CARLO CAMARGO PASSEROTTI
Projetos de Pesquisa
Unidades Organizacionais
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
17 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 17
- 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.
- 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.
- Evaluation of a novel gel-based ureteral stent with biofilm-resistant characteristics(2014) ROSMAN, Brian M.; BARBOSA, Joao A. B. A.; PASSEROTTI, Carlo P.; CENDRON, Marc; NGUYEN, Hiep T.Current ureteral stents, while effective at maintaining a ureteral lumen, provide a substrate for bacterial growth. This propensity for biofilm formation may be a nidus for bacterial growth leading to infection and a reason for early removal of a stent before it is clinically indicated. A newly devised stent, composed of a highly hydrated, partially hydrolyzed polyacrylonitrile polymer, is believed to have bacterial resistant properties. The objective of this study is to evaluate the biofilm growth and bacterial resistant properties of this novel stent. Multiple 1 cm sections of the pAguaMedicina (TM) Pediatric Ureteral Stent (pAMS) (Q Urological, Natick, MA) and the conventional polymer stent (SS) (Boston Scientific, Natick, MA) were incubated for 3 days in the 3 different growth media. Afterward, J96 human pathogenic Escherichia coli was added. At 3, 6, 9, 12, and 15 days following bacterial inoculation, the stent segments were washed, sonicated, and analyzed for bacterial growth. Scanning electron microscopy (SEM) imaging was performed to assess biofilm formation. pAMS demonstrated significant reductions (43-71 %) in bacterial counts when compared to standard stents in all conditions tested. SEM imaging demonstrated biofilm formation on both types of stents in all media, with a relative reduction in apparent cell debris and bacteria on the pAMS. In this study, the gel-based stent shows a demonstrable reduction in bacterial counts and biofilm formation. The use of the pAMS may reduce the risk of infection associated with stent usage.
- Variations in Management of Mild Prenatal Hydronephrosis Among Maternal-Fetal Medicine Obstetricians, and Pediatric Urologists and Radiologists(2012) ZANETTA, Vitor C.; ROSMAN, Brian M.; BROMLEY, Bryan; SHIPP, Thomas D.; CHOW, Jeanne S.; CAMPBELL, Jeffrey B.; HERNDON, C. D. Anthony; PASSEROTTI, Carlo C.; CENDRON, Marc; RETIK, Alan B.; NGUYEN, Hiep T.Purpose: There are no current guidelines for diagnosing and managing mild prenatal hydronephrosis. Variations in physician approach make it difficult to analyze outcomes and establish optimal management. We determined the variability of diagnostic approach and management regarding prenatal hydronephrosis among maternal-fetal medicine obstetricians, pediatric urologists and pediatric radiologists. Materials and Methods: Online surveys were sent to mailing lists for national societies for each specialty. Participants were surveyed regarding criteria for diagnosing mild prenatal hydronephrosis and recommendations for postnatal management, including use of antibiotic prophylaxis, followup scheduling and type of followup imaging. Results: A total of 308 maternal-fetal medicine obstetricians, 126 pediatric urologists and 112 pediatric radiologists responded. Pediatric urologists and radiologists were divided between Society for Fetal Urology criteria and use of anteroposterior pelvic diameter for diagnosis, while maternal-fetal medicine obstetricians preferred using the latter. For postnatal evaluation radiologists preferred using personal criteria, while urologists preferred using anteroposterior pelvic diameter or Society for Fetal Urology grading system. There was wide variation in the use of antibiotic prophylaxis among pediatric urologists. Regarding the use of voiding cystourethrography/radionuclide cystography in patients with prenatal hydronephrosis, neither urologists nor radiologists were consistent in their recommendations. Finally, there was no agreement on length of followup for mild prenatal hydronephrosis. Conclusions: We observed a lack of uniformity regarding grading criteria in diagnosing hydronephrosis prenatally and postnatally among maternal-fetal medicine obstetricians, pediatric urologists and pediatric radiologists. There was also a lack of agreement on the management of mild intermittent prenatal hydronephrosis, resulting in these cases being managed inconsistently. A unified set of guidelines for diagnosis, evaluation and management of mild intermittent prenatal hydronephrosis would allow more effective evaluation of outcomes.
- Anatrophic Nephrotomy as Nephron-Sparing Approach for Complete Removal of Intraparenchymal Renal Tumors(2012) DALL'OGLIO, Marcos F.; BALLAROTTI, Lucas; PASSEROTTI, Carlo C.; PALUELLO, Davi V.; COLOMBO JUNIOR, Jose Roberto; CRIPPA, Alexandre; SROUGI, MiguelObjective: Partial nephrectomy for small kidney tumors has increased in the last decades, and the approach to non-palpable endophytic tumors became a challenge, with larger chances of positive margins or complications. The aim of this study is to describe an alternative nephron-sparing approach for small endophytic kidney tumors through anatrophic nephrotomy. Patients and Methods: A retrospective analysis of patients undergoing partial nephrectomy at our institution was performed and the subjects with endophytic tumors treated with anatrophic nephrotomy were identified. Patient demographics, perioperative outcomes and oncological results were evaluated. Results: Among the partial nephrectomies performed for intraparenchymal tumors between 06/2006 and 06/2010, ten patients were submitted to anatrophic nephrotomy. The mean patient age was 42 yrs, and the mean tumor size was 2.3 cm. Mean warm ischemia time was 22.4 min and the histopathological analysis showed 80% of clear cell carcinomas. At a mean follow-up of 36 months, no significant creatinine changes or local or systemic recurrences were observed. Conclusion: The operative technique described is a safe and effective nephron-sparing option for complete removal of endophytic renal tumors.
- Development and Initial Validation of a Scoring System to Diagnose Testicular Torsion in Children(2013) BARBOSA, Joao A.; TISEO, Bruno Camargo; BARAYAN, Ghassan A.; ROSMAN, Brian M.; TORRICELLI, Fabio Cesar Miranda; PASSEROTTI, Carlo C.; SROUGI, Miguel; RETIK, Alan B.; NGUYEN, Hiep T.Purpose: Testicular torsion is a surgical emergency requiring prompt intervention. Although clinical diagnosis is recommended, scrotal ultrasound is frequently ordered, delaying treatment. We created a scoring system to diagnose testicular torsion, decreasing the indication for ultrasound. Materials and Methods: We prospectively evaluated 338 patients with acute scrotum, of whom 51 had testicular torsion. Physical examination was performed by a urologist, and all patients underwent scrotal ultrasound. Univariate analysis and logistic regression were performed, and a scoring system for risk stratification of torsion was created. Retrospective validation was performed with 2 independent data sets. Results: The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1) and high riding testis (1). Cutoffs for low and high risk were 2 and 5 points, respectively. Ultrasound would be indicated only for the intermediate risk group. In the prospective data set 69% of patients had low, 19% intermediate and 11.5% high risk. Negative and positive predictive values were 100% for cutoffs of 2 and 5, respectively (specificity 81%, sensitivity 76%). Retrospective validation in 1 data set showed 66% of patients at low, 16% intermediate and 17% high risk. Negative and positive predictive values for cutoffs of 2 and 5 were 100% (specificity 97%, sensitivity 54%). The second retrospective data set included only torsion cases, none of which was misdiagnosed by the scoring system. Conclusions: This scoring system can potentially diagnose or rule out testicular torsion in 80% of cases, with high positive and negative predictive values for selected cutoffs. Ultrasound orders would be decreased to 20% of acute scrotum cases. Prospective validation of this scoring system is necessary.
conferenceObject Elaborating a learning program on laparoscopy: Assessment of the evolution of the novices' performance according to initial training with simulator or animal model(2012) DUARTE, R. J.; BRITO, A. H.; PASSEROTTI, C.; JR, J. R. Colombo; ARAP, M.; I, A. Mitre; SROUGI, M.INTRODUCTION & OBJECTIVES: This study sought to determinate the most efficient sequence for training new surgeons in laparoscopy: beginning with simulators, followed by surgery on animals, or beginning with surgery on animals and then using manual and virtual simulators. MATERIAL & METHODS: Forty-eight medical students without any experience in laparoscopy were enrolled and split into two groups. Group A consisted of 24 students who started with laparoscopic nephrectomy on pigs, followed by the use of simulators. Group B consisted of 24 students who started with manual and virtual simulators, followed by nephrectomy. In group A, one student performed the surgery, while the other used a camera over a one hour period, after which they switched roles(arterial clipping 30 points; vein clipping 30 points; complete nephrec tomy 20 points; no accidents 20 points). In group B, six pairs of students started with the virtual simulator in cutting and tying activities(50 points). Another six pairs of students began with the manual simulator, evaluated by a board incutting and tying(50 points). After one hour, the students changed roles. Nonparametric test was init ially applied to assess any starting point difference among groups. Then groups A and B were assessed regarding the score index improvement independently of the training sequence, in order to disclose an eventual difference of rhythm of improvement between groups. If a di fference of rhythm of improvement of the score between groups A and b was detected, the data were analyzed in order to disclose the sequence with the most increased score variation. RESULTS: There was no absolute variation of score between groups from the starting until the end of training (p=0.124 and p= 0.053). However, there was a difference in the rhythm of improvement of the novices, when we compare groups from the start to the end of training period (p<0.0001). The analysis of the absolute variation of the score according to the initial sequence of training, showed that the group who started in the animal model presented a skill improvement of 30.5% when after training on the si mulator, although those who started training in simulators presented a performance improvement of 98% after training in animal(p<0.001). CONCLUSIONS: Our data show that nov ice surgeons who start training in animal model have poor improvement with forward training with simulators. These data and the ethical and economic issues will be considered for the refinement of an educational curriculum.- Bladder exstrophy: reconstructed female patients achieving normal pregnancy and delivering normal babies(2011) GIRON, Amilcar Martins; PASSEROTTI, Carlo Camargo; Hiep Nguyen; CRUZ, Jose Arnaldo Shiomi da; SROUGI, MiguelPurpose: Bladder exstrophy (BE) is an anterior midline defect that causes a series of genitourinary and muscular malformations, which demands surgical intervention for correction. Women with BE are fertile and able to have children without this disease. The purpose of this study is to assess the sexual function and quality of life of women treated for BE. Materials and Methods: All patients in our institution treated for BE from 1987 to 2007 were recruited to answer a questionnaire about their quality of life and pregnancies. Results: Fourteen women were submitted to surgical treatment for BE and had 22 pregnancies during the studied period. From those, 17 pregnancies (77.2%) resulted in healthy babies, while four patients (18.1%) had a spontaneous abortion due to genital prolapse, and there was one case (4.7%) of death due to a pneumopathy one week after delivery. There was also one case (5.8%) of premature birth without greater repercussions. During pregnancy, three patients (21.4%) had urinary tract infections and one patient (7.14%) presented urinary retention. After delivery, three patients (21.4%) presented temporary urinary incontinence; one patient (7.14%) had a vesicocutaneous fistula and seven patients (50%) had genital prolapsed. All patients confirmed to have achieved urinary continence, a regular sexual life and normal pregnancies. All patients got married and pregnant older than the general population. Conclusions: BE is a severe condition that demands medical and family assistance. Nevertheless, it is possible for the bearers of this condition to have a satisfactory and productive lifestyle.