0.001) and 38% (p=0.001) faster in the second procedure, respectively. Complications included 3 renal vein lesions, 2 kidney lacerations and 1 lesion of a lumbar artery. All were immediately identified and corrected laparoscopically through the single-port system, except for one renal vein lesion, which required the introduction an auxiliary laparoscopic port. Conclusion: Laparoscopic single-port nephrectomy in the experimental animal model is a feasible but relatively difficult procedure for those with intermediate laparoscopic experience. Intraoperative complications might be successfully treated with the single-port system. Training aids reducing surgical time and improves outcomes.
- Robotic Laparoscopic Pyeloplasty(2014) CHAMMAS JR., Mario F.; MITRE, Anuar I.; HUBERT, Nicolas; EGROT, Christophe; HUBERT, JacquesBackground and Objectives: We aimed to assess the feasibility and outcomes of complex ureteropelvic junction obstruction cases submitted to robotic-assisted laparoscopic pyeloplasty. Methods: The records of 131 consecutive patients who underwent robotic-assisted laparoscopic pyeloplasty were reviewed. Of this initial population of cases, 17 were considered complex, consisting of either atypical anatomy (horseshoe kidneys in 3 patients) or previous ureteropelvie junction obstruction management (14 patients). The patients were divided into 2 groups: primary pyeloplasty (group 1) and complex cases (group 2). Results: The mean operative time was 117.3 +/- 33.5 minutes in group 1 and 153.5 +/- 31.1 minutes in group 2 (P = .002). The median hospital stay was 5.19 +/- 1.66 days in group 1 and 5.90 +/- 2.33 days in group 2 (P = .326). The surgical findings included 53 crossing vessels in group 1 and 5 in group 2. One patient in group 1 required conversion to open surgery because of technical difficulties. One patient in group 2, with a history of hemorrhagic rectocolitis, presented with peritonitis postoperatively due to a small colonic injury. A secondary procedure was performed after the patient had an uneventful recovery. At 3 months, significant improvement (clinical and radiologic) was present in 93% of cases in group 1 and 88.2% in group 2. At 1 year, all patients in group 2 showed satisfactory results. At a late follow-up visit, 1 patient in group 1 presented with a recurrent obstruction. Conclusions: Robotic pyeloplasty appear to be feasible and effective, showing a consistent success rate even in complex situations. Particular care should be observed
- Laparoscopic ureterocalicostomy for complicated upper urinary tract obstruction: mid-term follow-up(2014) ARAP, Marco Antonio; ANDRADE, Hiury; TORRICELLI, Fabio Cesar Miranda; DENES, Francisco Tibor; MITRE, Anuar Ibrahim; DUARTE, Ricardo Jordao; SROUGI, MiguelTo report on the largest series of laparoscopic ureterocalicostomies done for complicated upper urinary obstruction. We retrospectively reviewed the data from 6 transperitoneal laparoscopic ureterocalicostomies performed in our institution from January 2008 to January 2012. Symptomatic complicated upper urinary obstruction was the main reason for all the procedures. The recorded data included age, gender, clinical presentation, duration of symptoms, laterality, mean operative time, hospital stay, complications and clinical and functional outcomes. The median patient age was 20.1 (2-44) years, and all patients were females. Patients underwent laparoscopic ureterocalicostomy due to previous failed procedures (3 patients), anatomic abnormalities (2 patients) and a severe upper ureteral stenosis (1 patient). The median operative time was 215 (180-270) min. There were no major complications. There were no conversions to open surgery. In a median follow-up of 30 (8-56) months, all patients presented with clinical and radiological improvement with no signs of obstruction. In all cases, the postoperative renal scintigraphy revealed a T1/2 lower than 10 min. Laparoscopic ureterocalicostomy is feasible and associated with high success rate in well-selected cases with complicated upper urinary obstructions.
- Use of biological Glue (Bioglue (R)) in laparoscopic partial nephrectomy: a study in pigs(2015) BRANDAO, Luis Felipe; TORRICELLI, Fabio Cesar Miranda; MELO, Glauco; TAKANO, Luiz Fernando; MITRE, Anuar Ibrahim; ARAP, Marco AntonioIntroduction: Partial nephrectomy is the standard of care for localized renal tumors. However, bleeding and warm ischemia time are still controversial when laparoscopic surgeries are carried out. Herein, we aim to compare the outcomes from laparoscopic partial nephrectomy with and without the use of biological glue with purified bovine albumin and glutaraldehyde (BioGlue (R)). Materials and Methods: Twenty-four kidneys of 12 pigs were used in this study. A pre-determined lower pole segment was resected (3 cm x 1 cm) and one of two different hemostatic techniques was performed. In one kidney, hemostatic ""U suture"" (poliglecaprone 3.0) was performed and in the contra-lateral kidney, only the biological glue was applied. Data recorded was comprised of warm ischemia time (seconds) and estimated blood loss (mL) for each procedure. In cases of bleeding after glue administration, a complementary suture was done. Results: Mean warm ischemia time was 492.9 +/- 113.1 (351-665) seconds and 746 +/- 185.3 (409-1125) seconds for biological glue and suture groups, respectively. There was a positive significant difference in terms of warm ischemia favoring the biological glue group over the suture group (p<0.001). Mean blood loss was 39.4 (0-115) mL for the biological glue group and 39.1 (5-120) mL for the suture group (p=0.62). Conclusion: Biological glue is an important tool for laparoscopic partial nephrectomies. It is effective for hemostatic control in selected cases, and it can be used in combination with the traditional suture techniques.
- Learning robotic pyeloplasty without simulators: an assessment of the learning curve in the early robotic era(2019) CHAMMAS JR., Mario F.; MITRE, Anuar I.; ARAP, Marco A.; HUBERT, Nicholas; HUBERT, JacquesOBJECTIVE: To analyze our experience and learning curve for robotic pyeloplasty during this robotic procedure. METHODS: Ninety-nine patients underwent 100 consecutive procedures. Cases were divided into 4 groups of 25 consecutive procedures to analyze the learning curve. RESULTS: The median anastomosis times were 50.0, 36.8, 34.2 and 29.0 minutes (p=0.137) in the sequential groups, respectively. The median operative times were 144.6, 119.2, 114.5 and 94.6 minutes, with a significant difference between groups 1 and 2 (p=0.015), 1 and 3 (p=0.002), 1 and 4 (p<0.001) and 2 and 4 (p=0.022). The mean hospital stay was 7.08, 4.76, 4.88 and 4.20 days, with a difference between groups 1 and 2 (p<0.001), 1 and 3 (p<0.001) and 1 and 4 (p<0.001). Clinical and radiological improvements were observed in 98.9% of patients. One patient presented with recurrent obstruction. CONCLUSIONS: Our results demonstrate a high success rate with low complication rates. A significant decrease in hospital stay and surgical time was evident after 25 cases.