Extraperitoneal laparoscopy: early experience and evaluation

Retroperitoneal renal laparoscopy

The retroperitoneal laparoscopic approach to the kidney offers a minimally invasive access that mimics the open surgical techniques of renal surgery. It allows renal surgery without violation of the peritoneal cavity with its attendant complications such as bowel injury and ileus. Over the last two decades, all renal surgery has been shown to be feasible through this technique. This includes complicated procedures such as a donor nephrectomy and radical nephroureterectomy for upper tract transitional cell cancers. We began performing retroperitoneoscopic renal surgery in the early 1990s and have developed a number of modifications to existing techniques so as to make this surgery easy and cost effective. In this review, we discuss the evolution of retroperitoneoscopic renal surgery, the indications, techniques and outcome of all types of retroperitoneoscopic renal surgery.

One hundred and ten consecutive uncomplicated retroperitoneal videoscopic adrenalectomies--Polish multicentre study

AIM

The authors evaluate the effectiveness of videoscopic adrenalectomy (VA) for a variety of endocrine disorders.

METHODS

One hundred and ten consecutive videoscopic adrenalectomies performed from October 1995 till December 2000 were reviewed and followed up for adequacy of surgical treatment in 2 surgical departments. There were 79 females and 31 males included in the study. The mean age was 48.0 years (range 23-71 years). Indications for the operations were: phaeochromocytomas (n=5), aldosterone-producing adenomas (n=19), cortisol-producing adenomas (n=10), Cushing's disease (n=3) and non-secreting tumours (n=72).

RESULTS

There was no mortality and no morbidity both intraoperatively and in the postoperative course. In 8 cases conversion to open surgery was instituted - in 4 cases due to an unintended lesion of pertioneum without damage to the intraperitoneal organs. Mean operative time was 156 min (range 52-280 min), and estimated blood loss was 73 ml (range 20-300 ml). The average length of hospital stay was 2.9 days (range 2-7 days). None of the patients revealed either recurrence of hormonal hypersecretion or tumour mass in imaging studies during the follow-up period (range 1-34 months).

CONCLUSION

1. VA is recommended in patients with hormonally active tumours and in patients with benign adrenal masses of a diameter up to 6 cm. 2. VA is a safe and feasible procedure if performed by a team experienced in endocrine and endoscopic surgery. 3. VA is a procedure better than open adrenalectomy in management of small, non-malignant tumours because of the reduction of operative trauma.

Retroperitoneal laparoscopic management of urolithiasis

Laparoscopic retroperitoneal pyelolithomy (Lap PL) and ureterolithotomy (Lap UL) were performed in 20 and 24 patients, respectively. The average operating time was 61.4 minutes for Lap UL and 80.2 minutes for Lap PL. The conversion rate for Lap PL was 4 (20%) patients, and none of the Lap ULs required conversion. There were no major postoperative complications, except prolonged tube drainage in 2 patients, and the average hospital stay was 3.6 days.

Laparoscopic Burch colposuspension for stress incontinence: preliminary results

OBJECTIVE

To assess the safety, effectiveness and potential benefits of laparoscopic Burch colposuspension.

DESIGN

Non-randomised prospective study.

SUBJECTS

Fifteen women, presenting consecutively with urodynamically confirmed urinary stress incontinence.

RESULTS

The operation was successfully completed with no perioperative morbidity in 14 women. One woman subsequently underwent laparotomy after injury to the inferior epigastric artery. The average duration of surgery was 110 minutes, postoperative catheterisation 30 hours, and hospital stay 2.3 days. There was little postoperative discomfort. Most women were able to return to normal activities within one to two weeks. At follow-up (6 weeks-9 months) all the women were continent.

CONCLUSION

Laparoscopic Burch colposuspension is a safe and feasible alternative to the open technique. Early results show the benefits of easy access to the cave of Retzius, a clear view of the operating field, minimal intraoperative blood loss, shortened postoperative catheterisation and hospitalisation times, little postoperative pain and early return to normal lifestyle.

Laparoscopic ureterolithotomy: the results of an initial series, and an evaluation of its role in the management of ureteric calculi

OBJECTIVE

To evaluate the place of laparoscopic ureterolithotomy in the management of ureteric calculi for which extracorporeal shockwave lithotripsy (ESWL) and endourological techniques are unsuitable.

PATIENTS AND METHODS

Laparoscopic ureterolithotomy was attempted in nine patients (eight men, one woman) with an age range of 26-81 years (mean 55.5) who had large, long standing and impacted calculi in the upper and mid ureter. The stone size ranged from 5 to 28 mm (mean 13.2) and stone duration ranged from one to 24 months (mean 8.2). The transperitoneal route was used in six patients and the extraperitoneal route in three but was converted to a transperitoneal approach in two.

RESULTS

The stone was successfully removed in all nine patients. The operative time ranged from 80 to 260 minutes (mean 158). No intra-operative complication was encountered and no patient required a blood transfusion. Post-operative complications included urinary leak and fever. The post-operative stay ranged from 2 to 13 days (mean 5.2).

CONCLUSIONS

Laparoscopic ureterolithotomy has definite advantages over open ureterolithotomy. Furthermore, the more difficult a stone is for treatment by ESWL and endourological techniques, the more suitable it is for laparoscopic removal. For large, hard, long-standing and impacted ureteric calculi, one laparoscopic ureterolithotomy as initial therapy may be preferable to multiple endourological and ESWL procedures.

Laparoscopic extraperitoneal inguinal hernia repair using a balloon dissection technique

A laparoscopic extraperitoneal approach using a balloon dissection technique was used to repair 40 inguinal hernias in 35 patients. The initial experience with this method is presented. Thirty-four of these hernias were indirect, five direct and one sliding. Three were recurrent hernias. The operation time ranged from 40 to 135 min. Thirty-two of the patients stayed overnight in the hospital; Three stayed 2 nights. Return to normal activities ranged from 3 to 21 days. None of the patients had problems with nerve entrapment and to date there have been no recurrences of the hernias following the repairs. The procedure has been very well-tolerated by all patients.