Outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation

Authors

  • Maximilian G. Fidel Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  • Jainik Shah Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  • Dhiraj S. Bal Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  • Yool Ko Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  • Connor Roque Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  • Harliv Dhillon Men’s Health Clinic Manitoba, Winnipeg, Manitoba
  • David Chung Section of Urology, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  • Alagarsamy Pandian Department of Anesthesia, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  • Jasmir G. Nayak Section of Urology, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  • Premal Patel Section of Urology, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

DOI:

https://doi.org/10.5489/cuaj.8841

Keywords:

conscious sedation, ambulatory surgery, deep sedation, surgical outcomes

Abstract

INTRODUCTION: We aimed to investigate the surgical outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation (DIVS) with multimodal local anesthesia (LA).

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

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Published

2024-06-10

How to Cite

Fidel, M. G., Shah, J., Bal, D. S., Ko, Y., Roque, C., Dhillon, H., … Patel, P. (2024). Outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation. Canadian Urological Association Journal, 18(10), 335–40. https://doi.org/10.5489/cuaj.8841

Issue

Vol. 18 No. 10 (2024): CUAJ October

Section

Original Research

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