CARLO CAMARGO PASSEROTTI
Projetos de Pesquisa
Unidades Organizacionais
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
35 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 35
- Predicting Anatomical Urological Abnormalities in Children Who Present With Their First Urinary Tract Infection(2013) ZANETTA, Vitor C.; ROSMAN, Brian M.; ROWE, Courtney K.; BUONFIGLIO, Helena B.; PASSEROTTI, Carlo C.; YU, Richard N.; NGUYEN, Hiep T.Objectives. Classically, presence of fever 38.0 degrees C is used to distinguish pyelonephritis from cystitis. We analyzed whether this is an appropriate marker to initiate further workup and whether temperature is correlated with urological abnormalities and further surgical or pharmacological intervention. Methods. Children who presented for their first workup of urinary tract infection between October 1, 2008, and September 30, 2009 were retrospectively selected from our institution. Demographics and clinical details were correlated with the diagnosis of urological abnormalities and requirement for intervention. Results. Age was the most important variable to predict urological abnormalities. The temperature value of 38.3 degrees C maximized the balance between sensitivity (90%) and specificity (46%) for predicting the need to intervene and the presence of anatomical urological abnormalities. Conclusion. Young age (2 years) and temperature are the best factors to predict further intervention and urological abnormalities, with a temperature value of 38.3 degrees C being a better predictive value than the currently used 38.0 degrees C.
- Comparison of the learning curves and frustration level in performing laparoscopic and robotic training skills by experts and novices(2015) PASSEROTTI, Carlo C.; FRANCO, Felipe; BISSOLI, Julio C. C.; TISEO, Bruno; OLIVEIRA, Caio M.; BUCHALLA, Carlos A. O.; INOUE, Gustavo N. C.; SENCAN, Arzu; SENCAN, Aydin; PARDO, Rogerio Ruscitto do; NGUYEN, Hiep T.Robotic assistance may provide for distinct technical advantages over conventional laparoscopic technique. The goals of this study were (1) to objectively evaluate the difference in the learning curves by novice and expert surgeons in performing fundamental laparoscopic skills using conventional laparoscopic surgery (CLS) and robotic-assisted laparoscopic surgery (RALS) and (2) to evaluate the surgeons' frustration level in performing these tasks. Twelve experienced and 31 novices in laparoscopy were prospectively evaluated in performing three standardized laparoscopic tasks in five consecutive, weekly training sessions. Analysis of the learning curves was based on the magnitude, rate, and quickness in performance improvement. The participant's frustration and mood were also evaluated during and after every session. For the novice participants, RALS allowed for shorter time to task completion and greater accuracy. However, significant and rapid improvement in performance as measured by magnitude, rate, and quickness at each session was also seen with CLS. For the experienced surgeons, RALS only provided a slight improvement in performance. For all participants, the use of RALS was associated with less number of sessions in which they felt frustrated, less number of frustration episodes during a session, lower frustration score during and after the session, and higher good mood score. The advantages of RALS may be of most benefit when doing more complex tasks and by less experienced surgeons. RALS should not be used as a replacement for CLS but rather in specific situations in which it has the greatest advantages.
conferenceObject A scoring system for testicular torsion: Decreasing costs and therapeutic delay(2012) BARBOSA, J. A. B. A.; OLIVEIRA, C. M.; TISEO, B. C.; PASSEROTTI, C. C.; SROUGI, M.; NGUYEN, H. T.; RETIK, A. B.NTRODUCTION & OBJECTIVES: Testicular torsion is a surgical emergency requiring prompt intervention to prevent testicular loss. Differential diagnosis is not easily done with clinical evaluation, and imaging studies are usually required, especially ultrasound, causing therapeutic delay. Our objective was to create a scoring system for clinical diagnosis of testicular torsion, thus eliminating the necessity of ultrasound (US). MATERIAL & METHODS: Patients presenting with acute scrotum at a tertiary care center were prospectively evaluated and physical examination was performed by the first urologist to see the patient. Scrotal ultrasound was performed in all patients after visit. Single variate analysis was performed and clinical variables associated with testicular torsion were identified. A scoring system was created based upon logistic regression with relevant variables from univariate analysis. Retrospective validation of the scoring system was performed including all patients seen with suspicion for testicular torsion at this institution up to 2 years prior to the beginning of the prospective evaluation. RESULTS: Two hundred and thirty one patients were enrolled in the first phase of the study. Mean age of patients was 12.1 years and mean duration of symptoms was 40.2 hours. Thirty-three patients had a final diagnosis of torsion. Clinical variables associated with torsion were scrotal swelling, nausea and vomiting from history and testicular swelling, high-riding test icle, horizontal lie of the testicle, increased consistency of the testicle to palpation, presence of a thickened spermatic cord, negative Prehn's sign, absent cremasteric reflex and fixed scrotal skin to testis on physical examination (p<0.05). A scoring system was created with 5 variables, and patients were stratified in low, intermediate and high risk for torsion. Twenty-two patients were at high risk for testicular torsion, all of which had a final diagnosis of torsion, and 170 patients were at low risk for torsion, none of which had a diagnosis for this condition. Low and high risk groups comprised 82% of all patients seen. Retrospective validation was performed for 116 patients and 83% of cases fell within low or high risk categories; all patients in the high risk category had a final diagnosis of torsion and none in the low risk group. CONCLUSIONS: The present scoring system is a valuable tool for diagnosis of testicular torsion, eliminating the necessity of ultrasound in 80% of cases. Prospective validation of this score is necessary.- Surgical Performance During Laparoscopic Radical Nephrectomy Is Improved With Training in a Porcine Model(2012) CRUZ, Jose Arnaldo Shiomi da; PASSEROTTI, Carlo Camargo; FRATI, Rodrigo Marcus Cunha; REIS, Sabrina Thalita dos; OKANO, Marcelo Takeo Rufato; GOUVEIA, Eder Maxwell; BIOLO, Karlo Domelles; DUARTE, Ricardo Jordao; Hiep Nguyen; SROUGI, MiguelBackground and Purpose: Becoming proficient in laparoscopic surgery is dependent on the acquisition of specialized skills that can only be obtained from specific training. This training could be achieved in various ways using inanimate models, animal models, or live patient surgery-each with its own pros and cons. Currently, there are substantial data that support the benefits of animal model training in the initial learning of laparoscopy. Nevertheless, whether these benefits extent themselves to moderately experienced surgeons is uncertain. The purpose of this study was to determine if training using a porcine model results in a quantifiable gain in laparoscopic skills for moderately experienced laparoscopic surgeons. Materials and Methods: Six urologists with some laparoscopic experience were asked to perform a radical nephrectomy weekly for 10 weeks in a porcine model. The procedures were recorded, and surgical performance was assessed by two experienced laparoscopic surgeons using a previously published surgical performance assessment tool. The obtained data were then submitted to statistical analysis. Results: With training, blood loss was reduced approximately 45% when comparing the averages of the first and last surgical procedures (P = 0.006). Depth perception showed an improvement close to 35% (P = 0.041), and dexterity showed an improvement close to 25% (P = 0.011). Total operative time showed trends of improvement, although it was not significant (P = 0.158). Autonomy, efficiency, and tissue handling were the only aspects that did not show any noteworthy change (P = 0.202, P = 0.677, and P = 0.456, respectively). Conclusions: These findings suggest that there are quantifiable gains in laparoscopic skills obtained from training in an animal model. Our results suggest that these benefits also extend to more advanced stages of the learning curve, but it is unclear how far along the learning curve training with animal models provides a clear benefit for the performance of laparoscopic procedures. Future studies are necessary to confirm these findings and better understand the impact of this learning tool on surgical practice.
- Assessment of a new kind of surgical simulator. The physical surgical simulator(2018) CRUZ, Jose Arnaldo Shiomi da; MIRANDA, Andre Filipe; COSTA, Lucas Evangelista da; AZEVEDO, Rafael Ulysses de; REIS, Sabrina Thalita dos; SROUGI, Miguel; PASSEROTTI, Carlo CamargoPurpose: To evaluate whether the use of the physical surgical simulator may benefit the development of laparoscopic skills. Methods: Ten medical students were divided into two groups: the first one performed ten weekly training sessions with a physical surgical simulator - ETX A2 LAP and, afterwards, one laparoscopic cholecystectomy in a porcine model, while the second group performed only a laparoscopic cholecystectomy. Both groups were compared regarding bleeding, total surgical time, time to perform each surgical step and qualitative parameters, based on a previously validated tool. Results: There was no difference in any of the evaluated parameters. Conclusion: We did not find any evidence of benefit in the use of the physical simulator for surgical performance in medical students.
- Robot-assisted single port radical nephrectomy and cholecystectomy: description and technical aspects(2018) MOTA FILHO, Francisco Hidelbrando Alves; SAVIO, Luis Felipe; SAKATA, Rafael Eiji; IVANOVIC, Renato Fidelis; SILVA, Marco Antonio Nunes da; MAIA, Ronaldo Soares; PASSEROTTI, Carlo CamargoIntroduction: Robot-Assisted Single Site Radical Nephrectomy (RASS-RN) has been reported by surgeons in Europe and United States (1-3). To our best knowledge this video presents the first RASS-RN with concomitant cholecystectomy performed in Latin America. Case: A 66 year-old renal transplant male due to chronic renal failure presented with an incidental 1.3cm nodule in the upper pole of the right kidney. In addition, symptomatic gallbladder stones were detected. Results: Patient was placed in modified flank position. Multichannel single port device was placed using Hassan's technique through a 3cm supra-umbilical incision. Standard radical nephrectomy and cholecystectomy were made using an 8.5mm camera, two 5mm robotic arms and an assistant 5mm access. Surgery time and estimated blood loss were 208 minutes and 100mL, respectively. Patient did well and was discharged within less than 48 hours, without complications. Pathology report showed benign renomedullary tumor of interstitial cells and chronic cholecystitis. Discussion: Robotic technology improves ergonomics, gives better precision and enhances ability to approach complex surgeries. Robot-assisted Single Port aims to reduce the morbidity of multiple trocar placements while maintaining the advantages of robotic surgery (2). Limitations include the use of semi-rigid instruments providing less degree of motion and limited space leading to crash between instruments. On the other hand, it is possible to perform complex and concomitant surgeries with just one incision. Conclusion: RASS-RN seems to be safe and feasible option for selected cases. Studies should be performed to better understand the results using single port technique in Urology.
- Use of artificial intelligence for sepsis risk prediction after flexible ureteroscopy: a systematic review(2023) ALVES, BEATRIZ MESALIRA; BELKOVSKY, MIKHAEL; PASSEROTTI, CARLO CAMARGO; ARTIFON, EVERSON LUIZ DE ALMEIDA; OTOCH, JOSÉ PINHATA; CRUZ, JOSÉ ARNALDO SHIOMI DAABSTRACT Introduction: flexible ureteroscopy is a minimally invasive surgical technique used for the treatment of renal lithiasis. Postoperative urosepsis is a rare but potentially fatal complication. Traditional models used to predict the risk of this condition have limited accuracy, while models based on artificial intelligence are more promising. The objective of this study is to carry out a systematic review regarding the use of artificial intelligence to detect the risk of sepsis in patients with renal lithiasis undergoing flexible ureteroscopy. Methods: the literature review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The keyword search was performed in MEDLINE, Embase, Web of Science and Scopus and resulted in a total of 2,496 articles, of which 2 met the inclusion criteria. Results: both studies used artificial intelligence models to predict the risk of sepsis after flexible uteroscopy. The first had a sample of 114 patients and was based on clinical and laboratory parameters. The second had an initial sample of 132 patients and was based on preoperative computed tomography images. Both obtained good measurements of Area Under the Curve (AUC), sensitivity and specificity, demonstrating good performance. Conclusion: artificial intelligence provides multiple effective strategies for sepsis risk stratification in patients undergoing urological procedures for renal lithiasis, although further studies are needed.
- Laparoscopic Insertion of Various Shaped Trocars in a Porcine Model(2019) MORENO, Danilo Galante; PEREIRA, Cesar Augusto Martins; ANNA, Ricardo Kyoiti Sant; AZEVEDO, Rafael Ulysses de; SAVIO, Luiz Felipe; DUARTE, Ricardo Jordao; SROUGI, Miguel; PASSEROTTI, Carlo CamargoBackground and Objective: The number of laparoscopic procedures increases annually with an estimated 3% of complications, one third of them linked to Verres' needle or trocar insertion. The safety and efficacy of ports insertion during laparoscopic surgery may be related the technique but also to trocar design. This study aims to compare physical parameters of abdominal wall penetration for 5 different trocars. Methods: Eleven pigs were studied. Five different commercially available trocars were randomically inserted at the midline. Real-time video recording of the insertions was achieved to measure the excursion of the abdominal wall and the time and distance the cutting surface of the bladed trocars was exposed inside the abdominal cavity. An especially designed hand sensor was developed and placed between the trocar and the hand of the surgeon to record force required for abdominal wall perforation. Results: Greater deformations and forces occurred in non-bladed as compared to bladed trocars, and in conical trocars as compared to pyramidal pointed ones, except for peritoneum perforation. Greater distance and time of blade exposure occurred in pyramidal laminae as compared to conical. Conclusion: The bladed trocars have lower forces and deformations in their introduction, and should be those that cause less injury and are more suitable for first entry. Conical and pyramidal trocars with the same blade size showed similar force, deformation, time, and distance of exposed blade.
- Is age an independent factor for prostate cancer? A paired analysis(2017) CRUZ, J. A. S. Da; PASSEROTTI, C. C.; REIS, S. T. Dos; GUARIERO, M. E. S.; CAMPOS, O. D. De; LEITE, K. R. M.; SROUGI, M.Introduction: Prostate cancer is the most prevalent malignant neoplasia among men worldwide. Several prognostic factors, including Gleason's score, the measurement of serum prostate-specific antigen (PSA) and the evaluation of the percentage of fragments affected by cancer on prostate biopsy, have already been established. Age alone, however, has yet to be studied as a prognostic factor independently from other known factors. The aim of the present study was to compare the characteristics and the evolution of prostate cancer in different age groups using a paired analysis for patients with equivalent known prognostic factors. In addition, we aimed to determine the true impact of age on the prognosis of prostate cancer. Material and Methods: The data from 2,283 patients subjected to radical retropubic prostatectomy between 1998 and 2009 were reviewed. The patients were divided into three age groups: < 55 years old, between 56 and 65 and > 65 years old. Each patient was matched to another patient in the other groups who had the same PSA range (< 4.0, between 4.0 and 10.0 and > 10), Gleason score on the surgical specimen and prognostic range of positive fragments in the prostate biopsy (< 33%, between 34 and 50% and > 50%). After pairing, each group consisted of 215 patients, who were compared using the biochemical recurrence of the disease (PSA > 0.2), the interval for biochemical relapse, extra-capsular invasion and invasion of the seminal vesicles or the lymph nodes. RESULTS. No significant difference was observed between the groups regarding the frequency of relapses, interval of relapse, extra-capsular invasion and invasion of the seminal vesicles or lymph nodes. Discussion: None of the studied factors were affected by the age of the patients. Therefore, patients of different ages had tumors with similar characteristics and behaviors. Conclusion: When assessed separately, without the effects of the main prognostic factors, age does not appear to be an independent prognostic factor for prostate cancer. © 2015 S. Karger AG, Basel.
- Role of Genetic Polymorphisms in the Development and Prognosis of Sporadic and Familial Prostate Cancer(2016) REIS, Sabrina T.; VIANA, Nayara I.; LEITE, Katia R. M.; DIOGENES, Erico; ANTUNES, Alberto A.; ISCAIFE, Alexandre; NESRALLAH, Adriano J.; PASSEROTTI, Carlo C.; SROUGI, Victor; PONTES-JUNIOR, Jose; SALLES, Mary Ellen; NAHAS, William C.; SROUGI, MiguelBackgrounds Our aim was to evaluate the role of 20 genetic polymorphisms in the development and prognosis of sporadic and familial PC. A case-control study of 185 patients who underwent radical prostatectomy from 1997 to 2011. These patients were divided into two groups based on their family history. Gleason grade, PSA value and pathological TNM 2002 stage were used as prognostic factors. Blood samples from 70 men without PC were used as controls. The SNPs were genotyped using a TaqMan SNP Genotyping Assay Kit. Results Considering susceptibility, the polymorphic allele in the SNP rs2660753 on chromosome 3 was significantly more prevalent in controls (p = 0.01). For familial clustering, the polymorphic homozygote genotype of the SNP rs7931342 was five times more frequent in patients with familial PC compared to sporadic PC (p = 0.01). Regarding the SNP 1447295, the polymorphic homozygote genotype was more prevalent in patients with organ-confined PC (p = 0.05), and most importantly, the polymorphic allele occurred more frequently in patients without biochemical recurrence (p = 0.01). Kaplan-Meier analysis showed a median biochemical recurrence free survival of 124.2 compared to 85.6 months for patients with the wild-type allele (p = 0.007). Conclusion Our findings provide the evidence for the association of 20 recently highlighted SNPs and their susceptibility, familial clustering, staging, Gleason score and biochemical recurrence of PC. We believe that the association between these SNPs and PC may contribute to the development of alternative tools that can facilitate the early detection and prognosis of this disease.