Skill and talent
Umbilical single-port pyelolithectomy on horseshoe kidney: A new indication
Pielolitectomía por puerto único umbilical sobre riñón en herradura: una nueva indicación
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A. Identificación de la unión pieloureteral. B. Pielotomía e identificación de la litiasis. C. Extracción litiásica. D. Inicio de pielorrafia mediante sutura continua con doble-J en la vía.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P.M. Cabrera, F. Cáceres, A. García-Tello, J.M. García-Mediero, J. Arconada, J.C. Angulo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "P.M." "apellidos" => "Cabrera" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Cáceres" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "García-Tello" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "García-Mediero" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Arconada" ] 5 => array:2 [ "nombre" => "J.C." "apellidos" => "Angulo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173578612000613" "doi" => "10.1016/j.acuroe.2012.04.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000613?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480611003780?idApp=UINPBA00004N" "url" => "/02104806/0000003600000002/v2_201304261303/S0210480611003780/v2_201304261303/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S2173578612000583" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2011.07.005" "estado" => "S300" "fechaPublicacion" => "2012-02-01" "aid" => "345" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2012;36:117-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1568 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 1242 "PDF" => 313 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Skill and talent</span>" "titulo" => "High-pressure balloon dilatation for treatment of orthotopic ureterocele" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "117" "paginaFinal" => "120" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dilatación con balón de alta presión como tratamiento del ureterocele ortotópico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 932 "Ancho" => 950 "Tamanyo" => 59232 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Vision of the end of the ureter from the interior of the ureterocele.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Parente, J.M. Angulo, R.M. Romero, S. Rivas, A.R. Tardáguila, C. Corona" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Parente" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Angulo" ] 2 => array:2 [ "nombre" => "R.M." "apellidos" => "Romero" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Rivas" ] 4 => array:2 [ "nombre" => "A.R." "apellidos" => "Tardáguila" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Corona" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480611003056" "doi" => "10.1016/j.acuro.2011.07.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480611003056?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000583?idApp=UINPBA00004N" "url" => "/21735786/0000003600000002/v1_201304251738/S2173578612000583/v1_201304251738/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Skill and talent</span>" "titulo" => "Umbilical single-port pyelolithectomy on horseshoe kidney: A new indication" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "121" "paginaFinal" => "125" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P.M. Cabrera, F. Cáceres, A. García-Tello, J.M. García-Mediero, J. Arconada, J.C. Angulo" "autores" => array:6 [ 0 => array:3 [ "nombre" => "P.M." "apellidos" => "Cabrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Cáceres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "García-Tello" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "García-Mediero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:4 [ "nombre" => "J." "apellidos" => "Arconada" "email" => array:1 [ 0 => "jangulo.hugf@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 5 => array:3 [ "nombre" => "J.C." "apellidos" => "Angulo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Urología, Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo Taper, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pielolitectomía por puerto único umbilical sobre riñón en herradura: una nueva indicación" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 634 "Ancho" => 951 "Tamanyo" => 131245 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Richard Wolf<span class="elsevierStyleSup">®</span> single-port system placed at the umbilicus for single-port laparoscopic pyelolithectomy ‘without incision’.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The experience with laparoendoscopy through single port in Urology started with renal surgery, probably due to familiarity with the laparoscopic transperitoneal approach for this type of surgery, particularly tumor and subsequently partial nephrectomy and prostatectomy.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The shortage of studies comparing laparoscopy through single port and conventional laparoscopic surgery makes real comparison between both techniques difficult. However, the yet more recent addition of robotics to single-port surgery has led to increased popularity for this type of approach, but the reality is that very few highly specialized centers have this technique in its portfolio of services, because it needs great training, even for experienced laparoscopists, and also important instrumental resources.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The single-port reusable prototype developed by Richard Wolf has significant advantages, since it can be used on multiple occasions, and the incision required is significantly smaller than in other elements of similar approach. Moreover, it does not require any external fixation and the instruments with double rotation (DuoRotate-Instruments<span class="elsevierStyleSup">®</span>) used allow for very precise movements. Its totally umbilical placement can even perform surgery ‘without visible incision’.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Many procedures are being developed at present with this type of single-port devices, although many surgeries require the placement of fine accessory ports of 2–3.5<span class="elsevierStyleHsp" style=""></span>mm caliber. There is no doubt that surgery through a single port is assuming a technology upgrade challenge, still under development. The first descriptions of its application in Urology were flank incision nephrectomy and transumbilical ureterolithectomy.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Transumbilical nephrectomy<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and pyeloplasty<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> were then described. Gradually, most urologic procedures have been developed using single port: adrenalectomy, nephroureterectomy, living donor nephrectomy, ureteral replacement, ureteral reimplantation, augmentation enterocystoplasty, radical cystectomy, and radical prostatectomy.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6–10</span></a> We describe the first case of pyelolithectomy ‘without incision’ through single port on a horseshoe kidney with large lithiasis.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Casuistry</span><p id="par0020" class="elsevierStylePara elsevierViewall">We report a 47-year-old male with horseshoe kidney and left renal pelvis lithiasis of 4<span class="elsevierStyleHsp" style=""></span>cm in diameter. The patient had a body mass index (BMI) of 38.2<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> and complained about abdominal pain accompanied by occasional hematuria. The study by abdominal CT scan showed the presence of solitary renal lithiasis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). We proposed the performance of single-port transumbilical pyelolithectomy, to which the patient agreed. Six months earlier, he had received conventional laparoscopic cholecystectomy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Surgical technique</span><p id="par0025" class="elsevierStylePara elsevierViewall">Under general anesthesia, it was placed in lithotomy for left double-J ureteral catheter placement. Subsequently, the patient was placed in right lateral decubitus. A 25-mm incision was performed at the umbilical level reaching the fascia. No radial cut was necessary to increase the length of the incision or enlargement of the fascial incision, introducing Richard Wolf<span class="elsevierStyleSup">®</span> single-port by rotating maneuver that fits an incision of this size, getting excellent fastening to the abdominal wall without requiring accessory suture (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The pneumoperitoneum was achieved through one of the holes that the port designed for that purpose has. During the operation, we used of a long optical of 30° and 5<span class="elsevierStyleHsp" style=""></span>mm in diameter, and two specific DuoRotate-Instruments<span class="elsevierStyleSup">®</span> (double rotation pre-curved elements) combined with the Eragon<span class="elsevierStyleSup">®</span> system (Richard Wolf) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), both for dissection and pyelotomy, lithiasis extraction, and subsequent pyelorraphy (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). These elements were used alternately with the suction pipe and hemostasis system Forcetriad<span class="elsevierStyleSup">®</span> (Covidien Surgical) of 5<span class="elsevierStyleHsp" style=""></span>mm. It was very important to occasionally perform clear gel application (Cathejell<span class="elsevierStyleSup">®</span>, Teleflex Medical) outside the outer sheath of the elements for proper lubrication, without specifying any other specific maneuver.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The lithiasis (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) was extracted in a bag applying a slight pressure without need for extending the umbilical incision, which was closed with intradermal suture. The final incision was invisible thanks to its small size and fully endoumbilical placement.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The total surgical time was 280<span class="elsevierStyleHsp" style=""></span>min and bleeding 30<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>. The patient was discharged after 24<span class="elsevierStyleHsp" style=""></span>h without any pain, referring less discomfort than in the postoperative period of the prior laparoscopic cholecystectomy, both at the level of the abdominal muscles and the initial ambulation maneuvers. The double-J catheter was removed after three weeks. On the third day, the patient had recovered his working life.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">The therapeutic options for renal calculi on horseshoe kidneys are complex. It is generally considered that percutaneous nephrolithotomy presents in these cases better results than extracorporeal lithotripsy, although not without complications such as bleeding.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Recently, the performance of retrograde intrarenal surgery has been favored in these cases, although there is an obvious limitation related to the size of the lithiasis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Laparoscopic or robotic pyelolithectomy is an indication of recent introduction in this type of patients.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13–15</span></a> Even laparoendoscopic pyelolithectomy is a possible indication, although it has not been described previously. Our experience shows that the performance of pyelolithectomy ‘without incision’ with single port is feasible, even in a patient with BMI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>30, in very competitive times, and it leads to excellent, both functional and esthetic, recovery. Of course, this technique is not intended to replace other minimally invasive techniques to treat kidney lithiasis, but it can be an excellent complement to them.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Laparoscopic single-port surgery is the concentration through a single point of trocar insertion and extraction of the specimen (in this case the lithiasis), so that with a very small incision, it is possible to perform a complete laparoscopic procedure. It meets the requirements for inclusion in the surgery called ‘scarless’<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,10</span></a>, or at least surgery without ‘visible’ scar. From a technical point of view, single-port pyelolithectomy is similar to performing a single-port pyeloplasty.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,16,17</span></a> Extensive practice is recommended for safe performance in experimental models, such as suture simulators and cystorrhaphies or pyelorraphies in suidae model. It also requires knowledge of the working material for single port, so the pure transumbilical completion of the procedure must be completely feasible. The placement of a double-J on the tract makes it possible to check the water-tightness of the suture without leaving any abdominal drainage. The required comparison of the instruments and the loss of laterality perception are problems that are solved with experimental exercise.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In summary, the prototype of Richard Wolf<span class="elsevierStyleSup">®</span> single-port with dual rotating instruments (DuoRotate-Instruments<span class="elsevierStyleSup">®</span>), which use double rotating maneuver, is a practical and economical alternative to be able to perform high-precision surgeries with exquisite results, not only anatomical and functional but esthetic as well. This system makes it possible to recover effective triangulation and the sensation of depth, avoiding the collision of instruments and improving the capacity of organ retraction, without any need to fold the hands of the surgeon. It can also be used with tissue sealing systems without room conflict and without need to work with auxiliary ports in selected cases.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">Drs. P.M. Cabrera, F. Cáceres, A. García-Tello, and J.C. Angulo declare that they have no conflict of interest.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Mr. J. Arconada works for the Grupo Taper (Spain).</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres100572" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec87738" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres100573" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Material y Métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec87737" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Casuistry" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical technique" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Comment" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack35369" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-10-11" "fechaAceptado" => "2011-10-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec87738" "palabras" => array:4 [ 0 => "Single-port" 1 => "Pyelolitectomy" 2 => "Horseshoe kidney" 3 => "Surgical technique" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec87737" "palabras" => array:4 [ 0 => "Puerto-único" 1 => "Pielolitectomía" 2 => "Riñón en herradura" 3 => "Técnica quirúrgica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Laparoscopic surgery through a single port is an evolution of laparoscopic surgery, possible after recent technological development of new access systems. It is an established minimally invasive technique, although its indications in the field of Urology are currently under development.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present the first case of incision-less pyelolithectomy, performed through a single-port placed in the umbilicus, performed in a 47-year-old male patient (38.2 BMI) with solitary 4-cm-diameter lithiasis in a horseshoe kidney. An umbilical 2.5-cm incision was used for the introduction of a prototype of the reusable Richard Wolf single-port system, without any ancillary elements.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">After placement of left double-J stent proximal left ureter and renal pelvis, pyelolithectomy and pyelorraphy were performed with DuoRotate-Instruments © (Richard Wolf). Water-tightness was demonstrated with methylene blue intravesical instillation and no drain was placed. The procedure lasted for 280<span class="elsevierStyleHsp" style=""></span>min and bleeding was 30<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>. The patient was discharged 24<span class="elsevierStyleHsp" style=""></span>h later without pain.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Incision-less pyelolithectomy is a feasible and resolutive option to treat pelvic lithiasis. It can be considered the most beneficial option in esthetical terms in experienced centers, especially in peculiar cases like horseshoe kidney.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La cirugía laparoscópica a través de puerto único es una evolución de la cirugía laparoscópica, que resulta posible gracias al desarrollo tecnológico reciente de nuevos sistemas de acceso. Se trata de una técnica establecida en el campo de la cirugía mínimamente invasiva, pero sus indicaciones en el campo de la Urología están desarrollándose en la actualidad.</p> <span class="elsevierStyleSectionTitle">Material y Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Presentamos la primera pielolitectomía sin incisión, a través de puerto único colocado en el ombligo, realizada en un paciente varón de 47 años (IMC 38,2) con riñón en herradura portador de una litiasis piélica única de 4<span class="elsevierStyleHsp" style=""></span>cm de diámetro. Se empleó una incisión umbilical de 2,5<span class="elsevierStyleHsp" style=""></span>cm para la introducción del prototipo de puerto único reutilizable de Richard Wolf, sin necesidad de elemento auxiliar adicional alguno.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Tras colocación de doble-J izquierdo se llevó a cabo liberación de uréter proximal izquierdo y pelvis renal, pielolitectomía y pielorrafia con instrumentos-DuoRotate © (Richard Wolf). Se comprobó estanqueidad de la vía urinaria mediante instilación intravesical de azul de metileno y no se dejó drenaje. El procedimiento duró 280 minutos y el sangrado fue 30 cc. El paciente fue dado de alta a las 24 horas sin dolor alguno.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La pielolitectomía sin incisión es una opción factible y resolutiva para el tratamiento de la litiasis piélica. En centros con experiencia en cirugía a través de puerto único puede considerarse la opción más beneficiosa estéticamente hablando, sobre todo en casos especiales como el riñón en herradura.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article; Cabrera PM, et al. Pielolitectomía por puerto único umbilical sobre riñón en herradura: una nueva indicación. Actas Urol Esp. 2012;36:121–5.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 782 "Ancho" => 951 "Tamanyo" => 77581 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Renal lithiasis in horseshoe kidney on abdominal CT.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 634 "Ancho" => 951 "Tamanyo" => 131245 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Richard Wolf<span class="elsevierStyleSup">®</span> single-port system placed at the umbilicus for single-port laparoscopic pyelolithectomy ‘without incision’.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 848 "Ancho" => 1502 "Tamanyo" => 220070 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Single-port pyelolithectomy. (A) Identification of the ureteropelvic junction, (B) pyelotomy and identification of the lithiasis, (C) lithiasis extraction and (D) start of the pyelorraphy by continuous suture with double-J in the tract.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 929 "Ancho" => 950 "Tamanyo" => 180632 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">4<span class="elsevierStyleHsp" style=""></span>cm lithiasic specimen.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoendoscopic single-site surgery in urology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.S. Eisenberg" 1 => "J.A. Cadeddu" 2 => "M.H. Desai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MOU.0b013e32833625a3" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Urol" "fecha" => "2010" "volumen" => "20" "paginaInicial" => "141" "paginaFinal" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20098327" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical evaluation of a novel laparoscopic port (R-port) and evolution of the single laparoscopic port procedure (SliPP)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Rane" 1 => "S. Kommu" 2 => "B. Eddy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Endourol" "fecha" => "2007" "volumen" => "21" "numero" => "Suppl. 1" "paginaInicial" => "A22" "paginaFinal" => "A23" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ureterolitectomía laparoscópica con incisión única transumbilical" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G.L. Almeida" 1 => "N.G. Lima" 2 => "C.S. Schmitt" 3 => "J.H. Kaouk" 4 => "C. Teloken" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2010.04.015" "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "52" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21256395" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laboratory and clinical development of single keyhole umbilical nephrectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.D. Raman" 1 => "K. Bensalah" 2 => "A. Bagrodia" 3 => "J.M. Stern" 4 => "J.A. Cadeddu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.urology.2007.10.001" "Revista" => array:6 [ "tituloSerie" => "Urology" "fecha" => "2007" "volumen" => "70" "paginaInicial" => "1039" "paginaFinal" => "1042" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18158008" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.M. Desai" 1 => "P.P. Rao" 2 => "M. Aron" 3 => "G. Pascal-Haber" 4 => "M.R. Desai" 5 => "S. Mishra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1464-410X.2007.07359.x" "Revista" => array:6 [ "tituloSerie" => "BJU Int" "fecha" => "2008" "volumen" => "101" "paginaInicial" => "83" "paginaFinal" => "88" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18086101" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoendoscopic single site surgery in urology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.H. Irwin" 1 => "P.P. Rao" 2 => "R.J. Stein" 3 => "M.M. Desai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ucl.2009.02.011" "Revista" => array:6 [ "tituloSerie" => "Urol Clin North Am" "fecha" => "2009" "volumen" => "36" "paginaInicial" => "223" "paginaFinal" => "235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19406323" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single-port laparoscopic radical prostatectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.H. Kaouk" 1 => "R.K. Goel" 2 => "G. Haber" 3 => "S. Crouzet" 4 => "M.M. Desai" 5 => "I.S. Gill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.urology.2008.06.010" "Revista" => array:6 [ "tituloSerie" => "Urology" "fecha" => "2008" "volumen" => "72" "paginaInicial" => "1190" "paginaFinal" => "1193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19041022" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.H. Kaouk" 1 => "R. Autorino" 2 => "F.J. Kim" 3 => "D.H. Han" 4 => "S.W. Lee" 5 => "S. Yinghao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2011.06.002" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2011" "volumen" => "60" "paginaInicial" => "998" "paginaFinal" => "1005" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21684069" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Láparo-endoscopia por acceso único: experiencia inicial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Sotelo" 1 => "J.C. Astigueta" 2 => "O. Carmona" 3 => "R. de Andrade" 4 => "R. Sánchez-Salas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2009" "volumen" => "33" "paginaInicial" => "172" "paginaFinal" => "181" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19418842" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Experiencia pionera en España con nefrectomía LESS de donante vivo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Musqueira" 1 => "L. Peri" 2 => "L. Izquierdo" 3 => "P. Campillo" 4 => "M.J. Ribal" 5 => "A. Alcaraz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2011.04.007" "Revista" => array:7 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "559" "paginaFinal" => "562" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21696861" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0034935612001041" "estado" => "S300" "issn" => "00349356" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Palmero JL, Amoros A, Ramírez M, Pastor JC, Benedicto A. Tratamiento quirúrgico de la litiasis en riñones en herradura. Actas Urol Esp, <a class="elsevierStyleInterRef" href="http://dx.doi.org/10.1016/j.acur.2011.10.005">doi:10.1016/j.acuro.2011.10.005</a>." ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cirugía retrógrada intrarrenal (CRIR). Complemento técnico para casos con excesiva carga litiásica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.H. Amón" 1 => "M. Cepeda" 2 => "C. Conde" 3 => "D. Alonso" 4 => "V. González" 5 => "J.M. Martínez-Sagarra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2010.12.004" "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "108" "paginaFinal" => "114" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21292353" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoscopic pyelolithotomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.H. Jordan" 1 => "K.A. McCammon" 2 => "E.L. Robey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0090-4295(96)00363-9" "Revista" => array:6 [ "tituloSerie" => "Urology" "fecha" => "1997" "volumen" => "49" "paginaInicial" => "131" "paginaFinal" => "134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9000203" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Robot-assisted laparoscopic pyeloplasty with stone removal in an ectopic pelvic kidney" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Nayyar" 1 => "P. Singh" 2 => "N.P. Gupta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4293/108680810X12674612015102" "Revista" => array:6 [ "tituloSerie" => "JSLS" "fecha" => "2010" "volumen" => "14" "paginaInicial" => "130" "paginaFinal" => "132" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20529538" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoscopic surgery for renal urolithiasis: pyelolithotomy, caliceal diverticulectomy, and treatment of stones in a pelvic kidney" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Ramakumar" 1 => "J.W. Segura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/end.2000.14.829" "Revista" => array:6 [ "tituloSerie" => "J Endourol" "fecha" => "2000" "volumen" => "14" "paginaInicial" => "829" "paginaFinal" => "832" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11206616" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perioperative outcomes in patients undergoing conventional laparoscopic versus laparoendoscopic single-site pyeloplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.R. Tracy" 1 => "Raman" 2 => "A. Bagrodia" 3 => "J.A. Cadeddu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.urology.2009.04.089" "Revista" => array:6 [ "tituloSerie" => "Urology" "fecha" => "2009" "volumen" => "74" "paginaInicial" => "1029" "paginaFinal" => "1034" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19660793" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoendoscopic single-site pyeloplasty: a comparison with the standard laparoscopic technique" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.J. Stein" 1 => "A.K. Berger" 2 => "R. Brandina" 3 => "N.S. Patel" 4 => "D. Canes" 5 => "B.H. Irwin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1464-410X.2010.09558.x" "Revista" => array:6 [ "tituloSerie" => "BJU Int" "fecha" => "2011" "volumen" => "107" "paginaInicial" => "811" "paginaFinal" => "815" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20804488" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack35369" "titulo" => "Acknowledgements" "texto" => "<p id="par0075" class="elsevierStylePara elsevierViewall">To Benjamin Seidenspinner and Susanne Bareis (Produktmanagement Richard Wolf, Knittlingen, Germany) for their fundamental assistance and to José Domínguez (Departamento de Fotografía, Hospital Universitario de Getafe) and Mario Arenilla (Veterinario, Hospital Universitario de Getafe) for their excellent work.</p>" ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000003600000002/v1_201304251738/S2173578612000613/v1_201304251738/en/main.assets" "Apartado" => array:4 [ "identificador" => "6276" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Skill and talent" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003600000002/v1_201304251738/S2173578612000613/v1_201304251738/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000613?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2018 December | 1 | 2 | 3 |
| 2018 February | 4 | 1 | 5 |
| 2018 January | 7 | 0 | 7 |
| 2017 December | 9 | 0 | 9 |
| 2017 November | 10 | 2 | 12 |
| 2017 October | 17 | 4 | 21 |
| 2017 September | 13 | 4 | 17 |
| 2017 August | 23 | 5 | 28 |
| 2017 July | 19 | 1 | 20 |
| 2017 June | 17 | 3 | 20 |
| 2017 May | 15 | 1 | 16 |
| 2017 April | 19 | 4 | 23 |
| 2017 March | 21 | 22 | 43 |
| 2017 February | 26 | 0 | 26 |
| 2017 January | 17 | 2 | 19 |
| 2016 December | 20 | 5 | 25 |
| 2016 November | 32 | 8 | 40 |
| 2016 October | 26 | 11 | 37 |
| 2016 September | 31 | 5 | 36 |
| 2016 August | 30 | 1 | 31 |
| 2016 July | 22 | 1 | 23 |
| 2016 June | 21 | 4 | 25 |
| 2016 May | 16 | 10 | 26 |
| 2016 April | 22 | 18 | 40 |
| 2016 March | 38 | 11 | 49 |
| 2016 February | 24 | 10 | 34 |
| 2016 January | 37 | 13 | 50 |
| 2015 December | 20 | 9 | 29 |
| 2015 November | 19 | 4 | 23 |
| 2015 October | 29 | 5 | 34 |
| 2015 September | 15 | 3 | 18 |
| 2015 August | 15 | 6 | 21 |
| 2015 July | 12 | 2 | 14 |
| 2015 June | 5 | 3 | 8 |
| 2015 May | 14 | 5 | 19 |
| 2015 April | 31 | 8 | 39 |
| 2015 March | 26 | 3 | 29 |
| 2015 February | 19 | 2 | 21 |
| 2015 January | 38 | 5 | 43 |
| 2014 December | 27 | 5 | 32 |
| 2014 November | 16 | 2 | 18 |
| 2014 October | 39 | 7 | 46 |
| 2014 September | 34 | 6 | 40 |
| 2014 August | 43 | 6 | 49 |
| 2014 July | 37 | 3 | 40 |
| 2014 June | 17 | 4 | 21 |
| 2014 May | 22 | 1 | 23 |
| 2014 April | 14 | 1 | 15 |
| 2014 March | 30 | 4 | 34 |
| 2014 February | 17 | 4 | 21 |
| 2014 January | 2 | 2 | 4 |
| 2013 December | 7 | 2 | 9 |
| 2013 November | 9 | 1 | 10 |
| 2013 October | 6 | 2 | 8 |
| 2013 September | 6 | 2 | 8 |
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