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Xu Q, Zhu L, Chen W, Peng W. The clinical effect of endoscopic and open surgery in the treatment of thyroid cancer and their effect on the blood coagulation state: a comparative study. Ann Surg Treat Res 2024; 107:127-135. [PMID: 39282099 PMCID: PMC11390278 DOI: 10.4174/astr.2024.107.3.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 09/18/2024] Open
Abstract
Purpose This study was performed to compare the therapeutic efficacy of endoscopic surgery and open surgery and their effects on postoperative blood coagulation state in patients with thyroid cancer, and to provide evidence for the prevention measurement of thrombosis in the perioperative period. Methods One hundred patients with thyroid cancer who received treatment in our hospital from January 2021 to December 2021, were randomly divided into an endoscopic group and an open surgery group, with 50 patients in each group. The patients in the open surgery group were treated by traditional open surgery, while patients in the endoscopic group accepted endoscopic surgery. The clinically therapeutic effect and blood coagulation of the 2 groups were compared. Results Intraoperative blood loss and length of hospital stay were lower, and operative time was longer in the endoscopic group than in the open surgery group (P < 0.05). The 24-hour postoperative fibrinogen and D-dimer levels were higher in both groups than in the preoperative period, while PT was shorter (P < 0.05). There were no significant differences in postoperative complications and follow-up between the 2 groups (P > 0.05), but the incidence of complications, postoperative metastases, and thrombosis was relatively low in the endoscopic group. Conclusion In the treatment of patients with thyroid cancer, endoscopic surgery has the advantages of less blood loss, fewer complications, and so on. Endoscopic and open surgery can lead to a hypercoagulable state, but the effect of endoscopic surgery is better than that of open surgery.
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Affiliation(s)
- Qiyin Xu
- Department of Gastrointestinal Surgery, The First People's Hospital of Yibin, Yibin, China
| | - Li Zhu
- Department of Gastrointestinal Surgery, The First People's Hospital of Yibin, Yibin, China
| | - Weiping Chen
- Department of Gastrointestinal Surgery, The First People's Hospital of Yibin, Yibin, China
| | - Weibin Peng
- Department of Gastrointestinal Surgery, The First People's Hospital of Yibin, Yibin, China
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Chen YH, Xiao T, Zheng XM, Xu Y, Zhuang KT, Wang WJ, Chen XM, Hong Q, Cai GY. Local Renal Treatments for Acute Kidney Injury: A Review of Current Progress and Future Translational Opportunities. J Endourol 2024; 38:466-479. [PMID: 38386504 DOI: 10.1089/end.2023.0705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Acute kidney injury (AKI) constitutes a significant public health concern, with limited therapeutic options to mitigate injury or expedite recovery. A novel therapeutic approach, local renal treatment, encompassing pharmacotherapy and surgical interventions, has exhibited positive outcomes in AKI management. Peri-renal administration, employing various delivery routes, such as the renal artery, intrarenal, and subcapsular sites, has demonstrated superiority over peripheral intravenous infusion. This review evaluates different drug delivery methods, analyzing their benefits and limitations, and proposes potential improvements. Renal decapsulation, particularly with the availability of minimally invasive techniques, emerges as an effective procedure warranting renewed consideration for AKI treatment. The potential synergistic effects of combined drug delivery and renal decapsulation could further advance AKI therapies. Clinical studies have already begun to leverage the benefits of local renal treatments, and with ongoing technological advancements, these modalities are expected to increasingly outperform systemic intravenous therapy.
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Affiliation(s)
- Yu-Hao Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese PLA, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Tuo Xiao
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese PLA, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xu-Min Zheng
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese PLA, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Yue Xu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese PLA, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Kai-Ting Zhuang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese PLA, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Wen-Juan Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese PLA, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiang-Mei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese PLA, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Quan Hong
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese PLA, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Guang-Yan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese PLA, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
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Laparoscopic Single-Incision Triangulated Umbilical Surgery Adrenalectomy for Large (>5 cm) Tumors of the Adrenal Gland: Initial Experience with 16 Cases. JOURNAL OF ONCOLOGY 2022; 2022:5966530. [PMID: 36213839 PMCID: PMC9534670 DOI: 10.1155/2022/5966530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/03/2022] [Indexed: 12/01/2022]
Abstract
Background and ObjectivesLaparoscopic single-incision triangulated umbilical surgery (SITUS), which enables the extraction of intraabdominal specimens through a single umbilical incision, has yet to be used to perform adrenalectomy. We have modified SITUS to enable extraction of large (>5 cm) adrenal masses with optimal cosmetic outcomes and investigated efficacy and safety. Methods. In this retrospective study, we analyzed data of 16 patients with adrenal tumors >5 cm who had undergone adrenalectomy by SITUS between October 2015 and April 2018. Two C-shaped incisions were made around the umbilicus and sutured centripetally. After extracting the specimen, we evaluated these patients' operative/postoperative data. Results. SITUS was performed in all 16 patients without conversion to laparoscopic or open surgery. The mean operation time was 75.31 ± 21.54 min (intraperitoneal time 41.94 ± 17.57 min; incision suturing time 33.38 ± 6.34 min). The estimated median blood loss was 57.5 mL (range 30–610 mL). Drainage time and duration of hospital stay were 55.69 ± 12.92 h and 3.94 ± 0.90 d, respectively. After surgery, all incisions were hidden under the umbilicus. Three patients developed keloid diathesis, resulting in enlargement of their scars. Conclusions. SITUS is a safe and feasible procedure for removing large adrenal tumors. In addition to its cosmetic advantages, SITUS facilitates functional recovery, particularly in patients with large adrenal tumors.
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Ma T, Yang WZ, Cui Z, Zhao C. Experience in the application of laparoscopic anatomical adrenalectomy via the renal cortex surface monolayer. Pak J Med Sci 2020; 36:717-722. [PMID: 32494262 PMCID: PMC7260897 DOI: 10.12669/pjms.36.4.2102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: To discuss the clinical application of laparoscopic anatomical adrenalectomy via the renal cortex surface in the operation of adrenal masses. Methods: A retrospective analysis was performed on 231 patients with adrenal masses who were received and cured in the urology department of the Affiliated Hospital of Hebei University from July 2016 to January 2019. All patients received retroperitoneal adrenalectomy by means of laparoscopic anatomical adrenalectomy via the renal cortex surface. Operation duration, bleeding volume, postoperative complications, retention time of the drainage tube were measured and analyzed, and postoperative follow-up surveys were administered. Results: All cases were successfully operated. Two cases were converted to open surgery due to the presence of large adrenal tumors, and the patients suffered no significant complications. The mean operation duration, bleeding volume and retention time of the drainage tube were 31 minutes, 20 mL and 1.2±0.6 d, respectively. In terms of the postoperative pathology of adrenal tumors, 183 cases were shown to have adenomas, 34 had pheochromocytomas, nine had schwannomas, 3 had metastases from lung cancer, and two had sarcomas. A total of 174 patients were followed up for three to 18 months. Only one case with sarcoma that relapsed within half a year of the operation. Conclusion: In the treatment of adrenal masses, laparoscopic anatomical adrenalectomy via the renal cortex surface has many advantages including the large operation space, clear view of anatomical markers, little bleeding, small trauma, few postoperative complications, simple operational procedures and short learning curves. This technique needs clinical promotion.
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Affiliation(s)
- Tao Ma
- Tao Ma, Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, P. R. China
| | - Wen-Zeng Yang
- Wen-zeng Yang, Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, P. R. China
| | - Zhenyu Cui
- Zhenyu Cui, Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, P. R. China
| | - Chunli Zhao
- Chunli Zhao, Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, P. R. China
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Pediatric oncologic endosurgery. INTERNATIONAL JOURNAL OF SURGERY-ONCOLOGY 2017; 2:e30. [PMID: 29075678 PMCID: PMC5645938 DOI: 10.1097/ij9.0000000000000030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 11/26/2022]
Abstract
Despite increasing popularity of minimal-invasive techniques in the pediatric
population, their use in diagnosis and management of pediatric malignancy is still
debated. Moreover, there is limited evidence to clarify this controversy due to low
incidence of each individual type of pediatric tumor, huge diversity of the disease
entity, heterogeneity of surgical technique, and lack of well-designed studies on
pediatric oncologic minimal-invasive surgery. However, a rapid development of medical
instruments and technologies accelerated the current trend toward less invasive
surgery, including oncologic endosurgery. The aim of this article is to review
current literatures about the application of the minimal-invasive approach for
pediatric tumors and to give an overview of the current status, indications,
individual techniques, and future perspectives.
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Laguna MP. Re: Robot-Assisted vs Open Adrenalectomy: Evaluation of Cost-Effectiveness and Peri-Operative Outcome. J Urol 2017; 197:1438. [PMID: 28505893 DOI: 10.1016/j.juro.2017.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Re: Impact of Novel Techniques on Minimally Invasive Adrenal Surgery: Trends and Outcomes from a Contemporary International Large Series in Urology. J Urol 2017. [DOI: 10.1016/j.juro.2017.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wang Y, He Y, Li BS, Wang CH, Chen Z, Lu ML, Wen ZQ, Chen X. Laparoendoscopic Single-Site Retroperitoneoscopic Adrenalectomy Versus Conventional Retroperitoneoscopic Adrenalectomy in Obese Patients. J Endourol 2015; 30:306-11. [PMID: 26486758 DOI: 10.1089/end.2015.0526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To compare the operative outcomes of obese patients undergoing laparoendoscopic single-site (LESS) retroperitoneoscopic adrenalectomy or standard laparoscopic (LAP) retroperitoneoscopic adrenalectomy. METHODS Between September 2011 and April 2015, 51 obese patients underwent LESS retroperitoneoscopic adrenalectomy and their operative outcomes were compared with 65 obese patients who underwent standard retroperitoneoscopic adrenalectomy by the same surgeon. In the LESS group, a single-port access was positioned in the lumbar incision. The standard retroperitoneal adrenalectomy technique was performed with a combination of conventional and curved LAP instruments. The following parameters were adopted: patient demographics, surgical details, perioperative complications, postoperative outcome data, and short-term outcomes. RESULTS The LESS group was comparable with the LAP group in terms of total operative time (70.4 ± 21.3 vs 65.5 ± 24.8 minutes, p = 0.26), hospital length of stay (5.7 ± 1.2 vs 6.1 ± 1.5 days, p = 0.12), and incidence of complications (4/51 vs 5/65, p = 0.98) for patients with similar baseline demographics. The LESS group had significantly shorter surgical incisions (2.8 ± 0.3 vs 5.3 ± 0.6 cm, p < 0.0001), lower in-hospital analgesic requirement (7.6 ± 3.3 mg morphine equivalent vs 10.5 ± 6.2 mg, p = 0.003), and significantly superior scar satisfaction score (9.3 ± 0.7 vs 7.6 ± 1.4, p < 0.0001) than the LAP group. Although estimated blood loss was greater in the LESS group (28.1 ± 10.6 vs 16.9 ± 7.2 mL in the LAP group, p < 0.0001), <50 mL overall blood loss was not clinically significant. During a mean follow-up of 20.2 months, no recurrences or deaths were documented in either group. CONCLUSIONS In properly selected patients, LESS retroperitoneoscopic adrenalectomy for obese individuals is technically feasible and safe in experienced hands, offering perioperative outcomes comparable with those of the conventional multiport approach, but with a superior cosmetic outcome.
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Affiliation(s)
- Yang Wang
- Department of Urology, Xiangya Hospital, Central South University , Changsha, China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University , Changsha, China
| | - Bin-Shen Li
- Department of Urology, Xiangya Hospital, Central South University , Changsha, China
| | - Chao-Hui Wang
- Department of Urology, Xiangya Hospital, Central South University , Changsha, China
| | - Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University , Changsha, China
| | - Miao-Long Lu
- Department of Urology, Xiangya Hospital, Central South University , Changsha, China
| | - Zhi-Qiang Wen
- Department of Urology, Xiangya Hospital, Central South University , Changsha, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University , Changsha, China
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Xu W, Li H, Ji Z, Yan W, Zhang Y, Zhang X, Li Q. Transumbilical laparoendoscopic single-site surgery versus conventional laparoscopy for the resection of retroperitoneal paragangliomas. Int J Urol 2015; 22:844-9. [PMID: 26119870 DOI: 10.1111/iju.12834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/10/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare transumbilical laparoendoscopic single-site surgery with conventional laparoscopy for the resection of retroperitoneal paragangliomas. METHODS In the present case-control study, we compared 11 transumbilical laparoendoscopic single-site surgery procedures with 22 conventional laparoscopy procedures carried out to treat retroperitoneal paragangliomas between June 2004 and October 2013 at Peking Union Medical Hospital, Beijing, China. Operative time, estimated intraoperative blood loss, blood transfusions, intraoperative hypertension, intraoperative hypotension, highest intraoperative systolic blood pressure, lowest intraoperative systolic blood pressure, postoperative fatigue time, postoperative systematic inflammation reaction syndrome, 24-h postoperative visual analog scale scores, postoperative hospital stay duration, and postoperative complications were recorded and analyzed. RESULTS There were no significant differences in patient characteristics. All surgical procedures were successfully completed in both groups. Minor complications occurred in one case in the laparoendoscopic single-site surgery group and in two cases in the conventional laparoscopy group. In the laparoendoscopic single-site surgery group, the operative time was longer than that in the conventional laparoscopy group (P = 0.001). There were no significant differences in terms of intraoperative hypertension, intraoperative hypotension, highest intraoperative systolic blood pressure, lowest intraoperative systolic blood pressure, estimated blood loss, postoperative fatigue time, postoperative hospital stay or systematic inflammation reaction syndrome between the two groups. The 24-h postoperative visual analog scale score was lower in the laparoendoscopic single-site surgery group (P = 0.002). No recurrence or metastases were observed over the duration of the postoperative follow up. CONCLUSIONS In properly selected patients, transumbilical laparoendoscopic single-site surgery is a feasible, safe and effective procedure for the surgical treatment of retroperitoneal paragangliomas.
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Affiliation(s)
- Weifeng Xu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuebin Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Li
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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10
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Inoue S, Kajiwara M, Teishima J, Matsubara A. Needlescopic-assisted laparoendoscopic single-site adrenalectomy. Asian J Surg 2015; 39:6-11. [PMID: 25912104 DOI: 10.1016/j.asjsur.2015.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 02/04/2015] [Accepted: 02/10/2015] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Our objective was to compare the perioperative parameters of needle-assisted and conventional laparoendoscopic single-site adrenalectomy (LESS-A). METHODS We compared 23 patients undergoing needle-assisted LESS-A with 29 patients undergoing conventional LESS-A at Hiroshima University Hospital between November 2009 and February 2014. Needle-assisted LESS-A was performed using a MiniLap instrument (Stryker, San Jose, CA, USA). We used this instrument to protectively retract the liver at the right side of the tumor and the spleen at the left side by grasping with a Securea endoscopic surgical spacer (Hogy Medical Co., Ltd., Tokyo, Japan). Various parameters including insufflation time, estimated blood loss, pain scale, resumption of oral intake, transfusion rate, and complications were analyzed using the Mann-Whitney U test. RESULTS In all cases, LESS-A was completed successfully with no major intraoperative complications. Patients in both treatment groups had similar age, body mass index, sex, and laterality. Significantly, needle-assisted LESS-A was performed using the transumbilical approach rather than the subcostal approach. The insufflation time of the needle-assisted LESS-A was shorter than that of the conventional LESS-A (p = 0.0335). No patients required intraoperative or postoperative blood transfusions. Retrospective design and the small sample size are main limitations of this study. CONCLUSION Needle-assisted LESS-A was performed safely and in a manner that mitigated many of the difficulties of LESS surgery.
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Affiliation(s)
- Shogo Inoue
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
| | - Mitsuru Kajiwara
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Jun Teishima
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Yang XF, Luo GH, Ding ZH, Li GX, Chen XW, Zhong SZ. The urogenital-hypogastric sheath: an anatomical observation on the relationship between the inferomedial extension of renal fascia and the hypogastric nerves. Int J Colorectal Dis 2014; 29:1417-26. [PMID: 25060217 DOI: 10.1007/s00384-014-1973-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The study aimed to perform an anatomical observation on the inferomedial extension of the renal fascia (RF) to the pelvis and explore its relationship with the hypogastric nerves (HGNs). METHODS Gross anatomy was performed on 12 formalin-fixed and 12 fresh cadavers. Sectional anatomy was performed on four formalin-fixed cadavers. RESULTS Different from the traditional concept, both the anterior and posterior RF included the outer and inner layer with different inferomedial extensions. The multiple layers of RF extended downward to form a sandwich-like and compound fascia sheath with potential and expandable spaces which was named as "the urogenital-hypogastric sheath." Below the level of the origin of the inferior mesenteric artery, the bilateral urogenital-hypogastric sheath communicated with the counterpart in front of the great vessels in the midline and the superior hypogastric plexus ran into the urogenital-hypogastric sheath which carried the HGNs, ureters, and genital vessels downward to their terminations in the pelvis. In the retrorectal space, the urogenital-hypogastric sheath surrounded the fascia propria of the rectum posterolaterally as a layer of coat containing HGNs. CONCLUSION The multiple layers of RF with different extensions are the anatomical basis of the formation of the urogenital-hypogastric sheath. As a special fascial structure in the retroperitoneal space and the pelvis, emphasis on its formation and morphology may be helpful for not only unifying the controversies about the relationship between the pelvic fascia and HGNs but also improving the intraoperative preservation of the HGNs by dissecting in the correct surgical plane.
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Affiliation(s)
- X F Yang
- Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang, China
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Malkan AD, Loh AHP, Sandoval JA. Minimally invasive surgery in the management of abdominal tumors in children. J Pediatr Surg 2014; 49:1171-6. [PMID: 24952811 DOI: 10.1016/j.jpedsurg.2014.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 04/03/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Abstract
The application of minimally invasive surgical techniques to pediatric abdominal tumors is a controversial application towards the surgical management of childhood cancer. Although general pediatric surgeons practice minimally invasive surgery techniques in a vast array of abdominal cases, its role in pediatric oncology is still developing, with no consensus in North America about its use for pediatric solid abdominal tumors. The purposes of this article are to review the current literature about the use of minimally invasive surgery in pediatric abdominal oncology and to examine established indications, procedures and technologic advances.
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Affiliation(s)
- Alpin D Malkan
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Amos H P Loh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - John A Sandoval
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.
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13
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Bhandarkar DS, Mittal GK, Katara AN, Behera RR. Laparo-endoscopic single-site left adrenalectomy using conventional ports and instruments. Urol Ann 2014; 6:169-72. [PMID: 24833835 PMCID: PMC4021663 DOI: 10.4103/0974-7796.130660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 07/28/2012] [Indexed: 12/29/2022] Open
Abstract
Laparo-endoscopic single-site adrenalectomy (LESS-A) is commonly performed using specialized access devices and/or instruments. We report a LESS-A in a 47-year-old woman with a left aldosteranoma via a subcostal approach utilizing conventional laparoscopic ports and instruments. The feasibility and cost-effectiveness of this approach are highlighted and the literature on the subject is reviewed.
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Affiliation(s)
| | - Gaurav K Mittal
- Department of Surgery, Pushpanjali Crosslay Hospital, Vaishali, Ghaziabad, India
| | - Avinash N Katara
- Department of Minimal Access Surgery, Hinduja Hospital, Mahim, Mumbai, India
| | - Ramya R Behera
- Department of Minimal Access Surgery, Hinduja Hospital, Mahim, Mumbai, India
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14
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He Y, Chen Z, Luo YC, Fang XL, Chen X. Laparoendoscopic Single-Site Retroperitoneoscopic Adrenalectomy for Pheochromocytoma: Case Selection, Surgical Technique, and Short-Term Outcome. J Endourol 2014; 28:56-60. [PMID: 23941419 DOI: 10.1089/end.2013.0318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Yao He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yan-Cheng Luo
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xiao-Long Fang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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15
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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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16
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Wang L, Wu Z, Li M, Cai C, Liu B, Yang Q, Sun Y. Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic surgery: a systematic review and meta-analysis of observational studies. J Endourol 2013; 27:743-50. [PMID: 23611672 DOI: 10.1089/end.2012.0599] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess the surgical efficacy and potential advantages of laparoendoscopic single-site adrenalectomy (LESS-AD) compared with conventional laparoscopic adrenalectomy (CL-AD) based on published literature. METHODS An online systematic search in electronic databasesM including Pubmed, Embase, and the Cochrane Library, as well as manual bibliography searches were performed. All studies that compared LESS-AD with CL-AD were included. The outcome measures were the patient demographics, tumor size, blood loss, operative time, time to resumption of oral intake, hospital stay, postoperative pain, cosmesis satisfaction score, rates of complication, conversion, and transfusion. A meta-analysis of the results was conducted. RESULTS A total of 443 patients were included: 171 patients in the LESS-AD group and 272 patients in the CL-AD group (nine studies). There was no significant difference between the two groups in any of the demographic parameters expect for lesion size (age: P=0.24; sex: P=0.35; body mass index: P=0.79; laterality: P=0.76; size: P=0.002). There was no significant difference in estimated blood loss, time to oral intake resumption, and length of stay between the two groups. The LESS-AD patients had a significantly lower postoperative visual analog pain score compared with the CL-AD group, but a longer operative time was noted. Both groups had a comparable cosmetic satisfaction score. The two groups had a comparable rate of complication, conversion, and transfusion. CONCLUSIONS In early experience, LESS-AD appears to be a safe and feasible alternative to its conventional laparoscopic counterpart with decreased postoperative pain noted, albeit with a longer operative time. As a promising and emerging minimally invasive technique, however, the current evidence has not verified other potential advantages (ie, cosmesis, recovery time, convalescence, port-related complications, etc.) of LESS-AD.
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Affiliation(s)
- Linhui Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, PR China
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Tran GB, Nguyen TD, Le KV. Single-incision laparoscopic adrenalectomy at Viet Duc University Hospital. Asian J Endosc Surg 2013; 6:33-8. [PMID: 22989250 DOI: 10.1111/j.1758-5910.2012.00157.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 08/09/2012] [Accepted: 08/16/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Laparoscopic adrenalectomy is the technique of choice in the treatment of adrenal tumors. SILS has recently been introduced in this field and applied in Viet Duc University Hospital. Herein, we report our experience with single-incision transperitoneal adrenalectomy. METHODS Between August 2010 and January 2012, 61 patients (23 men, 38 women) underwent SILS adrenalectomy at our institution. The diagnoses consisted of 20 patients with pheochromocytoma, 17 with nonfunctioning adenoma, 16 with Conn syndrome, 4 with Cushing syndrome and 4 with adrenal cysts. The mean age was 47.8 years (range, 21-68 years). There were 29 right-sided and 32 left-sided tumors; their mean diameter was 30.7 mm (range, 8-59 mm). Patients were in the flank position with the operated side up. A 2.5-cm pararectal incision at the level of the umbilicus was made to insert the SILS Port. RESULTS The mean operating time was 78 min (range, 50-120 min), and mean blood loss was approximately 70 mL. Left-sided tumors were excised entirely with the SILS technique. Right-sided lesions sometimes required an additional trocar (hybrid technique). No drainage was needed at the operating site. There were no intraoperative or postoperative complications, but one case was converted to the conventional three-port technique. The mean length of hospital stay was 3.4 days (range, 2-6 days). CONCLUSION Our preliminary results show that SILS adrenalectomy is safe and technically feasible. It should be considered among the surgical managements for selected patients with adrenal tumors.
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Affiliation(s)
- Giang Binh Tran
- Department of General Surgery, Viet Duc University Hospital, Hanoi, Vietnam.
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Chen D, Xue B, Shan Y, Yang D, Sun C. Retroperitoneal laparoendoscopic single-site surgery by single trocar technique: initial experience with renal cyst decortication. J Laparoendosc Adv Surg Tech A 2012; 22:972-7. [PMID: 23072409 DOI: 10.1089/lap.2012.0255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To retrospectively review our initial experience with respect to evaluating the feasibility and safety of retroperitoneal laparoendoscopic single-site surgery (LESS) for renal cyst decortication using the single trocar technique. PATIENTS AND METHODS Between April 2010 and November 2011, 45 patients with symptomatic simple renal cyst have undergone retroperitoneal LESS using the single trocar technique by the same experienced laparoscopic surgeon. A 10-mm 0° laparoscope with a 6-mm working channel and straight conventional laparoscopic instruments were used during all the procedures. Salient demographic and operative data were recorded, including age, body mass index, operative time, estimated blood loss, perioperative complications, analgesic requirement, etc. RESULTS Forty-three cases were accomplished successfully. In the remaining 2 patients dense adhesions around the renal cyst were encountered, and the operations were completed with an additional 5-mm trocar. The mean operative time was 49 minutes. The mean estimated blood loss was 12 mL. The mean in-hospital analgesic requirement was 2.8 mg of morphine equivalent. The mean time for ambulation postoperatively was 2 days; at the same time the drainage catheter was removed. The mean hospital stay was 3 days. There were no major perioperative complications, but superficial wound infection was noted in 1 patient. CONCLUSIONS Our initial experience with retroperitoneal LESS by the single trocar technique shows the safety and feasibility for renal cyst decortication and provides acceptable operative outcomes.
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Affiliation(s)
- Dong Chen
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Retroperitoneal laparoendoscopic single-site surgery for the treatment of retrocaval ureter. World J Urol 2012; 31:205-11. [PMID: 23053215 DOI: 10.1007/s00345-012-0965-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To present our surgical techniques for retroperitoneal laparoendoscopic single-site (LESS) pyelopyelostomy for retrocaval ureter and our initial experience with this method in 4 patients. METHODS From June 2010 to May 2011, 4 patients with retrocaval ureter underwent retroperitoneal LESS pyelopyelostomy with a homemade single-port device and standard straight laparoscopic instruments. The single-port device was made with a surgical glove and Foley catheter and allowed the introduction of three trocars. A 3-cm incision was made at the middle axillary line, midway between the iliac crest and the twelfth rib. The retrocaval segment of the ureter was mobilized and transposed anteriorly to the inferior vena cava. The pyelopyelostomy anastomosis was completed with intracorporeal freehand suturing. A double-pigtail ureteral stent assembly was implanted in 3 of the 4 patients. RESULTS All retroperitoneal LESS pyelopyelostomies were successful without conversion to standard laparoscopy or open surgery. The mean operating time was 105 min (range, 90-135 min). The mean blood loss was 18 mL (range, 5-50 mL). None of the patients required blood transfusion. The double-pigtail ureteral stent was removed 4-6 weeks postoperatively. The mean postoperative hospital stay was 7.3 days (range, 6-9 days). No intraoperative or postoperative complications occurred. At a mean follow-up of 10 months, excellent improvement in the ureteral obstruction was observed. CONCLUSIONS We report our initial experience using LESS for the treatment of retrocaval ureter. Our results in 4 patients suggest that this minimally invasive approach is a feasible treatment of retrocaval ureter. Long-term follow-up of more cases is needed to confirm its benefits.
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Reply. Urology 2012. [DOI: 10.1016/j.urology.2011.09.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Heloury Y, Muthucumaru M, Panabokke G, Cheng W, Kimber C, Leclair MD. Minimally invasive adrenalectomy in children. J Pediatr Surg 2012; 47:415-21. [PMID: 22325405 DOI: 10.1016/j.jpedsurg.2011.08.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 07/14/2011] [Accepted: 08/09/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Minimally invasive adrenalectomy (MIA) is the criterion standard for removal of small adrenal tumors in adults. The purpose of this review was to determine the place of MIA in children. METHODS The authors conducted a systematic review of the pediatric and adult literature about MIA, focusing on the technique and indications. RESULTS Minimally invasive adrenalectomy appears superior to open adrenalectomy for small tumors. The potential advantages of MIA are appealing for postoperative pain, risk of intestinal obstruction, and quality of scars. The most common approach is the transperitoneal lateral laparoscopy, which allows for a large working space. For small tumors or for bilateral adrenalectomy, the prone retroperitoneoscopy is a promising new technique. In children, the learning curve is an issue because the indications are rare. The most common indication is neuroblastoma without image-defined surgical risk factors. The incidence of local recurrence is low, but the follow-up is short in most cases. CONCLUSIONS Minimally invasive adrenalectomy is promising for removal of small adrenal tumors. Long-term follow-up is required to evaluate the efficacy of MIA in neuroblastomas. Benign diseases are excellent candidates for this minimally invasive technique.
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Affiliation(s)
- Yves Heloury
- Department of Pediatric Surgery, Monash Children's, Monash Medical Center, Clayton, Victoria,3168, Australia.
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Miyajima A, Hattori S, Maeda T, Hasegawa M, Takeda T, Kikuchi E, Asanuma H, Nakagawa K, Oya M. Transumbilical approach for laparo-endoscopic single-site adrenalectomy: Initial experience and short-term outcome. Int J Urol 2011; 19:331-5. [DOI: 10.1111/j.1442-2042.2011.02932.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rane A, Cindolo L, Schips L, De Sio M, Autorino R. Laparoendoscopic single site (LESS) adrenalectomy: technique and outcomes. World J Urol 2011; 30:597-604. [PMID: 21519852 DOI: 10.1007/s00345-011-0678-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 04/08/2011] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe the surgical technique, to analyze outcomes and to provide an overview of the current status of laparoendoscopic single site (LESS) adrenalectomy. METHODS A comprehensive PubMed search was performed for all relevant urological literature regarding LESS and adrenal surgery. In addition, experience gained at the authors' own institutions was considered. Clinical descriptive and comparative reports on LESS adrenal surgery procedures were analysed. RESULTS LESS adrenal surgery has been effectively performed for a number of indications. A wide variety of approaches (transperitoneal versus retroperitoneal, multichannel trocar versus multiple ports, trans- or extraumbilical) have been described. LESS adrenalectomy seems to be safe, taking more time than the standard laparoscopic counterpart but appears to offer the patient less postoperative discomfort. Technical difficulties of the procedure include the requirement of more time for adjustment of articulating instruments, longer 'one-handed' manipulation time, and a high peroperative tissue re-grasping rate. CONCLUSIONS The feasibility and safety of LESS adrenalectomy has been demonstrated. Only long-term follow-up outcomes will prove its benefits over conventional laparoscopy and define the role and the oncological safety of LESS adrenal surgery.
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Affiliation(s)
- Abhay Rane
- Department of Urology, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK.
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