Mikhael Belkovsky

Universidade de São Paulo

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José Pinhata Otoch

Universidade de São Paulo

José Arnaldo Shiomi da Cruz

Universidade de São Paulo

Carlo Camargo Passerotti

Universidade de São Paulo

Stefan D. Holubar

Cleveland Clinic

Emre Görgün

Cleveland Clinic

Everson Luiz de Almeida Artifon

Universidade de São Paulo

Tracy L. Hull

Cleveland Clinic

Carlo C. Passerotti

Universidade de São Paulo

David Liska

Cleveland Clinic

Linda Ferreira Maximiano

Sociedade Brasileira de Cirurgia Plástica

Cooperative Institutions

Cleveland Clinic

Universidade de São Paulo

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Cleveland Clinic Lerner College of Medicine

American Society of Colon and Rectal Surgeons

Hospital Alemão Oswaldo Cruz

Case Western Reserve University

Universidade Nove de Julho

Hospital Israelita Albert Einstein

Universidade Federal de São Paulo

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Tamsulosin vs. Tadalafil as medical expulsive therapy for distal ureteral stones: a systematic review and meta-analysis

International braz j urol (2023)

Mikhael Belkovsky Giulia Veneziani Zogaib Carlo C. Passerotti Everson Luiz de Almeida Artifon José Pinhata Otoch

Purpose: Medical expulsive therapy (MET) is recommended for distal ureteral stones from 5 to 10 mm. The best drug for MET is still uncertain. In this review, we aim to compare the effectiveness of tadalafil and tamsulosin for distal ureteral stones from 5 to 10 mm in terms of stone expulsion rate (SER), stone expulsion time (SET) and the side effect profile. Materials and methods: A comprehensive literature search was conducted on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus and Web of Science, from inception until April 2023. Only randomized controlled trials were included in the analysis. Results: Eleven publications with 1,330 patients were included. We observed that tadalafil has a higher SER (OR 0.55, CI 95% 0.38;0.80, p=0.02, I2=52%) and the same efficacy in SET (MD 1.07, CI 95% -0.25; 2.39, p=0.11, I2=84%). No differences were found when comparing side effects as headache, backache, dizziness, and orthostatic hypotension. Conclusion: Tadalafil has a higher stone expulsion rate than tamsulosin as a medical expulsive therapy for patients with distal stones from 5 to 10 mm without differences in side effects.

Tamsulosin

Alfuzosin

10.1590/s1677-5538.ibju.2023.0345

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71 ONCOLOGIC OUTCOMES AFTER POUCH EXCISION: IS THERE A DIFFERENCE BETWEEN IBD AND FAP POUCH NEOPLASIA?

Gastroenterology (2024)

Megan Obi Mikhael Belkovsky Sarah Choi Jie Dai Tracy L. Hull

Pouch

10.1016/s0016-5085(24)04538-4

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The Old: Is There Any Role for Screening Colonoscopy after the Age of 75? The Surgeon's Perspective

Clinics in Colon and Rectal Surgery (2024)

Imran Khan Mikhael Belkovsky Emre Görgün

Abstract Guidelines recommend individualized decision making for screening colonoscopy for colorectal cancer (CRC) in patients after the age of 75 years due to low additional benefits. That should be taken with a grain of salt, as these recommendations are based on expert opinion and simulation models which do not consider (1) the differences in pathogenesis and cancer biology of CRC in elderly; (2) the risks of colonoscopy in this patient population; (3) and the impact of new surgical and nonsurgical therapies for CRC. In this review, our goal is to bring a surgeon's perspective to understand the role of screening colonoscopy in patients older than 75 years.

10.1055/s-0044-1787893

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Comparing outcomes of single-use vs reusable ureteroscopes: a systematic review and meta analysis

Urolithiasis (2024)

Mikhael Belkovsky Carlo Camargo Passerotti Ronaldo S. Maia Everson Luiz de Almeida Artifon José Pinhata Otoch

Ureteroscopy

Single use

10.1007/s00240-024-01537-8

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S11 Contemporary Surgical Management of Ileosigmoid Fistulas in Crohn’s Disease: A Systematic Review and Meta-analysis

The American Journal of Gastroenterology (2024)

Imran Khan Ece Unal Faris Almadi Mikhael Belkovsky Roy Apel

Background: Ileosigmoid fistula (ISF) is a common complication of Crohn's disease that is often diagnosed intraoperatively. Surgical management varies, including rates of laparoscopic surgery, primary repair vs sigmoid resection, and diversion rates. This variability highlights the need for a systematic review of the current literature. Methods: We conducted a systematic review of the literature by searching MEDLINE, EMBASE, Scopus, and the Cochrane Library. All searches covered the period from the inception of each respective database through August 6, 2024. Studies reporting the preoperative, intraoperative, and postoperative courses of patients with ileosigmoid fistulas were included. We specifically compared outcomes for patients who underwent ostomy vs no ostomy, laparoscopic vs open surgery, and primary repair vs resection. The quality of cohort studies was assessed using the Newcastle-Ottawa Scale (NOS), while the Joanna Briggs Institute's checklist was used for the case series. Results: From an initial search of 128 articles, 17 were selected for full-text review. Ultimately, 6 studies met the inclusion criteria—English language and published after 2000—including 5 retrospective cohort studies and 1 prospective case series, comprising a total of 493 patients. These studies were published between 2009 and 2024. Substantial heterogeneity was observed in surgical approaches and outcomes. The pooled estimate for proportion of ISF performed laparoscopically was 44.0% (95% CI: 0.21 - 0. 69, I2 = 95%). The pooled estimate for primary repair was 41.3% (95% CI: 0.28 - 0.56, I2 = 90%). Overall, 145 (29%) ileosigmoid fistulas were identified preoperatively, while emergency surgery and diversion rates varied from 5.7% to 57% and 11.9% to 57%, respectively. Postoperatively, the pooled leak rate was 8.34% (95% CI: 0.06 - 0.11, I2 = 21%). There was no significant difference in leak rates between primary repair and resection groups (pooled P = 0.22), and resection was associated with a longer hospital stay (pooled P = 0.007). Two studies found a significant association between sigmoid resection and diversion (pooled P = 0.0002), and additional small bowel resection was linked to higher diversion rates (pooled P = 0.003). Conclusions: This review highlights significant variability in the surgical management of ileosigmoid fistulas in Crohn's disease, underscoring the need for standardized guidelines. A multicenter study is recommended as a first step towards developing evidence-based guidelines.

10.14309/01.ajg.0001082576.91286.72

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Hernioplastia inguinal pré-peritoneal transabdominal bilateral e varicocelectomia laparoscópica bilateral na mesma intervenção: um estudo de viabilidade

Revista do Colégio Brasileiro de Cirurgiões (2023)

Mikhael Belkovsky EDGAR OLIVEIRA SARMENTO LUIS FELIPE COUTO NOVAES Carlo Camargo Passerotti JOSÉ PONTES

RESUMO Introdução: hérnia inguinal e varicocele são doenças comuns na população masculina. O advento da laparoscopia traz a oportunidade de tratá-las simultaneamente, pelo mesmo acesso. Entretanto, existem divergências sobre os riscos para a perfusão testicular de múltiplos procedimentos na região inguinal. Neste estudo, avaliamos a viabilidade de procedimentos laparoscópicos simultâneos estudando resultados clínicos e cirúrgicos de pacientes submetidos à hernioplastia inguinal bilateral pela técnica transabdominal préperitoneal (TAPP) com e sem varicocelectomia laparoscópica bilateral (VLB) concomitante. Métodos: uma amostra de 20 pacientes do Hospital Universitário da USP-SP com hérnia inguinal indireta e varicocele com indicação de correção cirúrgica foi selecionada. Os pacientes foram randomizados em dois grupos, sendo 10 submetidos à TAPP (Grupo I) e 10 submetidos à TAPP e VLB simultâneas (Grupo II). O tempo operatório total, complicações e dor pós-operatória foram coletados e analisados. Resultados: não houve diferença estatística entre os grupos com relação ao tempo operatório total e à dor pós-operatória. Apenas uma complicação (hematoma do cordão espermático) foi observada no Grupo I e não foram observadas complicações no Grupo II. Conclusões: no mesmo procedimento, submeter pacientes à TAPP e à VLB no mesmo procedimento se mostrou eficaz e seguro, o que fornece embasamento para a realização de estudos em maiores escalas.

10.1590/0100-6991e-20233468

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PCNL vs. two staged RIRS for kidney stones greater than 20 mm: systematic review, meta-analysis, and trial sequential analysis

Minerva Urology and Nephrology (2024)

BEATRIZ TAVEIRA CONSTANTINOU BIANCA CAROLINE BENEDICTO Breno Cordeiro Porto Mikhael Belkovsky Carlo C. Passerotti

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is considered the gold standard treatment for kidney stones greater than 20 mm. However, retrograde intrarenal surgery (RIRS) may achieve the same stone-free rate with repeated procedures, and potentially fewer complications. This study aimed to compare the efficacy and safety of PCNL and two-staged RIRS.EVIDENCE ACQUISITION: We conducted a systematic search in PubMed, Embase, Scopus, Cochrane, and Web of Science for studies comparing PCNL and RIRS for kidney stones greater than 20mm. The primary outcome is stone-free rate (SFR) of PCNL and RIRS (repeated once if needed). Secondary outcomes were SFR of PCNL versus RIRS (single procedure), operative time, hospital stay, need for auxiliary procedures, and complications. We performed a subgroup analysis for randomized trials, non-randomized trials, and patients with solitary kidney. We performed a trial sequential analysis for the main outcome.EVIDENCE SYNTHESIS: We included 31 articles, with 1987 patients in the PCNL and 1724 patients in RIRS. We confirmed the traditional result that after a single procedure PCNL has a higher SFR. We also found that comparing the SFR of PCNL and RIRS, repeated up to two times if needed, no difference in SFR was observed. Surprisingly, only 26% (CI95 23%-28%) of the patients required a second RIRS. In the trial sequential analysis, the last point of the z-curve was within futility borders. We observed that PCNL has a higher incidence of complications (RR=1.51; CI95 1.24, 1.83; P<0.0001; I2=28%), specifically CD2 (RR=1.82; CI95 1.30, 2.54; P=0.0004; I2=26%) and longer hospital stay (MD 2.57; 2.18, 2.96; P<0.00001; I2-98%). No difference was observed regarding operative time.CONCLUSIONS: RIRS repeated up to two times is equivalent to PCNL in terms of the SFR and may have the same safety.

Subgroup analysis

10.23736/s2724-6051.23.05577-5

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A curva de aprendizado da varicocelectomia laparoscópica bilateral: um estudo prospectivo

Revista do Colégio Brasileiro de Cirurgiões (2023)

Mikhael Belkovsky Carlo C. Passerotti Linda Ferreira Maximiano José Pinhata Otoch José Arnaldo Shiomi da Cruz

RESUMO Varicocele ocorre em 15% dos homens e em 35% dos homens inférteis. Desde 1992, a correção cirúrgica com varicocelectomia laparoscópica é o padrão ouro para o tratamento de pacientes sintomáticos ou com análise seminal anormal. A curva de aprendizado para esse procedimento frequentemente realizado ainda não foi descrita. No presente estudo, investigamos a curva de aprendizado de um único urologista em treinamento realizando suas primeiras 21 varicocelectomias laparoscópicas usando ferramentas qualitativas e quantitativas para avaliar seu desempenho durante o processo. Nossos resultados mostram que 14 varicocelectomias laparoscópicas bilaterais são suficientes para atingir o platô da curva de aprendizado.

10.1590/0100-6991e-20233456

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Uso da inteligência artificial na predição do risco de sepse pós-ureteroscopia flexível: uma revisão sistemática

Revista do Colégio Brasileiro de Cirurgiões (2023)

BEATRIZ MESALIRA ALVES Mikhael Belkovsky Carlo Camargo Passerotti Everson Luiz de Almeida Artifon José Pinhata Otoch

RESUMO Introdução: a ureteroscopia flexível é uma técnica cirúrgica minimamente invasiva utilizada para o tratamento de litíase renal. A urosepse pós-operatória é uma complicação rara, mas potencialmente fatal. Os modelos tradicionais utilizados para prever o risco dessa condição apresentam precisão limitada, enquanto modelos baseados em inteligência artificial são mais promissores. O objetivo desse estudo é realizar uma revisão sistemática a respeito do uso de inteligência artificial para detecção do risco de sepse em pacientes com litíase renal submetidos à ureteroscopia flexível. Métodos: a revisão de literatura está de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A busca com palavras-chave foi realizada no MEDLINE, Embase, Web of Science e Scopus e resultou no total de 2.496 artigos, dos quais 2 se enquadraram nos critérios de inclusão. Resultados: os dois estudos utilizaram modelos de inteligência artificial para predizer o risco de sepse após utereroscopia flexível. O primeiro teve uma amostra de 114 pacientes e foi baseado em parâmetros clínicos e laboratoriais. O segundo teve uma amostra inicial de 132 pacientes e foi baseado em imagens de tomografia computadorizada no pré-operatório. Ambos obtiveram boas medidas de Area Under the Curve (AUC), sensibilidade e especificidade, demonstrando boa performance. Conclusão: a inteligência artificial fornece múltiplas estratégias eficazes para estratificação do risco de sepse em pacientes submetidos a procedimentos urológicos para litíase renal, ainda que mais estudos sejam necessários.

Web of science

10.1590/0100-6991e-20233561

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Diameter of ureteral access sheath and ureteral stenosis development: a systematic review

Acta Cirúrgica Brasileira (2023)

Tamires Battistini Pissaia Mikhael Belkovsky Carlo Camargo Passerotti Everton Luiz de Almeida Artifon José Pinhata Otoch

Purpose: Ureteral access sheaths (UAS) are widely used in ureteroscopy. UAS are believed to pose a significant risk for ureteral stenosis due to ureteral mucosal compression, but little evidence supports this claim. Our systematic review aimed to investigate the relationship between different UAS diameters and stenosis risk. Methods: A systematic search was conducted in PubMed, Embase, Web of Science, Scopus, and Cochrane, from its inception to May 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines were followed. χ2 test was performed to compare the prevalence within the groups. Results: Six nonrandomized trials and one randomized, with a total of 962 patients, were included. The overall incidence of ureteral stenosis of 0.9%. UAS sizes were: 9.5/11.5Fr, 10/12Fr, 11/13Fr, 12/14Fr, and 14/16Fr. Within each subgroup, the incidence of ureteral stenosis was: 0.4, 8, 0, 1, and 1% (p = 0.099). No trend for stenosis was observed among larger UAS. Conclusions: In this systematic review, no relationship between UAS diameter and incidence of ureteral stenosis was observed. Nonetheless, additional randomized controlled trials are required to support this finding.

Ureteroscopy

Cochrane collaboration

10.1590/acb387423

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