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Laparoscopic simple prostatectomy (adenomectomy): Experience in 59 consecutive patients
Prostatectomía simple (adenomectomía) por vía laparoscópica: experiencia en 59 pacientes consecutivos
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"apellidos" => "Campos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Urología, Clínica Indisa, Santiago, Chile" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Facultad de Medicina, Universidad de Chile, Santiago, Chile" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prostatectomía simple (adenomectomía) por vía laparoscópica: experiencia en 59 pacientes consecutivos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Benign prostatic hyperplasia (BPH) is a common disease in men, and lower urinary tract symptoms (LUTS) occur in 30% of men over 65.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Currently, transurethral resection of prostate (TURP) remains the gold standard for the surgical treatment of benign prostatic hyperplasia for adenomas with a volume of more than 80<span class="elsevierStyleHsp" style=""></span>cc (guidelines). There is a group of patients (10%) that does not benefit from TURP, and its main limitation is related to the size and shape of the prostate, which determines the surgical time for resection and may have an impact on the form of treatment. Comorbidities such as lithiasis, bladder diverticula, inguinal hernia and ankylosis of the hip may also limit the use of TURP.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The development of laparoscopic surgery caused interest in simple prostatectomy as an option for the treatment of BPH. The laparoscopic experience gained in the treatment of prostate carcinoma improves surgical possibilities in simple prostatectomy.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Several authors<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–13</span></a> have reported the advantages in the patients treated with laparoscopic simple prostatectomy. In order to determine the real clinical applicability of simple laparoscopic prostatectomy, we present our initial experience with this surgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">From June 2003 to June 2006, 59 extraperitoneal laparoscopic simple prostatectomies were performed by the same surgeon (OAC). Inclusion criteria were the presence of lower urinary tract symptoms (LUTS) due to BPH and formal indications for surgery, such as refractory urinary retention, renal insufficiency due to BPH, bladder stones, recurrent urinary tract infections and recurrent hematuria.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In summary, the surgical technique included vascular control with 2-0 Vicryl stitches on a CT-1 needle of the lateral pedicles and dorsal venous complex. A longitudinal incision of the bladder and prostatic capsule was performed, and after the adenoma enucleation, a trigonization with 3-0 Vicryl separated stitches from the edge of the bladder mucosa to the urethra, between 3 and 9<span class="elsevierStyleHsp" style=""></span>o’clock was carried out. The vesicoprostatic incision was sutured in a Monocryl 3-0 plane.</p><p id="par0025" class="elsevierStylePara elsevierViewall">All the patients had a clinical history of cardiovascular parameters, evaluation of prostate symptoms through IPSS, physical examination, prostate specific antigen (PSA), creatinine, and urinalysis. Transabdominal ultrasound was performed in all the patients to determine the size of the prostate, the upper urinary tract dilation and the postmictional residue. Preoperative flowmetry was advised in selected patients. PSA values did not indicate a prostate biopsy in any case.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The data were collected prospectively in a database and the analysis was performed retrospectively. The variables analyzed were surgical time, external blood loss, transfusion rate, conversion rate, perioperative period, bladder catheterization, postoperative complications, continence, and potency.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The mean operative time was 123<span class="elsevierStyleHsp" style=""></span>min (90–180). The average blood loss was 415<span class="elsevierStyleHsp" style=""></span>cc (50–1500). Four patients (14.8%) received heterologous transfusions; each of them received 2<span class="elsevierStyleHsp" style=""></span>units. There were no intraoperative complications. Postoperative complications occurred in two patients. The first one experienced a urinary fistula and was reoperated laparoscopically on the fourth day after the first operation to resuture the cervical capsular incision. The other patient had urinary retention after the bladder catheter removal, which was solved with catheterization for three days. The mean hospital stay was 3.5 days (2–7). There were no conversions to open surgery in the series.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The final pathological study reported BPH in all the cases. The average weight of the pieces was 95.2<span class="elsevierStyleHsp" style=""></span>g (40–150). The functional results in terms of continence and potency were dealt with in consultation with the surgeon. The mean preoperative IPSS was 18 (range 12–26), decreasing in the postoperative to an average of 2 (2–5). There were no cases of postoperative urinary incontinence, and 100% of the patients with EIFF greater than 25 maintained it in the postoperative period.</p><p id="par0045" class="elsevierStylePara elsevierViewall">No patient had late complications or mortality. With a median follow-up of 30 months (16–60) all the patients remain free of symptoms.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Our results indicate that laparoscopic simple prostatectomy is a viable option for the surgical treatment of BPH. Current clinical series evidence that in patients with BPH and surgical criteria, this technique, if performed correctly, can improve accuracy in vascular control.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Mariano et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> reported the first simple laparoscopic prostatectomy with vascular control of an adenoma of 120<span class="elsevierStyleHsp" style=""></span>g with a blood loss of 800<span class="elsevierStyleHsp" style=""></span>cc and operative time of more than 3<span class="elsevierStyleHsp" style=""></span>h. Nadler et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> also presented a case of BPH treated with preperitoneal laparoscopic simple prostatectomy. The surgical technique has evolved since then. Van Velthoven et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> reported 18 laparoscopic simple prostatectomies in which the lateral pedicle vascular control was performed. In this series, the mean operative time was 145<span class="elsevierStyleHsp" style=""></span>min and the mean blood loss was 192<span class="elsevierStyleHsp" style=""></span>cc. The average weight of the piece was 47.6<span class="elsevierStyleHsp" style=""></span>g.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The largest published series on laparoscopic simple prostatectomy has been presented by Mariano et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> They conduct a transperitoneal technique with vascular control; in their experience, the transfusion of the patients was not necessary and the average prostate weight was 144<span class="elsevierStyleHsp" style=""></span>g, with an operative time of 139<span class="elsevierStyleHsp" style=""></span>min and blood loss of 330<span class="elsevierStyleHsp" style=""></span>cc. There were three cases of ileus, probably due to the transperitoneal approach. This series presents a shorter hospital stay and early return to normal activities.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Sotelo et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> reported a series of 17 laparoscopic simple prostatectomies with a mean operative time of 156<span class="elsevierStyleHsp" style=""></span>min, blood loss was 516<span class="elsevierStyleHsp" style=""></span>cc and the mean sample volume was 72<span class="elsevierStyleHsp" style=""></span>g. More recently, the Venezuelan group have updated their series and presented 71 patients treated with laparoscopic simple prostatectomy that confirmed their preliminary results.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">A series of 10 patients has recently been published by Fata et al.,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> a series in which they analyzed 10 patients who were treated with the same technique. The results of operative time are similar to ours, of 112.5<span class="elsevierStyleHsp" style=""></span>min (80–135) versus 123<span class="elsevierStyleHsp" style=""></span>min (90–180) in our series. Notably, the average prostatic volume in our series by far outweighs 108.5<span class="elsevierStyleHsp" style=""></span>cc (75–150) versus the one published in the aforementioned series of 62-g (40–93).</p><p id="par0075" class="elsevierStylePara elsevierViewall">We believe that the feasibility of laparoscopic simple prostatectomy for high-volume adenomas depends essentially on a thorough vascular control, as reported by Rehman et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> in their series. In our series, we treated 20 patients (34%) in whom the prostate volume exceeded 75<span class="elsevierStyleHsp" style=""></span>cc suggesting the possible reliability of the technique when this is performed with a precise vascular control.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Meanwhile, a group of minimally invasive innovative techniques have emerged for the surgical treatment of BPH.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,19,20</span></a> Among them, Holmium laser enucleation has proven superior to other therapeutic options.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Open simple prostatectomy has the advantage of the complete enucleation of high volume adenomas; however, it remains a surgical procedure with high morbidity due to the significant blood loss and long hospital stay.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22,23</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">It would be of great importance to establish an objective comparison between laparoscopic and open simple prostatectomy, but prospective randomized trials to compare these two techniques are unlikely to be conducted when there is a wide range of minimally invasive procedures to treat BPH, and comparison efforts at this time tend to seek the efficacy of techniques such as HoLEP.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,21</span></a> However, Baumert et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> have recently presented an interesting comparative study between laparoscopic and open simple prostatectomy that showed advantages in terms of lower blood loss (average 367<span class="elsevierStyleHsp" style=""></span>cc), requirement for bladder washings, bladder catheterization and hospital stay in the laparoscopy group. An average weight of the piece of 74 and 81<span class="elsevierStyleHsp" style=""></span>g was reported in the Millin group and in the transvesical one, respectively. In laparoscopy, operative time was higher compared with open surgery. Porpiglia et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> have also presented a prospective non-randomized and comparative study on extraperitoneal transcapsular adenomectomy (Millin) versus open surgery. They compared two groups of 20 patients each, and concluded that the techniques are comparable, showing the advantages of the laparoscopic group in terms of perioperative bleeding.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In 2008, Sotelo et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> contributed for the first time to the use of robotics in simple prostatectomy in 7 cases, which was performed through transperitoneal approach. This minimally invasive treatment allows for an enucleation of the adenoma without special devices due to the advantages provided by the EndoWrist<span class="elsevierStyleSup">®</span> of the robotic instrument. It also facilitates the control of hemostasis, resulting in a lower intraoperative blood loss.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Since May 2010, 14 robot-assisted simple prostatectomies were performed at our center, pending the start of the analysis of our results.</p><p id="par0095" class="elsevierStylePara elsevierViewall">We believe that advances in minimally invasive surgery, such as an articulated robot, might enable a greater precision imitating open surgery.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The limitations of our study might be the lack of preoperative and postoperative flowmetry, which would improve the assessment of functional outcomes. On the other hand, the use of transrectal ultrasound (TRUS) is preferable when establishing the prostate volume, although transabdominal ultrasound has been used because, in addition to measuring the size of the gland, it allows us to evaluate the upper urinary tract dilation and the residual urine, as well as to perform the diagnosis of concomitant bladder lithiasis.</p><p id="par0105" class="elsevierStylePara elsevierViewall">It is important to remember that medical therapy and minimally invasive techniques are still very expensive and unavailable worldwide procedures. There are ways in which open prostatectomy remains the most widely used technique,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> so the laparoscopic version might represent a good option for surgery in these cases.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">Extraperitoneal laparoscopic simple prostatectomy with vascular control is an effective procedure for the treatment of large prostate adenomas. In our experience, this surgical technique proved to be feasible and reproducible. It seems to have less perioperative morbidity; however, its important learning curve is an issue necessary to address.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres98372" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec85531" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres98371" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec85532" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec85531" "palabras" => array:3 [ 0 => "Surgical treatment of BPH" 1 => "Adenomectomy" 2 => "Laparoscopy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec85532" "palabras" => array:3 [ 0 => "Tratamiento quirúrgico de la HBP" 1 => "Adenomectomía" 2 => "Laparoscopia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Laparoscopic adenomectomy 150 is a minimally invasive alternative to open surgery in large prostates. Our aim is to discuss our series of 59 patients treated by means of laparoscopic adenomectomy with precise vascular control.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Between June 2003 and June 2006, a total of 59 patients with a mean age of 65.5<span class="elsevierStyleHsp" style=""></span>years (51–82), underwent laparoscopic extraperitoneal adenomectomy. All the patients had a history of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). The mean International Prostate Symptom Score (IPSS) was 20 points (16–22). The information was collected prospectively in a database. The analysis was performed subsequently.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All 59 adenomas were completely removed laparoscopically without conversion to open surgery. The mean preoperative prostate volume by ultrasound was 108.5<span class="elsevierStyleHsp" style=""></span>cc (75–150). The average operating time was 123<span class="elsevierStyleHsp" style=""></span>min (90–180). The mean loss of blood was 415<span class="elsevierStyleHsp" style=""></span>ml (50–1500) and 4 patients (14.8%) required a blood transfusion. Two (7.4%) of the patients presented perioperative complications. The mean hospital stay and the bladder catheterization time were 3.5 (2–7) and 4.2 (3–7) days, respectively.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Laparoscopic extraperitoneal simple prostatectomy is an effective procedure for the treatment of large prostatic adenomas. There seems to be less perioperative morbidity and, in our experience, this technique seems to be feasible and reproducible; however, its learning curve is a complicated matter to deal with.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La adenomectomía laparoscópica es una alternativa mínimamente invasiva a la cirugía abierta en próstatas de gran volumen. Nuestro objetivo es dar a conocer nuestra serie de 59 pacientes tratados mediante adenomectomía laparoscópica con control vascular preciso.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Entre junio de 2003 y junio de 2006 un total de 59 pacientes con una edad promedio de 65,5 años (51 a 82) fueron sometidos a adenomectomía laparoscópica extraperitoneal. Todos los pacientes tenían un historial de síntomas del tracto urinario inferior (STUI) y de hiperplasia benigna de próstata (HPB). La mediana del <span class="elsevierStyleItalic">International Prostate Symptom Score</span> (IPSS) fue de 20 puntos (16-22). La información fue recogida de forma prospectiva en una base de datos. El análisis fue realizado <span class="elsevierStyleItalic">a posteriori</span>.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Todos los 59 adenomas fueron extirpados en su totalidad por vía laparoscópica sin conversión a cirugía abierta. La mediana de volumen prostático preoperatorio medida por ultrasonidos fue de 108,5 cc (75-150). El tiempo operatorio promedio fue de 123 minutos (90-180). La pérdida de sangre promedio fue 415<span class="elsevierStyleHsp" style=""></span>ml (50-1500) y 4 pacientes (14,8%) requirieron transfusión de sangre. Dos (7,4%) de los pacientes presentaron complicaciones perioperatorias. La mediana de estancia hospitalaria y el tiempo de sonda vesical fueron de 3,5 (2-7) y 4,2 (3-7) días respectivamente.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La prostatectomía laparoscópica simple extraperitoneal es un procedimiento efectivo para el tratamiento de grandes adenomas prostáticos. Parece haber menos morbilidad perioperatoria y en nuestra experiencia esta técnica parece factible y reproducible; sin embargo, su curva de aprendizaje es un tema complicado de abordar.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Castillo OA, et al. Prostatectomía simple (adenomectomía) por vía laparoscópica: experiencia en 59 pacientes consecutivos. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 11 | 1 | 12 |
| 2018 February | 12 | 2 | 14 |
| 2018 January | 15 | 1 | 16 |
| 2017 December | 6 | 0 | 6 |
| 2017 November | 15 | 0 | 15 |
| 2017 October | 24 | 2 | 26 |
| 2017 September | 12 | 1 | 13 |
| 2017 August | 17 | 4 | 21 |
| 2017 July | 21 | 3 | 24 |
| 2017 June | 22 | 3 | 25 |
| 2017 May | 33 | 4 | 37 |
| 2017 April | 19 | 5 | 24 |
| 2017 March | 22 | 28 | 50 |
| 2017 February | 22 | 2 | 24 |
| 2017 January | 20 | 2 | 22 |
| 2016 December | 16 | 4 | 20 |
| 2016 November | 25 | 9 | 34 |
| 2016 October | 32 | 10 | 42 |
| 2016 September | 12 | 7 | 19 |
| 2016 August | 24 | 4 | 28 |
| 2016 July | 10 | 5 | 15 |
| 2016 June | 14 | 6 | 20 |
| 2016 May | 16 | 18 | 34 |
| 2016 April | 25 | 10 | 35 |
| 2016 March | 33 | 13 | 46 |
| 2016 February | 22 | 17 | 39 |
| 2016 January | 27 | 15 | 42 |
| 2015 December | 13 | 13 | 26 |
| 2015 November | 9 | 11 | 20 |
| 2015 October | 9 | 10 | 19 |
| 2015 September | 11 | 10 | 21 |
| 2015 August | 15 | 3 | 18 |
| 2015 July | 9 | 5 | 14 |
| 2015 June | 8 | 2 | 10 |
| 2015 May | 14 | 6 | 20 |
| 2015 April | 22 | 12 | 34 |
| 2015 March | 20 | 7 | 27 |
| 2015 February | 12 | 10 | 22 |
| 2015 January | 22 | 4 | 26 |
| 2014 December | 29 | 5 | 34 |
| 2014 November | 19 | 2 | 21 |
| 2014 October | 44 | 9 | 53 |
| 2014 September | 32 | 12 | 44 |
| 2014 August | 28 | 7 | 35 |
| 2014 July | 23 | 3 | 26 |
| 2014 June | 30 | 2 | 32 |
| 2014 May | 19 | 4 | 23 |
| 2014 April | 16 | 2 | 18 |
| 2014 March | 31 | 3 | 34 |
| 2014 February | 17 | 7 | 24 |
| 2014 January | 9 | 4 | 13 |
| 2013 December | 16 | 4 | 20 |
| 2013 November | 15 | 5 | 20 |
| 2013 October | 28 | 5 | 33 |
| 2013 September | 14 | 2 | 16 |
| 2013 August | 19 | 7 | 26 |
| 2013 July | 5 | 0 | 5 |
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