ALEXANDRE ISCAIFE
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
2 resultados
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- Holmium Laser Enucleation of the Prostate Simulation: Analysis of Realism and Level of Difficulty by Holmium Laser Enucleation of the Prostate-naive Urologists(2019) ANTUNES, Alberto A.; ISCAIFE, Alexandre; BARBOSA, Joao Arthur B. A.; ANJOS, Gabriel dos; NAHAS, William C.; SROUGI, MiguelOBJECTIVE To evaluate the opinion of Holmium laser enucleation of the prostate (HoLEP)-naive urologists about a surgical simulator and the level of difficulty at each step. MATERIALS AND METHODS We evaluated 40 HoLEP-naive urologists in a course involving 4 steps: lecture introducing Holmium laser basics and technique; live surgery; video explaining prostate enucleation using simulators; and simulator trial. A survey was applied to evaluate content validity and face validity of the simulator. Subjects also ranked the level of difficulty of each surgical step. RESULTS All urologists agreed on the importance of a validated HoLEP simulator in training; 95% agreed that simulation-based training is essential for patient safety. The mean rate of face validity of all analyzed components was 8.4 (8.1-9.0). Instrumentation was considered the most realistic component, followed by laser-tissue interaction. Positioning the fiber and bladder neck incisions (BNIs) at 5 and 7-o'clock were the easiest steps. Detaching the median lobe from the bladder neck, BNI at 12, dividing the mucosal bridge distally, and joining the upper and lower incisions were the most difficult steps. Residents found more difficulty in joining the BNIs distally (3.6 vs 2.4, P = .006) and in dividing the mucosal bridge distally (4.0 vs 3.0, P = .038) when compared to specialists. CONCLUSIONS HoLEP-naive urologists found this simulator useful and important for patient safety. Most components were considered realistic. Simulation was able to reproduce the levels of difficulty usually found in real life cases. The level of expertise may influence the learning process of some steps. (C) 2019 Elsevier Inc.
- Holmium Laser Resection of Large Bladder Tumors: Technique Description, Feasibility, and Histopathological Quality Analysis(2022) ISCAIFE, Alexandre; RIBEIRO FILHO, Leopoldo Alves; PEREIRA, Maikon Willian Aparecido; GALLUCCI, Fabio Pescarmona; CHADE, Daher; MURTA, Claudio Bovolenta; CORDEIRO, Mauricio Dener; CARDILI, Leonardo; SARKIS, Alvaro Sadeki; SROUGI, Miguel; NAHAS, William C.BACKGROUND The HoLERBT (Holmium Laser En-bloc Resection of Bladder Tumors) has emerged as an alternative to classical TURBT (Transurethral Resection of Bladder Tumor). Recent randomized trial and meta-analysis corroborate with the benefits in pathological analysis, perioperative and longterm oncological outcomes.(1-3) However, the treatment of large tumors and the technique of extraction from the bladder is a problem to be overcome.(1,4) OBJECTIVE To describe the laser resection of bladder tumors and demonstrate the feasibility of this procedure even for large tumors throughout a series of cases. It is also discussed the quality of the histopathological analysis. METHODS A series of 8 cases randomized selected to be the pilot for a trial comparing TURBT and HoLERBT in large tumors (>3 cm) in progress was analyzed (Brazilian Registry of Clinical Trials number RBR-67npwrk). The perioperative data and 1-year outcomes were assessed and the quality of histopathological analysis after morcellation was evaluated in terms of histopathology, grade, and stage. The entire procedure of one case is shown in a step-by-step video. RESULTS The mean follow-up was 12.6 months. The mean age was 59.6 (42-85) years, and the mean tumor size was 4.7 (4-8) cm. All the resections were En-bloc. There were 2 cases of NMIBC, 4 cases of MIBC, 1 paraganglioma, and 1 adenocarcinoma. The histopathological analysis confirmed the presence of detrusor muscle layer and accurate diagnosis and staging in all cases (100%). There were no perioperative Clavien-Dindo > 1 complications, no blood transfusion, and no bladder perforations. The histopathology analysis reveals excellent quality without artifacts of fulguration. CONCLUSION The holmium laser resection followed by morcellation of large bladder tumors is a feasible procedure. No complications occurred in our series of cases and all cases provided excellent material for histopathological analysis. (C) 2022 Elsevier Inc.