RICARDO JORDAO DUARTE

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder

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Autor: SROUGI, Miguel ×

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Agora exibindo 1 - 10 de 27
  • article 7 Citação(ões) na Scopus
    Is there a model to teach and practice retroperitoneoscopic nephrectomy?
    (2013) HISANO, Marcelo; DUARTE, Ricardo Jordao; COLOMBO JR., Jose Roberto; SROUGI, Miguel
    Introduction: Although the retroperitoneal approach has been the preferred choice for open urological procedures, retroperitoneoscopy is not the preferred approach for laparoscopy. This study aims to develop a training model for retroperitoneoscopy and to establish an experimental learning curve. Material and methods: Fifteen piglets were operated on to develop a standard retroperitoneoscopic nephrectomy (RPN) training model. All procedures were performed with three ports. Intraoperative data (side, operative time, blood loss, peritoneal opening) were recorded. Animals were divided into groups A, the first eight, and B, the last seven cases. Data were statistically analyzed. Results: We performed fifteen RPNs. The operative time varied from 15 to 50 minutes (median 30 minutes). Blood loss varied from 5 to 100 mL (median 20 mL). We experienced five peritoneal openings; we had two surgical vascular complications managed laparoscopically. There was statistical difference between groups A and B for peritoneal opening (p = 0.025), operative time (p = 0.0037), and blood loss (p = 0.026). Discussion: RPN in a porcine model could simulate the whole procedure, from creating the space to nephrectomy completion. Experimental learning curve was eight cases, after statistical data analysis. Conclusion: RPN in a porcine model is feasible and could be very useful for teaching and practicing retroperitoneoscopy.
  • article 14 Citação(ões) na Scopus
    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, Miguel
    Background 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.
  • article 15 Citação(ões) na Scopus
    Establishing the minimal number of virtual reality simulator training sessions necessary to develop basic laparoscopic skills competence: evaluation of the learning curve
    (2013) DUARTE, Ricardo Jordao; CURY, Jose; OLIVEIRA, Luis Carlos Neves; SROUGI, Miguel
    Introduction: Medical literature is scarce on information to define a basic skills training program for laparoscopic surgery (peg and transferring, cutting, clipping). The aim of this study was to determine the minimal number of simulator sessions of basic laparoscopic tasks necessary to elaborate an optimal virtual reality training curriculum. Materials and Methods: Eleven medical students with no previous laparoscopic experience were spontaneously enrolled. They were submitted to simulator training sessions starting at level 1 (Immersion Lap VR, San Jose, CA), including sequentially camera handling, peg and transfer, clipping and cutting. Each student trained twice a week until 10 sessions were completed. The score indexes were registered and analyzed. The total of errors of the evaluation sequences (camera, peg and transfer, clipping and cutting) were computed and thereafter, they were correlated to the total of items evaluated in each step, resulting in a success percent ratio for each student for each set of each completed session. Thereafter, we computed the cumulative success rate in 10 sessions, obtaining an analysis of the learning process. By non-linear regression the learning curve was analyzed. Results: By the non-linear regression method the learning curve was analyzed and a r(2) = 0.73 (p < 0.001) was obtained, being necessary 4.26 (similar to five sessions) to reach the plateau of 80% of the estimated acquired knowledge, being that 100% of the students have reached this level of skills. From the fifth session till the 10th, the gain of knowledge was not significant, although some students reached 96% of the expected improvement. Conclusions: This study revealed that after five simulator training sequential sessions the students' learning curve reaches a plateau. The forward sessions in the same difficult level do not promote any improvement in laparoscopic basic surgical skills, and the students should be introduced to a more difficult training tasks level.
  • article 5 Citação(ões) na Scopus
    Pyeloplasty in Adults With Ureteropelvic Junction Obstruction in Poorly Functioning Kidneys: A Systematic Review
    (2021) FREITAS, Pedro. F. S.; BARBOSA, Joao. A. B. A.; ANDRADE, Hiury S.; ARAP, Marco A.; MITRE, Anuar I.; NAHAS, William C.; SROUGI, Miguel; DUARTE, Ricardo J.; SROUGI, Victor
    OBJECTIVES To systematically summarize the available evidence concerning the impact of pyeloplasty on symptoms and differential renal function (DRF) in adults with unilateral UPJO in poorly functioning kidneys (PFK), and to identify potential predictors of kidney function recovery that could help clinicians select candidates for pyeloplasty. METHODS A literature search (MEDLINE, Embase, Google Scholar, Scopus, ClinicalTrials.gov, and the WHO Clinical Trials Registry) and systematic review were performed up to September 2020 according to the PRISMA guidelines. PFK were defined as a baseline DRF =30% on renal scintigraphy. The primary endpoints were symptom relief and postoperative scintigraphic DRF. Predictors of kidney function recovery were evaluated and compared among studies. RESULTS Nine studies comprising 731 patients met the inclusion criteria and were included for evidence synthesis. A DRF increase >5% occurred in 13.3%-53.8% of 160 patients with a pre- and postoperative renal scan. Symptoms improved in 73.3%-93.3% of 141 adults after pyeloplasty. Neither patient's age, baseline DFR, comorbidities, degree of hydronephrosis, kidney parenchymal thickness, nor kidney biopsy findings consistently predicted a significant DRF increase among 375 patients undergoing pyeloplasty. CONCLUSION Based on a low level of evidence, pyeloplasty may relieve symptoms and stabilize kidney function in adults with UPJO in PFK. A significant number of patients showed a DRF increase >5%, yet no consistent predictor of kidney function recovery was identified. Until more evidence becomes available, pyeloplasty could be considered for selected cases after accounting for the risks of a failure requiring a future nephrectomy. (C) 2021 Elsevier Inc.
  • article 0 Citação(ões) na Scopus
    The influence of interstitial cells of Cajal density in the outcomes of pyeloplasty in adults: A prospective analysis
    (2023) SROUGI, Victor; BANDEIRA, Rodolfo Anisio Santana de Torres; REIS, Sabrina Thalita; SANTOS, Gabriel Arantes dos; ANDRADE, Hiury da Silva; LEITE, Katia Ramos Moreira; HAMILTON-CHO, David; MITRE, Anuar Ibrahim; ARAP, Marco Antonio; SROUGI, Miguel; DUARTE, Ricardo Jordao
    Purpose: To evaluate if the density of interstitial cells of Cajal (ICC) in the ureteropelvic junction (UPJ) influences the outcomes of pyeloplasty in adults. Methods: Twenty-three patients with the diagnosis of ureteropelvic junction obstruction (UPJO) that underwent laparoscopic dismembered pyeloplasty were included. ICC density was measured using immunohistochemistry reaction for c-KIT expression in the resected UPJ segment. Pyeloplasty outcome was evaluated by patient self-report pain, urinary outflow using DTPA renogram and hydronephrosis assessment using ultrasound (US) at 12 months of follow-up. A logistic regression analysis was performed to assess the association of pyeloplasty outcomes and ICC density. Results: Low, moderate, and high ICC density were present in 17.4%, 30.4%, and 52.2% of the patients, respectively. Complete pain resolution was observed in 100%, 85.7%, and 75% of patients with low, moderate and high ICC density, respectively (p = 0.791). DTPA renogram improved in 75%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively (p = 0.739). Hydronephrosis improved in 25%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively (p = 0.032). Conclusions: Patients with high ICC density have a significant amelioration of hydronephrosis after pyeloplasty. However, ICC density is not associated with functional outcomes.
  • article 5 Citação(ões) na Scopus
    The role of urinary KIM-1, NGAL, CA19-9 and beta 2-microglobulin in the assessment of ureteropelvic junction obstruction in adults
    (2017) MIRANDA, Eduardo P.; DUARTE, Ricardo J.; BESSA JR., Jose de; LOPES, Roberto I.; SROUGI, Victor; ANDRADE, Hiury S.; BANDEIRA, Rodolfo A. S. T.; ARAP, Marco A.; MITRE, Anuar I.; VIANA, Nayara I.; REIS, Sabrina T.; LEITE, Katia R. M.; SROUGI, Miguel
    Purpose: The objective of this study is to evaluate the diagnostic properties of urinary biomarkers in adults with ureteropelvic junction obstruction: KIM-1, NGAL, CA19-9, and beta 2-microglobulin. We also assessed urinary biomarker concentrations following pyeloplasty. Material and methods: We prospectively studied adults from December 2013 to February 2015. We included 47 patients with a mean age of 38.6 +/- 12.7 years. Each patient provided four samples of voided urine for biomarker measurement, one at pre-operative consultation and the others at 1, 3, and 6 months of post-operative follow-up. The control group consisted of 40 healthy individuals with no hydronephrosis on ultrasound evaluation. Results: KIM-1 had an area under the curve of 0.79 (95% CI 0.70-0.89), NGAL 0.71 (95% CI 0.61-0.83), CA19-9 0.70 (95% CI 0.60-0.81), and beta 2-microgloblin 0.61 (95% CI 0.50-0.73). KIM-1 was the most sensitive marker with a cut-off of 170.4 pg/mg creatinine (sensitivity 91.4%, specificity 59.1%), whereas CA19-9 was the most specific with a cut-off of 51.3 U/mg creatinine (sensitivity 48.9%, specificity 88.0%). Urinary concentrations of biomarkers decreased after pyeloplasty. Conclusions: The evaluation of urinary biomarkers is useful in adults undergoing pyeloplasty. KIM-1, NGAL, and CA19-9 were elevated and significantly decreased after surgery.
  • article 2 Citação(ões) na Scopus
    Step-by-step Laparoscopic Vesiculectomy for Hemospermia
    (2017) MELLO, Marcos Figueiredo; ANDRADE, Hiury Silva; SROUGI, Victor; ARAP, Marco Antonio; MITRE, Anuar Ibrahim; DUARTE, Ricardo Jordao; SROUGI, Miguel
    Hemospermia has been considered as a benign and self-limiting condition. It usually has an inflammatory or infectious cause. However, recurrent or persistent hemospermia may indicate a more serious underlying pathology, especially over 40 years of age. Biopsy or surgical excision is indicated in cases of suspicious findings during investigation, such as cysts or masses. Open surgery has been considered the definitive form of treatment, however, it can be associated with significant morbidity. With growing experience in laparoscopics, this approach is becoming the preferable way to access the seminal vesicles. Our objective is to demonstrate a step-by-step operative technique for laparoscopic unilateral vesiculectomy approach in a man with hemospermia. Case: A 61 year-old man presented with 1 year of hemospermia. He was treated empirically with a fluoroquinolone plus a nonsteroidal anti-inflammatory without resolution of symptoms. Ultrasonography and MRI showed a solid-cystic mass in the right seminal vesicle. The patient was submitted to a laparoscopic unilateral vesiculectomy. Histopathological analysis showed intraluminal dilatation with blood content. During follow-up, complete resolution of symptoms was seen. Results: Three patients composed our cohort. Mean age was 53 years-old (range 45-61 years), the right side was more commonly affected (two unilateral on the right and bilateral). Mean operative time was 55 minutes (range 40-120min). One patient presented amyloidosis in the histopathological analysis. All cases presented complete resolution of symptoms. Conclusions: Laparoscopic vesiculectomy is a safe and feasible approach in cases of hemospermia. This technique showed good outcomes and minimal morbidity.
  • article 2 Citação(ões) na Scopus
    Infrared Thermometer: an accurate tool for temperature measurement during renal surgery
    (2013) MARCHINI, Giovanni Scala; DUARTE, Ricardo Jordao; MITRE, Anuar Ibrahim; TISEO, Bruno Camargo; CASSAO, Valter Dell'Acqua; TORRICELLI, Fabio Cesar Miranda; ARAP, Marco Antonio; SROUGI, Miguel
    Purpose: To evaluate infrared thermometer (IRT) accuracy compared to standard digital thermometer in measuring kidney temperature during arterial clamping with and without renal cooling. Materials and Methods: 20 pigs weighting 20Kg underwent selective right renal arterial clamping, 10 with (Group 1 - Cold Ischemia with ice slush) and 10 without renal cooling (Group 2 - Warm Ischemia). Arterial clamping was performed without venous clamping. Renal temperature was serially measured following clamping of the main renal artery with the IRT and a digital contact thermometer (DT): immediate after clamping (T0), after 2 (T2), 5 (T5) and 10 minutes (T10). Temperature values were expressed in mean, standard deviation and range for each thermometer. We used the T student test to compare means and considered p < 0.05 to be statistically significant. Results: In Group 1, mean DT surface temperature decrease was 12.6 +/- 4.1 degrees C (5-19 degrees C) while deep DT temperature decrease was 15.8 +/- 1.5 degrees C (15- 18 degrees C). For the IRT, mean temperature decrease was 9.1 +/- 3.8 degrees C (3-14 degrees C). There was no statistically significant difference between thermometers. In Group 2, surface temperature decrease for DT was 2.7 +/- 1.8 \degrees C (0-4 degrees C) and mean deep temperature decrease was 0.5 +/- 1.0 degrees C (0-3 degrees C). For IRT, mean temperature decrease was 3.1 +/- 1.9 degrees C (0-6 degrees C). No statistically significant difference between thermometers was found at any time point. Conclusions: IRT proved to be an accurate non-invasive precise device for renal temperature monitoring during kidney surgery. External ice slush cooling confirmed to be fast and effective at cooling the pig model.
  • article 6 Citação(ões) na Scopus
    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 Camargo
    Background 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.
  • article 21 Citação(ões) na Scopus
    Videolaparoscopic radical nephrectomy after chemotherapy in the treatment of Wilms' tumor: Long-term results of a pioneer group
    (2017) DUARTE, Ricardo Jordao; CRISTOFANI, Lilian Maria; ODONE FILHO, Vicente; SROUGI, Miguel; DENES, Francisco Tibor
    Introduction A high cure rate for Wilms' tumor has been achieved using a multidisciplinary approach. The natural step forward is to offer the benefits of a minimally invasive technique for surgery, which is an obligatory part of treatment. Nevertheless, some authors resist using videolaparoscopic radical nephrectomy (VRN) because of concerns about reducing the cure index. Methods The present study included children with unilateral Wilms' tumor treated from December 2003 to December 2015 with neoadjuvant chemotherapy followed by VRN. Patients were selected based on the size of their tumors compared with the contralateral kidney, and on their stature. Results VRN was performed in 24 patients of age range 10-93 months, with an average of 38.04 +/- 23.37 months. The tumoral kidney's largest diameter after chemotherapy averaged 10% of a patient's height. There was no tumor rupture or spillage and no patient presented intra or immediate postoperative complications, except for prolonged ileum in two patients. One patient required intraoperative transfusion because of preoperative anemia. Another developed a late herniation in the umbilical port that required surgical correction. After an average of 6.65 years of follow-up, two patients presented relapse: one with a stage IV disease had relapse in the lung and another with a stage III, involving the liver, had local relapse because of an unwanted delay in the adjuvant treatment. Conclusion VRN can be considered a feasible alternative to open surgery in selected cases of children with Wilms' tumor. The present experience shows that besides the benefits of minimally invasive procedures and better cosmetic results, there is no evidence of increased tumor rupture or spillage, peritoneal or port site metastasis, and the long-term oncological results are the same as open procedures.