Fidel Maximilian G, Shah Jainik, Bal Dhiraj S, Ko Yool, Roque Connor, Dhillon Harliv, Chung David, Pandian Alagarsamy, Nayak Jasmir G, Patel Premal
Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Men's Health Clinic Manitoba, Winnipeg, MB, Canada.
Can Urol Assoc J. 2024 Oct;18(10):335-340. doi: 10.5489/cuaj.8841.
We aimed to investigate the surgical outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation (DIVS) with multimodal local anesthesia (LA).
We conducted a retrospective cohort study from September 2022 to December 2023 including adult patients deemed eligible for day surgery (American Society of Anesthesiologist score 1-3) undergoing radical orchiectomy (RO), microscopic varicocelectomy (MV), or microscopic denervation of the spermatic cord (MDSC). All procedures were performed at a single urologic ambulatory surgical center and outpatient clinic, and by a single surgeon (PP). Procedures were performed through a subinguinal or inguinal approach with DIVS and adjunctive multimodal LA. We evaluated intraoperative complications and relevant surgical outcomes and parameters.
A total of 103 patients were included in the analysis with a mean age ± standard deviation of 37.3±9.6. This included 25 patients who underwent RO, 54 patients who underwent MV, and 24 patients who underwent MDSC. All procedures were completed successfully without intraoperative complications. Oncologic outcomes were preserved, fertility outcomes improved, and pain scores reduced similarly to the expected rates in the literature.
Our preliminary results demonstrate the safety, effectiveness, and feasibility of performing inguinal and subinguinal urologic procedures under DIVS with LA. These findings suggest that this technique preserves high-quality care while avoiding the unnecessary risks of general or spinal anesthesia, representing an opportunity to transfer these cases outside of hospitals' operating rooms into outpatient ambulatory centers.
我们旨在研究在深度静脉镇静（DIVS）联合多模式局部麻醉（LA）下进行腹股沟及腹股沟下泌尿外科手术的手术效果。
我们进行了一项回顾性队列研究，研究时间为2022年9月至2023年12月，纳入了符合日间手术条件（美国麻醉医师协会评分1 - 3）的成年患者，这些患者接受根治性睾丸切除术（RO）、显微镜下精索静脉曲张切除术（MV）或显微镜下精索去神经术（MDSC）。所有手术均在单一泌尿外科门诊手术中心和门诊诊所由同一位外科医生（PP）进行。手术通过腹股沟下或腹股沟入路，采用DIVS及辅助多模式LA进行。我们评估了术中并发症以及相关的手术效果和参数。
共有103例患者纳入分析，平均年龄±标准差为37.3±9.6岁。其中包括25例行RO的患者、54例行MV的患者和24例行MDSC的患者。所有手术均成功完成，无术中并发症。肿瘤学结局得以保留，生育结局得到改善，疼痛评分降低，与文献中的预期率相似。
我们的初步结果表明，在DIVS联合LA下进行腹股沟及腹股沟下泌尿外科手术具有安全性、有效性和可行性。这些发现表明，该技术在避免全身麻醉或脊髓麻醉不必要风险的同时，保持了高质量的医疗护理，为将这些病例从医院手术室转移至门诊日间中心提供了契机。
