[Results of comprehensive data collection concerning urologic laparoscopy]

[Laparoscopic radical and partial nephrectomy: an overview]

Laparoscopy has been progressively gaining acceptance in the urologic arena. The start with renal surgery was slow; however, after complete establishment for benign indications the breakthrough occurred due to the success of laparoscopy in the field of oncologic surgery. Laparoscopic radical nephrectomy for stage T1 and T2 tumours, whether transperitoneal or retroperitoneal, can be performed safely. The surgical steps duplicate the open procedure. The overall complication rate is low and does not significantly differ from that of the open procedure. Laparoscopic partial nephrectomy is, in contrast, a technically challenging procedure despite its realisation laparoscopically. Although the intermediate outcomes are comparable to those of the open procedure, there are concerns related to warm ischemia time and the risk of major complications such as urinary leakage and haemorrhage requiring transfusion, so that it should be performed only in centres with expertise.

Laparoscopic Retroperitoneal Lymph-Node Dissection with the Waterjet Is Technically Feasible and Safe in Testis-Cancer Patient

BACKGROUND AND PURPOSE

The acceptance of open retroperitoneal lymph node dissection (RPLND) for stage I and II nonseminomatous testicular cancer has decreased because of the intraoperative and postoperative morbidity of the procedure. Laparoscopic RPLND is a minimally invasive and safe alternative for low-stage germ-cell tumors. It is, however, technically demanding and should therefore be performed only in experienced centers. The purpose of the present study was to evaluate the waterjet technique for laparoscopic RPLND.

PATIENTS AND METHODS

A series of 18 patients with clinical stage I testis cancer (group A) and 7 patients who had received chemotherapy for stage II disease (group B) underwent laparoscopic RPLND at our institution. The procedure was performed identically to the open approach using the modified template according to Weissbach and associates. The waterjet was used for removal of lymphatic tissue from the aorta and the vena cava, as well as from the sympathetic trunk.

RESULTS

The operation was completed in all patients without conversion to open surgery. The mean operating time was 232 +/- 48 minutes. The waterjet was able to remove lymphatic tissue easily and atraumatically. At pressures of 20 bar, the lymph-node capsule remained completely intact, thus avoiding tumor-cell spread. Antegrade ejaculation could be preserved in all patients, who, to date, show no evidence of disease.

CONCLUSIONS

The waterjet allows the safe and complete removal of lymphatic tissue, leaving vulnerable anatomic structures intact. It can decrease the learning curve of laparoscopic RPLND and contribute to better acceptance of this procedure.

[Laparoscopic vs. open nephrectomy. 10 years' results of a nonrandomized comparative study of 549 patients with benign kidney diseases]

We report the results from a nonrandomized comparison of open flank vs laparoscopic nephrectomy in patients with benign renal disease. Between 1993 and 2002, 549 nephrectomies for benign renal disease were performed at the Department of Urology of the Medical University of Lübeck and the Urological Department of the Martin Luther University in Halle/Wittenberg. There were 236 patients in the open flank nephrectomy group and 313 patients in the laparoscopic nephrectomy group. Clinical parameters were compared among both groups. Median operative time in the open flank nephrectomy group was 90 min (range: 30-240 min) and also 90 min in the laparoscopic nephrectomy group (range: 41-210 min). There were 54 complications (17.2%) in the laparoscopic nephrectomy group compared to 60 complications (25.4%) in the open flank nephrectomy group. Patients in the laparoscopy group demonstrated clear advantages in terms of analgesic use for pain control, hospital stay, and convalescence. Laparoscopic nephrectomy results in a significantly briefer postoperative course when compared to open flank nephrectomy. However, due to a limited number of patients, a laparoscopic nephrectomy is mainly reserved for laparoscopic centers. Nevertheless, the laparoscopic approach should be offered to the majority of patients with benign renal disease requiring nephrectomy.