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Paule B, Saint F. [Simultaneous chemotherapy/radiotherapy in locally advanced unresectable cancer of the bladder]. Prog Urol 2001; 11:132-40. [PMID: 11296634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The development of new treatment techniques, including concomitant chemotherapy/radiotherapy, appears to achieve higher response rates in advanced bladder cancer. Previous studies have suggested that continuous infusion chemotherapy and concomitant irradiation act synergistically to induce significantly increased tumour cell destruction. With the combination of 5FU and radiotherapy, the local control rate of transitional cell bladder cancers was 70% with a 5-year survival rate of 36% to 62%. Concomitant cisplatin and irradiation improved the control of locally advanced bladder cancers, but failed to improve overall survival. The use of concomitant cisplatin has no effect on distant metastases. These treatment modalities require further evaluation because of the relationships between radiotherapy- and drug-induced apoptosis, delayed cell death, survival of clonogenic cells, clinical response and overall survival. The optimum concomitant chemotherapy/radiotherapy protocol has not yet been defined.
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Augusto D, Leroy X, Saint F, Tiberghien E, Gosselin B. [An intratesticular nodule]. Ann Pathol 2001; 21:95-6. [PMID: 11223571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Cicco A, Salomon L, Saint F, Hoznek A, Chopin D, Abbou CC. [Retroperitoneal laparoscopic surgery and carcinogenic risk]. Prog Urol 2001; 11:8-15. [PMID: 11296653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To retrospectively evaluate the development of metastasis at trocar sites, local recurrence and distance metastases associated with retroperitoneal laparoscopic surgery performed in the context of a malignant tumour. METHODS From 1994 to 1999, 228 retroperitoneal laparoscopic surgical operations were performed in our centre. Fifty six operations (24.6%) were performed for malignant tumours and comprised 41 radical nephrectomies and 8 partial nephrectomies for renal tumour and 7 nephro-ureterectomies for upper urinary tract tumours. The pathological stage and surgical margins were correlated with TNM 1997 stage. Postoperative data were obtained by physical and radiological examination performed one month and three months after the operation and then every six months. Metastases at the trocar site, local recurrences and distant metastases were investigated. The specific progression-free survival was calculated according to the Kaplan-Meier method. RESULTS The mean follow-up was 24.9 +/- 13.85 months. All patients had tumour-free surgical margins. No trocar site metastasis was observed. For retroperitoneal laparoscopic radical nephrectomies: one patient developed a local recurrence with liver metastases 9 months after the operation (pT3G2) and died 19.7 months after the operation. One patient with a pT3G3M+ renal tumour at the time of diagnosis died 23.1 months after radical nephrectomy with no signs of local recurrence. For laparoscopic retroperitoneal nephro-ureterectomies: one patient with a pT3G3 lesion developed a local recurrence at 12.1 months and died 26.6 months after surgery. One patient with a pT1G2 tumour developed bone metastases at 9 months and died 29 months after the operation. The recurrence-free survival at 54 months was 91% for radical nephrectomies, 71% at 30 months for nephro-ureterectomies and 100% at 49 months for partial nephrectomies. CONCLUSION Malignant tumours of the upper urinary tract can be managed by retroperitoneal laparoscopy. The short-term results suggest that this surgical technique is not associated with an increased risk of trocar site metastases or local recurrence and that recurrence-free survival rates comparable to those reported in series of conventional surgery.
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Saint F, Patard JJ, Salomon L, Alamé W, Cicco A, Abbou CC, Chopin D. [Mechanisms of action of BCG: towards a new individualized therapeutic approach?]. Prog Urol 2000; 10:1118-26. [PMID: 11217546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A better knowledge of antitumour immunity and the mechanisms allowing the tumour to overcome the host's immune surveillance has led to progress in the understanding of the mechanisms of action of Bacille Calmette-Guérin (BCG), as the local intravesical immune response is intimately related to the interaction of three systems: the host (the patient), the BCG (mycobacteria) and the tumour. This interaction gives rise to a cascade of immunological events, some of which are essential to the protective action of BCG against relapse and tumour progression. The immune response to BCG is currently considered to comprise three phases. First of all, the BCG adheres to the urothelium and is then phagocytosed by antigen-presenting cells. This phase corresponds to early release of so-called inflammatory cytokines (IL1, IL6, IL8). These cytokines could be responsible for certain adverse effects, but could also participate in cytotoxic phenomena. The second phase consists of recognition of bacterial antigens by helper CD4 lymphocytes, which mainly release IL2 and IFNg (Th1 response). This cellular activation leads to the third phase: amplification of cytotoxic populations capable of killing tumour cells: CD8, gd lymphocytes, macrophages, NK, LAK, BAK cells. All these cells also produce cytokines, which participate in regulation of the immune response. The understanding of these mechanisms of action, urinary cytokine assays, a better definition of cytotoxic cells and their role, molecular analysis of the tumour and probably certain genetic characteristics of the host will allow the elaboration of more effective immunization protocols by defining an individualized therapeutic approach.
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Cicco A, Salomon L, Hoznek H, Alame W, Saint F, Bralet MP, Antiphon P, Chopin DK, Abbou CC. Carcinological risks and retroperitoneal laparoscopy. Eur Urol 2000; 38:606-12. [PMID: 11096244 DOI: 10.1159/000020339] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the incidence of trocar site spillage, local recurrence, and metastatic disease associated with retroperitoneal laparoscopic tumor resection. METHODS From 1994 to 1999, 228 retroperitoneal laparoscopic procedures were performed at our institution. Fifty-six procedures (24.6%) were for malignancies and comprised 41 radical nephrectomies and 8 partial nephrectomies for renal tumors, and 7 nephro-ureterectomies for renal pelvis tumors. The pathological stage and the status of surgical margins were noted according to the 1997 TNM classification. Postoperative follow-up data were obtained by means of physical and radiological examinations after 1 and 3 months, and then half-yearly. Trocar site seeding, local recurrence and metastatic disease were recorded. Kaplan-Meier actuarial analysis was used to determine the disease-free survival likelihood. RESULTS The mean follow-up was 24.9+/-13.85 months. All the patients had tumor-free surgical margins. No laparoscopic trocar site recurrences were identified. For laparoscopic radical nephrectomy: one patient had a local recurrence with hepatic metastasis of a pT(3)G(2) tumor after 9 months and died 19.7 months after the procedure. One patient with a pT(3a)G(3)M+ tumor died 23.1 months after radical nephrectomy without any sign of local recurrence. For laparoscopic nephro-ureterectomy: one patient with a pT(3)G(3) tumor had a local recurrence 12.1 months after the procedure and died 26.6 months after surgery. One patient with a pT(1)G(2) renal pelvis tumor had bone metastasis at 9 months and died 29 months after the procedure. The Kaplan-Meier actuarial disease-free survival rate was 91% at 54 months for radical nephrectomy, 61% at 30 months for nephro-ureterectomy and 100% at 49 months for partial nephrectomy. CONCLUSION Malignancies of the upper urinary tract can be managed by means of retroperitoneal laparoscopy. Short-term results suggest that this procedure is not associated with an increased risk of portsite or local recurrence, and that disease-free survival is equivalent to that obtained with open surgery.
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Moukassa D, Leroy X, Bouchind'homme B, Saint F, Lemaître L, Gosselin B. [Primary large cell neuroendocrine carcinoma of the kidney: morphologic and immunohistochemical features of two cases]. Ann Pathol 2000; 20:357-60. [PMID: 11015655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Primary neuroendocrine carcinomas of the kidney are infrequent. The large cell neuroendocrine carcinoma is a subtype with an aggressive course and a worse prognosis. We report two cases, a 35-year-old man and a 75-year-old woman who died within 6 and 5-months after surgery despite radical nephrectomy and chemotherapy. Histological and immunohistochemical features are presented.
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Saint F, Gueguen G, Biserte J, Fontaine C, Mazeman E. [Rupture of the patellar ligament one month after treatment with fluoroquinolone]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET REPARATRICE DE L'APPAREIL MOTEUR 2000; 86:495-7. [PMID: 10970974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Musculoskeletal disorders including arthralgia and myalgia are adverse effect common to all fluoroquinolones. We report a case of spontaneous rupture of the patellar ligament in a 37-year-old man participating in leisure sports which occurred one month after a three-week course of Ciprofloxacine(R). Several cases of tendon ruptures have been reported in the literature, including the patellar tendon. Unusual features in our case were the one-month delay before tendon rupture and the absence of inaugural signs. We reviewed the pathophysiological mechanisms leading to fluoroquinolone-related tendon rupture as well as the risk factors and discussed proper management. Care must be taken when prescribing fluoroquinolones for patients at risk. Close follow-up is most important.
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Abbou CC, Hoznek A, Salomon L, Lobontiu A, Saint F, Cicco A, Antiphon P, Chopin D. [Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case]. Prog Urol 2000; 10:520-3. [PMID: 11064890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Robotics has been commonly employed in numerous industrial fields for several decades. However, the application of this technology to surgery is a recent innovation. It provides new possibilities for facilitating specific surgical tasks, especially in the field of laparoscopy. We report a case of laparoscopic radical prostatectomy completed with the help of a remotely controlled da Vinci robot. This system offered a user friendly surgical platform and enhanced surgical dexterity. Operating time was 420 minutes and the hospital stay was 4 days. The bladder catheter was removed after 3 days. One week later, the patient was fully continent. Pathologic examination showed a pT3a tumor, with negative margins. Robotically assisted laparoscopic radical prostatectomy is feasible. Further developments in this field of technology may have new applications in laparoscopic telesurgery.
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Ben Slama MR, Salomon L, Hoznek A, Cicco A, Saint F, Alame W, Antiphon P, Chopin DK, Abbou CC. Extraperitoneal laparoscopic repair of ureteropelvic junction obstruction: initial experience in 15 cases. Urology 2000; 56:45-8. [PMID: 10869620 DOI: 10.1016/s0090-4295(00)00558-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the feasibility and results of retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. METHODS From September 1996 to January 1999, 15 patients underwent extraperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction. Aberrant vessels were noted in 4 patients. Dismembered pyeloplasty was performed in 7 patients and nondismembered Fenger plasty in 7 patients. Pyeloplasty was not possible in 1 patient. RESULTS Fourteen of the 15 procedures were successfully completed. The procedure was not possible in 1 patient who had already undergone endopyelotomy repair. The mean operating time was 178 minutes (range 100 to 250), and the mean postoperative hospital stay was 4.8 days (range 1 to 14). Postoperative complications occurred in 3 patients (two hematomas and one urinoma). Radiographic assessment by intravenous urography 3 months after the procedure showed good results. CONCLUSIONS Retroperitoneoscopy, by providing easy and rapid access to the retroperitoneal space, seems to be a valuable alternative treatment for ureteropelvic junction obstruction.
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Saint F, Balon JM, Biserte J, Mazeman E. A renal foreign-body stone as a complication of myelography. BJU Int 2000; 85:969-70. [PMID: 10792185 DOI: 10.1046/j.1464-410x.2000.00634.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abbou CC, Salomon L, Hoznek A, Antiphon P, Cicco A, Saint F, Alame W, Bellot J, Chopin DK. Laparoscopic radical prostatectomy: preliminary results. Urology 2000; 55:630-4. [PMID: 10792066 DOI: 10.1016/s0090-4295(00)00502-1] [Citation(s) in RCA: 290] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate our preliminary experience with laparoscopic radical prostatectomy. The indications for laparoscopy are currently being extended to complex oncologic procedures. METHODS Forty-three men underwent laparoscopic radical prostatectomy. We used five trocars. The surgical technique replicates the steps of traditional retropubic prostatectomy, except that the rectoprostatic cleavage plane is developed transperitoneally at the beginning of the procedure. In the first 10 patients, we performed the vesicourethral reconstruction with interrupted sutures; in the remaining 33 patients, we performed it with two hemicircumferential running sutures. The specimen was removed through the umbilical port site. RESULTS Once the developmental phase with the first 10 patients was concluded, the median operating time was 4.3 hours without pelvic lymphadenectomy, and the median postoperative bladder catheterization was 4 days. Two (4.7%) of 43 patients underwent transfusion. Twelve patients (27.9%) had positive surgical margins; all patients had a postoperative prostate-specific antigen level of less than 0.1 ng/mL at 1 month. Rectal injury occurred in 1 patient, requiring colostomy, and 4 patients had urethrovesical anastomotic leakages requiring surgical repair. One month postoperatively, 36 patients (84%) were fully continent (no leakage). Six patients had had erections, and four stated they had had sexual intercourse. CONCLUSIONS Laparoscopic radical prostatectomy has evolved to a fully standardized and reproducible procedure. The short-term oncologic and functional efficacy rates are equivalent to those for open surgery. The operating time is reasonable once the learning curve is over, and postoperative morbidity is diminished. Because of the improved visual accuracy, permitting more precise dissection, this technique has the potential to become an important advancement in urologic surgery.
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Leroy X, Moukassa D, Copin MC, Saint F, Mazeman E, Gosselin B. Utility of cytokeratin 7 for distinguishing chromophobe renal cell carcinoma from renal oncocytoma. Eur Urol 2000; 37:484-7. [PMID: 10765081 DOI: 10.1159/000020172] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Chromophobe renal cell carcinoma is a relatively uncommon variant of renal carcinoma described in 1985. The main differential diagnosis is renal oncocytoma. Hale's colloidal iron staining is a powerful adjunct to morphological interpretation but it is not specific and is sometimes difficult to interpret. We studied the immunohistochemical expression of cytokeratin 7 to determine its value in distinguishing chromophobe renal cell carcinoma from renal oncocytoma. METHODS Immunostaining was performed on paraffin-embedded tumor tissue of 6 chromophobe renal cell carcinomas and 11 oncocytomas with an antibody to cytokeratin 7 (clone OV-TL 12/30, Dako, France) using a streptavidin-biotin method. RESULTS All chromophobe renal cell carcinomas showed strong cytoplasmic staining with peripheral cell accentuation. In contrast, 8 of 11 oncocytomas were entirely negative and 3 showed only weak and focal staining in less than 5% of the tumor cells. CONCLUSION Immunohistochemical staining for cytokeratin 7 may be useful for the differential diagnosis of renal oncocytomas and chromophobe renal cell carcinomas when Hale's colloidal iron staining is uncertain.
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Saint F, Legeais D, Leroy X, Biserte J, Gosselin B, Mazeman E. [Therapeutic management of epidermoid carcinoma of the penis: anatomoclinical discussion and review of the literature]. Prog Urol 2000; 10:128-33. [PMID: 10785933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The therapeutic management of penile tumours is determined by the degree of local extension of the tumour, and the presence of lymph node involvement and visceral metastases. Many published studies have tried to define the best treatment options as a function of tumour grade and stage. However, in daily practice, the treatment of penile tumours still remains highly controversial. After reviewing the literature, the authors discuss the various treatment options available to urologists as a function of tumour stage and recall the management difficulties related to lymph node staging.
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Irani J, Goujon JM, Ragni E, Peyrat L, Hubert J, Saint F, Mottet N. High-grade inflammation in prostate cancer as a prognostic factor for biochemical recurrence after radical prostatectomy. Pathologist Multi Center Study Group. Urology 1999; 54:467-72. [PMID: 10475356 DOI: 10.1016/s0090-4295(99)00152-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To assess the prognostic value of prostatic stromal inflammation in surgically treated localized prostate carcinoma for biochemical recurrence-free survival. METHODS Stromal prostatic inflammation grading was studied in 161 patients who underwent radical prostatectomy for prostate cancer without involvement of the lymph nodes and who did not receive preoperative or postoperative radiotherapy or hormonal therapy until recurrence occurred. Inflammation was graded as high-grade inflammation if confluence of inflammatory cell infiltrate and/or glandular epithelium disruption associated with interstitial inflammatory infiltrate were present and as low-grade inflammation otherwise. Each specimen was graded separately first in the stroma surrounding nonmalignant glands and second in the stroma surrounding malignant glands. Biochemical recurrence based on serum prostate-specific antigen (PSA) level was defined as two successive PSA measurements greater than 1 ng/mL. RESULTS Malignant tissue was significantly less involved in high-grade inflammation than benign adjacent tissue (9.3% and 19.9%, respectively; P <0.01). In a univariate Kaplan-Meier analysis, the 5-year recurrence-free survival rate for patients with high-grade and low-grade classified prostates was 61.0% and 66.7% in benign tissue and 27.0% and 65.3% in malignant tissue, respectively, with a significant difference between grades only in malignant tissue (P <0.02). In a multivariate analysis controlling for Gleason grade, preoperative serum PSA, pathologic stage, and inflammation grade in malignant tissue, the latter factor remained significantly predictive of biochemical recurrence (P = 0.03). CONCLUSIONS Patients with high-grade inflammation surrounding malignant glands in radical prostatectomy specimens had significantly more postoperative biochemical recurrence than patients with low-grade inflammation.
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Patard JJ, Saint F, Velotti F, Abbou CC, Chopin DK. Immune response following intravesical bacillus Calmette-Guerin instillations in superficial bladder cancer: a review. UROLOGICAL RESEARCH 1998; 26:155-9. [PMID: 9694595 DOI: 10.1007/s002400050039] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Local immunotherapy with bacillus Calmette-Guerin (BCG) can prevent recurrences and progression of superficial bladder cancer, but the antitumoral mechanism of BCG is still unclear. The first event seems to be binding of BCG to urothelial cells via fibronectin, and processing of mycobacterial antigens by antigen-presenting cells. Experimental data suggest that bacterial antigens can also be processed by urothelial cells. CD4 lymphocytes subsequently recognize antigenic peptides presented by HLA class II molecules. The most common profile of urinary cytokines is interleukin-2 and interferon-gamma, suggesting the predominant involvement of the Th1 lymphocyte subpopulation. Natural killer cells, lymphocyte-activated killer cells, BCG-activated killer cells and macrophages are able to kill bladder tumor cells in vitro, but there is no evidence that a major histocompatibility complex (MHC)-restricted specific T cytotoxic response is involved in BCG antitumor activity.
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Patard JJ, Muscatelli-Groux B, Saint F, Popov Z, Maille P, Abbou C, Chopin D. Evaluation of local immune response after intravesical bacille Calmette-Guérin treatment for superficial bladder cancer. BRITISH JOURNAL OF UROLOGY 1996; 78:709-14. [PMID: 8976765 DOI: 10.1046/j.1464-410x.1996.01928.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To help define the optimal protocol of Bacille Calmette-Guérin (BCG) treatment for transitional cell carcinoma (TCC) of the bladder by examining cytokine production and antigen presentation to effector cells after instillations of BCG in patients with bladder TCC. PATIENTS AND METHODS Sixty-four urine samples from 11 patients were tested for the production of interferon gamma (IFN-gamma) using a modified commercial enzyme-linked immunosorbent assay (ELISA) kit. Urine was collected before and at intervals up to 24 h after the intravesical instillation of BCG. Immunohistological studies were also carried out using a two-step alkaline phosphatase technique to explore the expression of tumour-associated antigens (TAAs) (E7, 19A211, T138), major histocompatibility complex (MHC) molecules and lymphocyte subset infiltrates (CD3, CD4, CD8) in bladder biopsies before and 3 weeks after the completion of treatment in seven patients. RESULTS IFN-gamma was only detected 4, 6 and 8 h after instillation, with a maximum concentration at 6 h (2.9-34.7 IU/mL in 10 patients). During a 6-week course of BCG, IFN-gamma was barely detectable after the first two instillations, but gradually increased from the third instillation onwards. TAA and MHC II antigens, which were absent or faintly expressed on normal urothelial cells before treatment, were expressed strongly in five patients after treatment. The local recruitment of immunocompetent cells was detected in all patients. CONCLUSION These results suggest that the local immune response after the intravesical instillation of BCG can be quantified using simple ELISA tests and could be useful in defining objective criteria for rationalizing treatment (dose and duration), and in determining the relation between the immune response and anti-tumour activity. There is evidence that antigen presentation is enhanced after BCG instillations, suggesting that a T cell-MHC restricted pathway might be involved in the anti-tumour response. This study supports the search for tumour-rejection antigens in bladder cancer.
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Gasman D, Saint F, Barthelemy Y, Antiphon P, Chopin D, Abbou CC. Retroperitoneoscopy: a laparoscopic approach for adrenal and renal surgery. Urology 1996; 47:801-6. [PMID: 8677567 DOI: 10.1016/s0090-4295(96)00064-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Retroperitoneoscopy has gained acceptance for urologic surgery. We assessed the safety and efficacy of this procedure for renal and adrenal surgery. METHODS Since December 1994, 20 patients (18 to 75 years old) have undergone laparoscopic adrenalectomy and nephrectomy, including simple nephrectomy in 8, partial nephrectomy in 1, radical nephrectomy in 2, tumorectomy with cyst excision in 1, and adrenalectomy in 8. The retroperitoneal space was created by blunt dissection with the index finger, completed by insufflation, without balloon dissection. RESULTS Average kidney size was 65 m (range 50 to 108), and average adrenal tumor size was 31 mm (range 20 to 40). The average operating time was 127 minutes (range 60 to 180) for nephrectomy and 84 minutes (range 45 to 140) for adrenalectomy. The average hospital stay was 3 days (range 1 to 7) for nephrectomy and 2.4 days (range 1 to 4) for adrenalectomy. Average blood loss was 65 mL for both nephrectomy and adrenalectomy. Conversion from the laparoscopic procedure to open surgery was never required. Peritoneal effraction and ureteral injury occurred in only 4 patients and 1 patient, respectively. CONCLUSIONS The laparoscopic retroperitoneal approach is safe and effective for simple renal nephrectomy and for excision of small adrenal tumors. Perioperative morbidity and hospital stay are reduced.
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