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Yan F, Dou X, Zhu G, Tang Q, Zhang B, Zhao B, Yu L, Wang H, Wang Y. Laparoscopic aspirator bracket: a new instrument facilitating the aspiration and exposure of operative field simultaneously in laparoscopic nephron-sparing surgery. Front Oncol 2023; 13:1216963. [PMID: 37655100 PMCID: PMC10466786 DOI: 10.3389/fonc.2023.1216963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Background This study aims to describe a novel laparoscopic aspirator bracket (LAB) and its use in laparoscopic nephron-sparing surgery (NSS) by a simple enucleation (SE) technique. Methods A total of 123 renal tumor cases who underwent laparoscopic NSS via LAB or laparoscopic aspirator between July 2017 and April 2021 were retrospectively analyzed. General characteristics, perioperative data and postoperative follow-up data of patients were compared. Results The application of LAB in laparoscopic renal tumor SE surgery shortened the operation time (88.58 ± 38.25 vs. 102.25 ± 35.84 min, p < 0.05) and improved the zero ischemia rate (18.75% vs. 3.39%, p < 0.05), shortened warm ischemia time (16.17 ± 5.16 vs. 19.39 ± 5.62 min, p < 0.05) and decreased intraoperative blood loss (166.19 ± 111.60 vs. 209.15 ± 127.10 ml, p < 0.05). In addition, the serum creatinine and eGFR values in the LAB group also showed faster and better renal function recovery. Conclusion The new LAB could aspirate and expose the operative field with a single instrument. In operations that need to expose and aspirate simultaneously, such as in renal tumor simple enucleation, it could shorten operation time, reduce intraoperative blood loss and improve the postoperative renal function recovery.
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Affiliation(s)
- Fengqi Yan
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Xiaoliang Dou
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Guangfeng Zhu
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Qisheng Tang
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Bo Zhang
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Bo Zhao
- Department of Urology, Bao Ji People’s Hospital, Baoji, Shaan’xi, China
| | - Lei Yu
- Department of Urology, Xi Jing Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - He Wang
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
| | - Yong Wang
- Department of Urology, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaan’xi, China
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Eichelberger S, Schindera S, Nebiker CA. Prevention of conversion in posterior retroperitoneal adrenalectomy by measuring pre-operative anatomical conditions on cross-sectional imaging (computerised tomography or magnetic resonance imaging). J Minim Access Surg 2023; 19:51-56. [PMID: 36722530 PMCID: PMC10034802 DOI: 10.4103/jmas.jmas_65_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023] Open
Abstract
Background In addition to the common laparoscopic lateral transperitoneal adrenalectomy (LTA), the posterior retroperitoneal adrenalectomy (PRA) is becoming increasingly important. Both techniques overlap in their indication, resulting in uncertainty about the preferred approach in some patients. We hypothesise that by determining anatomical characteristics on cross-sectional imaging computerised tomography or magnetic resonance imaging, we can show the limitations of the PRA and prevent patients from being converted to LTA. Methods This retrospective study includes 14 patients who underwent PRA (n = 15) at a single institution between 2016 and 2018. Previously described parameters such as the retroperitoneal fat mass (RPF) were measured on pre-operative imaging. We compared data from one patient who had a conversion with those from 13 patients without conversion. Furthermore, we explored the influence of these parameters on the operative time. Results Conversion to LTA was necessary during 1 PRA procedure. Fourteen PRAs in 13 patients were successfully completed. The mean body mass index was 30 kg/m2 and the mean operation time was 98 min. One patient who underwent a conversion had a substantially higher RPF (25 mm) compared to the patients with successfully completed PRA (median: 5.5 mm [P = 0.001]). Furthermore, the operation time strongly correlated with the RPF (P = 0.004, r = 0.713). Conclusions Surgeons can use pre-operative imaging to assess the anatomical features to determine whether a PRA can be performed. Patients with an RPF under 14.3 mm can be safely treated with PRA. In contrast, LTA access should be considered for patients with a higher RPF (>25 mm).
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Kuo CC, Chen GH, Chang CH, Huang CY, Chen CH, Li CC, Wu WJ, Yu CC, Lo CW, Chen YT, Chen SH, Cheng PY, Hsueh T, Chiu AW, Lin PH, Tseng JS, Lin JT, Jiang YH, Wu CC, Lin WY, Huang HC, Chiang HS, Chiang BJ. Surgical outcome predictor analysis following hand-assisted or pure laparoscopic transperitoneal nephroureterectomy using the Taiwan upper urinary tract urothelial carcinoma database. Front Surg 2022; 9:934355. [PMID: 36117820 PMCID: PMC9475171 DOI: 10.3389/fsurg.2022.934355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTaiwan has a high incidence of upper tract urothelial carcinoma (UTUC). This study aimed to compare the surgical outcomes following transperitoneal hand-assisted laparoscopic nephroureterectomy (TP-HALNU) and transperitoneal pure laparoscopic nephroureterectomy (TP-LNU) from the Taiwan nationwide UTUC collaboration database using different parameters, including surgical volumes.Materials and methodsThe nationwide UTUC collaboration database includes 14 hospitals in Taiwan from the Taiwan Cancer Registry. We retrospectively reviewed the records of 622 patients who underwent laparoscopic nephroureterectomy between July 1988 and September 2020. In total, 322 patients who received TP-LNU or TP-HALNU were included in the final analysis. Clinical and pathological data and oncological outcomes were compared.ResultsOf the 322 patients, 181 and 141 received TP-LNU and TP-HALNU, respectively. There were no differences in clinical and histopathological data between the two groups. No differences were observed in perioperative and postoperative complications. There were no significant differences in oncological outcomes between the two surgical approaches. In the multivariate analysis, the cohort showed that age ≥70 years, positive pathological lymph node metastasis, tumors located in the upper ureter, and male sex were predictive factors associated with an increased risk of adverse oncological outcomes. A surgical volume of ≥20 cases showed a trend toward favorable outcomes on cancer-specific survival [hazard ratio (HR) 0.154, p = 0.052] and marginal benefit for overall survival (HR 0.326, p = 0.019) in the multivariate analysis.ConclusionAlthough different approaches to transperitoneal laparoscopic nephroureterectomy showed no significant differences in surgical outcomes, age, sex, lymph node metastasis, and tumor in the upper ureter in the following period were predictive factors for oncological outcomes. Higher surgical volume did not impact disease-free survival and bladder recurrence-free survival but was associated with improved overall survival and cancer-specific survival. Exploration of unknown influencing factors is warranted.
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Affiliation(s)
- Chih-Chun Kuo
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Guang-Heng Chen
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- Department of Urology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Shin-Hong Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Pai-Yu Cheng
- Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei, Taiwan
| | - Thomas Y. Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Allen W. Chiu
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Han Lin
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Mackay Medical College, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
- Chang Gung University of Science and Technology, Chia-Yi, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsu-Che Huang
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Han-Sun Chiang
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Urology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
- Correspondence: Bing-Juin Chiang ; Han-Sun Chiang
| | - Bing-Juin Chiang
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Correspondence: Bing-Juin Chiang ; Han-Sun Chiang
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Miki J, Yamasaki T, Komai Y, Kanno T, Ohba K, Misawa T. Intra- and post-operative management of pancreatic injury during laparoscopic nephrectomy. Int J Urol 2022; 29:905-907. [PMID: 35441402 DOI: 10.1111/iju.14899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jun Miki
- Department of Urology, Kashiwa Hospital, The Jikei University School of Medicine, Chiba, Japan
| | - Takeshi Yamasaki
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yoshinobu Komai
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Kojiro Ohba
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Takeyuki Misawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Retroperitoneoscopic Drainage of Psoas Abscess: A Systematic Review. Surg Laparosc Endosc Percutan Tech 2020; 31:241-246. [PMID: 33252578 DOI: 10.1097/sle.0000000000000879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/22/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Psoas abscess is a relatively rare clinical condition that can occur worldwide, is difficult to diagnose, and has a severe clinical course. Conventional treatment ranges from antibiotic therapy alone to computed tomography (CT)-guided and/or open surgical drainage. Retroperitoneoscopic drainage represents a minimally invasive and potentially definitive therapeutic option. MATERIALS AND METHODS A systematic review of the literature on minimally invasive extraperitoneal access for drainage of psoas abscess was conducted through PUBMED, EMBASE, and COCHRANE databases, according to the PRISMA statement guidelines. We considered only studies in English and with a full text. The quality of all selected articles was assessed for the risk of methodological bias. Additional literature sources were used to put into context the indications and limits of retroperitoneoscopic drainage. RESULTS Seven papers published between 2004 and 2020, including a total of 56 patients, met the eligibility criteria and were included in the qualitative analysis. Causative agents of psoas abscess included Mycobacterium tuberculosis, Klebsiella pneumoniae, Enterobacter aerogenes, Staphylococcus aureus, and Streptococcus spp. Tuberculous abscess was more common than pyogenic abscess (92.8% vs. 7.2%). Main clinical findings were back pain (76.8%) and fever (53.6%). All patients were preoperatively evaluated by CT or magnetic resonance imaging. Only 4 patients (7.1%) had previously undergone CT-guided percutaneous drainage. Retroperitoneoscopic drainage was combined with antibiotic therapy in all cases. No Clavien-Dindo grade >3 complications occurred, and there was no 30-day postoperative mortality. The recurrence rate was 1.8% at a mean follow-up of 21 months. CONCLUSION Retroperitoneoscopic surgical drainage is a safe and effective approach for the treatment of psoas abscess.
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Yang B, Qiu C, Wan S, Liu J, Li Q, Mai Z, Zeng T, Liu Y, He W, Zeng G. Long-term follow-up study of the malignant transformation potential of the simple renal cysts. Transl Androl Urol 2020; 9:684-689. [PMID: 32420175 PMCID: PMC7215042 DOI: 10.21037/tau.2020.03.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background We conducted a multi-center study to investigate the prevalence, the malignant transformation potential of the simple renal cysts and the factors that might predict malignancy. Methods We defined the simple renal cysts as Bosniak class I & II (including IIF) lesions. In the prevalence study, data from 115,132 ultrasonographies was collected from individuals who participated in a multiphasic health wellness screen. In the natural history and progression study, we retrospectively reviewed 333 participants with simple renal cysts and were followed for at the least 3 years with a mean of 6.3±2.9 years (ranged from 3 to 13 years). Results About 7.2% (8,303) of the individuals who participated in the study were found to have at the least one simple renal cyst. The incidence increased with age from 0.6% in the first decade to 28.0% in the eighth or later decade of life. The Bosniak class I lesion accounted for 7,559 or 91.0% of the cysts whereas 744 or 9.0% were class II. A slower growth rate was observed in the older age group. Twenty-four patients (7.2%) had their renal cysts upgraded according to the Bosniak classification. Gender, age, initial cyst size, number of cysts and bi-laterality failed to predict the malignancy tendency. Conclusions Most of the cysts discovered were the Bosniak class I and II lesions and they rarely progress further. Treatment for the asymptomatic simple renal cyst is not warranted. Treatment decision-making based on older age or larger initial cyst size should not be recommended.
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Affiliation(s)
- Bicheng Yang
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou 510230, China
| | - Chunhua Qiu
- Department of Medical Ultrasound, Guangzhou First People's Hospital, South China University of Technology, Guangzhou 510080, China
| | - Shawpong Wan
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou 510230, China
| | - Jianhua Liu
- Department of Medical Ultrasound, Guangzhou First People's Hospital, South China University of Technology, Guangzhou 510080, China
| | - Qingxiu Li
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou 510230, China
| | - Zanlin Mai
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou 510230, China
| | - Tao Zeng
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou 510230, China
| | - Yang Liu
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou 510230, China
| | - Weizhen He
- Health Screen Center, Shaoyang Central Hospital, Shaoyang 422000, China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou 510230, China
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Drake T, Austin T, Solomon L. Pancreatitis and pseudocyst formation as a complication of laparoscopic left retroperitoneal nephrectomy. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415816648074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Akkoc A, Topaktas R, Aydin C, Altin S, Girgin R, Yagli OF, Sentürk AB, Metin A. Which intraperitoneal insufflation pressure should be used for less postoperative pain in transperitoneal laparoscopic urologic surgeries? Int Braz J Urol 2017; 43:518-524. [PMID: 28266816 PMCID: PMC5462144 DOI: 10.1590/s1677-5538.ibju.2016.0366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/20/2016] [Indexed: 11/26/2022] Open
Abstract
Purpose To determine whether using different intraperitoneal insufflation pressures for transperitoneal laparoscopic urologic surgeries decreases postoperative pain. Materials and Methods 76 patients who underwent transperitoneal laparoscopic upper urinary tract surgery at different insufflation pressures were allocated into the following groups: 10mmHg (group I, n=24), 12mmHg (group II, n=25) and 14mmHg (group III, n=27). These patients were compared according to age, gender, body mass index (BMI), type and duration of surgery, intraoperative bleeding volume, postoperative pain score and length of hospital stay. A visual analog scale (VAS) was used for postoperative pain. Results Demographic characteristics, mean age, gender, BMI and type of surgeries were statistically similar among the groups. The mean operation time was higher in group I than group II and group III but this was not statistically significant (P=0.810). The mean intraoperative bleeding volume was significantly higher in group I compared with group II and group III (P=0.030 and P=0.006). The mean length of postoperative hospital stays was statistically similar among the groups (P=0.849). The mean VAS score at 6h was significantly reduced in group I compared with group III (P=0.011). At 12h, the mean VAS score was significantly reduced in group I compared with group II and group III (P=0.009 and P<0.001). There was no significant difference in the mean VAS scores at 24h among three groups (P=0.920). Conclusion Lower insufflation pressures are associated with lower postoperative pain scores in the early postoperative period.
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Affiliation(s)
- Ali Akkoc
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Ramazan Topaktas
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Cemil Aydin
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Selcuk Altin
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Reha Girgin
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Omer Faruk Yagli
- Department of Urology, Kartal Yavuz Selim State Hospital, Istanbul, Turkey
| | - Aykut Bugra Sentürk
- Department of Urology, Hitit University, Training and Research Hospital, Corum, Turkey
| | - Ahmet Metin
- Department of Urology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
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Srivastava A, Sureka SK, Vashishtha S, Agarwal S, Ansari MS, Kumar M. Single-centre experience of retroperitoneoscopic approach in urology with tips to overcome the steep learning curve. J Minim Access Surg 2016; 12:102-8. [PMID: 27073300 PMCID: PMC4810941 DOI: 10.4103/0972-9941.178517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
CONTEXT: The retroperitoneoscopic or retroperitoneal (RP) surgical approach has not become as popular as the transperitoneal (TP) one due to the steeper learning curve. AIMS: Our single-institution experience focuses on the feasibility, advantages and complications of retroperitoneoscopic surgeries (RS) performed over the past 10 years. Tips and tricks have been discussed to overcome the steep learning curve and these are emphasised. SETTINGS AND DESIGN: This study made a retrospective analysis of computerised hospital data of patients who underwent RP urological procedures from 2003 to 2013 at a tertiary care centre. PATIENTS AND METHODS: Between 2003 and 2013, 314 cases of RS were performed for various urological procedures. We analysed the operative time, peri-operative complications, time to return of bowel sound, length of hospital stay, and advantages and difficulties involved. Post-operative complications were stratified into five grades using modified Clavien classification (MCC). RESULTS: RS were successfully completed in 95.5% of patients, with 4% of the procedures electively performed by the combined approach (both RP and TP); 3.2% required open conversion and 1.3% were converted to the TP approach. The most common cause for conversion was bleeding. Mean hospital stay was 3.2 ± 1.2 days and the mean time for returning of bowel sounds was 16.5 ± 5.4 h. Of the patients, 1.4% required peri-operative blood transfusion. A total of 16 patients (5%) had post-operative complications and the majority were grades I and II as per MCC. The rates of intra-operative and post-operative complications depended on the difficulty of the procedure, but the complications diminished over the years with the increasing experience of surgeons. CONCLUSION: Retroperitoneoscopy has proven an excellent approach, with certain advantages. The tips and tricks that have been provided and emphasised should definitely help to minimise the steep learning curve.
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Affiliation(s)
- Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Saurabh Vashishtha
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shikhar Agarwal
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Md Saleh Ansari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Manoj Kumar
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Sanli O, Tefik T, Erdem S, Ortac M, Salabas E, Karakus S, Yucel B, Boyuk A, Oktar T, Ozcan F, Aras N, Tunc M, Nane I. Prospective evaluation of complications in laparoscopic urology at a mid-volume institution using standardized criteria: Experience of 1023 cases including learning curve in 9 years. J Minim Access Surg 2016; 12:33-40. [PMID: 26917917 PMCID: PMC4746972 DOI: 10.4103/0972-9941.158154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIM: To evaluate the laparoscopic operations performed in our department according to the modified Clavien classification system of complications. MATERIALS AND METHODS: Between September, 2005 and February, 2014, a total of 1023 laparoscopic cases were performed. This period was divided into three terms (Terms 1, 2 and 3 consisting of 38, 32 and 32 months, respectively). According to the European Scoring System (ESS), easy (E), slightly difficult (SD), fairly difficult (FD), difficult (D), very difficult (VD) and extremely difficult (ED) cases were 35, 88, 170, 390, 203 and 137, respectively. The perioperative complications were evaluated based on the 3 time periods, with a specific emphasis on determining the learning curve according to the modified Clavien classification system of complications. RESULTS: A total of 236 (23.1%) complications were observed according to the modified Clavien classification. The minor (Clavien I-II) and major (Clavien III, IV and V) complication rates were 20.5% (n = 210) and 2.4% (n = 26), respectively. Clavien I was the most frequently encountered type of complication (n = 120, %11.7). No significant difference was observed among all 3 time periods regarding total complication rates. The D cases had the highest complication rate compared to E, SD, FD, VD and ED cases among all three terms. The total number of complications increased significantly with increasing grade of technical difficulty according to the ESS. CONCLUSION: Complications encountered in our laparoscopic surgery experience were predominantly minor, and the rate of complications was not significantly increased during the learning curve. The present data can provide guidance and manage expectations for surgeons introducing laparoscopy into their practice.
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Affiliation(s)
- Oner Sanli
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tzevat Tefik
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selcuk Erdem
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mazhar Ortac
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emre Salabas
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serkan Karakus
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Yucel
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Abubekir Boyuk
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tayfun Oktar
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Faruk Ozcan
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Necdet Aras
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Tunc
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ismet Nane
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Comparison of 30-day perioperative outcomes in adults undergoing open versus minimally invasive pyeloplasty for ureteropelvic junction obstruction: analysis of 593 patients in a prospective national database. World J Urol 2015; 33:2107-13. [DOI: 10.1007/s00345-015-1586-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/28/2015] [Indexed: 11/25/2022] Open
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Nestler S, Neisius A, Roos F, Hampel C, Rubenwolf P, Jäger W, Thüroff JW, Thomas C. Pancreatic Fistulae after Urologic Surgery - A Single Centre Experience. Urol Int 2015; 95:346-51. [PMID: 25871316 DOI: 10.1159/000381561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To evaluate incidence, symptoms and management of postoperative pancreatic fistula (POPF) after urologic surgery based on our experience. MATERIAL AND METHODS Database was searched for clinically evident POPF after urologic surgery between 1998 and 2014. Fistulae were graded using the POPF classification. Clinical course of every POPF patient was evaluated. RESULTS During this time, 3,200 surgeries for renal, adrenal and retroperitoneal pathologies were performed. Twelve POPF occurred postoperatively in this series. Eight fistulae were POPF grade A, 3 POPF grade B and one POPF grade C. POPF became clinically evident after a median of 3 days (IQR 2-3). In all POPF grade A/B patients, secretion from the pancreatic fistula completely subsided under conservative therapy. In one POPF grade C patient with positive surgical margins of urothelial cancer, conservative treatment failed and the patient died due to POPF-related sepsis. CONCLUSIONS POPF is a rare complication after urologic surgery. Conservative therapy is the first choice of treatment and will be successful in the majority of cases. Pancreatic fistula after surgery of recurrent malignancy may have a poor outcome.
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Xu Z, Zhang Z, Gao J, Wei Z, Xu X, Dong J, Tang H, Yi X, Tang C, Zhou W. A modified adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy. World J Surg Oncol 2014; 12:179. [PMID: 24902995 PMCID: PMC4062894 DOI: 10.1186/1477-7819-12-179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/29/2014] [Indexed: 11/15/2022] Open
Abstract
Background The objective of this study was to modify the adrenal gland-sparing strategy based on retroperitoneal laparoscopic radical nephrectomy by reviewing the anatomic relationship between the kidney and the adrenal gland. Methods From June 2010 to October 2012, a total of 68 patients (45 males and 23 females) with localized renal cell carcinoma were treated at our hospital. The study included 35 cases that were right side and 33 cases that were left, and average patient age was 54.06 years. The average tumor size was 4.7 cm. Tumors were classified via the TNM staging system. All patients underwent adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy. Results For each patient, surgery was successful without conversion to open surgery. The average operative time was 56.65 ± 26.60 min, and the mean blood loss was 70.61 ± 60.96 ml. All patients were discharged from the hospital 3 to 8 days after surgery. During surgery, the adrenal gland was slightly lacerated in three cases and the peritoneum showed perforation in six cases. Only one case recurred during the study follow-up. Conclusions Based on retroperitoneal laparoscopy radical nephrectomy, this effective adrenal gland-sparing surgery showed direct exposure of tissue and little interference of the upper pole of the kidney. Elevation of the adrenal gland could help with the complete dissection of the adrenal gland from the kidney. The separation of the kidney was rapid, simple and accurate. The probability of adrenal gland damage was reduced. This strategy is recommended for widespread use in T1-2 renal neoplasms.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Wenquan Zhou
- Department of Urology, Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, Nanjing 210002, China.
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Garg M, Singh V, Sinha RJ, Sankhwar SN. Prospective Randomized Comparison of Retroperitoneoscopic vs Open Pyeloplasty With Minimal Incision: Subjective and Objective Assessment in Adults. Urology 2014; 83:805-11. [DOI: 10.1016/j.urology.2013.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/09/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
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Miyano G, Takahashi T, Nakamura H, Doi T, Okawada M, Koga H, Lane GJ, Okazaki T, Kato Y, Yamataka A. Retroperitoneoscopic nephrectomy/heminephrectomy in children planned, performed, and managed by supervised senior pediatric surgical trainees. J Laparoendosc Adv Surg Tech A 2013; 23:723-7. [PMID: 23901885 DOI: 10.1089/lap.2013.0135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Retroperitoneoscopic nephrectomy (R-neph) is still not generally favored by pediatric surgeons for various reasons, including lack of experience of retroperitoneal anatomy compared with pediatric urologists, concern about long operative times, and related complications. MATERIALS AND METHODS We compared nephrectomies/heminephrectomies planned, performed, and managed by five senior pediatric surgical trainees (SPST) under the supervision of a board-certified pediatric surgeon (BCPS) (A.Y.) using four-trocar retroperitoneoscopy (R-neph) (n=11) with conventional open nephrectomy and heminephrectomy (O-neph) (n=20) performed by 4 BCPS. RESULTS O-neph comprised 14 nephrectomies and 6 upper pole nephrectomies; R-neph comprised 9 total nephrectomies and 2 upper pole nephrectomies. Mean age and mean weight at nephrectomy were not statistically different. Mean operating time (MOT) was 137 (range, 85-290) minutes in O-neph versus 197 (116-341) minutes in R-neph. MOT for the first 5 R-neph cases was 249 minutes versus 153 minutes for the last 6 cases. Mean blood loss was 17 (range, 1-55) mL in O-neph versus 10.3 (2-40) mL in R-neph. One R-neph case required conversion to O-neph. There were no transfusions and no intraoperative complications. Two partial heminephrectomy patients (one O-neph and one R-neph) developed transient urinoma postoperatively that resolved conservatively. Mean duration of postoperative bed rest was 1.0 day in O-neph versus 0.6 days in R-neph. Differences in mean postoperative fentanyl requirement (O-neph, 21.5 [10-40] μg/kg; R-neph, 4.1 [0-20] μg/kg) and duration of nonsteroidal anti-inflammatory suppository usage (O-neph, 2.3 [0-5] days; R-neph, 0.9 [0-2] days) were significant (both P<.05). Full oral feeding was resumed after a mean of 1.6 (1-2) days in O neph and 1.2 (1-2) days in R-neph. CONCLUSIONS R-neph was safely performed by SPST, and results were comparable to those with O-neph performed by BCPS.
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Affiliation(s)
- Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
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Arslan M, Akin Y, Ates M, Degirmenci T, Kozacioglu Z, Ors B, Gunlusoy B. Changing surgical approaches for laparoscopic adrenalectomy: single-surgeon data of a 6-year experience. Urol Int 2013; 91:304-9. [PMID: 24051760 DOI: 10.1159/000351959] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
Abstract
AIM To evaluate outcomes of laparoscopic adrenalectomy (LA) and laparoendoscopic single-site surgery (LESS) for adrenal masses in the light of changing laparoscopic surgical techniques. MATERIALS AND METHODS Seventy-three patients were analyzed retrospectively. There were 2 groups; group 1 included patients who had conventional transperitoneal LA and transperitoneal LESS, and group 2 included patients who had lateral retroperitoneal LA, retroperitoneal LA in prone position, and retroperitoneal LESS. Demographic data, urine 3-methoxy-4-hydroxymandelic acid, normetanephrine, epinephrine, serum cortisol, aldosterone, adrenocorticotropic hormone, American Society of Anesthesiologists score, side and size of mass, conversion to open surgery, complications, estimated blood loss, operation time, pathological results were recorded and analyzed. RESULTS There was no difference in demographic data and serum parameters between both groups. Tumor size, estimated blood loss, operation time, transfusion rate and hospital stay were less for group 2 (p < 0.05, p = 0.0001). However, the complication rate was similar in both groups; in retroperitoneal prone position, the complication rate was less than for other surgical approaches, but statistically significant results could not be assessed. CONCLUSIONS Even if the diameter of adrenal mass is larger than 6 cm, LA may be considered as the gold standard. The retroperitoneal approach especially in prone position may be a promising treatment method in the near future for adrenalectomy in selected patients.
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Affiliation(s)
- Murat Arslan
- Department of Urology, Izmir University Faculty of Medicine, Izmir, Turkey
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Qian J, Jing JH, Tian DS, Zhang JS, Chen L. Safety and efficacy of a new procedure for treating traumatic iliopsoas hematoma: a retroperitoneoscopic approach. Surg Endosc 2013; 28:265-70. [PMID: 24061622 DOI: 10.1007/s00464-013-3183-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Surgical treatment is often recommended for traumatic iliopsoas hematoma. Open surgeries lead to severe surgical trauma, and minimally invasive surgeries cannot completely remove the hematoma. A new treatment protocol for traumatic iliopsoas hematoma by retroperitoneoscopic approach has been introduced. The goal of this study was to determine the safety and efficacy of retroperitoneoscopic approach used to remove iliopsoas hematoma. METHODS Between January 2009 and July 2012, 13 patients were diagnosed of traumatic iliopsoas hematoma. Retroperitoneoscopic surgeries were performed on all patients to remove the hematomas after admission. The size of hematoma, VASA score and neurologic status were dynamic evaluated before and after surgery. Soft tissue damage and complications caused by retroperitoneoscopic approach also were recorded and evaluated. RESULTS We performed retroperitoneoscopic surgery to remove traumatic iliopsoas hematoma successfully on 13 patients without complications. The mean procedure time was 52.5 ± 13.4 min, and mean blood loss was 30.7 ± 9.2 ml. Hematoma was completely removed confirmed by ultrasound after surgery. Pain in the affected lower abdominal and thigh immediately was relieved totally for ten patients and partly for three patients after surgery. Quadriceps strength was restored to grade 5 and pain completely disappeared 2 months postoperatively on all patients. Numbness along the femoral nerve distribution disappeared for 11 patients and improved for 2 patients until the last follow-up. None of 13 patients suffered from infection or a new hematoma during follow-up. CONCLUSIONS Retroperitoneoscopic approach is a safe and effective procedure alternative to conventional surgical approach for treating traumatic iliopsoas hematoma in terms of complete removal of hematoma, minimal invasiveness, absence of radiation, and rapid recovery.
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Affiliation(s)
- Jun Qian
- Department of Orthopaedics, The Second Hospital of An Hui Medical University, Hefei, 230601, China,
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Huyghe E, Crenn G, Duly-Bouhanick B, Vezzosi D, Bennet A, Atallah F, Mazerolles M, Salloum A, Thoulouzan M, Delaunay B, Grunenwald S, Amar J, Plante P, Chamontin B, Caron P, Soulié M. Retroperitoneoscopic adrenalectomy: comparison of retrograde and antegrade approach among a series of 279 cases. Urology 2013; 81:85-91. [PMID: 23273074 DOI: 10.1016/j.urology.2012.08.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 07/09/2012] [Accepted: 08/01/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the results of retroperitoneal laparoscopic adrenalectomy using the antegrade and retrograde approach. MATERIALS AND METHODS We performed an analysis of a single-center series of 279 retroperitoneal laparoscopic adrenalectomies from 1996 to 2010. We compared 172 cases performed with an antegrade approach and 107 with a retrograde approach without dissection of the renal hilum and initial control of the adrenal vein in comparable populations. RESULTS The operative time was shorter in the group treated with the retrograde technique, 101±51 vs 140±40 minutes, respectively (Student's t test, P<.001). Blood loss was similar in both groups, 85±224 vs 80±126 mL, respectively (P=NS). Hemodynamic instability was defined as the maximal systolic blood pressure minus the minimal systolic blood pressure divided the maximal systolic blood pressure. It was lower in the group who underwent the retrograde technique (32.7 vs 37.6 mL; Student's t test, P=.005) with a lower perioperative consumption of ephedrine (2.2 vs 5.1 mg, P=.004) and atropine (0.09 vs 0.22 mg, P=.026). No difference was found between the 2 groups in the frequency of perioperative complications or postoperative mortality (1 death in each group of causes unrelated to the surgery). CONCLUSION Retroperitoneal laparoscopic adrenalectomy using a retrograde approach is a safe and reproducible technique. It makes it possible to perform adrenalectomy without dissection of the renal hilum, with a reduction in the operative time. The good hemodynamic stability observed with this technique makes it very attractive for the treatment of pheochromocytoma.
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Affiliation(s)
- Eric Huyghe
- Department of Urology, Toulouse Rangueil University Hospital, Toulouse, France.
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Wang K, Liu DF, Wang L, Lin CH, Men CP, Wan FC, Wang H, Gao ZL. Inguinal incision as a successful route to extract the kidney during laparoscopic retroperitoneal live-donor nephrectomy. EXP CLIN TRANSPLANT 2013; 11:396-9. [PMID: 23432532 DOI: 10.6002/ect.2012.0180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We sought to evaluate the advantages of an inguinal incision in extracting the kidney during retroperitoneal laparoscopic live-donor nephrectomy. MATERIALS AND METHODS From May 2008 to June 2011, fifty-eight cases of retroperitoneal live-donor nephrectomy were performed at our hospital; all data were analyzed retrospectively. All donors were grouped in a test group (n=32, inguinal incision) or a control group (n=26, lumbar incision) according to the selected graft retrieval incision. Donors were compared with regard to operative time and warm ischemia time, operative blood loss, hospital stay, cosmetic satisfaction, and incision complications. RESULTS All 58 cases of retroperitoneal live-donor nephrectomy were successfully accomplished, without donor death, serious complications, and conversion to open surgery. There were no differences in mean operative time, mean blood loss, mean warm ischemic time, graft function, and 1-year graft survival rate between the groups. However, in a test group, the mean hospital stay was shorter (P < .01), and the satisfaction with cosmesis was higher (P < .01). The incidence rates of abdomen asymmetry (9/28), incision hernia (4/28), wound infection (5/28), and wound faulty union (6/28) were higher in the control group than they were in the test group. CONCLUSIONS Inguinal incision is a safe and practical graft retrieval incision in retroperitoneal laparoscopic donor nephrectomy and can be generally applied.
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Affiliation(s)
- Ke Wang
- Urology Department of Yantai Yuhuangding Hospital, Yantai 264000, China
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Nozaki T, Iida A, Morii A, Fujiuchi Y, Fuse H. Novel technique for retroperitoneoscopic nephroureterectomy for patients with huge hydronephrosis. SURGICAL PRACTICE 2012. [DOI: 10.1111/j.1744-1633.2012.00601.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tetsuo Nozaki
- Department of Urology; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| | - Akihiro Iida
- Department of Urology; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| | - Akihiro Morii
- Department of Urology; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| | - Yasuyoshi Fujiuchi
- Department of Urology; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
| | - Hideki Fuse
- Department of Urology; Graduate School of Medicine and Pharmaceutical Sciences for Research; University of Toyama; Toyama; Japan
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Saito M, Tsuchiya N, Narita S, Kumazawa T, Maita S, Numakura K, Obara T, Tsuruta H, Inoue T, Horikawa Y, Satoh S, Habuchi T. Comparison of the Clinical Outcome and Systemic Inflammatory Marker Levels Between Retroperitoneal and Transperitoneal Laparoscopic Donor Nephrectomy. J Endourol 2012; 26:1038-43. [DOI: 10.1089/end.2012.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Mitsuru Saito
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Teruaki Kumazawa
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinya Maita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Takashi Obara
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Tsuruta
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Takamitsu Inoue
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yohei Horikawa
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shigeru Satoh
- Division of Renal Replacement Therapeutic Science, Akita University Graduate School of Medicine, Akita, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
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Hisano M, Duarte RJ, Colombo JR, Srougi M. Is there a model to teach and practice retroperitoneoscopic nephrectomy? MINIM INVASIV THER 2012; 22:33-8. [PMID: 22694248 DOI: 10.3109/13645706.2012.696544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although the retroperitoneal approach has been the preferred choice for open urological procedures, retroperitoneoscopy is not the preferred approach for laparoscopy. This study aims to develop a training model for retroperitoneoscopy and to establish an experimental learning curve. MATERIAL AND METHODS Fifteen piglets were operated on to develop a standard retroperitoneoscopic nephrectomy (RPN) training model. All procedures were performed with three ports. Intraoperative data (side, operative time, blood loss, peritoneal opening) were recorded. Animals were divided into groups A, the first eight, and B, the last seven cases. Data were statistically analyzed. RESULTS We performed fifteen RPNs. The operative time varied from 15 to 50 minutes (median 30 minutes). Blood loss varied from 5 to 100 mL (median 20 mL). We experienced five peritoneal openings; we had two surgical vascular complications managed laparoscopically. There was statistical difference between groups A and B for peritoneal opening (p = 0.025), operative time (p = 0.0037), and blood loss (p = 0.026). DISCUSSION RPN in a porcine model could simulate the whole procedure, from creating the space to nephrectomy completion. Experimental learning curve was eight cases, after statistical data analysis. CONCLUSION RPN in a porcine model is feasible and could be very useful for teaching and practicing retroperitoneoscopy.
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Affiliation(s)
- Marcelo Hisano
- CEPEC Vicky Safra, University of São Paulo, Division of Urology , São Paulo, SP.
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Laparoscopic partial nephrectomy: is it worth still performing the retroperitoneal route? Adv Urol 2012; 2012:473457. [PMID: 22754565 PMCID: PMC3384931 DOI: 10.1155/2012/473457] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 03/28/2012] [Indexed: 12/02/2022] Open
Abstract
Objective. The objective of this study was to compare perioperative, oncologic, and functional outcomes of TLPN (transperitoneal
laparoscopic partial nephrectomy) versus RLPN (retroperitoneal).
Patients and Methods. From 1997 to 2009, a retrospective study of 153 consecutive patients who underwent TLPN or RLPN for suspicious renal masses was performed. Complications, functional and oncological outcomes were compared between the 2 groups.
Results. With a mean followup of 39 and 32 months, respectively, 66 and 87 patients had TLPN and RLPN, respectively. Tumor location was more often posterior in the RLPN and more often anterior in the TLPN. Mean operative time and mean hospital stay were longer in the TLPN group with 190 ± 85 min versus 154 ± 47 (P = 0.001) and 9.2 ± 6.4 days versus 6.2 ± 4.5 days (P < 0.05), respectively. Transfusion and urinary fistulas rates were similar in the 2 groups. After 3-year followup, chronic kidney failure occurred in 6 and and 4% (P = 0.67) in after TLPN and RLPN, respectively. After 3-year followup, recurrence free survival was 96.7% and 96.6% (P = 0.91) in the TLPN and RLPN groups, respectively.
Conclusion. Our study confirmed that TLPN had longer operative time and hospital stay than RLPN. The complication rates were similar. Furthermore, mid-term oncological and functional outcomes were similar.
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Habuchi T, Terachi T, Mimata H, Kondo Y, Kanayama H, Ichikawa T, Nutahara K, Miki T, Ono Y, Baba S, Naito S, Matsuda T. Evaluation of 2,590 urological laparoscopic surgeries undertaken by urological surgeons accredited by an endoscopic surgical skill qualification system in urological laparoscopy in Japan. Surg Endosc 2011; 26:1656-63. [PMID: 22179473 DOI: 10.1007/s00464-011-2088-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 11/17/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND In 2003, the Japanese Urological Association (JUA) and Japanese Society of Endourology (JSE) established a urological laparoscopic skill qualification system, called the Endoscopic Surgical Skill Qualification System in Urological Laparoscopy of JUA and JSE (ESSQSJJ). The main goal of the system is to decrease the prevalence of complications associated with laparoscopic surgery. To validate the qualification system, perioperative outcome and the prevalence of complications in different types of urological laparoscopic surgery performed by accredited surgeons were evaluated. METHODS One hundred thirty-six surgeons who obtained the qualification in 2004 were prospectively asked to submit intraoperative and postoperative data of their latest 20 cases at the end of 2009, along with the number of laparoscopic urological surgeries performed in each year for a 5-year period (2004-2009). Intraoperative and postoperative complications were graded according to the Satava classification and modified Clavien classification, respectively. RESULTS Data of 2,590 urological laparoscopic surgeries of 130 surgeons, including 904 laparoscopic radical nephrectomies, 430 laparoscopic nephroureterectomies, 390 laparoscopic adrenalectomies, 320 laparoscopic radical prostatectomies, and 170 laparoscopic partial nephrectomies, were analyzed. Complications were noted in 97 (3.7%) patients. Major intraoperative complications (grade II or III) occurred in 32 (1.2%) patients, and major postoperative complications (grade III or higher) occurred in 24 (0.9%) patients. The prevalence of conversion to open surgery, allogeneic transfusion, and perioperative mortality was 2.5%, 1.6%, and 0%, respectively. The number of surgeries performed by each qualified surgeon or the role of the surgeon (main operator vs. mentor/instructor) in the surgery did not affect the prevalence of intraoperative complications or postoperative complications. The open conversion rate was significantly higher in surgeons with a low surgical volume. CONCLUSIONS ESSQSJJ can ensure urological laparoscopic surgeons who can perform various types of urological laparoscopic surgeries with a low prevalence of perioperative complications and reasonable outcomes.
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Affiliation(s)
- Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
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Büyükbebeci O, Seçkiner I, Karslı B, Karakurum G, Başkonuş I, Bilge O, Kacira BK. Retroperitoneoscopic drainage of complicated psoas abscesses in patients with tuberculous lumbar spondylitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:470-3. [PMID: 22015814 DOI: 10.1007/s00586-011-2049-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 08/17/2011] [Accepted: 10/09/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Nowadays, endoscopic techniques are widely used in surgical procedures. Retroperitoneoscopy has been an extremely valuable tool for a wide variety of urologic disorders, whereas, it has limited use in orthopedic procedures. METHODS We performed retroperitoneoscopic drainage (in combination with medical treatment) of complicated psoas abscess on 12 patients with tuberculous spondylitis. All the procedures were done under general anesthesia and in the lateral decubitus position. Psoas abscess was evacuated during procedure, and postoperatively, drainage was continued through a large silastic tube. The definitive diagnosis and the treatment were made based on the results of culture-antibiogram and PCR testing. RESULTS Complete clinical and radiologic remission was observed in all patients in 3-6 months. The complication was not observed in any case postoperatively. CONCLUSIONS Retroperitoneoscopic drainage of psoas abscesses gains advantages in terms of rapid recovery, minimal invasiveness, absence of radiation, and shorter hospital stay. This procedure can be used not only for cold abscesses but also for other pathologies of lumbar vertebral area.
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Affiliation(s)
- Orhan Büyükbebeci
- Department of Orthopedic Surgery, Meram Faculty of Medicine, Selcuk University, Meram, Konya, Turkey.
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Ito H, Makiyama K, Kawahara T, Sano F, Murakami T, Hayashi N, Miyoshi Y, Nakaigawa N, Yao M, Kubota Y. Retroperitoneoscopic radical nephrectomy with a small incision for renal cell carcinoma: comparison with the conventional method. J Negat Results Biomed 2011; 10:11. [PMID: 21846398 PMCID: PMC3169504 DOI: 10.1186/1477-5751-10-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 08/16/2011] [Indexed: 11/30/2022] Open
Abstract
purpose When retroperitoneoscopic radical nephrectomy for renal cell carcinoma was introduced into our institution, we performed a combined small skin incision method. In this method, a small incision was made to approach the retroperitoneal space prior to setting trockers and thereafter a LAPDISC was placed in the incision to start the retroperitoneoscopic procedure. In this study, we compared the outcomes between the combined small skin incision method ("A method" hereinafter) and the conventional method ("B method" hereinafter). material and methods Among the cases of T1N0M0 suspicious renal cell carcinoma treated at Yokohama City University between May 2003 and June 2009, the A method was performed in 51 cases and the B method was performed in 33 cases. The factors in the outcomes compared between the A and B methods were the duration of procedure, volume of bleeding, volume of transfusion, weight of the specimen, incidence of peritoneal injury, rate of conversion to open surgery, and perioperative complications. results The duration of the procedure was 214.4 ± 46.9 minutes in the A method group and 208.1 ± 36.4 minutes in the B method group (p = 0.518). The volume of bleeding and the weight of the specimen were 105.5 ± 283.2 ml and 335.1 ± 137.4 g in the A method group and 44.8 ± 116 ml (p = 0.247) and 309.2 ± 126 g (p = 0.385) in the B method group. There was no significant difference in all factors analyzed. conclusion The A method would be highly possible to produce stable results, even during the introduction period when the staff and the institution are still unfamiliar with the retroperitoneoscopic surgery.
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Affiliation(s)
- Hiroki Ito
- Department of Urology, Yokohama City University Graduate School of Medicine and School of Medicine, Yokohama, Japan.
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Verhoest G, Shariat SF, Chromecki TF, Raman JD, Margulis V, Novara G, Seitz C, Remzi M, Rouprêt M, Scherr DS, Bensalah K. Predictive factors of recurrence and survival of upper tract urothelial carcinomas. World J Urol 2011; 29:495-501. [PMID: 21681525 DOI: 10.1007/s00345-011-0710-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 05/29/2011] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE UTUCC is a rare tumor, and most reports on prognostic factors come from small single-center series. The objective of this article was to provide an updated overview of current clinical, pathological and biological prognostic factors of UTUC. METHODS PubMed was searched for records from 2002 to 2010 using the terms "prognostic factors", "recurrence", "survival", and "upper tract urothelial carcinoma". Among identified citations, papers were selected based on their clinical relevance. RESULTS Classical clinical factors that influence UTUC prognosis include age, presence of symptoms, hydronephrosis, and interval from diagnosis. Many biomarkers have shown promises to better appraise the natural course of UTUC although none is currently used in clinical practice. Stage, grade, lymph node metastases, lymphovascular invasion, tumor necrosis, and tumor architecture are strong pathological parameters. RNU is the standard treatment of localized UTUC. Both laparoscopic and open approaches seem to offer similar cancer control. Lymph node dissection increases staging accuracy and might confer a survival benefit. CONCLUSION RNU is the standard treatment for most patients with UTUC. Recent multicenter studies confirmed the prognostic value of classical prognostic parameters. Better survival prediction might be obtained with prognostic systems including clinical data and new biomarkers.
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Affiliation(s)
- Grégory Verhoest
- Department of Urology, CHU Rennes, University of Rennes, Rennes, France
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Upadhyaya M, Sundararajan LS, Woodward MN. Dangerous deliveries: lessons learned during retroperitoneal specimen retrieval. J Pediatr Surg 2011; 46:e13-e15. [PMID: 21496519 DOI: 10.1016/j.jpedsurg.2010.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/18/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
Abstract
Laparoscopy is now a standard technique in pediatric surgery and urology. Unique complications have been reported during port/instrument insertion and dissection, often relating to issues of visibility or working space. Complications during specimen retrieval are currently unreported. We describe our experience of 2 serious complications occurring during attempted retrieval of a specimen through a port site at the end of the laparoscopic procedure.
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Affiliation(s)
- M Upadhyaya
- Department of Paediatric Surgery, Bristol Children's Hospital, Bristol.
| | - L S Sundararajan
- Department of Paediatric Surgery, University Hospital of Wales, Cardiff
| | - M N Woodward
- Department of Paediatric Surgery, Bristol Children's Hospital, Bristol
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29
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Giri SK, Murphy D, Costello AJ, Moon DA. Laparoscopic Pyeloplasty Outcomes of Elderly Patients. J Endourol 2011; 25:251-6. [DOI: 10.1089/end.2010.0384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Subhasis K. Giri
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Declan Murphy
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Anthony J. Costello
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Daniel A. Moon
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
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Shigemura K, Yasufuku T, Arakawa S, Yamashita M, Fujisawa M. Efficacy of early use of snake retractor in retroperitoneoscopic nephrectomy or nephroureterectomy. J Endourol 2010; 24:1771-4. [PMID: 20849307 DOI: 10.1089/end.2009.0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE A snake retractor is generally used to create a better surgical field and space, but when to start using it is still controversial. In this study, we used a snake retractor starting in an early stage of the procedure to safely perform surgery and compared the results with a control group in which the procedure depended on operator discretion. PATIENTS AND METHODS Twelve patients were enrolled in this study and compared with a control group (n = 12) in which no special technique was used. We used four ports in both right- and left sided cases and used a snake retractor when removing the flank pad to create a better surgical space and field. We compared two groups in operative time, intraoperative blood loss, and body mass index (BMI). RESULTS Three surgeons were enrolled. In the intervention group (early use of snake retractor), operative time was 107 to 300 minutes (median 162 min), and intraoperative blood loss was 0 to 462 g (69.5 g). In the control group, operative time was 185 to 485 minutes (258 min) and intraoperative blood loss was 0 to 302 g (40 g). Operative time was significantly shorter in the intervention group than the control group (P = 0.0034). There was no significant correlation with intraoperative blood loss volume and BMI in these two groups. We did not have any patients with metastasis or recurrence of cancer in either group in post-operative follow-up. Only the control group included a case with a slight duodenum injury. CONCLUSIONS Early use of the snake retractor in retroperitoneoscopic nephrectomy or nephroureterectomy may produce a significantly safer operative procedure.
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Schwartz MJ, Faiena I, Cinman N, Kucharczyk J, Meriggi JS, Waingankar N, Richstone L, Kavoussi LR. Laparoscopic Bowel Injury in Retroperitoneal Surgery: Current Incidence and Outcomes. J Urol 2010; 184:589-94. [DOI: 10.1016/j.juro.2010.03.133] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Michael J. Schwartz
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Izak Faiena
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Nadya Cinman
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - John Kucharczyk
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Jenna S. Meriggi
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Nikhil Waingankar
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Lee Richstone
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Louis R. Kavoussi
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
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Karanikola E, Tsigris C, Kontzoglou K, Nikiteas N. Laparoscopic adrenalectomy: where do we stand now? TOHOKU J EXP MED 2010; 220:259-65. [PMID: 20383036 DOI: 10.1620/tjem.220.259] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Laparoscopic adrenalectomy (LA) has become the procedure of choice for the surgical removal of the vast majority of small sized adrenal tumors (<or= 6 cm), because of its significant and multiple advantages: reduced hospital stay and wound morbidity, decreased transfusion requirements, postoperative pain and complications. The role of LA in patients with large adrenal lesions or potential malignancy remains controversial. The aim of this article is to review the current and up-to-date surgical approaches for LA, which include: 1) transabdominal anterior or flank approach and 2) retroperitoneal technique with the patient in either lateral or prone position. Specific advantages and disadvantages are referred to for each of them. The choice of each of these techniques is determined particularly by the preference and the experience of the surgeon, but other objective criteria must be taken into consideration, such as the size of the adrenal and history of previous abdominal surgeries.
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[What is the importance of kidney cancer surgery in contrast with targeted therapies?]. Bull Cancer 2010; 97:91-6. [PMID: 20418208 DOI: 10.1684/bdc.2010.1074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite the extraordinary development of the medical treatment of kidney cancer, its treatment remains very surgical in localized and metastatic stage. Advances in surgery have accompanied the advent of targeted therapies. The laparoscopy has become the reference procedure for radical nephrectomy in the case of T1-T2 tumors. Partial nephrectomy, currently widespread, should be the first surgical procedure to consider in cases of tumors less than 4 cm. Partial nephrectomy for tumors between 4 and 7 cm is feasible for selected patients with favorable tumor localization. In the future, the use of neo-adjuvant anti-angiogenesis agents could broaden the scope of partial nephrectomy. Laparoscopic partial nephrectomy is spreading but is still considered as a therapeutic option, conducted in reference centres. In case of metastatic disease, pending the results of randomized trials including patients on anti-angiogenesis agents, cytoreductive nephrectomy remains indicated for patients in good general condition with kidney cancer metastatic immediately.
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Beyer-Westendorf J, Werth S, Halbritter K, Weiss N. Cancer in males and risk of venous thromboembolism. Thromb Res 2010; 125 Suppl 2:S155-9. [DOI: 10.1016/s0049-3848(10)70035-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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