Retroperitoneal Laparoscopy Research Articles

New technique of En bloc vertebral resection in the thoracolumbar region assisted by retroperitoneal laparoscopy in a single prone position: first results.

To describe the technique and review the oncological and surgical results of the En Bloc resection assisted by retroperitoneal laparoscopy in a single prone position for tumors in the thoracolumbar region. Monocentric retrospective case study. Procedure was performed in a single prone position by a dual team of spine and thoracovascular surgeons. An endoscopic balloon was inflated in the right retroperitoneal cavity. A plan was developed between the anterior spine and vena cava as well as abdominal aorta with segmental vessels ligation. Structures at risk were safely protected under endoscopy during horizontal or sagittal osteotomies. From 2021, seven patients aged a median 52years old (range, 34-67) were included. Involved spinal segments went from T11 to L3. Surgery was aborted in one case due to massive bleeding and ventilating difficulties. There were two partial and four total vertebral resections. Median operating duration and estimated blood loss were 405min (range, 360-540) and 2.1 L (range, 1.2-19), respectively. Postoperative complications consisted of 1 urinary infection; 1 transient urinary retention; 1 posterior wound infection; 1 pneumothorax; 1 persistent partial motor deficit; 1 transient confusion; 1 pulmonary embolism; 1 CSF leak; 1 subdural hematoma; 1 retroperitoneal lymphocele. All margins were uncontaminated. All patients were alive and ambulatory at last follow-up. Early results suggest En Bloc resection assisted by retroperitoneal videoscopy in tumors from T11 to L3/4 disk space is feasible, less invasive and safe. Careful surgical planning and experience in endoscopic vascular surgery are mandatory.

Patient satisfaction analysis of robot-assisted minimally invasive adrenalectomy: a single-center retrospective study.

The objective of this study is to compare the satisfaction of patients undergoing robot-assisted retroperitoneal laparoscopy adrenalectomy under the ambulatory mode and conventional mode. Basic information and clinical data of patients who underwent robotic-assisted posterior laparoscopic adrenalectomy between June 2020 and June 2023 were queried from our case system. The Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems Survey (OAS CAHPS®) was used to investigate patient satisfaction with preoperative preparation, discharge counseling, postoperative instructions, postoperative pain, and satisfaction with nursing work. The stats R package was used to select the appropriate statistic for the statistics based on the characteristics of the data. A total of 311 patients who underwent robot-assisted posterior laparoscopic adrenalectomy were enrolled in our case system. There were no statistical differences between the two groups in gender, age, body mass index, ASA classification, laterality, maximum tumor diameter, type of resection, hormonal activity, disease type, pathological classification, duration of surgery, estimated intraoperative bleeding, postoperative complications and follow-up period that were compared between the two groups of patients. There were no significant differences in preoperative preparation score, discharge counseling score, postoperative guidance score and nursing care satisfaction score (P > 0.05). Postoperative hospitalization, peristalsis time, defecation time, time to first postoperative mobilization, duration of indwelling drain and hospitalization costs in patients in the ambulatory model group were significantly less than patients in the conventional model group (P < 0.001). Patients in the ambulatory model group had significantly higher postoperative pain relief scores than patients in the conventional model group. In conclusion, our data suggest that patient satisfaction is equal between the conventional and ambulatory mode of performing robotic-assisted adrenalectomy. Patient satisfaction was probably associated with shorter hospitalization days, adequate preoperative preparation and standardized, high-quality post-discharge information and guidance.

Pure Retroperitoneal Laparoscopic Peritoneum Incision Technique in Right Nephrectomy and Inferior Vena Cava Tumor Thrombectomy: A Novel Surgical Technique and Long-Term Outcomes from a Large Chinese Center.

Purpose: To explore the safety and effectiveness of the Pure Retroperitoneal Laparoscopic Peritoneum Incision Technique (PREP-IT) in laparoscopic radical nephrectomy (LRN) and inferior vena cave (IVC) tumor thrombectomy for right renal-cell carcinoma (RCC) with level Mayo I to III venous tumor thrombus (VTT). Patients and Methods: From May 2015 to September 2020, 92 patients with right RCC and Mayo I to III VTT were retrospectively reviewed, including 57 patients who underwent retroperitoneal LRN and IVC thrombectomy using PREP-IT, and 35 patients who underwent open surgery. PREP-IT refers to dissecting the retroperitoneum and temporarily placing the right kidney into the abdominal cavity to enlarge the retroperitoneal workspace for a safer and faster IVC operation. Results: Compared with the open surgery group, the PREP-IT group had a larger tumor diameter, while a larger proportion of Mayo I tumor thrombus and smaller maximum tumor thrombus width. Two patients (3.5%) in the PREP-IT group had a history of abdominal surgery. No conversion to open surgery or standard laparoscopic surgery occurred in PREP-IT group. Laparoscopic surgery with PREP-IT was characterized by shorter operative time, less surgical blood loss, shorter postoperative hospital stay, and lower postoperative complication rate. With a 33-month (ranges: 2-86) follow-up time period, the estimated mean overall survival time was 57.2 ± 5.3 and 58.1 ± 71.5 months in the PREP-IT group and open surgery group, respectively. Log-rank test indicated no significant difference between the two groups in terms of overall survival and cancer-specific survival. Conclusions: The PREP-IT is relatively safe and feasible for retroperitoneal LRN with right renal tumor and IVC tumor thrombus, allowing for a large workspace and wide exposure for IVC operations.

MP69-17 NECESSITY OF PROPHYLACTIC DRAINAGE TUBE IN RETROPERITONEAL LAPAROSCOPIC NEPHROURETERECTOMY WITH OPEN DISTAL URETERECTOMY: A MATCHED-PAIR ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP69-17 NECESSITY OF PROPHYLACTIC DRAINAGE TUBE IN RETROPERITONEAL LAPAROSCOPIC NEPHROURETERECTOMY WITH OPEN DISTAL URETERECTOMY: A MATCHED-PAIR ANALYSIS Hiroki Hagimoto, Mutsushi Kawakita, and Toshinari Yamasaki Hiroki HagimotoHiroki Hagimoto More articles by this author , Mutsushi KawakitaMutsushi Kawakita More articles by this author , and Toshinari YamasakiToshinari Yamasaki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the necessity of prophylactic drain placement in retroperitoneal laparoscopic nephroureterectomy with open distal ureterectomy for upper tract urothelial cancer. METHODS: Between July 2011 and March 2021, 200 patients with localized clinical Tis-T3 upper urinary tract urothelial carcinoma underwent laparoscopic nephroureterectomy with open distal ureterectomy. After removing the specimen, drainage tubes were placed on the renal beds and/or in the retrovesical spaces. Drain tubes were omitted for most patients after 2017. We compared the postoperative outcomes between the patients with drain placement (D+ group) and without drain placement (D- group) by propensity score matching. RESULTS: A total of 164 patients (90 in the D+ group and 74 in the D- group) were enrolled, and matched pairs of 108 patients were analyzed. There was no significant difference in the incidence of complications according to Clavien–Dindo grade in the two groups after the propensity score matching. There was no significant difference in the incidence of postoperative lymphocele (n=5 vs. 9, p=0.395) and symptomatic lymphocele (n=1 vs. 1, p=1) between the two groups. The length of hospital stay was significantly shorter in the D- group (11 vs. 8 days, p<0.0001). CONCLUSIONS: Omitting the drainage tube after laparoscopic radical nephroureterectomy does not increase postoperative complications or lymphocele and shortens the post-hospital stay. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e971 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiroki Hagimoto More articles by this author Mutsushi Kawakita More articles by this author Toshinari Yamasaki More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of the efficacy of robotic-assisted retroperitoneal laparoscopy and traditional retroperitoneal laparoscopy in partial nephrectomy among patients with renal tumors: A retrospective cohort study.

The efficacy of robotic-assisted retroperitoneal laparoscopy (RARL) and traditional retroperitoneal laparoscopy (TRL) in patients undergoing partial nephrectomy for treatment of a renal tumor were compared in this study. The retrospective study reviewed patients with renal tumors who underwent partial nephrectomy in our hospital between January 2020 and February 2022. According to different surgical methods, the patients were enrolled into the RARL (experimental group, n=65) or the TRL (control group, n=63) partial nephrectomy group. One hundred twenty-eight patients were reviewed. The number of patients with collecting system injuries in the experimental group (19 cases) was significantly less than in the control group (32 cases; p<0.05). The operative time (115.7±48.2 min vs. 143.1±25.5 min) and heat ischemia time (18.7±4.9 min vs. 26.4±5.2 min) were significantly shorter in the experimental group than in the control group. The intraoperative blood loss (35.4±13.2 mL vs. 96.1±34.3 mL) and postoperative drainage volume (55.9±26.4 mL vs. 75.2±32.6 mL) were significantly less in the experimental group than in the control group (p<0.05). The change in postoperative glomerular filtration rate decrease in the experimental group was significantly lower than that in the control group (p<0.05). The change level in postoperative creatinine increase in the experimental group were significantly lower than those in the control group (p<0.05). There were no considerable differences in other clinical indicators or follow-up results between the two groups. RARL was superior to TRL for renal tumor treatment with respect to operative time, intraoperative blood loss, warm ischemia time, and postoperative renal function recovery.

Application of retroperitoneal laparoscopy and robotic surgery in complex adrenal tumors

Application of retroperitoneal laparoscopy and robotic surgery in complex adrenal tumors

Retroperitoneoscopic nephrectomy versus open surgery for non-tuberculous pyonephrotic nonfunctioning kidney: a single-center experience.

BackgroundPatients with obstructive pyonephrotic nonfunctioning kidney (OPNK) often require simple nephrectomy for long-term severe clinical symptoms. We aimed to analyze the outcomes of retroperitoneal laparoscopy versus open surgery for OPNK.MethodsThe study included clinical data of 69 patients with non-tuberculous OPNK from January 2015 to June 2019 in a single center. The patients were divided into laparoscopic group (LS, N=33) and open surgery group (OS, N=36). Those whose pathological findings were xanthogranulomatous inflammation or tuberculous granuloma were excluded. Statistical analysis compared the two groups in terms of basic demographic characteristics, preoperative laboratory examination results, and intraoperative and postoperative observation indicators.ResultsThe results showed that non-tuberculous OPNK were more common in women (female/male =4:1). Compared with the LS group, patients in the OS group had higher white blood cells (WBC; P=0.010) and neutrophils (P=0.005) counts before surgery. The main clinical symptoms were low back pain, pyuria, and fever; among them, low back pain combined with pyuria was in the majority. More intraoperative hypotension events were observed in the OS group (P=0.007). Notably, subgroup analysis showed larger stone size happened in the OS group (OR 3.538, 95% CI, 1.337, 9.208). No statistical difference was found in the duration of surgery between the two groups while the length of postoperative hospitalization and retroperitoneal drainage, and postoperative blood transfusion rate increased significantly in the OS group. Postoperative use of non-steroidal anti-inflammatory drugs was more common in the LS group, while opioid analgesics were in the OS group (P=0.0006). There was no statistical difference in other complications.ConclusionsIn conclusion, considering the advantages of LS in terms of postoperative blood transfusion, surgical drainage and length of hospital stay, we recommend it for non-tubercular OPNK when the stone load of pyonephrosis side was less than 280 mm2 and the preoperative WBC and neutrophil count were within the normal range.

Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cysts: What we learned and a review of the literature.

To avoid Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cyst (diameter > 70 mm), we present two cases of iatrogenic ureteral injury and discuss their clinical courses and final outcomes. Two male patients (47 years old and 74 years old) with large left simple renal cysts underwent a retroperitoneal laparoscopic operation to treat the cysts. In the first patient, the left proximal ureter was partially transected (Grade 3) during the operation. The injury was identified intraoperatively. The transection was managed with a primary ureteroureterostomy (end to end) along with a double J ureteral stent. In the second patient, the left proximalureter was partially transected (Grade 4). However, the injury was unrecognized postoperatively for two days. After recognition of the complication, the injury was managed with an early primary ureteroureterostomy, which followed a failed attempt to place ureteral stent endoscopically. In the first patient, a postoperative urinary leakage developed and lasted for 13 days. During long term follow-up of the first patient after the urine leak resolved, there were no reports of pain in the lumbar region or other discomfort. No recurrence of the renal cyst occurred, which was confirmed with an ultrasound at one year postoperatively. In the second patient a ureteral fistula and severe perirenal infection occurred and lasted for 86 days. The patient ultimately underwent a left nephrectomy after conservative management for this surgical complication failed. This patient developed a chronic wound infection that lasted for 3.14 months following the nephrectomy. During follow-up post nephrectomy, the patient developed stage 3B moderate chronic kidney disease (CKD) (GFR = 30 -44 ml/min). For single large (diameter > 70 mm) renal cysts located at the lower pole of the kidney, it is recommended to not completely dissect out and mobilize the entire renal cyst for cyst decortication in order to avoid injuring the ureter. Iatrogenic ureteral injury increases the risk of readmission and serious life-threatening complications. The immediate diagnosis and proper management ureteric injury can reduce complications and long term sequalae.

Resection of adult polycystic kidney with retroperitoneal laparoscopic technique assisted by arterial embolization.

BackgroundTraditional surgical methods have high complication rate and large injury in the resection of adult polycystic kidney. We investigated the effect of retroperitoneal laparoscopic resection of adult polycystic kidney assisted by arterial embolization.MethodsThe data of adult polycystic kidney patients who underwent laparoscopic surgery assisted by arterial embolization from November 2015 to November 2018 in our hospital were retrospectively analyzed, and the data of patients who underwent open surgery during the same period were collected. The basic data, surgical conditions, postoperative recover situation, and complications of the two groups were compared.ResultsThere was no significant difference in the basic situation between the laparoscopic operation group and open operation (control) group. The bleeding volume, hospitalization time, and the length of incision in the laparoscopic operation group were significantly better than those in the open operation (control) group, but the operation time was significantly longer than that in the open operation group. There was no significant difference in drainage tube extraction time, bed rest time and blood transfusion rate between the two groups. There was no significant difference in the complication rate between the two groups.ConclusionsArterial interventional embolization-assisted retroperitoneal laparoscopy is an effective method for the resection of polycystic kidney.

Kết quả phẫu thuật nội soi sau phúc mạc cắt thận mất chức năng do bệnh lý lành tính tại Bệnh viện Đa khoa tỉnh Ninh Bình

Abstract Introduction: Evaluating the result of laparoscopic retroperitoneal nephrectomy for benign nonfunctioning pathology at Ninh Binh General Hospital. Materials and Methods: 20 patients underwent laparoscopic nephrectomy surgery from 08/2016 - 03/2020 at Ninh Binh General Hospital, research with descriptive and prospective method. Results: The average operating time is 100,25 ± 22 minutes (80 - 180 minutes), the average amount of blood loss is 61,5 ± 26,6ml (30 - 100ml), the average amount of drain removal time is 2,5 ± 0,5 day (2 - 3 days), the time of taking analgesic is 3 days, the average amount of time for treatment in the hospital is 4,25 ± 1,1 days (3 - 6 days). During the operations, there is 1 case in which renal abscess and kidney inflammation occur. Therefore, it's difficult to carry out the umbilicus dissection and have to switch to kidney – removal open surgery. There are no adverse medical events or complications after the surgery. Conclusions: Laparoscopic retroperitoneal surgery in kidney removal due to nonfunctioning benign pathology is a safe and effective treatment method. Keywords: Laparoscopic nephrectomy, retroperitoneal laparoscopy.

Multiple inferior vena cava aneurysms mimic a retroperitoneal tumor: a case report

BackgroundInferior vena cava (IVC) aneurysms are extremely rare with variable clinical manifestations. Patients are usually asymptomatic or present with complications of thrombosis and rupture. To date, there have been only a few reports of the condition in the literature, and diagnosis of IVC aneurysms may be difficult.Case presentationA 33-year-old male patient presented to hospital because of a retroperitoneal mass found by computerized tomography during a health examination. He was asymptomatic, and post medical history and physical examination were unremarkable. Laboratory tests including tests for paraganglioma were all negative. Contrast-enhanced computed tomography scan revealed a stenosis of IVC in the suprarenal segment and two retroperitoneal mass on the right side of IVC. The larger one is about 3 cm in diameter and the smaller one is about 1 cm in diameter, which was considered as a retroperitoneal tumor with an enlarged lymph node. However, two IVC diverticular aneurysms were confirmed during the retroperitoneal laparoscopic exploration. The larger aneurysm was resected from the IVC successfully. Since the smaller aneurysm was about 1 cm in diameter without thrombosis, we did not resect it during surgery. The patient recovered well from surgery and discharged from our department successfully.ConclusionsThis is the first report of multiple IVC aneurysms. Because of the extremely low prevalence of IVC diverticular aneurysm, it may be misdiagnosed as other disease. Due to the high rate of thrombosis, surgical treatment especially retroperitoneal laparoscopy is recommended for small diverticular aneurysms.

Retrospective comparison of three minimally invasive approaches for adrenal tumors: perioperative outcomes of transperitoneal laparoscopic, retroperitoneal laparoscopic and robot-assisted laparoscopic adrenalectomy

BackgroundTo compare the perioperative outcomes of transperitoneal laparoscopic (TLA), retroperitoneal laparoscopic (RLA), and robot-assisted transperitoneal laparoscopic (RATLA) adrenalectomy for adrenal tumors in our center.MethodsBetween April 2012 and February 2018, 241 minimally invasive adrenalectomies were performed. Cases were categorized based on the minimally invasive adrenalectomy technique. Demographic characteristics, perioperative information and pathological data were retrospectively collected and analyzed.ResultsThis study included 37 TLA, 117 RLA, and 87 RATLA procedures. Any two groups had comparable age, ASA score, Charlson Comorbidity Index, and preoperative hemoglobin. The tumor size for RLA patients was 2.7 ± 1.1 cm, which was significantly smaller compared to patients who underwent TLA/RATLA (p = 0.000/0.000). Operative time was similar in any two groups, while estimated blood loss was lower for RATLA group (75.6 ± 95.6 ml) compared with the TLA group (131.1 ± 204.5 ml) (p = 0.041). Conversion to an open procedure occurred in only one (2.7%) patient in the TLA group for significant adhesion and hemorrhage. There were no significant differences between groups in terms of transfusion rate and complication rate. Length of stay was shorter for the RATLA group versus the TLA/RLA group (p = 0.000/0.029). In all groups, adrenocortical adenoma and pheochromocytoma were the most frequent histotypes.ConclusionsMinimally invasive adrenalectomy is associated with expected excellent outcomes. In our study, the RATLA approach appears to provide the benefits of decreased estimated blood loss and length of stay. Robotic adrenalectomy appears to be a safe and effective alternative to conventional laparoscopic adrenalectomy.

The comparative study on clinical effects of different nephron-sparing surgical methods for T1 and T2a renal cell carcinoma

Objective To compare the clinical effect of three different nephron-sparing surgical methods including peritoneal laparoscopy, retroperitoneal laparoscopy and open surgery for localized renal carcinoma. Methods The clinical data of 139 patients with localized renal carcinoma was retrospectively analyzed from March 2008 to March 2015. According to the methods of operation, they were divided into three groups, peritoneal laparoscopic excision group (35 cases), retroperitoneal laparoscopic excision group (60 cases) and open surgery group (42 cases). The operating time, renal warm ischemia time, blood loss, hospital stay, postoperative recurrence and metastasis were compared among the three groups and were statistically analyzed. Results One case in the abdominal group and the retroperitoneum group were transferred to open surgery because of extensive adhesion around the tumor, except for this study, and 137 cases were eventually included. Operation time of three groups was(145.3±32.4)min, (126.4±33.1)min and(114.0±31.3)min respectively. There was no significant difference in operative time between the abdominal laparoscopy group and the laparoscopic group. The operative time in the two groups was higher than that in the open operation group(P 0.05). The indwelling time of abdominal drainage tube was (7.1±3.2)d, (5.4±2.4)d and (5.3±1.6)d, respectively, and there was no significant difference among the three groups(P>0.05). The hospitalization time of the three groups was (11.6±4.3)d, (10.1±3.6)d and (13.8±3.2)d, respectively. The time of hospitalization in the abdominal laparoscopy group and the retroperitoneoscope group was significantly lower than that in the open operation group, with statistical significance(P 0.05). Follow-up for 2 to 3 years, there was no significant difference in mortality, recurrence and metastasis between the three groups, and there was no significant difference in postoperative complications(P>0.05). Postoperative pathological types suggested clear cell carcinoma in 122 cases, papillary cell carcinoma in 10 cases, chromophobe cell carcinoma in 4 cases, and collecting duct carcinoma in 1 cases. The R. E.N.A.L scoring system was significantly associated with renal ischemia time, operation time, and affected glomerular filtration rate (P 0.05). Conclusions Peritoneal laparoscopic and retroperitoneal laparoscopic nephron-sparing surgery for localized renal carcinoma have the advantages of minimal invasion, quick recovery and equal clinical effect with open surgery, and can substitute for open surgery. Key words: Carcinoma, Renal Cell; Laparoscopy; Urologic Surgical Procedures

Reflective Practice About Retroperitoneal Laparoscopy in Comparison to Open Surgery for Ureteropelvic Junction Obstruction Repair in Children Less Than 1 Year of Age.

Introduction: The interest in laparoscopy in the treatment of ureteropelvic junction obstruction (UPJO) in children under 12 months of age remains controversial. The aim of this study is to evaluate feasibility and benefits of retroperitoneal laparoscopy (RL) compared to open surgery in this age group.Materials and Methods: Between January 2012 and May 2017, we performed 222 pyeloplasties: 144 by laparoscopy and 78 by open surgery. From 2012, the choice of operative technique was decided according to the laparoscopic experience of the surgeon; two surgeons operated laparoscopically on all children <12 months of age, while others operated using posterior lumbotomy (PL). The RL is standardized and performed by 3 trocars (5, 3, 3). Pre, per and postoperative parameters were analyzed retrospectively. Statistical tests: Pearson, Fisher, Student and Mann-Whitney.Results: During this 5-year period, 24 RL and 53 PL were included with a median follow-up of 27 months (5–63). In the LR group, postoperative drainage was performed by JJ (13 cases) and external stent (11 cases). No conversion has been listed in this group. In each group there was one failure that needed redo pyeloplasty. Duration of hospitalization and intravenous acetaminophen use were significantly lower in the RL group (2.8 vs. 2.3 days, p = 0.02, respectively) while operating time was significantly longer (163 vs. 85.8 min, p = 0.001). The postoperative complication rate was statistically identical in each group (urinary tract infection, wall hematoma, hematuria…).Conclusion: RL is feasible in children under 1 year of age in the hands of well-experienced surgeons with longer operative time but without added morbidity. Subject to the retrospective nature of our study, the RL seems to offer a benefit regarding duration of hospitalization and analgesics consumption.

Total laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma under a single surgical position

BackgroundTo assess the feasibility and effectiveness of total laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma (UUTUC) under a single surgical position.MethodsThe medical data of 89 UUTUC patients were collected, who were treated in our institution from Jan 2016 to Jun 2018. The 45 cases that underwent total laparoscopic nephroureterectomy with a single position were allocated in the test group, while the 44 patients who received retroperitoneal laparoscopy combined with hypogastric oblique incision were assigned in the control group. We compared the two groups in perioperative indicators and tumor recurrence rate and analyzed the clinical effect of the new surgical treatment of UUTUC.ResultsAll 89 operations for UUTUC were successful and had no conversion to open surgery. No obvious complications occurred during the perioperative period. The test group had significantly shorter average operation time (96.58 ± 8.56 min versus 147.45 ± 9.16 min), less blood loss (39.58 ± 4.15 ml versus 46.50 ± 4.58 ml), earlier ambulation (7.47 ± 1.01 h versus 11.39 ± 1.82 h), and shorter length of stay in hospital (6.98 ± 1.14 days versus 9.89 ± 1.51 days) (P < 0.05). The visual analogue scale (VAS) scores of the test group at 1 h, 12 h, and 24 h after operation were lower compared with those of the control group (P < 0.05). No significant difference was found in the tumor stage, tumor grade, postoperative gastrointestinal function recovery time, follow-up time, and tumor recurrence rate between the two groups.ConclusionsCompared with the traditional surgical methods, the total laparoscopic treatment of UUTUC under a single surgical position had advantages of shorter operation time, less blood loss, and early postoperative ambulation. The new operative method could shorten the length of stay and accelerate recovery of patients, and it is a viable surgical procedure which deserved clinical application and promotion.Trial registrationOur trial was approved and has been registered in the ethics committee of the Yantai Yuhuangding Hospital (Approval NO.[2015]171).

1,000 Retroperitoneoscopic Procedures of the Upper Urinary Tract: Analysis of Complications

Background and Objective: To evaluate risk factors and complications of retroperitoneoscopic procedures of upper urinary tract and adrenal gland. Methods: From 1994 to 2016, 1,000 retroperitoneal laparoscopies were performed – 476 nephrectomies, 201 adrenalectomies, 103 partial nephrectomies, 91 pyeloplasties, 70 nephro-ureterectomies, and 59 miscellaneous surgeries (diverticulectomy). Data collection was prospective. We analyzed age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, operative time, blood loss, hospitalization stay and complications. Risks factors were explored with univariate and multivariate analysis. Results: The mean BMI was 25 and median ASA 2. The mean operative time was 136 mn, mean blood loss 149 mL. There were 49 conversions. Of the patients, 41 required re-interventions, predominantly due to urinary fistula or post-operative bleeding. Post-operatively, 145 complications were recorded. In multivariate analysis, partial nephrectomies (OR 2.12, p = 0.031, 95% CI [1.07–4.22]) and pyeloplasties (OR 1.97, p = 0.02, 95% CI [1.11–3.48]) were significantly more at risk of complication than nephrectomies. An ASA score of 3 was also a significant risk factor of complications (OR 2.3, p = 0.014, 95% CI [1.17–4.47]) and an increased BMI carried a higher risk of conversion. There was no significant difference of conversion or complication rates between the first and last 500 patients. Conclusions: Upper urinary tract and adrenal surgeries can be performed by retroperitoneal laparoscopy. This surgical technic is safe and reproducible. The choice of the technic must be oriented by ASA, BMI and the type of surgery.

Posterior Extraperitoneal Laparoscopic Adrenalectomy for Children with Adrenal Tumors

Abstract Purpose: Retroperitoneal laparoscopy that provides a direct access to the retroperitoneal cavity is an interesting approach to adrenal gland surgery. We report our initial experience with ...

Spigelius' line incision as a successful route to extract the kidney during retroperitoneal laparoscopic live-donor nephrectomy

Objective To introduce the advantages, incision designing methods and surgical procedures of spigelius’ line incision in retroperitoneal laparoscopic living donor nephrectomy. Methods Among the 114 donors, 39 were obtained by spigeliu’line incision (13 males and 26 females), with an average age of 35 years, 35 left kidneys and 4 right kidneys. Gibson incision was performed in 75 patients (28 males and 47 females), with an average age of 31 years, 73 left kidneys and 2 right kidneys.The clinical data of 114 donors undergoing retroperitoneal laparoscopic living donor nephrectomy from September 2012 to July 2017 were analyzed retrospectively. The operation was performed by laparoscopic surgery to separate the ureter, renal vessels and perirenal fat. Finally, the renal vessels were removed and the kidneys were removed with hand-assistant. 75 cases were taken out of the kidney through the inguinal parallel incision(Gibson incision), while the other 39 cases used the spigelius’ line incision(Through the linea pararectalis, the anterior sheath is cut opened at the margin of the rectus sheath (spigelius’ line) and the lateral peritoneum is pushed into the midline between the arcuate line and the inferior abdominal vessels to expose the retroperitoneal space). The intraoperative data were collected. Results All the operations were not converted to open surgery. The incision length of the spigelius’ line incision group was (6.8±0.6)cm, and the incision length of the Gibson incision group was (7.0±0.4)cm, P=0.02. The blood loss of the operation of the spigelius’ line incision group was (59.2±33.4)ml, while the Gibson incision group was(80.7±32.8)ml, P=0.002. The warm ischemia time of the spigelius’ line incision group was (2.8±1.1)min, while the Gibson incision group was(3.1±1.7)min, P=0.31. The operation time of the spigelius’ line incision group was (160.8±30.7)min, while the Gibson incision group was(162.5±28.1)min, P=0.77. There was no significant difference between the two groups in the warm ischemia time and the operation time. No incisional hernia was found in these two groups. Conclusions Compared with Gibson incision, the spigelius’ line incision is safe. It can completely avoid to cut the abdominal muscles, and effectively avoid the abdominal nerves injury. Without damaging the integrity of the peritoneum, it can avoid abdominal organ injury. Key words: Living donor kidney transplantation; Retroperitoneal laparoscopes; Living donor nephrectomy; Incision

MP03-14 RETROPERITONEAL LAPAROSCOPIC COOL-TIP RADIOFREQUENCY ABLATION OF ADRENOCORTICAL ADENOMA WITH CUSHING SYNDROME

You have accessJournal of UrologyAdrenal1 Apr 2018MP03-14 RETROPERITONEAL LAPAROSCOPIC COOL-TIP RADIOFREQUENCY ABLATION OF ADRENOCORTICAL ADENOMA WITH CUSHING SYNDROME Linfang Yao, Shiwei Zhang, Xiaozhi Zhao, Rong Yang, and Hongqian Guo Linfang YaoLinfang Yao More articles by this author , Shiwei ZhangShiwei Zhang More articles by this author , Xiaozhi ZhaoXiaozhi Zhao More articles by this author , Rong YangRong Yang More articles by this author , and Hongqian GuoHongqian Guo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.3057AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the feasibility, safety, and therapeutic effects of retroperitoneoscopic-guided cool-tip radiofrequency ablation (RCRFA) used for the treatment of adrenocortical adenoma with Cushing syndrome. METHODS From May 2006 to May 2009, 12 female patients with adrenocortical adenoma and Cushing syndrome underwent RCRFA. Ten tumors were in the left adrenal gland and two tumors were in the right, with a mean tumor size of 2.8+0.5cm (range 2.0 to 3.5). Technical success was defined as disappearance of tumor enhancement on contrast-enhanced computed tomography imaging acquired within 4 week after RCRFA. Clinical success was defined as improvement in serum cortisol and adrenocorticotropic hormone (ACTH) values and symptoms at the end of follow-up. RESULTS Tumor enhancement disappeared after initial RCRFA in all patients (technical success rate 100%) one month later. Both the serum cortisol and ACTH levels returned to normal and the symptoms related to Cushing syndrome had disappeared. Every patient was followed up for more than 6 years (mean 85.2±11.2 months). There was no evidence of residual or recurrent lesion postoperatively. All tumors showed involution (1.5+0.6cm) at the end of the study. No major complications occurred related to the procedures. CONCLUSIONS Using RCRFA for adrenocortical adenoma with Cushing syndrome is a feasible, safe, and promising treatment method in selected patients. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e27-e28 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Linfang Yao More articles by this author Shiwei Zhang More articles by this author Xiaozhi Zhao More articles by this author Rong Yang More articles by this author Hongqian Guo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Application of endoscopy in pediatric surgery

The application of endoscopy in pediatric surgery began in 1970s, and it was used for diagnosis of disease at first.After that, laparoscopy and thoracoscopy were widely applied in pediatric general surgery, urology and thoracic surgery.Nowadays, most pediatric abdominal and thoracic diseases could be treated by endoscopic minimally invasive surgery, including pediatric congenital malformation, acute abdominal disease, tumor, and so on.Neonatal laparoscopy has developed rapidly in recent years, which could be performed in most neonatal surgeries.With the development of technology, the application of 3D laparoscopy and surgical robot bring laparoscopy into a new era.Predictably, with the updates of endoscopic devices and the technical improvement, endoscopy could be more popular and used for more difficult surgery and younger children. Key words: Laparoscopy; Retroperitoneal laparoscopy; Thoracoscopy; Child