Laparoscopic Transperitoneal Research Articles

Comparison between helical computed tomography angiography and intraoperative findings.

Background:Live donor nephrectomy has gained popularity on account of the laparoscopic technique, to overcome a small donor pool. Laparoscopic donor nephrectomy requires a precise study of the vascular and morphological renal anatomy, as laparoscopy is technically challenging due to the limited field of vision. In-depth knowledge of the renal anatomy before a laparoscopic procedure is essential for a successful transplant. The left kidney is preferred over the right even in cases of multiple vessels because of the long renal vein, which requires precise preoperative vascular mapping. Helical computerized tomography (CT) angiography, with its axial, coronal, and 3D reconstruction, gives a better understanding of renal anatomy. There are instances where the helical CT findings are misleading and less informative in a small number of cases. This study highlights a case study of the helical CT findings compared with the intraoperative findings of 200 live donors, who underwent laparoscopic donor nephrectomy, and the renal anatomy has been understood at the same time.Aims:1. To compare the helical CT findings on the operated side with the intraoperative findings. 2. To analyze the CT findingsMaterials and Methods:Two hundred cases of laparoscopic transperitoneal donor nephrectomy were included in this study.Statistical Method Used:Chi square test was the statistical test used to compare the findings between CT and the intraoperative data.Results:The axial, coronal, and 3D images of the CT findings were on par with the intraoperative findings in most of the cases. Incidental findings help in the better planning of surgery. Multiple vessels on the left side are preferred over the right sided normal anatomy; with not much technical difficulty with the aid of a helical CT. Male donors had more incidences of multiple vessels, gonadal vein, Retroaortic Renal Vein (RARV), lumbar vein, and duplication of ureter, compared to females. Furthermore, these variations are more in the left side donors. Ninety-two percent of the cases in this study are left-sided donors. The helical CT finding shows that renal vein variations are more on the right side.Conclusions:Helical CT is important in delineating the arterial, venous, and ureteral anatomy and can show the important incidental findings. Left renal donors and males have more variations in their renal anatomy. Technically challenging laparoscopic nephrectomy on the multiple-vessel-side donor is possible with the aid of helical CT. The importance of the CT in evaluating donor renal anatomy for a technically challenging laparoscopic donor nephrectomy is commendable.

Laparoscopic Transmesenteric Nephrectomy for Nonfunctioning Hydronephrotic Crossed Renal Ectopia with Fusion

Introduction: Laparoscopy with low morbidity and a rapid recovery process than open surgery is a preferred surgical technique.1,2 Crossed renal ectopia is the most common fusion abnormality after the horseshoe kidney abnormality.3 In this video, laparoscopic transmesenteric nephrectomy for nonfunctioning hydronephrotic crossed renal ectopia from left to right with fusion is presented. The aim of this video is to illustrate how we can perform nephrectomy of nonfunctioning crossed renal ectopia with fusion anomalia, giving minimal damage to the normal kidney. Materials and Methods: A twenty-year-old mentally retarded male patient was admitted to the outpatient clinic with the complaint of abdominal pain. The left kidney was not visualisated, but a 15×10 cm cystic lesion in the right retroperitoneal area conjoined to the right kidney was observed in an ultrasonographic examination. In a computed tomographic examination, the absence of the left kidney was confirmed; however, there was a sharply marginated, homogeneous, cystic, without contrast enhancement 14×12×8 cm benign lesion in the lower half of the right kidney. Ventral malrotation of the right kidney and the compression of the lesion to the proximal ureter were observed. Early segmental arteries supplied by the right renal artery and millimetric arteries supplied by the right common iliac artery, extending toward the cystic mass was seen in computed tomography. Additionally, agenesis of the left seminal vesicle was seen. This cystic mass was thought to be left to the right ectopic kidney with these outcomes. Laparoscopic transperitoneal excision of the nonfunctioning, hydronephrotic cross-ectopic kidney was planned. Results: After creating pneumoperitoneum, the mass was seen transmesenterically. Without mobilizing the colon, we pass through the retroperitoneal space transmesenterically. The ectopic kidney was dissected from the surrounding tissues and excised. The operation time was 150 minutes and blood loss was 50 cc. The pathologic examination was reported as cystic kidney disease. After 6 months of follow-up, there was no pathology in the computed tomography. Conclusion: During the ascent of the kidney, it normally rotates anteromedially. Malrotation occurs if it fails to rotate or over-rotates. This anomaly can be unilateral or bilateral. Patients with renal malrotation have no specific complications, but malrotation is usually associated with other renal anomalies, such as ectopia with or without fusion or horseshoe kidney.4 The vesicoureteral reflux and malrotation of kidney may present with crossed renal ectopia. Coexistence of these abnormalities can lead to hydronephrosis and loss of renal function. Crossed renal ectopia should be considered in such patients who apply with nonspecific symptoms with concomitant anomalies. As a minimally invasive procedure, nonfunctioning, cross-ectopic nephrectomy can be performed laparoscopically with transmesenteric access without any damage at mesenteric tissues. None of the authors have any commercial associations that may create a conflict of interest in connection with this video. Runtime of video: 8 mins 26 secs

Laparoscopic surgery of vesicoureteral reflux: An experience in 42 patients with the Lich-Gregoir extravesical technique

IntroductionVesico-ureteral reflux (VUR) is a common congenital anomaly of the urinary tract in the pediatric population, existing controversy regarding its management. Patients selected for treatment options are offered from endoscopic injection of substances sub-ureteral to ureteral reimplantation surgery. ObjectiveTo evaluate the use of the laparoscopic surgical technique for the treatment of vesico-ureteral reflux, with an analysis of the procedure, results and complications. Materials and methodsWe evaluated a series of 50 ureteral units in 42 patients, who undergoing laparoscopic transperitoneal ureteral reimplant, using the classic technique of Lich-Gregoir detrusorrafia. ResultsThe mean operative time was 74min. There were neither intraoperative nor immediate postoperative morbidities. At longer follow-up VUR was cured in all cases. ConclusionsLaparoscopic surgery is an effective alternative in the surgical treatment of vesico-ureteral reflux, with results comparable to open surgery techniques and over sub-ureteral injection techniques.

Laparoscopic Non-O'Connor Transperitoneal Extravesical Vesicovaginal Fistula Repair in 41 Patients: A Descriptive Technique and Feasibility Study

To describe the surgical technique and feasibility of a laparoscopic transperitoneal extravesical vesicovaginal fistula (VVF) repair (not an O'Connor technique) in patients with either primary or recurring cases of VVF.

Laparoscopic Adrenalectomy for Hemorrahagic Adrenal Pseudocyst Discovered During Pregnancy

Adrenal pseudocysts are rare cystic masses usually nonfunctional and asymptomatic, discovered incidentally during diagnostic imaging or when complicated by rupture and hemorrhage or infection. Few cases of hemorrhagic adrenal pseudocyst during pregnancy are reported, but a causal relationship between pregnancy and pseudocyst formation has not been shown. We describe a case of a 30-year-old pregnant woman referred to our surgical unit at the 20th week of gestation for incidental detection of left-side upper abdominal cystic mass, with signs of intralesion hemorrhage. The lesion was monitored and the woman gave birth at the 39th week, without complications. After 3 months from delivery, a multislide computed tomography scan confirmed a cystic mass measuring 10×7×10 cm. An elective transperitoneal laparoscopy was performed and a well-capsulated, hemorrhagic adrenal pseudocyst was removed. The optimal surgical treatment for hemorrhagic adrenal pseudocyst during pregnancy is still controversial. The present case shows that adrenal pseudocyst should be carefully monitored and can be treated by elective laparoscopic surgery after delivery.

Laparoscopic Ureteral Reimplantation With Extracorporeal Tailoring and Direct Nipple Ureteroneocystostomy for Adult Obstructed Megaureter: A Novel Technique

To describe a novel technique using extracorporeal tailoring and an inverted ureteral nipple to perform laparoscopic transperitoneal ureteral reimplantation for adult obstructed megaureter and our initial experience with 10 patients. Ten patients (mean age 39.2 years [range, 21-62]) with adult obstructed megaureter underwent transperitoneal laparoscopic ureteral reimplantation by a 3- or 4-port technique. In each case, the affected ureter was freed and delivered out of the peritoneal cavity through the ipsilateral 12-mm port. The lower end of the ureter was tailored by approximately 6 cm, and the tip was folded back onto itself and secured with absorbable sutures to form a nipple. A double-J stent was placed, the entire assembly was carefully replaced into the abdomen, and the ureter was reimplanted into the posterolateral wall of the bladder. Surgery was successful in all the 10 patients without the need for open conversion. At a mean follow-up of 17 months, all patients were asymptomatic, and hydronephrosis was relieved in 9 cases. Laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy is an easy, safe, and effective procedure for adult obstructed megaureter.

Laparoscopic Transperitoneal Heminephrectomy for Duplex Kidney in Infants and Children: A Comparative Study

Evaluation of the feasibility, safety, and outcome of laparoscopic heminephrectomy for duplex kidneys in children above and below the age of 12 months. The transperitoneal surgical technique included division of the parenchyma with a sealing device (LigaSure™; Covidien, Mansfield, MA) and amputation of the ureter as low as possible. A follow-up study was performed. Patients' records were analyzed retrospectively for operative details and postoperative complications. Long-term outcome was assessed during follow-up visits and a final telephone interview. Outcome was compared between two groups: Group 1 (G1), age at surgery<12 months; Group 2 (G2), age at surgery >12 months. Between July 2004 and September 2012, in total, 22 laparoscopic heminephrectomies (20 upper poles and 2 lower poles) were performed in 20 patients (G1, 12 cases; G2, 10 cases). A mean (range) age at surgery was 7.1 (3-11) months in G1 and 49.4 (15-128) months in G2. Mean (range) operative time was 152 (81-220) min in G1 and 197 (90-265) min in G2 (P=.06). All procedures were completed laparoscopically. Major postoperative complication was one urinoma in G1, which was surgically revised. Mean hospital stay was 3.6 days (G1, 4.0 days; G2, 3.1 days). During long-term follow-up (median, 5.2 years) febrile urinary tract infections occurred to the same extent in both groups (G1, 1/12; G2, 2/10; P=.57). Laparoscopic transperitoneal heminephrectomy for duplex kidneys is safe and feasible even in small infants. Long-term results are excellent irrespective of the patient's age.

Laparoscopic Transperitoneal Repair of Pediatric Diaphragm Eventration Using an Endostapler Device

Minimally invasive repairs of pediatric diaphragm eventration have been well described via a thoracoscopic approach, oftentimes requiring single-lung ventilation and tube thoracostomy, with the disadvantage of not being able to clearly visualize what lies beneath the diaphragm. We describe a novel pediatric diaphragm eventration repair using a laparoscopic transperitoneal approach and an endostapler device. We also describe our initial experience with this technique. Four pediatric diaphragmatic eventration patients underwent laparoscopic transperitoneal repair using an endostapler device. Repairs were performed in both male and female patients with right-sided eventrations. We approach the repair in a transperitoneal fashion using inverting sutures at the apex of the diaphragm to create tension toward the pelvis. Subsequently, an endostapler is used to remove the redundant portion of diaphragm, leaving a repaired, taut diaphragm. The median age at operation was 10.5 months. The median operative time was 70 minutes. There was no mortality, surgical complications, or recurrence at a median follow-up of 17 months. This laparoscopic approach allows for clear visualization of the intraabdominal organs and, at least in our early experience, a very simple, straightforward operation. Additionally, with the use of the endostapler, the redundant, often weakened diaphragm is removed, leaving the native, healthy diaphragm behind, resulting in a reliable and reproducible repair. This repair should be considered as a feasible alternative approach to the more traditional open and thoracoscopic repairs.

Cirugía laparoscópica del reflujo vesicoureteral: experiencia en 42 pacientes con la técnica extravesical de Lich-Gregoir

IntroductionVesico-ureteral reflux (VUR) is a common congenital anomaly of the urinary tract in the pediatric population, existing controversy regarding its management. Patients selected for treatment options are offered, from endoscopic injection of substances sub-ureteral to ureteral reimplantation surgery. ObjectiveTo evaluate the use of the laparoscopic surgical technique for the treatment of vesico-ureteral reflux, with an analysis of the procedure, results and complications. Material and methodsWe evaluated a series of 50 ureteral units in 42 patients, who undergoing laparoscopic transperitoneal ureteral reimplant, using the classic technique of Lich-Gregoir detrusorrafia. ResultsThe mean operative time was 74minutes. There were no intraoperative nor immediate postoperative. At longer follow-up VUR was cured in all cases. ConclusionsLaparoscopic surgery is an effective alternative in the surgical treatment of vesico-ureteral reflux, with results comparable to open surgery techniques and over sub-ureteral injection techniques.

Laparoscopic Transperitoneal Ureterolithotomy: A Single-Center Experience

This study aimed to evaluate success and complications of laparoscopic transperitoneal ureterolithotomy at our center. From November 2008 until September 2011, 33 patients, including 22 men and 11 women, with a mean age of 45.3 years (range, 19-67 years), underwent laparoscopic ureterolithotomy at our center. Locations of stones were the upper, middle, and lower ureter in 29, 1, and 3 patients, respectively. Ten patients had a history of previous abdominal or pelvic surgery. Laparoscopic ureterolithotomy was performed via a transperitoneal approach. Complications and outcomes were evaluated. Mean operation time was 85.48±15.11 minutes. Except for one stone migration and one conversion to open surgery, all the ureteral stones were extracted laparoscopically (94% success rate). A double J stent was inserted antegradely during the procedure and remained for about 1 month in all cases except in 1 patient in whom both antegrade insertion and ureteroscopic relocation were used. Postoperative hypercapnia was detected in a young patient, who recovered with conservative treatment. No visceral complication occurred. The mean hospital stay and the drain installation interval were 4.1 days (range, 3-9 days). The mean return to full activity was 11.91±4.65 days. Preoperative hydronephrosis resolved at follow-up ultrasonography (3 months later) in all patients except 2 cases, in whom intravenous pyelography showed no obstruction (memorial hydronephrosis). Laparoscopic transperitoneal ureterolithotomy is a safe and effective treatment modality for skilled surgeons and a convenient option for patients. Challenges, such as lower ureteral stones, redo cases, and antegrade double J stent insertion, can be overcome by experience.

Intravesical and transperitoneal laparoscopy in the management of tumor in the residual ureter

The occurrence of tumor in the residual ureter after an incomplete nephroureterectomy required by a tumor of renal collecting system is an uncommon but a well described situation. The recommended treatment in this situation is the radical excision of the remaining ureter, being the open technique the most used approach. The aim of this video is to demonstrate a new approach using intravesical and transperitoneal laparoscopy to remove the residual ureter following the oncological concepts. A 67 year-old male patient underwent an incomplete open right radical nephroureterectomy for a transitional cell carcinoma of the renal collecting system. After 16 months, the cystoscopy diagnostic revealed a recurrence of it in the residual ureter. An intravesical approach followed by a transperitoneal laparoscopy has removed the remaining ureter. Operative time was 110 minutes, blood loss 100 mL, the patient was discharged on the first postoperative day and the Foley catheter was removed on the seventh one. Pathological examination revealed low grade transitional cell carcinoma and free surgical margins, no recurrence was observed after six months. To our knowledge, this is the first treatment description of a tumor in the residual ureter with these techniques. This approach can be a minimal invasive alternative in this unusual situation.

Retroperitoneal versus transperitoneal laparoscopy for simple nephrectomy

BackgroundLaparoscopic surgery is a safe and reliable option for renal procedures. Many renal procedures are performed laparoscopically through two approaches namely transperitoneal and retroperitoneal. We assessed at similar insufflation pressure alterations in hemodynamic, ventilatory and cerebral variables during retroperitoneal and transperitoneal CO2 insufflation.Patients and methodsThirty adult patients of ASA I, II were randomly allocated into two groups; retroperironeal group (Ret group, n = 15) and transperitoneal group (Tran group, n = 15) for simple laparoscopic nephrectomy under general anesthesia. After carbon dioxide insufflation, cardiovascular and respiratory variables were measured at predetermined times with the same insufflation pressure while ventilation was adjusted to maintain normal end tidal CO2. Also, cerebral blood flow velocity (CBFV) was measured by using transcranial doppler ultrasonography.ResultsMean arterial pressure and heart rate were significantly greater with transperitoneal (Tran) than retroperitoneal (Ret) group during CO2 insufflation period. While both groups required increased minute ventilation to adjust ETCO2, transperitoneal CO2 insufflation resulted in a significantly greater increase of PaCO2 than retroperitoneal group at the same insufflation pressure. Furthermore, significantly greater peak airway pressure was required with Tran group than Ret group to administer the same minute ventilation. Following CO2 decompression, all these variables did not differ significantly from preinsufflation values. Peak airway pressure also decreased after decompression; however, values still differed significantly when compared to preinsufflation in transperitoneal group. Transperitoneal CO2 insufflation resulted in a rapid increase in CBFV during the first 30 min of pneumoperitoneum and attained a plateau throughout the procedure. In contrast, CBFV increased gradually throughout the retroperitoneal CO2 insufflation and both groups returned to baseline values after desufflation.ConclusionRetroperitoneal laparoscopic approach for simple nephrectomy is not associated with greater effects on ventilatory, hemodynamic and cerebral functions compared to transperitoneal laparoscopy.

V58 Intravesical and transperitoneal laparoscopy in the management of tumor in the residual ureter

V58 Intravesical and transperitoneal laparoscopy in the management of tumor in the residual ureter

Mini-Invasive Surgery for Adrenocortical Carcinoma in Children: Is It Safe?

Mini-invasive surgery for adrenocortical carcinoma in children: is it safe? Laparoscopy in adrenocortical carcinoma is controversial due to high risk of local recurrence in case of per-operative spillage. We wanted to report the case of a successful laparoscopic transperitoneal adrenalectomy performed in a 3-year-old girl presenting a 5.5-cm adrenocortical carcinoma.

Weight-Adapted Surgical Approach for Laparoendoscopic Single-Site Surgery in Pediatric Patients Using Low-Cost Reusable Instrumentation: A Prospective Analysis

Laparoendoscopic single-site surgery (LESS) in pediatric patients has emerged as a viable alternative to standard laparoscopy. The aim of our investigation was to assess different surgical approaches for LESS, stratifying by weight. From March 2010 to April 2012 LESS was performed in 42 children. Children weighing below 10 kg underwent LESS through an umbilical incision using two 3-mm trocars and one 5-mm trocar. Patients above 10 kg were operated on using a metal multiuse single-site single port (X-Cone; Karl Storz Endoskope, Tuttlingen, Germany). Conventional straight laparoscopic instruments were used in all cases. Mean age at operation was 100 months (range, 0.25-207 months), and mean weight was 27 kg (range, 3.1-82 kg). Median operating time was 74 minutes (range, 36-300 minutes). Eighteen children underwent LESS using two 3-mm trocars and one 5-mm trocar; 1 case required two 5-mm trocars and one 10-mm trocar. Twenty-three patients were operated on with the multiuse device. All operations were carried out safely in a standard laparoscopic transperitoneal technique with full achievement of the surgical target. In none of the patients was an intraoperative complication noticed. Postoperatively two complications were noted, which resolved spontaneously. LESS for pediatric patients can be done safely and efficiently with even less trauma than in conventional laparoscopy irrespective of age and weight. However, different surgical approaches have to be considered as disposable single-site ports are not available for infants and small children. To decrease operative expenses, conventional multiuse trocars and a multiuse single-site port were used with conventional laparoscopic instruments.

Asportazione Laparoscopica di Rene Policistico per via Retroperitoneale: Note di Tecnica

We present our technique of laparoscopic nephrectomy with intact specimen extraction for patient with autosomal dominant polycystic kidney disease (ADPKD). A 5-port retroperitoneal laparoscopic approach was used to dissect the involved kidney, which was then removed intact through a Gibson modified incision. The operative time was 110 minutes. Blood loss accounted for 50 mL. There were no intra or post-operative complications. The hospital stay was 4 days. Laparoscopic nephrectomy for ADKD is technically feasible and clinically safe. The advantages of these technique compared to transperitoneal laparoscopy are the quick access to the hilar vessels and the strict extraperitoneal route, which prevent the risk of sepsis.

Laparoscopic adrenalectomy by the lateral transperitoneal approach in patients with a history of previous abdominal surgery.

IntroductionEven the half of patients undergoing laparoscopic adrenalectomy has history of previous abdominal surgeries. However, it is still uncertain if this fact has an impact on the operation itself as well as the postoperative course.AimTo analyze the effects of previous abdominal surgery on surgical outcomes in adrenal tumor patients subjected to laparoscopic adrenalectomy.Material and methodsThis study included 268 patients with adrenal gland tumors operated on by means of laparoscopic lateral transperitoneal adrenalectomy: 1) previously subjected to at least one abdominal surgery (group A, n = 101), or 2) with no history of previous abdominal operations (group B, n = 167).ResultsGroups A and B did not differ in terms of tumor size (p = 0.132), mean operation time (p = 0.456), mean intraoperative blood loss (p = 0.754), or perioperative complication rate (p = 0.833). Dissection of intraperitoneal adhesions was considered difficult in 32 patients from group A (31.6%) and 8 subjects from group B (4.7%, p < 0.001). Conversion was required in three subjects from group A (2.9%) and 3 patients from group B (1.8%, p = 0.529).ConclusionsPrevious abdominal surgery does not constitute a contraindication to laparoscopic transperitoneal adrenalectomy.

Clinical application of transperitoneal laparoendoscopic single-site nephrectomy

Objective To verify the safety and feasibility of applying transperitoneal laparoendoscopic single-site surgery (LESS) nephrectomy in the treatment of kidney malignant and benign diseases.Methods From Nov.2010 to Jun.2012,we had used LESS nephrectomy technique treated four kidney tumors,one renal pelvic tumor and one atrophic kidney. Quadport was introduced into abdominal cavity through a paraumbilical incision. Conventional laparoscopic instruments,prebent laparoscopic instruments and flexible tip 5mm laparoscope were used. The standard laparoscopic transperitoneal nephrectomy technique was then performed.We evaluated this technique in respects of operative time,estimated blood loss,intraoperative complications,1st post-operative day pain (VAPS),drainage time,post-operative hospital stay and pathological results. Results The 6 procedures in this group were completed successfully with LESS nephrectomy. There was no additional trocar added,no conversion to conventional laparoscopic or open surgery.Application of Quadport and prebent instruments reduced the clash of instruments,both intracorporally and extracorporally.The average operative time were 181.7 (145.0 -235.0) min,average estimated blood loss were 78.3 (20.0 - 150.0) ml.There was no severe intraoperative complication.The average VAPS in the first post - operative day was 1.7 ( 1.0 - 2.0).The average drainage time was 2.8 ( 1.0 -4.0) d,post-operative hospital stays was 6.8 ( 1.0 - 10.0) d.There was no secondary bleeding or wound infection.Pathological results showed 3 cases of renal clear cell carcinoma,1 case of chromophobic carcinoma,1 case of high-grade urothelial carcinoma and 1 case of atrophic kidney.All the specimens in this group were surgical margin negative. Conclusions LESS nephrectomy is a safe and feasible treatment option for the treatment of kidney surgical diseases. Key words: Kidney neoplasm; Renal pelvic tumor; Renal atrophy; Laparoendoscopic single site surgery; Nephrectomy

The Evaluation on the Results of the Laparoscopic Transperitoneal Ureteroureterostomy for the Injured Ureter during Gynecologic Laparoscopic Operation

The Evaluation on the Results of the Laparoscopic Transperitoneal Ureteroureterostomy for the Injured Ureter during Gynecologic Laparoscopic Operation

The Evaluation on the Results of the Laparoscopic Transperitoneal Ureteroureterostomy for the Injured Ureter during Gynecologic Laparoscopic Operation

The Evaluation on the Results of the Laparoscopic Transperitoneal Ureteroureterostomy for the Injured Ureter during Gynecologic Laparoscopic Operation