Transperitoneal Laparoscopic Approach Research Articles

Eighteen years of experience in laparoscopic implantation of artificial urinary sphincter in women with intrinsic sphincter deficiency

Introduction and objectives: Artificial urinary sphincter (AUS) is a treatment option for women with stress urinary incontinence (SUI) after failure of previous surgery or as a primary procedure in severe intrinsic sphincter deficiency (ISD). The aim of the study was to assess the long-term efficacy and risk factors for surgical revision and definitive explantation of AUS laparoscopic implantation in female patients.Methods: A retrospective review of all women submitted to AUS implantation between April 2005 and March 2023 was conducted. The AUS was implanted via transperitoneal laparoscopic approach, by two experienced surgeons. The primary endpoint was postoperative continence. Continence was defined as no leakage and no pad usage or leakage and/or pad usage with no impact on social life and failure as leakage and/or pad usage impacting social life. As secondary outcomes, clinical predictive factors for AUS revision and definitive explantation were evaluated.Results: In the last 18 years, females with a mean age of 68±12 years-old were submitted to laparoscopic implantation of AUS. Early overall complication rate was 16%, but only one case was Clavien-Dindo ≥3. After a median follow-up of 67 months, 22.2% of the patients needed a device revision, the majority due to mechanical device dysfunction. AUS definitive explantation was performed in 16%, mainly due to urethral/vaginal erosion (9.9%) and infection (6.2%). Patients with age ≥70 years and follow-up ≥10 years significantly predisposed for device revision. At the time of the last follow-up, 72% of the patients were keeping the urinary continency.Conclusions: Laparoscopic AUS implantation in females is an effective treatment for SUI due to ISD. Meanwhile, adequate patient selection, multidisciplinary evaluation and careful expectation management are essential to achieving good results, concerning their significant complication rate.

Laparoscopic strategies in complex upper urinary tract obstruction

We enumerate the various laparoscopic strategies to resolve upper urinary tract (UUT) obstruction in the context of variations in anatomy and report their outcomes. Retrospective review of primary laparoscopic UUT reconstructions performed between May 2012 and May 2021. Anomalies included: malrotated kidney (MRK), horseshoe kidney (HSK), duplex kidney (DK), pure intrarenal pelvis (IRP) and mid-ureteric stenosis (MUS). Success was defined by postoperative resolution of symptoms, improvement of anterior-posterior renal pelvic diameter (APD) on US and drainage on Mag3. Complications were categorised by Clavien-Dindo grading. Outcomes compared using the student's t-test with P<0.05 considered statistically significant. Of the 214 laparoscopic primary UUT reconstructions, 37 (17.2%) were: 13-MRK, 12-HSK, 4-DK, 4-IRP and 4-MUS. Median age at surgery was 5-years (range 0.3-15). Dismembered pyeloplasty: 8; pyeloplasty with renal sinus dissection: 8; neo-PUJ anastomosis: 8; primary ureterocalycostomy: 7; pyeloureterostomy: 2; and uretero-ureterostomy: 4. Median follow-up was 43-months (range 8-108) with a success rate of 94.5% (35/37). Complete resolution of symptoms in 20/21 patients; improvement of hydronephrosis on US in 35/37 patients (median pre-operative APD 27mm vs. median postoperative APD 8mm) [P<0.001]; improvement of drainage on diuretic renogram in 32/34 kidneys and stable/improved DRF in 34/35 kidneys (median preoperative DRF - 45% vs. median postoperative DRF - 47%) [P>0.05]. Postoperative complications managed medically (II Clavien) included urinary tract infections - 2 patients (5%), stent-related symptoms in 2 (5%) and umbilical port site collection in 1 patient (3%). Recurrent pelvi-ureteric junction obstruction PUJO occurred in one patient (3%) requiring redo surgery (IIIb Clavien), renal stones in 1 (3%) which resolved with ESWL (IIIb Clavien); in 1 (3%) patient with a HSK there was complete loss of ipsilateral kidney function but this was managed conservatively up to date (I Clavien). Laparoscopic transperitoneal approach allows the prompt recognition of in-situ anatomical variants. UUT obstruction in such settings calls for a variety of strategies with excellent outcomes.

Safety and efficacy of laparoscopic transperitoneal versus retroperitoneal resection for benign retroperitoneal tumors: a retrospective cohort study.

Benign retroperitoneal tumors (BRTs) are clinically rare solid tumors. This study aimed to compare the safety and efficacy of laparoscopic transperitoneal versus retroperitoneal resection for BRTs. The clinical data of 43 patients who had pathologically confirmed BRTs and underwent laparoscopic resection in a single center from January 2019 to May 2022 were retrospectively analyzed. Patients were divided into two groups according to the surgical methods: the Transperitoneal approach group (n = 24) and the Retroperitoneal approach group (n = 19). The clinical characteristics and perioperative data between the two groups were compared. The baseline data and surgical variables were analyzed to determine the impact of different surgical approaches on the treatment outcomes of BRTs. No significant difference was observed between the two groups in gender, age, body mass index, the American Society of Anesthesiologists score, presence of underlying diseases, tumor size, tumor position, operation duration, intraoperativehemorrhage, postoperative hospital stay, intestinalfunctionrecoverytime, and postoperative complication rate. The conversion rate from laparoscopic to open surgery was significantly lower in the Transperitoneal approach group than in the Retroperitoneal approach group (1/24vs.5/19, χ2 = 4.333,P = 0.037). Tumor size was an independent influencing factor for the effect of surgery (odds ratio = 1.869, 95% confidence interval = 1.135-3.078,P = 0.014) and had a larger efficacy on the retroperitoneal group (odds ratio = 3.740, 95% confidence interval = 1.044-13.394,P = 0.043). The laparoscopic transperitoneal approach has the inherent advantages of anatomical hierarchies and surgical space, providing a better optical perspective of the targeted mass and improved bleeding control. This approach may have better efficacy than the retroperitoneal approach, especially in cases of a large tumor or when the tumor is located near important blood vessels.

Heminephrectomy in the pediatric population – single-center comparison of the open versus transperitoneal laparoscopic approach

IntroductionHeminephrectomy is considered the method of choice in the treatment of symptomatic or poorly working moiety of a duplex kidney as well as in oncology.AimThe study aims to retrospectively analyze the laparoscopic approach to heminephrectomy (LHN) in comparison with the open approach (OHN).Material and methodsFrom 2011 to 2020, 28 heminephrectomies were performed in the Clinical Ward of Pediatric Surgery and Urology of the Regional Specialized Children’s Hospital in Olsztyn: 10 with the laparoscopic transperitoneal method (LHN), and 18 with the open method (OHN). The mean age was 37.4 months (1–197 months). In total, 20 patients were female, and 8 were male. Loss of function of the moiety was a prerequisite for surgery. Hydronephrosis, dysplasia of the moiety, and vesicoureteral reflux were the most prevalent in both groups. Data regarding patients were collected based on available medical documentation and retrospectively analyzed.Results and discussionThere was no significant difference between the LHN and OHN groups regarding mean operating time (157 vs 128 minutes; &lt;i&gt;P&lt;/i&gt; = 0.226) and mean postoperative hospital stay (5.20 vs 6.53; &lt;i&gt;P&lt;/i&gt; = 0.64). The refeeding time is comparable and not statistically significant (1.90 vs 1.83 days; &lt;i&gt;P&lt;/i&gt; = 0.555). Postoperative analgesic intake was found to be significantly lower (10.4 vs 17.5 doses, &lt;i&gt;P&lt;/i&gt; = 0.004).ConclusionsBoth open and laparoscopic approaches are safe and feasible in the pediatric population. Both are comparable in operative time, hospital stay and refeeding time. LHN displays a better cosmetic effect and requires significantly lesser analgesic use.

Experiences with an Extraperitoneal Transvesicoscopic Repair of a Vesicovaginal Fistula.

Purpose A vesicovaginal fistula (VVF) is a debilitating condition for women in terms of both its personal and social impacts. A reported transperitoneal laparoscopic approach to treatment has some limitations such as risk of intra-peritoneal organ injury and unnecessary bladder dissection. We here report on our experiences with an extraperitoneal transvesicoscopic approach to a VVF repair, which overcomes these drawbacks. Materials and Methods Seven VVF patients were treated using the transvesicoscopic approach. Under general anesthesia, patients were placed in the dorsal lithotomy position. The VVF orifice was obstructed via the vaginal canal using a Foley catheter. The bladder was then filled with normal saline under cystoscopic inspection, and a 5 mm trocar was inserted into it at the suprapubic area. The bladder wall was next fixed to the anterior abdominal wall. Thereafter, two 3 mm ports were punctured at the interspinous skin crease allowing the fistula margin to be cut and sutured in layers. Results Six of the study subjects in whom we attempted a transvesicoscopic repair of VVF had undergone a hysterectomy due to myoma and one had an intraabdominal abscess removal with Behcet's disease. One myoma patient who had a preexisting vesicoperitoneal fistula was converted to an open transabdominal VVF repair. The mean age of the 6 remaining patients was 46.0 ± 7.2 years (range, 35-57). The mean operation time was 273 ± 40.6 minutes (range, 223-323). There was no instances of significant pain or other immediate complications. Five patients showed no recurrence of the fistula during the follow-up period (8.7±5.1 months). Conclusion A transvesicoscopic approach is an effective modality for the repair of a VVF that is more minimally invasive and has a lower morbidity than a transabdominal procedure.

Retroperitoneoscopic or Transperitoneal Approach for Neurogenic and Adrenal Tumors in Children? A Comparison on the Way to Enhanced Recovery in Pediatric Surgical Oncology

BackgroundMinimally invasive surgery is increasingly utilized for resection of neurogenic tumors in children. The minimally invasive retroperitoneoscopic approach was recently reported in children, but transperitoneal laparoscopy still remains the most common technique. The aim of this study is to compare a novel single-port retroperitoneoscopy (SPR) approach for pediatric neurogenic tumor resection with transperitoneal laparoscopic (TPL). MethodsPatients undergoing minimally invasive resection of abdominal neurogenic tumors over 5 years at a single institution (from 2018 to 2022) were retrospectively reviewed. Tumor volume, stage, presence of image-defined risk factors (IDRFs), neoadjuvant chemotherapy, operative time, estimated blood loss (EBL), length of stay (LOS), complications, oral morphine equivalents per kilogram (OME/Kg), and time to chemotherapy were assessed and compared with SPR and TPL approaches. ResultsEighteen and fifteen patients underwent TPL and SPR, respectively. No significant differences were found between the TPL and SPR approaches in terms of tumor characteristics and IDRFs. Patients who underwent SPR had a significantly faster recovery (p = 0.008) and less postoperative opioid use compared to those in TPL (p = 0.02), thus allowing an enhanced recovery after surgery (ERAS) protocol application. TPL and SPR approaches were performed in presence of IDRFs, respectively in 2 (11%) and 4 patients (27%), with a IDRFs-related conversion in one TPL procedure. Both approaches had one < Grade 3 Clavien Dindo complication, but not requiring further surgery. DiscussionSPR approach can be considered as a safe and feasible minimally invasive approach for the resection of pediatric primary adrenal and neurogenic tumors. The retroperitoneoscopic approach performed using a single port technique represents a promising new frontier of ERAS application in pediatric surgical oncology. ConclusionSPR is a viable surgical alternative in selected neurogenic abdominal tumors with limited IDRFs, thus allowing for the application of ERAS protocols in these patients. Level of EvidenceLevel III.

The feasibility and outcome of laparoscopic vesicovaginal fistula repair as a minimally invasive technique: a retrospective descriptive monocentric study

vesicovaginal fistula (VVF) is the most common type of urogenital fistula. The laparoscopic approach to VVF repair offers the advantage of minimally invasive surgery with similar principles to the open trans-abdominal approach. The purpose of our study was to evaluate the transperitoneal laparoscopic approach as a minimally invasive tool for VVF repair. this was a retrospective study including 14 patients with VVF who underwent transperitoneal laparoscopic fistula repair between 2016 and 2020 in the urology department of the university hospital, Kairouan. Patients had undergone surgery at least six months after their primary gynecological surgery and were followed during 9 months after laparoscopic fistula repair. Data regarding patients' characteristics, operative data, and outcomes were gathered. The main outcome was the success rate of VVF closing and postoperative complications. fourteen patients were included. The patient's mean age was 34.8±8.2years. Size of fistula varied from 0.5 to 2cm and all the VVF were supratrigonal. The mean operative time was 145±23.4 minutes with no significant blood loss. The mean hospital stay was 4±1.4 days without major complications. Regarding analgesia, paracetamol was used for the first two days to meet the analgesia needs of all patients, and morphine was used in three cases (21.4%). During follow-up, two patients were re-operated for early recurrence (14.2%) and the total success rate was 85.7% (12 patients). the laparoscopic repair of VVF is a safe, effective, minimally invasive procedure, and without major complications.

Evaluation of Outcomes between the Right and Left-Sided Transperitoneal Laparoscopic Adrenalectomy in a Tertiary Care Center: A Retrospective Study

Introduction: Several studies have corroborated the feasibility and safety of laparoscopic transperitoneal adrenalectomy for the removal of adrenal tumours however, there is very limited clinical evidence comparing right and left transperitoneal laparoscopic adrenalectomies. This comparison enables surgeons in preoperative counseling of patients regarding postoperative outcomes. Aim: To evaluate the outcomes between the right and left-sided laparoscopic adrenalectomy in patients admitted to a tertiary care center. Materials and Methods: The present retrospective study considered data from patients, who underwent transperitoneal laparoscopic adrenalectomy between December 2013- December 2019 admitted to the Vydehi Institute of Medical Sciences and Research Centre. All the selected subjects with adrenal tumours were operated on by a single surgeon through a standardised transperitoneal laparoscopic approach for right and left-side adrenalectomies. The data collected were age, gender, symptoms, size of the tumour, duration of surgery, intraoperative blood loss, complications, duration of stay and histopathology of tumours. Both sides were compared for age, gender, size of tumour, operative time, blood loss, duration of hospital stay, histopathological diagnosis, benign and malignant lesions. The Student’s t-test was used for the evaluation of continuous data and the Chi-square test and Fisher’s-exact test for categorical variables. Results: The study considered the data of 42 patients. The corresponding number of subjects who had undergone right and left adrenalectomies for various adrenal pathologies were 18 (42.85%, 9 each of both genders) and 24 (17 males, 7 females). The mean age for right-sided adrenalectomy was 44.17 and the left-side was 46.83. The mean tumour size (in cm) was significantly larger in the right-side group as opposed to the left-side (7.97±2.7 vs. 5.62±2.37, p-value=0.0053). The duration of surgery (136.22±25.53 vs.112.92±27.21 min, p=0.0074) and average intraoperative blood loss were also more in the rightside group (431.67±259.73 vs 277.08±193.92 mL, p=0.02). There was no significant difference in the mean duration of hospital stay between the groups (3.94±1.06 vs. 3.67±1.13, p=0.4212). The most common tumour was adenoma in both groups. No major complications were noted in either group. Conclusion: Outcomes were comparable between right and left-side adrenalectomies. However, longer mean operative time and larger tumour size were noted for right-side laparoscopic adrenalectomy

A Canadian centre's experience with prone retroperitoneoscopic adrenalectomy.

Minimally invasive adrenalectomy is the standard of care for the surgical management of benign adrenal disease. The transperitoneal laparoscopic approach (TLA) is the most common approach used worldwide; however, many centres have adopted a posterior retroperitoneoscopic approach (PRA), as it is reported to offer several advantages. We describe our experience with PRA. We performed a retrospective review of the charts of patients who underwent minimally invasive adrenalectomy via PRA or TLA performed by a single endocrine surgeon between September 2010 and December 2019 at a tertiary academic centre in British Columbia, Canada. Patient and tumour characteristics, operative times and postoperative outcomes were compared between the 2 groups. During the study period, 58 patients underwent adrenalectomy via PRA, and 41 underwent adrenalectomy via TLA. The median American Society of Anesthesiologists score was higher in the TLA group than the PRA group (3.0 v. 2.6, p = 0.02). Adrenal glands were heavier in the TLA group than the PRA group (mean 63.4 g v. 19.2 g, p < 0.001). The mean anesthesia preparation time was shorter with PRA than with TLA (51.5 min v. 63.7 min, p < 0.001), as was mean operative time (77.9 min v. 118.4 min, p < 0.001) and mean hospital length of stay (2 d v. 4 d, p < 0.001). There was no difference in the complication rate between the 2 groups. Our study shows that PRA offers shorter operative time and length of stay for appropriately selected patients. Thus, it has become the preferred approach at our centre for minimally invasive adrenalectomy.

Perception versus reality: A case-matched study assessing the intraoperative hemodynamics of minimally invasive retroperitoneal versus transperitoneal approach to pheochromocytomas

BackgroundPheochromocytomas produce excess catecholamines that can result in intraoperative hemodynamic instability. Centers have reported variations in intraoperative hemodynamics with the retroperitoneoscopic versus the laparoscopic transperitoneal approach to adrenalectomies. When the retroperitoneoscopic approach was initiated for pheochromocytomas at our institution, the perception was of improved intraoperative hemodynamics, hypothesizing that increased retroperitoneoscopic insufflation pressures caused decreased venous return and less fluctuation in circulating catecholamines. The purpose of this study was to examine if a difference in intraoperative hemodynamics exists between a size-matched cohort of laparoscopic transperitoneal and retroperitoneoscopic pheochromocytoma patients. MethodsUnilateral adrenalectomies for pheochromocytoma performed via laparoscopic transperitoneal or retroperitoneoscopic approaches from 2015 to 2021 were identified from a surgical database. As larger tumors often underwent a laparoscopic transperitoneal approach, cases were matched 1:1 by tumor size. All patients received phenoxybenzamine. Groups were compared by patient characteristics, preoperative blockade, intraoperative hemodynamics and management, and early postoperative outcomes. ResultsThere were 13 laparoscopic transperitoneal adrenalectomy cases matched to 13 retroperitoneoscopic cases according to tumor size. Both groups (laparoscopic transperitoneal and retroperitoneoscopic) were similar for age (53 years), body mass index (28.5 vs 29.7), sex (69% female), and side (8 vs 7 right). There was no difference in preoperative 24-hour urine metanephrines/normetanephrines (9.9/8.0 vs 2.4/5.7 μmol/day). The phenoxybenzamine dose was similar in both groups (112 vs 114 mg/24 hours), as were baseline heart rate, blood pressure, and mean arterial pressure. There was no difference in any intraoperative hemodynamic parameters or vasoactive interventions. Operative time, length of stay, and 30-day emergency visits were similar between groups. ConclusionThis matched cohort study did not find a difference in intraoperative hemodynamics between laparoscopic transperitoneal and retroperitoneoscopic adrenalectomy approaches for pheochromocytoma in appropriately selected and blocked patients.

P-092 LAPAROSCOPIC TRANS-PERITONEAL HERNIOPLASTY (TAPP) IN EMERGENCY

Abstract The aim efficacy and technical feasibility of TAPP operation by analyzing patients operated on incarcerated inguino-crural hernia in emergency setting. Materials and methods In 1 year, we enrolled 8 urgent incarcerated hernia patients operated using laparoscopic trans-peritoneal approach (TAPP) operated on acutely for inguino-crural incarcerated hernia associated with suspected visceral ischemic damage. Results We repaired 6 inguinal incarcerated hernia and 2 cases of crural hernia. Among 6 inguinal hernia, only one was recurrent. In one case the laparoscopic approach permitted to exclude an obstructed Spigelian hernia diagnosed through tomography. In another case, TAPP allowed to diagnose omental incarcerated Spigelian hernia. In 3 cases this approach permitted to diagnose concomitant unknown wall defects. All cases presented signs of small bowel obstruction. The content of the sac in three cases was small bowel, in other three cases it was omentum, and in other two cases it contained lipoma. None of the cases were converted to open technique. The operative average time was 95 min; the average hospital stay was 1.5 days. No chronic pain or recurrences were observed after a mean follow up time of 8 months. Conclusions The repair of complicated inguino-crural with TAPP in emergency is not a standard treatment. In our experience the laparoscopic approach allowed a safe reduction of hernia, the observation of the feature of hernia content, the diagnosis and repair of unknown wall defect, and a crural defects and contralateral inguinal hernia.

Retroperitoneal approach in a child with ganglioneuroma: points of technique and literature review

Background dataGanglioneuroma is rare in children and often incidentally discovered. The transperitoneal laparoscopic approach is the surgical choice for most of the surgeons because of the familiar anatomy and the wider working spaces. However, a posterior retroperitoneal approach started to be used in pediatric population demonstrating to be safe and effective.Case presentationWe present a case of a child with radiological finding of a right adrenal mass. Due to the increased risk of having a malignant transformation, a surgical resection was decided using a retroperitoneal approach. The adrenal mass was recognized and completely enucleated. The histopathological examination revealed a GN. Clinical course was uneventful with hospital discharge after 3 days. The outcome was evaluated by ultrasound examination performed 3–6 to 12–24 months and then annually. After 24 months, the patient is completely asymptomatic, and no adrenal masses in both sides have been detected.ConclusionsThe posterior retroperitoneoscopy permits a more direct exposure of the adrenal gland, without violating the peritoneum, and a close vision to the main vessels. We believe that this technique is a valid option for pediatric patients with small adrenal lesions.

Quadratus Lumborum Block with Laparoscopic Assisted Catheter Placement Technique in Donor Nephrectomy: A Preliminary Report

Quadratus lumborum block (QLB) is a new fascial plane block that may be helpful for laparoscopic surgeries. In this present study, we aim to evaluate the analgesic efficacy of QLB in laparoscopic living related donor nephrectomy (LLRDN) applied continuously via a catheter that was placed under laparoscopic vision by the surgeon. Following the approval of the Clinical Research Ethics Committee of Istanbul University, Istanbul Medical Faculty (2019/1552), 9 study (Group QLB) and 26 control (Group M) patients that underwent LLRDN were enrolled in this retrospective study. All donors underwent left nephrectomy via transperitoneal laparoscopic approach. An epidural catheter was placed between the QL and psoas major (PM) fascial plane intraoperatively by the surgeon under laparoscopic direct vision, and bupivacaine 0.25% 20 mL was injected through the catheter. After the operation, for group QLB, we used a continuous infusion of bupivacaine 0.1% 7 mL/h over 24 hours. Group M patients received intravenous morphine patient controlled analgesia for 24 hours, postoperatively. Pain scores, total morphine consumption, and complications during the first 24 hours after surgery were recorded. During the first postoperative 24 hours, morphine requirement decreased by more than 70% in Group QLB (Group QLB: 5.11 ± 1.16 mg vs Group M: 16.8 ± 7.1 mg) (P < .0001). Postoperative Numeric Rating Scale (NRS) values at the 45th minute and first hour were both significantly lower in Group QLB than Group M (P < .01). This preliminary report showed that QL catheter placement technique provides good postoperative analgesia in patients undergoing LLRDN. However, further randomized controlled studies with extended patient numbers are required to test the efficacy of the technic.

A Case Report of Three Port Management of Zinner Syndrome

A peculiar case of ischuria secondary to Zinner syndrome. A complete excision via laparoscopic approach given a 100 percent symptomatic relief is a safe and effective. Symptomatic congenital cysts require an appropriate management. Case Description: Case of 21 years male presented in urology unit with features of obstructive uropathy, acute urinary retention and severe lower abdominal pain on evaluation found to had left kidney agenesis and left seminal vesical cyst [1]. A Three port laparoscopic transperitoneal approach performed and left side seminal vesical cyst removal done. The peritoneum was incised between the bladder and the rectum to reveal the left seminal vesicle, which was resected from the surrounding tissue and removal of the cyst done. Discussion: Aim of the study was to show the advancement and usefulness of the laparoscopic approach with short hospital stay and painless procedure, minimal blood loss. Procedure lasted for 60 mins. Unrecordable post intraoperative complications. Patient had been discharged after 36 hours after the procedure, on follow up patient is asymptomatic for 24 months of the procedure. Symptomatic Zinner syndrome with appropriate identification and laparoscopic approach and magnified view better than open and other invasive techniques should be a method of choice in treatment of the congenital seminal vesical cyst and currently a golden surgical standard.

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.

Outcomes after 20years of experience in minimally invasive living-donor nephrectomy.

The transperitoneal laparoscopic approach is considered the gold standard technique for living kidney donation. Other accepted laparoscopic techniques include the retroperitoneal approach, natural orifice transluminal endoscopic surgery (NOTES)-assisted, laparo-endoscopic single-site surgery (LESS), with excellent results in the donor and graft. Many studies have compared these techniques with open ones. Our objective is to describe our experience and results in minimally invasive living-donor nephrectomies (MILDN): laparoscopic, NOTES-assisted, and LESS since their introduction in March 2002. We conducted a retrospective observational study of donors undergoing MILDN between March 2002 and March 2020. A total of 714 MILDNs were performed at our centre. All were completed, except for one, because of recipient death. The conventional laparoscopic approach was used in 541 cases (75.88%), NOTES in 116 (16.9%), LESS in 55 (7.7%), and one mini open (0.14%). Two-thirds of the donors were females (478 cases). The mean donor age was 52.87years (SD 10.93). Six donors (0.8%) were diagnosed beforehand with a small renal mass, which was removed before transplantation in bench surgery. The right kidney was removed in 17.8% of cases. Warm ischaemia time was higher in the NOTES and LESS groups. We had eight conversions. The global intraoperative and postoperative complication rates were 6.8% and 4.9%, respectively. None of the donors developed renal disease during follow-up (mean 3.68years). Five-year recipient and graft survival rates were 98.8% and 96.8%, respectively. MILDN techniques are safe for donors and grafts, with low complication.

Pediatric laparoscopic mitrofanoff procedure- preliminary results of a simplified technique

Laparoscopic appendicovesicostomy (LA) is a rather new technique and still a challenging procedure even for the most experienced surgeons because it requires advanced laparoscopic experience and surgical skill. The aim of this study is to analyze the short-term results and benefits of laparoscopic LA in children. Prospective study of children undergoing LA at our institution between January 2018 and October 2021. The procedure was perfomed using a laparoscopic transperitoneal approach. The distal end of the appendix was spatulated and reimplanted in the bladder by a modified Shanfield technique. The proximal end was brought out as the cutaneous umbilical stoma. Over the study period 15 patients underwent LA (14 males,1 female). Mean age at intervention was 8.8 years (SD:3.1). Indication for surgery was pain during CIC in 13 (86.7%) and difficulty for CIC in 2 (13.3%). Eight patients (53.5%) presented end-stage renal disease (ESRD). Median operative time was 217.3min (r:140-300). Two patients (13.3%) experienced early postoperative complications: ileus (1) and internal hernia over the mesoappendix with subsequent intestinal obstruction. Mean hospital stay was 6.8 days (SD:1.7). Four patients (26.7%) experienced late postoperative stoma related complications: stomal stenosis (1), granuloma (1) and inability to catheterize (2). With a mean follow-up of 21.46 months (SD: 13) all except the patent who lost the conduit are continent and on CIC every 3h. We suggest that LA by this technique is effective, safe and reproducible, and is associated with good short-term results. The complication rate is similar to the open procedure being intestinal obstruction due to internal hernia probably the most serious.

Erratum: Comparison of Laparascopic and Open Adrenalectomy

Purpose: Laparoscopic adrenalectomy, which was performed successfully for the first time in 1992, has become the preferred method in adrenal surgery especially in adrenal diseases. In this study, our aim is to compare the demographic and operative data of laparoscopic and open adrenalectomies performed in the general surgery clinic of our hospital. Methods: The records of the patients who were operated in hospital due to a surrenal mass between August 2006 and December 2012 have been retrospectively assessed. Demographic characteristics of the patients, such as age, sex, the size and location of tumors were included. Surgical indications were classified in terms of their radiologic and biochemical investigations. Type of the surgery (lateral transperitoneal laparoscopic or open approach), the incision used in these surgeries (midline, subcoastal and paramedian), the length of operation, the length of hospital stay, postoperative complications and the final pathology results were all examined. Results: During the afformentioned period, adrenalectomy was performed in 106 patients. Eighty of these patients (%75,4) were operated by open and 26 of them (%24,6) by lateral transperitoneal laparoscopic surgery. Subcostal incision was used 61 of 80 patients (% 82,4), whereas 17 patients (% 22,9) were operated by midline incision and 2(% 2,7) were by paramedian incision. No mortality was encountered. Operation time was statistically significantly shorter in the open group (p<0,0166). Duration of hospital stay was statistically significantly longer in open group (p<0,0083). Hospital stay time was statistically significantly longer in midline incision group (p<0,0083). Except for the weight of masses, statistically significant difference was not found between two groups (laparascopic and open surgery) in demographic and operative features (age,gender,side,pathological diagnose,size of mass) releated to postoperative complications. Conclusion: In carefully selected group of patients laparoscopic adrenalectomy offered lesser postoperative hospital stay than the open adrenalectomy. The longer operative time can be decreased when more experience is gained in laparascopic adrenalectomy. Laparoscopic adrenalectomy should be preferred in adrenal disease as the gold standard in centers with completed learning curve. "The list of authors in our article, which was published in the 2021-July issue, was made inadvertently. Considering the contribution of the author in the previous poster paper of the article in 2014, the list of authors has been changed." The original article was published on 01 July 2021. http://journal.acibadem.edu.tr/en/pub/issue/62213/862954

Abordaje laparoscópico transperitoneal en tumores retroperitoneales del adulto

Background: The retroperitoneal space contains organs, blood vessels, a rich network of lymphatic nodes, abundant connective tissue and neural tissue, and different types of embryonic remnants. Retroperitoneal tumors originate in these tissues and conventionally do not include those located in organs in the retroperitoneal space (kidneys, adrenal glands or pancreas). Material and methods: Patients undergoing retroperitoneal tumors by transperitoneal laparoscopic approach between 2008 and 2019 were included. Those cases with tumors with suspected malignancy, tumor recurrence, need for multivisceral resection and those &lt; 18 years were excluded. Results: 9 patients were included; 55% (n = 5) were men; mean age was 42.3 years (19-62); body mass index (BMI) 28.3 kg/m2 (25-35.8). The tumor was located was below the third part of the duodenum in 1 patient, and in the inframesocolic space in 8: 3 on the right, 3 on the left, 2 intercavo-aortic tumors, and 1 para-aortic lesion. The mean size of the lesions was 13.05 cm (4-29 cm). Mean operative time was 184.4 minutes (110-330 min). Length of hospital stay was 3.33 days (2-6 d). Conversion: 1 (11.1%). The pathology examination reported well-differentiated liposarcoma (lipoma-like lesion) (n = 2); cystic lymphangioma (n = 2); hemangioma (n = 1); functioning paraganglioma (n = 1); schwannoma (n = 1); simple serous cyst (n = 1); and adipose tissue fibrosis (n = 1). Long-term follow-up was 30 months (12- 72 months). Conclusion: The transperitoneal laparoscopic approach for the management of retroperitoneal masses is feasible, with appropriate operative time and low rate of conversion and of complications. Future studies with a larger number of patients are necessary to obtain definite results.

Combination laparoscopy and nephrolithotomy technique in the same session in patients with complete staghorn stones and poor performance status: case series in a single center with long-term follow-up

The management of complete staghorn stones remains a challenge for urologists, owing to the high stone burden, low stone free rate, and high rate of complications. Hence, we aimed to evaluate the outcomes of a technique involving combination laparoscopy and nephrolithotomy in the same session in patient with complete staghorn stones and poor performance status. We retrospectively evaluated seven patients with complete staghorn stones who underwent a combination of laparoscopy and nephrolithotomy in the same session in our center between December 2016 and October 2019. The surgical technique was as follows. Through a four-port transperitoneal laparoscopic approach, the kidney was mobilized after complete dissection of the renal pedicle. The renal pelvis was then incised with a cold scalpel. A nephroscope was inserted into the renal collecting system through both a laparoscopic port and the renal pelvis incision. This method enabled visualization of and access to almost all calyces for clearing the stones from the affected kidneys in a hand-assisted manner which a hand was inserted in the peritoneal cavity. The outcome data included the stone-free rate, short-term and long-term complication rates, and stone recurrence rate. The stone free rate was 85.70% (6/7). No patients had sepsis or required blood transfusion perioperatively, and no major short-term complications occurred. After 24.00 (15.00, 48.00) months' follow-up, no patients had long-term complications, and only one patient had stone recurrence. The technique of combining laparoscopy and nephrolithotomy in the same session was an effective and safe treatment for patients with complete staghorn stones and poor performance status. The method was scarcely affected by the stone burden and morphology, had a satisfactory stone free rate, and resulted in no major complications, particularly life-threatening sepsis. It might be an option for such patients.