FABIO CARVALHO VICENTINI
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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article 3 Citação(ões) na Scopus Endoscopic guided PCNL in the prone split-leg position versus supine PCNL: a comparative analysis stratified by Guy's stone score(2019) BATAGELLO, Carlos A.; SANTOS, Hugo D. Barone dos; NGUYEN, Andrew H.; ALSHARA, Luay; LI, Jianbo; MARCHINI, Giovanni Scala; VICENTINI, Fabio C.; TORRICELLI, Fabio Cesar Miranda; DANILOVIC, Alexandre; PEREIRA, Jessica Goulart; ROSE, Emily; SROUGI, Miguel; NAHAS, Willian C.; MAZZUCCHI, Eduardo; MONGA, ManojIntroduction: The optimal patient positioning for percutaneous nephrolithotomy (PCNL) based on the complexity of stone burden is not yet defined. Thus, we aimed to evaluate the intraoperative parameters, effectiveness and complications of patients undergoing PCNL between the endoscopic-guided prone split-leg PCNL (ePSL) and the supine PCNL by stratifying patients according to Guy's stone score (GSS). Materials and methods: A retrospective chart review was conducted of patients undergoing PCNL at two high-volume tertiary referral centers. At one center, patients underwent PCNL using the ePSL technique, while at the second center, patients underwent PCNL in supine. Patient demographics and stone characteristics, operative details, complications and effectiveness were compared between groups. The impact of obesity was also investigated. Results: Of 830 subjects, a total of 449 (54%) underwent PCNL in ePSL and 381 (46%) in supine. The ePSL group had a greater mean age and body mass index. No statistical differences were found in gender, serum chemistry and Charlson comorbidity index. After stratifying patients by GSS, the differences in baseline stone burden between PSL and supine lost significance and both groups could be compared. Complications were not statistically different between both groups. Univariate analysis demonstrated that multiple tracts and lower pole access were more prevalent in supine. In addition, for GSS1-3, ePSL was correlated with reduced operative time, radiation exposure, length of hospital stay and need for secondary procedure. Multivariate analysis correlated ePSL with lower radiation exposure and need for secondary procedures (p = 0.01). In comparison to the whole trial population, the same tendencies were appreciated for obese cohort. Conclusions: This is the first report focusing on the performance differences between ePSL and supine PCNL stratified by GSS. Both techniques are safe, with a low rate of complications. For GSS1-3, ePSL reduces radiation exposure and requires less need for both multiple access and secondary procedure.article 13 Citação(ões) na Scopus Outcomes of surgical treatment of ureteral strictures after laser ureterolithotripsy for impacted stones(2015) SROUGI, Victor; PADOVANI, Guilherme P.; MARCHINI, Giovanni S.; VICENTINI, Fabio C.; MAZZUCCHI, Eduardo; SROUGI, MiguelIntroduction: To evaluate the outcomes of ureteral strictures treatment after endoureterotomy using the holmium laser or open/laparoscopic surgery. Material and methods: From a database of 1101 patients that underwent semi-rigid holmium laser ureterolithotripsy from 2003 to 2013, we performed a search for patients treated for ureteral stricture. Parameters analyzed included patient demographic, stone burden, and ureteral stricture characteristics. Treatment included holmium laser endoureterotomy for stenosis cm and open/laparoscopic repair for stenosis >1 cm or for failed endoscopic treatment. Outcomes and complications were assessed. Success was defined as symptom improvement and radiographic obstruction resolution. Results: Of all the patients, 32 (2.8%) evolved with ureteral stenosis and all had impacted calculi at the time of surgery. Twenty-two patients with complete follow up were studied. After a mean follow up of 18.5 months (range 3-70), the success rates for endoureterotomy and open/laparoscopic stricture repair group were 50% and 82%, respectively. The hospitalization period was significantly shorter for patients who had undergone endoureterotomy (2.7 +/- 1.4 days versus 4.8 +/- 1.4 days; p = 0.003). Only minor complications occurred in both groups. Conclusion: The rate of ureteral stricture after holmium laser ureterolithotripsy for impacted calculi is higher than reported for non-impacted stones. Holmium laser endoureterotomy for stenosis shorter than 1 cm treated half of the cases. Open/laparoscopic repair had good outcomes in cases of longer stenosis.article 1 Citação(ões) na Scopus Supine percutaneous nephrolitotripsy in septuagenarian and octogenarian patients: outcomes of a case-control study(2018) TORRICELLI, Fabio C. M.; OGAWA, Guilherme K. M.; VICENTINI, Fabio C.; MARCHINI, Giovanni S.; DANILOVIC, Alexandre; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoIntroduction: Currently, there is a paucity of data evaluating the outcomes of supine percutaneous nephrolithotomy (PCNL) in septuagenarian and octogenarian patients. In this study we aim to compare the outcomes of supine PCNL in elderly patients with those of younger population. Material and methods: A matched case-control study was performed from January 2009 through December 2015 using our prospectively collected kidney stone database. Case group was composed of patients with age greater than 70 years. Control group included patients with less than 70 years old. Patients were randomly matched based on Guy's Stone Score as a surrogate of case complexity. Results: Fifty-four patients were enrolled in this study, 18 cases and 36 controls. There were no significant differences in gender and body mass index between groups. There were significantly more ASA 3 patients in septuagenarian and octogenarian patients (p = 0.012). Mean Charlson comorbidity index was significantly higher in septuagenarian and octogenarian patients (p = 0.041). Regarding PCNL technique, there were no differences in number of accesses, number of supra-costal accesses, and operative time. There was no significant difference in stone free rate, nephrostomy tube time, complication rate, mean decrease in hemoglobin level, and need of blood transfusion. Hospital stay time (days) was longer in case group (4.0 +/- 1.7 versus 2.4 +/- 1.1 days; p = 0.002). Conclusion: Septuagenarian and octogenarian patients have similar complication and stone-free rates compared to younger patients, although they demand a longer length of hospital stay.article 5 Citação(ões) na Scopus Supracostal punctures in supine percutaneous nephrolithotomy are safe(2017) WOOD, Guilherme J. A.; TORRICELLI, Fabio C. M.; VICENTINI, Fabio C.; SROUGI, Miguel; MAZZUCCHI, EduardoIntroduction: The feasibility and safety of supracostal punctures in supine percutaneous nephrolithotomy (PCNL) are still controversial. In this study we aim to compare success and complication rates from prone and supine PCNL with at least one supracostal puncture. Material and methods: We reviewed our electronic database for all supracostal PCNLs performed in our institution from February 2008 to September 2013. Patients were enrolled in the study if at least one supracostal puncture was required during surgery. Patients' demographics data, stone characteristics, intra and postoperative data, and success on first postoperative day CT were compared. Results: A total of 132 procedures were included in the analysis. Twenty-eight PCNLs were performed in supine position (21.2%), while 104 were done in prone position (78.8%). Patient's demographics and distribution of stones based on Guy's Score were similar between groups. Mean operative time and blood transfusion rate were not statistically different. There was no significant difference in the success rate (63.5% prone versus 71.4% supine, p = 0.507). Major complication rate (Clavien >= 3) was 16.3% in the prone group versus 3.6% in the supine group (p = 0.119). Conclusions: Supracostal punctures are safe and feasible in supine PCNL. It does not add additional risks and might provide equivalent success rates when compared to prone PCNLs.