Browsing by Author "Branco, F"
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- The incidence of cancer and potential role of sirolimus immunosuppression conversion on mortality among a single-center renal transplantation cohort of 1,816 patientsPublication . Branco, F; Cavadas, V; Osório, L; Carvalho, F; Martins, L; Dias, L; Castro-Henriques, A; Lima, EINTRODUCTION: The chronic use of immunosuppressive drugs in renal transplant recipients increases the risk of developing de novo malignancies. Herein we analyze the incidence of de novo tumors and the potential role of sirolimus to improve cancer-specific survival among a cohort at a single center. METHODS: This retrospective analysis of our 1,816 patients allografted between January 1983 and December 2009 sought subjects who developed de novo tumors. Epidemiological and clinical data were examined using Mann-Whitney and Pearson's chi-square or Fisher exact tests for statistical comparisons of continuous and categorical variables, respectively. Kaplan-Meier survival curves were used to determine cancer-specific survival according to type of neoplasia and immunosuppressive regimen, namely, conversion to sirolimus. RESULTS: One hundred patients (5.5%) were diagnosed with a de novo malignancy. The 110 different cancers were diagnosed at a median interval of 73 months after kidney transplantation. The overall cancer-specific survivals at 1 and 5 years after cancer diagnosis were 87.0% and 76.9%, respectively. The 15 patients converted to sirolimus showed no difference in survival. CONCLUSION: The observed frequencies of cancer in our center are consistent with the literature. Among our cohort, sirolimus did not significantly impact survival among subjects who had de novo malignancies.
- Transvesical natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with kidney morcellation: a proof of concept studyPublication . Lima, E; Branco, F; Parente, J; Autorino, R; Correia-Pinto, JStudy Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Until now, the transvaginal approach has been the only method of removing larger specimens from the abdominal cavity using natural orifice transluminal endoscopic surgery. There has been no means of extracting larger specimens in men and the means are restricted even in women, particularly in young women. The present study shows that the difficulty of large specimen retrieval can be overcome, irrespective of the diameter of the chosen port, through natural orifices using morcellation. OBJECTIVE: To show, in a porcine model, the feasibility of a complete transvesical natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with kidney extraction after morcellation through the same port. MATERIALS AND METHODS: Transvesical nephrectomy and morcellation were performed in six pigs at Minho University, Braga, Portugal after institutional review board approval. The transvesical port and the cystotomy were created under the guidance of a ureteroscope, while the remaining steps were done under the guidance of an operating telescope. Dissection of the renal vessels and kidney was performed using dissection grasping forceps and a vessel sealing system (LigaSure(™) ; Covidien, Mansfield, MA, USA) and morcellation was done using a Piranha(™) morcellator (Richard Wolf, Knittlingen, Germany). RESULTS: There were no complications related to the creation of transvesical access. The image provided by the telescope was superior to that of the ureteroscope, especially underwater. Morcellation was quick and effective, with the support of a fixing needle through the abdominal wall, designed to fix the kidney, after laceration of a bowel loop occurred in the first experiment. It was found that technical improvements are needed to ensure safety of NOTES morcellation. CONCLUSIONS: Kidney morcellation after nephrectomy, using a natural orifice exclusively, is feasible. Despite technical limitations, this proof of concept study can be regarded as a potential step towards the application of NOTES in urology.
- Transvesical peritoneoscopy with rigid scope: feasibility study in human male cadaverPublication . Branco, F; Giovannalberto, P; Osório, L; Cavadas, V; Versos, R; Gomes, M; Autorino, R; Correia-Pinto, J; Lima, EBACKGROUND: Transvesical port refers to the method of accessing the abdominal cavity through a natural orifice (i.e., urethra) under endoscopic visualization. Since its introduction in 2006, various reports have been published describing different surgical interventions using a rigid ureteroscope in a porcine model. The aim of this study was to test the access and feasibility of peritoneoscopy by using a rigid ureteroscope in a human male cadaver. METHODS: Two adult male cadavers were used to perform the procedures. A rigid ureteroscope was used for the creation of transvesical access into the peritoneal cavity. Peritoneoscopy, liver biopsy, and identification and manipulation of the ileocecal appendix were performed. RESULTS: Transvesical access into the peritoneal cavity was quickly established. The rigid ureteroscope easily allowed visualization of the abdominal cavity with good image quality. Liver biopsy and manipulation of ileocecal appendix were carried out without difficulties. CONCLUSIONS: Peritoneoscopy, liver biopsy, and ileocecal appendix manipulation using a rigid ureteroscope through a transvesical port is feasible in a cadaver model. The development of a specific rigid scope for the transvesical port might herald a promising future for this NOTES access.