Endoscopic Retroperitoneal Approach Research Articles

Endoscopic retroperitoneal repair of superior lumbar hernia (Grynfeltt hernia) using self-fixating mesh to prevent nerve injury: a case report

BackgroundThe primary superior lumbar hernia, also called the Grynfeltt Hernia, is a rare entity; hence, a standard surgical repair method has not been established. It is important for this repair procedure not only to prevent recurrence by placing an adequate size of mesh but also to avoid nerve injury. The endoscopic retroperitoneal approach is considered a useful technique for this procedure, requiring no mobilization of the colon and providing good visibility of the surrounding nerves. A self-fixating mesh does not require a traumatic fixation, which is considered advantageous for nerve preservation.Case presentationA 72-year-old woman, complaining of left lumbar swelling, was diagnosed with a primary left superior lumbar hernia and underwent endoscopic retroperitoneal hernia repair. With the patient in the right lateral decubitus position, five small ports were inserted, and the retroperitoneal space was dissected. The 2.0 × 1.0-cm hernial orifice was found, and the 12th subcostal nerve above the hernial orifice and the iliohypogastric and the ilioinguinal nerves below the hernial orifice were identified. A 15 × 10-cm self-fixating mesh was placed in the retroperitoneal space without mesh tacking. The postoperative course was uneventful, and the patient was discharged on the first postoperative day. Two years after surgery, there was no sign of recurrence, and chronic pain and neuropathic symptoms were absent.ConclusionsEndoscopic retroperitoneal repair of primary superior lumbar hernia using a self-fixating mesh seems to be useful for nerve preservation.

The adoption of the endoscopic retroperitoneal approach to the adrenal gland - Conversion factors and learning points

IntroductionMinimally invasive adrenalectomy includes laparoscopic transperitoneal (LA) and retroperitoneoscopic (RP) approaches. This study reviewed the local adrenalectomy practice to identify characteristics and outcomes between patients undergoing adrenalectomy via LA, RP, and RP requiring conversion (RPC). MethodsAdrenalectomies documented in a prospective surgical database were reviewed. Demographics, diagnosis, surgical approach/conversion, body mass index (BMI), radiographic body measurements (RBM), tumor size, operative time (OT), length of stay (LOS), and 30-day post-operative emergency (ED) visits were collected. Results203 adrenalectomies were reviewed from 2015 to 2020. The RP group had the shortest OT (124 ± 54 min, p = 0.281 vs LA, p < 0.001 vs RPC) and LOS (1.6 ± 1.0 days, p < 0.001 vs LA and RPC). There was an 18% conversion rate from RP to LA, and in one case to laparotomy. The RPC group had greater BMI, OT, LOS, and ED visits than LA and RP. The RPC group had less favorable RBM (p < 0.001). On multivariate analysis, RBM impacted OT, LOS, and ED visits (p < 0.05). DiscussionThe RP approach had shorter OT and LOS. BMI and RBM may increase risk of conversion, OT, LOS, and ED visits. Preoperative RBM may aid in appropriate patient selection for a RP approach.

Percutaneous Transabdominal Endoscopic Drainage in Infected Encapsulated Pancreatic Necrosis (Wall Off Necrosis): A Case Report

Introduction: The management of encapsulated pancreatic necrosis continues to be a challenge at present, in this context a percutaneous and retroperitoneal endoscopic approach is combined, with a satisfactory success rate. This technique arises when percutaneous drainage is insufficient and transgastric endoscopy is not possible due to the characteristics of the collection. We present a case of a retroperitoneal percutaneous-endoscopic approach for debridement of infected pancreatic necrosis.

Introducing robot‐assisted laparoscopic donor nephrectomy after experience in retroperitoneal endoscopic approach: a matched propensity score analysis

To assess the safety and efficacy of introducing robotic-assisted laparoscopic donor nephrectomy (RALDN) to the standard retroperitoneal endoscopic donor nephrectomy (REDN). Data were collected prospectively from 124 consecutive living kidney donors (93 for REDN subgroup and 31 for RALDN subgroup) from February 2018 to December 2020. Donor baseline demographics, perioperative outcomes and recipient outcomes were recorded, and these parameters were compared between the two subgroups before and after propensity-score matching. Mean age was 51.1 ± 9.1 years; 42.7% were males; mean body mass index was 22.7 ± 2.4; and there were 109 (88%) left kidneys. The following data of REDN and RALDN was, respectively, recorded: operative time (213 ± 43 versus 216 ± 39 min, p=0.721), warm ischemic time (4.7 ± 1.2 versus 4.9 ± 1.4 min, p=0.399), postoperative complications (5.4% versus 6.5%, p=1), haemoglobin (g/L) drop (9.4 ± 7.2 versus 9.7 ± 6.6, p=0.836), blood creatinine at 6 month (1.15 ± 0.23 versus 1.13 ± 0.24 mg/dL, p=0.734) and at 1 year (1.09 ± 0.22 versus 1.17 ± 0.28 mg/dL, p=0.591). In post-propensity score matched analyses, there was no significant differences between the two groups including intraoperative and postoperative complications. RALDN could be safely introduced into a living donor program experienced in laparoscopic donor nephrectomy. The outcomes of our study comparing these minimally invasive techniques are mostly similar in terms of intraoperative and postoperative outcomes for kidney donors.

Functional Adrenal Cortex Preservation: A Good Reason for Posterior Retroperitoneal Endoscopic Approach

IntroductionCortical-sparing adrenalectomy is a suitable treatment for hereditary and sporadic bilateral pheochromocytoma, in cases of low risk of malignancy, to reduce the possibility of adrenal insufficiency assuming the chance of local recurrence. The aim of the study is to analyze the functional results of partial adrenalectomy by retroperitoneal endoscopic approach in single-adrenal patients or patients requiring bilateral adrenalectomy. MethodsProspective study between January 2015 and February 2016 including pheochromocytoma patients diagnosed with low risk of malignant mutations. All patients agreed to be included in the study. Experienced endocrine surgeons who have been trained in minimally invasive endocrine surgery performed the procedure using the same surgical technique. Demographic variables and clinical characteristics were collected, subsequently carrying out the descriptive analysis of the data. ResultsA total of 6 patients were registered, four associated with MEN type 2 syndrome and two in the context of VHL syndrome. Retroperitoneoscopic resection was performed without laparoscopic or open conversion and no postoperative complications; the average hospital stay was 2.5 days. Preservation of the functional cortex without corticosteroids was achieved in 5 (83%) of out 6 cases with a follow-up of 26.2±6 months. Today, these 5 patients have a preserved adrenal function without hormone replacement. ConclusionsCortical-sparing adrenalectomy by the retroperitoneal endoscopic approach, in expert hands, is safe and feasible for the treatment of hereditary and sporadic pheochromocytoma in a context of low malignancy, making it possible to avoid the need for corticoid replacement in most cases.

Preservación de corteza adrenal funcionante. Una buena razón para realizar un abordaje endoscópico retroperitoneal posterior

IntroductionCortical-sparing adrenalectomy is a suitable treatment for hereditary and sporadic bilateral pheochromocytoma, in cases of low risk of malignancy, to reduce the possibility of adrenal insufficiency assuming the chance of local recurrence. The aim of the study is to analyze the functional results of partial adrenalectomy by retroperitoneal endoscopic approach in single-adrenal patients or patients requiring bilateral adrenalectomy. MethodsProspective study between January 2015 and February 2016 including pheochromocytoma patients diagnosed with low risk of malignant mutations. All patients agreed to be included in the study. Experienced endocrine surgeons who have been trained in minimally invasive endocrine surgery performed the procedure using the same surgical technique. Demographic variables and clinical characteristics were collected, subsequently carrying out the descriptive analysis of the data. ResultsA total of 6 patients were registered, four associated with MEN type 2 syndrome and two in the context of VHL syndrome. Retroperitoneoscopic resection was performed without laparoscopic or open conversion and no postoperative complications; the average hospital stay was 2.5 days. Preservation of the functional cortex without corticosteroids was achieved in 5 (83%) of out 6 cases with a follow-up of 26.2 ± 6 months. Today, these 5 patients have a preserved adrenal function without hormone replacement. ConclusionsCortical-sparing adrenalectomy by the retroperitoneal endoscopic approach, in expert hands, is safe and feasible for the treatment of hereditary and sporadic pheochromocytoma in a context of low malignancy, making it possible to avoid the need for corticoid replacement in most cases.

V11-07 SUCCESSFUL EXCISION OF RETROCAVAL TUMOR BY RETROPERITONEOSCOPIC APPROACH IN TWO PATIENTS

You have accessJournal of UrologyAdrenal/Single Port Surgery/LESS/NOTES1 Apr 2015V11-07 SUCCESSFUL EXCISION OF RETROCAVAL TUMOR BY RETROPERITONEOSCOPIC APPROACH IN TWO PATIENTS Tomonori Habuchi, Takamitsu Inoue, Ryuichi Ito, Yasushi Ichimura, Naoko Kawata, Norihiko Tsuchiya, and Masahiro Iinuma Tomonori HabuchiTomonori Habuchi More articles by this author , Takamitsu InoueTakamitsu Inoue More articles by this author , Ryuichi ItoRyuichi Ito More articles by this author , Yasushi IchimuraYasushi Ichimura More articles by this author , Naoko KawataNaoko Kawata More articles by this author , Norihiko TsuchiyaNorihiko Tsuchiya More articles by this author , and Masahiro IinumaMasahiro Iinuma More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2605AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic excision of a retroperitoneal tumor located dorsal to the inferior vena cava (IVC) is challenging. It is often difficult to manage such tumors located superior to the kidney by transperitoneal approach because of intraabdominal organs and IVC. We show the video of successful excision in two patients with a retrocaval tumor using the retroperitoneoscopic approach. METHODS Patient No.1 was a 43-year-old woman with repeated episodes of hypertensive attack and the high serum noradrenalin level. CT and MRI revealed a 35∼20∼35-mm tumor dorsal to the IVC at the level of the superior mesenteteric artery (SMA). The median border of the tumor extended beyond the SMA. MIBG scintigraphy was positive. Patient No. 2 was a 53-year-old woman with an incidentally found retrocaval tumor without any endocrinological abnormal findings. CT and MRI showed a 42∼30∼37-mm tumor dorsal to the IVC at the level of celiac arterial trunk. MIBG scintigraphy was negative. RESULTS In both patients, four trocars including a camera port were placed and the tumors were excised successfully without complications. Operating time was 168 minutes and 137 minutes, respectively. Postoperative course was uneventful in both patients. Pathologically, the tumor was paraganglioma in patient No.1 and schwannoma in patient No. 2. CONCLUSIONS The relatively large tumor located dorsal to the IVC can be successfully excised by the retroperitoneal endoscopic approach. By widely opening Gerata□fs (lateroconal) fascia and making a wide space superior and posterior to the kidney, a sufficient surgical view and space to operate the retrocaval tumor was obtained without being hindered by intra-abdominal organs. The retroperitoneoscopic surgical excision is feasible and safe for the management of retrocaval tumors. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e909 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tomonori Habuchi More articles by this author Takamitsu Inoue More articles by this author Ryuichi Ito More articles by this author Yasushi Ichimura More articles by this author Naoko Kawata More articles by this author Norihiko Tsuchiya More articles by this author Masahiro Iinuma More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgical treatment options for aldosteronomas.

IntroductionSingle access retroperitoneoscopic adrenalectomy (SARA) is the most feasible approach for removing aldosteronomas.AimTo analyse the advantages and disadvantages of surgical approaches to treating small adrenal tumours.Material and methodsIn the period 2002-2011, 31 patients were operated on at Vilnius University Hospital Santariskiu Clinics for aldosteronomas. Adrenalectomies were performed in the lateral laparoscopic (group A, n = 6), the endoscopic retroperitoneal (group B, n = 20), and the single incision laparoscopic surgery (SILS) and SARA (group C, n = 5) approaches. Seventy five percent of patients were operated on by the same surgeon. The duration of adrenalectomies, and intraoperative and postoperative complications were compared. The possibility of minimally invasive adrenalectomies was evaluated.ResultsAccording to the patients’ age, body mass index and tumour size, the groups were equal. The average duration of surgery in group A was shorter than in groups B and C (91 ±23 min vs. 118 ±57 min vs. 144 ±88 min). Right laparoscopic adrenalectomy was longer than the left (105 ±26 min vs. 77 ±6 min), whereas right endoscopic retroperitoneal adrenalectomy was shorter than the left (109 ±50 min vs. 126 ±57 min). The best cosmetic view was in group C. The SARA method was converted into the endoscopic retroperitoneal approach and then into the laparoscopic for one patient. There were no intraoperative or postoperative complications.ConclusionsEvaluating the minimal invasion of the method, its abilities and simplicity of conversion into another type of endoscopic surgical way, the SARA approach should be the first option for removing aldosteronomas.

Necrotizing Acute Pancreatitis Current Status - Emerging New Strategies in Surgical Management

Despite that pancreatic necrosis complicates only 15 % of cases of acute pancreatitis (AP), it is associated with high morbidity and considerable mortality. In an attempt to improve prognosis, many surgical strategies have been described during the last few decades. Currently, necrosectomy remains the cornerstone in the surgical treatment of infected pancreatic necrosis and in selected cases of sterile necrotizing pancreatitis. Following necrosectomy, continuous closed lavage is recommended by many authors, while closed abdominal packing /drainage and repeated planned necrosectomies- commonly using the zipper technique-are also acceptable alternative strategies. Open abdomen (laparostomy) is rarely indicated in carefully selected cases (typically in abdominal compartment syndrome associated with necrotizing AP). During the last decade, minimally invasive techniques (including percutaneous drainage, retroperitoneal endoscopic approach, transgastric endoscopic approach etc) have been extensively studied by some groups not only in the management of pancreatic abscesses and / or pseudocysts, but also as primary methods of treatment of necrotizing AP. Results have been impressive, but experience currently is limited to only a few centers around the world.

Bilateral Pheochromocytoma in von Hippel-Lindau Syndrome Simultaneously Removed by Lateral Retroperitoneal Endoscopic Approach

ABSTRACT Von Hippel-Lindau (VHL) syndrome is an autosomal dominant familial neoplastic syndrome caused by mutation in VHL tumor suppressor gene localized on chromosome 3p25. The disease is characterized by abnormal vascular proliferation and increased risk of developing renal cell carcinoma, pheochromocytoma, hemangioblastoma of the central nervous system, tumors of the endolymphatic bag, cysts of the kidney, liver and pancreas, epididymal cystadenomas, neuroendocrine tumors of the pancreas, angiomas in the retina. We report a case of a bilateral pheochromocytoma, simultaneously removed by unilateral total and contralateral subtotal retroperitoneal endoscopic adrenalectomy. How to cite this article Todorov G, Grozdev K, Lukanova T, Mioljevikj-Miserliovska B, Miserliovski R. Bilateral Pheochromocytoma in von Hippel-Lindau Syndrome Simultaneously Removed by Lateral Retroperitoneal Endoscopic Approach. World J Endoc Surg 2012;4(3):102-104.

V1018 LAPAROSCOPIC RETROPERITONEAL LYMPH NODE DISSECTION FOR RENAL CANCER METASTASIS

You have accessJournal of UrologyKidney & Ureter Oncology1 Apr 2011V1018 LAPAROSCOPIC RETROPERITONEAL LYMPH NODE DISSECTION FOR RENAL CANCER METASTASIS Vincent Flamand, Rafael Sanchez-Salas, Luc Vanseymortier, and Eric Leblanc Vincent FlamandVincent Flamand Lille, France More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas Paris, France More articles by this author , Luc VanseymortierLuc Vanseymortier Lille, France More articles by this author , and Eric LeblancEric Leblanc Lille, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1053AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Retroperitoneal lymph node metastatic recurrence after radical nephrectomy (RN) might indicate surgical intervention in selected cases. METHODS A 62 years old man who presented with a 32 mm inter aorta-caval mass at a 6 years follow up after a pT2 clear cell adenocarcinoma, Furhman I. Physical examination was normal. A retroperitoneal lumpectomy was performed through a retroperitoneal approach with patient placed in a supine position. Initial incision was performed at the right flank at the level of the anterior axilar line, two fingers breath distance from the anterior iliac spine. Finger-blunt dissection was done to develop the surgical field. 10 mm trocar is positioned in this incision and two other ports were placed under endoscopic vision. Lumpectomy was readily accomplished using sharp and blunt dissection. Removal of specimen was performed with an extraction device. RESULTS Operative time and total blood loss were 125 minutes and 20 cc, respectively; with a 2 days hospitalization period. No complications occurred. Pathology confirmed a RCC tumoral node invasion, with negative surgical margins. At 12 months follow-up the patient remains free of recurrence. CONCLUSIONS Retroperitoneal node metastasis for renal cell carcinoma can be seen in the long-term follow-up. These rare lesions are suitable for surgical treatment with a retroperitoneal endoscopic approach. Avoiding the penetration of peritoneal cavity might allow a faster recovery for the patient and a diminished risk of complications. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e411 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vincent Flamand Lille, France More articles by this author Rafael Sanchez-Salas Paris, France More articles by this author Luc Vanseymortier Lille, France More articles by this author Eric Leblanc Lille, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Retroperitoneal endoscopic release in the management of celiac artery compression syndrome

Celiac artery compression syndrome (CACS) can be treated successfully by division of the median arcuate ligament and celiac plexus fibers. The standard technique is the open approach by an upper midline or left subcostal incision. Only six single cases in which a laparoscopic transabdominal approach for CACS was used have been reported. We prospectively evaluated the feasibility of the endoscopic retroperitoneal approach for treatment of CACS. All patients with symptoms suggestive of CACS were evaluated using splanchnic duplex ultrasound scanning, gastric exercise tonometry (GET), and multiplane selective splanchnic angiography. The criteria for treatment were chronic abdominal symptoms, respiratory-dependent CA stenosis, and abnormal GET result. The release was performed by a retroperitoneal endoscopic approach. Anatomic success of the procedure was confirmed by angiography. The endoscopic retroperitoneal approach was used to treat 46 patients with CACS. One patient (2%) required conversion to an open procedure due to suprarenal artery bleeding. Release was ended prematurely in one patient due to a pneumothorax resulting in loss of working space. A postoperative pneumothorax developed in two patients, of which one needed treatment. No other complications were observed. Postoperative angiography during inspiration and expiration showed normal vessel anatomy in 36 of 46 patients. Six of 10 patients with persisting intraluminal stenoses were treated endovascularly. Five of these were successful, which brings the primary-assisted anatomic patency for the total group to 89% (41 of 46 patients). Three patients are being observed, and endovascular treatment remains an option in case of insufficient improvement. On median follow-up of 20 months (range, 2-42 months) 41 patients were free of symptoms or showed significant improvement. The endoscopic retroperitoneal approach for the release of the CA in CACS, with additional endovascular treatment of persistent stenosis, is feasible and effective. Short-term results were comparable with the open procedure.

Endoscopic retroperitoneal adrenalectomy

To determine prospectively in consecutive patients the value of endoscopic retroperitoneal adrenalectomy. Between March 1994 and March 1995, endoscopic adrenalectomy via a retroperitoneal approach was performed in eleven patients (three men, eight women; median age 61 [48-73] years), unilateral in nine, bilateral in two. The procedure was indicated if the adrenal tumour was thought to be benign and no larger than 5 cm in diameter (two adrenal and two central Cushing's syndromes; three incidentally detected adrenal adenomas, two phaeochromocytomas, two Conn adenomas). Twelve of the 13 procedures were successfully performed. In one case the primary incision in the mid-axillary line had been too large and no satisfactory pneumoretroperitoneum was achieved. Median duration of operation was 180 (125-330) min, and the intraoperative blood loss was 200 (125-330) ml. There were no postoperative complications and the median postoperative hospital stay was 6 days (3-12). In small (up to 5 cm) adrenal tumours not suspected to be malignant the endoscopic retroperitoneal approach constitutes a sparing alternative to the conventional access to the adrenal gland.

ENDOSCOPIC TOTAL RETROPERITONEAL DISTAL PANCREATECTOMY IN A LARGE ANIMAL MODEL

Traditionally, distal pancreatic lesions are resected by the open technique. An ever-increasing number of laparoscopic transperitoneal distal pancreatectomy cases are being reported. This study explores the possibility of performing distal pancreatectomy via an endoscopic retroperitoneal approach. This study was done in two stages using a total of 15 pigs: the first stage involved dissection in euthanized pigs, and the second stage involved anesthetized pigs. In both stages of the study, distal pancreatectomy could be performed within an acceptable time frame and with acceptable resection margins and morbidity rate. We introduce the concept of endoscopic total retroperitoneal distal pancreatectomy as an approach for distal pancreatectomy.

Retroperitoneoscopic Adrenalectomy Without Previous Control of Adrenal Vein Is Feasible and Safe for Pheochromocytoma

To evaluate the effectiveness and safety of retroperitoneal laparoscopic adrenalectomy for pheochromocytoma and report our experience in adrenalectomy without previous control of the adrenal vein. From January 2000 to December 2005, 56 patients underwent 58 retroperitoneal laparoscopic adrenalectomy procedures for the treatment of pheochromocytoma. Adequate preoperative antihypertensive preparation was performed. Intraoperative hemodynamic changes were documented in detail. During surgery, the adrenal vein was identified and ligated after dissection and mobilization of the adrenal gland. One patient required conversion to open surgery. The mean operative time and estimated blood loss was 50.4 +/- 19.8 minutes (range 25 to 150) and 76.4 +/- 23.5 mL (range 20 to 300), respectively. A systolic blood pressure greater than 200 mm Hg or less than 80 mm Hg was observed in 6 and 3 patients, respectively. Moreover, an upward fluctuation of systolic blood pressure (20 mm Hg or greater) was recorded during laparoscopic manipulation in 21 patients (37.5%), and in 8 of them, it was 50 mm Hg or greater. The mean diameter of the excised masses was 4.6 +/- 1.7 cm (range 1.5 to 10.0). The mean hospital stay was 5.2 +/- 1.3 days (range 3 to 9). No patients had a major complication and none died. During the follow-up period of 5 months to 3 years, 36 patients recovered normal blood pressure without antihypertensive drugs. No tumor recurrences developed. Retroperitoneal laparoscopic adrenalectomy without previous control of the adrenal vein is effective and safe for ablation of pheochromocytoma. For experienced surgeons, the tumors larger than 6 cm in diameter can also be removed using the retroperitoneal endoscopic approach.

Safety and efficacy of endoscopic retroperitoneal adrenalectomy

Minimally invasive adrenalectomy has replaced open surgery in the treatment of benign adrenal tumours. Transperitoneal and retroperitoneal approaches have been advocated. However, long-term outcome data are rare. Over a period of 8 years, 123 patients underwent surgery for benign adrenal lesions using the endoscopic retroperitoneal approach. Data were analysed retrospectively by review of medical charts. Long-term results were obtained by sending questionnaires to patients and contacting their primary physicians. One hundred and twenty-three patients underwent 126 endoscopic retroperitoneal adrenalectomies. Mean operating time for unilateral adrenalectomy was 115 min, whereas that for bilateral adrenalectomy was 208 min. The conversion rate was 4.8 per cent. Complications occurred after 15.9 per cent of adrenalectomies. One patient died during the postoperative period. Long-term results were obtained in 80 patients (74.8 per cent). Nine patients (11 per cent) reported chronic incisional pain and six patients (8 per cent) had chronic abdominal pain. Addisonian crisis after bilateral adrenalectomy occurred in three patients. Most patients (86 per cent) were satisfied with the cosmetic results. Endoscopic retroperitoneal adrenalectomy is a safe and effective procedure. Long-term outcome is acceptable and the procedure has excellent cosmetic results.

Extraperitoneal laparoscopic para-aortic lymphadenectomy for lymph node recurrence of fallopian tube carcinoma

The endoscopic retroperitoneal approach is a minimally invasive method for surgical staging of cervical cancer. A 57-year-old woman had an intraoperative diagnosis of carcinoma of the left fallopian tube and undergone a retroperitoneal pelvic and para-aortic lymphadenectomy with no peritonization during surgical staging. Small suspicious nodes in the serous membrane of the sigmoid colon and peritoneal washings were positive for malignancy. A total of 12 nodes were obtained, all of which were negative. She received six cycles of paclitaxel and platinum-based chemotherapy and showed a complete clinical response. Thirty-two months after surgery, the abdominal computed tomography scan showed a left para-aortic lymph node, 19 mm in diameter, which was successfully removed through an extraperitoneal laparoscopic approach. The extraperitoneal laparoscopic approach of the para-aortic region is a feasible procedure after previous transperitoneal lymphadenectomy and chemotherapy.

Extraperitoneal laparoscopic para-aortic lymphadenectomy for lymph node recurrence of fallopian tube carcinoma

The endoscopic retroperitoneal approach is a minimally invasive method for surgical staging of cervical cancer. A 57-year-old woman had an intraoperative diagnosis of carcinoma of the left fallopian tube and undergone a retroperitoneal pelvic and para-aortic lymphadenectomy with no peritonization during surgical staging. Small suspicious nodes in the serous membrane of the sigmoid colon and peritoneal washings were positive for malignancy. A total of 12 nodes were obtained, all of which were negative. She received six cycles of paclitaxel and platinum-based chemotherapy and showed a complete clinical response. Thirty-two months after surgery, the abdominal computed tomography scan showed a left para-aortic lymph node, 19 mm in diameter, which was successfully removed through an extraperitoneal laparoscopic approach. The extraperitoneal laparoscopic approach of the para-aortic region is a feasible procedure after previous transperitoneal lymphadenectomy and chemotherapy.

Inguinal neurectomy for nerve entrapment after open/laparoscopic hernia repair using retroperitoneal endoscopic approach

Inguinal neuralgia after open and laparoscopic hernia, repair occurs in about 0.5% of treated patients. If the pain and the functional inability persist, it is possible that the genitofemoral nerve and ileoinguinal nerve are involved in entrapment, and surgical treatment is a possible option. This paper reports a personal endoscopic retroperitoneal approach for ileoinguinal and genitofemoral branches neurectomy. A 12-mm trocar is inserted into the lower retroperitoneum and insufflated to create a work space. Neurectomy is performed under endoscopic guidance. Six patients were treated using this technique. The operating time was 55 min, and all patients were completely pain-free after surgery. All patients were discharged the first day after operation and there were no complications. This retroperitoneal endoscopic approach is proposed as a new surgical technique for treating inguinal entrapment neuralgia. It is simple and feasible.

Simpatectomia lombar retroperitoneal endoscópica

In the last few years, there has been an increase in the indication of lumbar sympathectomy for plantar hyperhidroses. There are few reports of the laparoscopic access for this operation, even when it seems to be a very apropriate method. A case of a left lumbar sympathectomy through the retroperitoneal endoscopic approach is presented. The total control of left plantar hiperhidroses was achieved, showing the effectiveness of this operation, completely feasible through extraperitoneal endoscopic route.