JOSE ROBERTO COLOMBO JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- Is there a model to teach and practice retroperitoneoscopic nephrectomy?(2013) HISANO, Marcelo; DUARTE, Ricardo Jordao; COLOMBO JR., Jose Roberto; SROUGI, MiguelIntroduction: 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.
- A prognostic model for survival after palliative urinary diversion for malignant ureteric obstruction: a prospective study of 208 patients(2016) CORDEIRO, Maurcio D.; COELHO, Rafael F.; CHADE, Daher C.; PESSOA, Rodrigo R.; CHAIB, Mateus S.; COLOMBO-JUNIOR, Jose R.; PONTES-JUNIOR, Jose; GUGLIELMETTI, Giuliano B.; SROUGI, MiguelObjective To identify factors associated with survival after palliative urinary diversion (UD) for patients with malignant ureteric obstruction (MUO) and create a risk-stratification model for treatment decisions. Patients and Methods We prospectively collected clinical and laboratory data for patients who underwent palliative UD by ureteric stenting or percutaneous nephrostomy (PCN) between 1 January 2009 and 1 November 2011 in two tertiary care university hospitals, with a minimum 6-month follow-up. Inclusion criteria were age >18 years and MUO confirmed by computed tomography, ultrasonography or magnetic resonance imaging. Factors related to poor prognosis were identified by Cox univariable and multivariable regression analyses, and a risk stratification model was created by Kaplan-Meier survival estimates at 1, 6 and 12 months, and log-rank tests. Results The median (range) survival was 144 (0-1084) days for the 208 patients included after UD (58 ureteric stenting, 150 PCN); 164 patients died, 44 (21.2%) during hospitalisation. Overall survival did not differ by UD type (P = 0.216). The number of events related to malignancy (>= 4) and Eastern Cooperative Oncology Group (ECOG) index (> 2) were associated with short survival on multivariable analysis. These two risk factors were used to divide patients into three groups by survival type: favourable (no factors), intermediate (one factor) and unfavourable (two factors). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favourable group; 78.0%, 36.3%, and 15.5% in the intermediate group; and 46.4%, 14.3%, and 7.1% in the unfavourable group (P < 0.001). Conclusions Our stratification model may be useful to determine whether UD is indicated for patients with MUO.
- Robotic simple prostatectomy: Technical considerations and outcomes(2012) COLOMBO, J. R. Jr.; MITRE, A. I.The open approach has been the gold standard for simple prostatectomy, either through a retropubic enucleation with an anterior transverse prostatic capsulotomy (Millin) or through a suprapubic transvesical access. The simple laparoscopic prostatectomy may be an alternative to open simple prostatectomy with potentially lower morbidity, lower blood loss, faster recovery, shorter hospital stay, and earlier return to normal activities In 2002, Mariano et al.7 first described the technique for laparoscopic simple prostatectomy that was modified by several authors using both transperitoneal and extraperitoneal approaches. The American Urological Association (AUA) and European Association of Urology (EAU) guidelines suggest that open surgery should be the treatment for prostate volume higher than 80 g. Similarly to others procedures, some skilled urologists have replaced the open simple prostatectomy by the laparoscopic counterpart. Robotics brought contributions to laparoscopic simple prostatectomy allowing the enucleation of adenoma without the need for special devices due to the advantages provided by better visualization and robotic-articulated instruments. It also potentially facilitates hemostatic sutures to control the main prostatic vessels, resulting in reduced intraoperative blood loss. The closure of bladder and/or prostatic capsule is easier with robotic assistance. Robotic simple prostatectomy seems to have a shorter learning curve than pure laparoscopic, what would be a real alternative to a larger number of urologists to perform such a procedure with the minimally invasive approach. The drawbacks of robotic simple prostatectomy are the costs and the preferential transperitoneal approach. Although currently literature is scanty on this subject, multicentric studies with larger numbers of subjects are expected to compare the open, laparoscopic, and robotic simple prostatectomy. © Springer-Verlag London Limited 2012.
conferenceObject PROSPECTIVE RANDOMIZED TRIAL COMPARING OPEN TO LAPAROSCOPIC PARTIAL NEPHRECTOMY, INTERIM ANALYSIS. (NCT01809119)(2016) GUGLIELMETTI, Giuliano; ADONIAS, Sanarelly; COELHO, Rafael; CORDEIRO, Mauricio; BORGES, Leonardo; COLOMBO, Jose Roberto; PESSOA, Rodrigo; NEVES, Luiz; PONTES, Jose; NESRALLAH, Adriano; SROUGI, Miguel; NAHAS, William- 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.
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.- Retzus-sparing robotic-assisted laparoscopic radical prostatectomy: a step-by-step technique description of this first brazilian experience(2016) TOBIAS-MACHADO, Marcos; NUNES-SILVA, Igor; HIDAKA, Alexandre Kiyoshi; SATO, Leticia Lumy Kanawa; ALMEIDA, Roberto; COLOMBO JR., Jose Roberto; ZAMPOLLI, Hamilton de Campos; POMPEO, Antonio Carlos Lima
- Predicting outcomes in partial nephrectomy: is the renal score useful?(2017) MATOS, Andre Costa; DALL'OGLIO, Marcos F.; COLOMBO JR., Jose Roberto; CRIPPA, Alexandre; JUVENIZ, Joao A. Q.; ARGOLO, Felipe CoelhoIntroduction and Objective: The R.E.N.A.L. nephrometry system (RNS) has been validated in multiple open, laparoscopic and robotic partial nephrectomy series. The aim of this study was to test the accuracy of R.E.N.A.L. nephrometry system in predicting perioperative outcomes in surgical treatment of kidney tumors <7.0cm in a prospective model. Materials and Methods: Seventy-one patients were selected and included in this prospective study. We evaluate the accuracy of RNS in predicting perioperative outcomes (WIT, OT, EBL, LOS, conversion, complications and surgical margins) in partial nephrectomy using ROC curves, univariate and multivariate analyses. R.E.N.A.L. was divided in 3 groups: low complexity (LC), medium complexity (MC) and high complexity (HC). Results: No patients in LC group had WIT >20 min, versus 41.4% and 64.3% MC and HC groups respectively (p=0.03); AUC=0.643 (p=0.07). RNS was associated with convertion rate (LC: 28.6%; MC: 47.6%; HC: 77.3%, p=0.02). Patients with RNS <8 were most often subjected to partial nephrectomy (93% x 72%, p=0.03) and laparoscopic partial nephrectomy (56.8% x 28%, p=0.02), AUC=0.715 (p=0.002). The RNS was also associated with operative time. Patients with a score >8 had 6.06 times greater chance of having a surgery duration > 180 min. (p=0.017), AUC=0.63 (p=0.059). R.E.N.A.L. score did not correlate with EBL, complications (Clavien > 3), LOS or positive surgical margin. Conclusion: R.E.N.A.L. score was a good method in predicting surgical access route and type of nephrectomy. Also was associated with OT and WIT, but with weak accuracy. Although, RNS was not associated with Clavien > 3, EBL, LOS or positive surgical margin.
- Nephron-sparing surgery for treatment of reninoma: a rare renin secreting tumor causing secondary hypertension(2015) TORRICELLI, Fabio Cesar Miranda; MARCHINI, Giovanni Scala; COLOMBO JUNIOR, Jose Roberto; COELHO, Rafael Ferreira; NAHAS, Willian Carlos; SROUGI, MiguelMain findings: A 25-year-old hypertensive female patient was referred to our institution. Initial workup exams demonstrated a 2.8 cm cortical lower pole tumor in the right kidney. She underwent laparoscopic partial nephrectomy without complications. Histopathologic examination revealed a rare juxtaglomerular cell tumor known as reninoma. After surgery, she recovered uneventfully and all medications were withdrawn. Case hypothesis: Secondary arterial hypertension is a matter of great interest to urologists and nephrologists. Renovascular hypertension, primary hyperadosteronism and pheocromocytoma are potential diagnosis that must not be forgotten and should be excluded. Although rare, chronic pyelonephritis and renal tumors as rennin-producing tumors, nephroblastoma, hypernephroma, and renal cell carcinoma might also induce hypertension and should be in the diagnostic list of clinicians. Promising future implications: Approximately 5% of patients with high blood pressure have specific causes and medical investigation may usually identify such patients. Furthermore, these patients can be successfully treated and cured, most times by minimally invasive techniques. This interesting case might expand knowledge of physicians and aid better diagnostic care in future medical practice.
- Robotic-assisted partial Nephrectomy: initial experience in South America(2011) LEMOS, Gustavo C.; APEZZATO, Marcelo; BORGES, Leonardo L.; COLOMBO JR., Jose R.Objective: To report the initial outcomes of robotic-assisted partial nephrectomy in a tertiary center in South America. Material and methods: From 11/2008 to 12/2009, a total of 16 transperitoneal robotic-assisted partial nephrectomies were performed in 15 patients to treat 18 kidney tumors. One patient with bilateral tumor had two procedures, while two patients with two synchronous unilateral tumors had a single operation to remove them. Eleven (73%) patients were male and the right kidney was affected in 7 (46%) patients. The median patient age and tumor size were 57 years old and 30 mm, respectively. Five (28%) tumors were hilar and/or centrally located. Results: The median operative time, warm ischemia time and estimated blood loss was 140 min, 27 min and 120 mL, respectively. Blood transfusion was required in one patient with bilateral tumor, and one additional pyelolithotomy was performed due to a 15mm stone located in the renal pelvis. The histopathology analysis showed 15 (83%) malignant tumors, which 10 (67%) were clear cell carcinoma. The median hospital stay was 72 hrs and no major complication was observed. Conclusion: Robotic-assisted partial nephrectomy is safe and represents a valuable option to perform minimally invasive nephron-sparing surgery.