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Impact of posterior retroperitoneoscopic adrenalectomy in a tertiary care center: a paradigm shift. Surg Endosc 2011; 25:3584-9. [DOI: 10.1007/s00464-011-1762-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 04/27/2011] [Indexed: 11/30/2022]
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Rassweiler JJ, Henkel TO, Stock C, Frede T, Alken P. Retroperitoneoscopic surgery — technique, indications and first experience. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/13645709409152729] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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3
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Bannenberg JJG, Meijer DW, Bannenberg JH, Hodde KC. Hand-assisted laparoscopic nephrectomy in the pig: Initial report. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709609153716] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fujisawa M, Kawabata G, Gotoh A, Hara I, Okada H, Arakawa S, Kamidono S. Posterior approach for retroperitoneal laparoscopic bilateral nephrectomy in a child. Urology 2002; 59:444. [PMID: 11880091 DOI: 10.1016/s0090-4295(01)01564-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report on a unique posterior approach for bilateral nephrectomy by retroperitoneoscopy that was conducted in a 13-year-old boy with end-stage renal disease managed by peritoneal dialysis. A posterior approach for bilateral nephrectomy by retroperitoneal laparoscopy provided adequate visualization and created enough working space for the manipulation. The procedure was performed during a short period, and the patient did not need to be repositioned. Retroperitoneal laparoscopic bilateral nephrectomy is a useful option in school-aged children with poorly functioning kidneys, particularly those children also undergoing peritoneal dialysis.
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Affiliation(s)
- Masato Fujisawa
- Division of Urology, Department of Organ Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan
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Prager G, Heinz-Peer G, Passler C, Kaczirek K, Schindl M, Scheuba C, Niederle B. Surgical strategy in adrenal masses. Eur J Radiol 2002; 41:70-7. [PMID: 11750156 DOI: 10.1016/s0720-048x(01)00441-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Endoscopic adrenalectomy represents the "New Golden Standard" in the surgical treatment of benign adrenal lesions up to 6 cm. Open adrenalectomy is recommended for patients with suspected malignant disease and tumors larger than 6 cm. METHODS AND MATERIAL The surgical technique of trans- and retroperitoneal adrenalectomy is described. Reviewing literature the importance of the endoscopic approach and its role in the surgical treatment of adrenal lesions is analyzed. RESULTS As in open adrenalectomy different endoscopic approaches to the adrenals were developed: adrenal tumors can be removed endoscopically using a transperitoneal (patient in a supine or lateral decubitus position) or extraperitoneal route (patient in a lateral decubitus or prone position). Reviewing literature the endoscopic transperitoneal adrenalectomy is documented in 1425 patients. 4.6% (66 patients) had to be converted to an open procedure. Five hundred and forty-four tumors were removed by an extraperitoneal access. The conversion rate was 4.4% (24 patients). CONCLUSION The basis of excellent results are careful patient selection, evaluation and preoperative preparation in a center with experience in the open techniques and at least 20 endoscopic adrenalectomies per year.
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Affiliation(s)
- Gerhard Prager
- Department of Surgery, Division of General Surgery, University of Vienna Medical School, Währinger Guertel 18-20, A-1090 Vienna, Austria
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GUAZZONI GIORGIO, CESTARI ANDREA, MONTORSI FRANCESCO, LANZI ROBERTO, NAVA LUCIANO, CENTEMERO ANTONELLA, RIGATTI PATRIZIO. EIGHT-YEAR EXPERIENCE WITH TRANSPERITONEAL LAPAROSCOPIC ADRENAL SURGERY. J Urol 2001. [DOI: 10.1016/s0022-5347(05)65844-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- GIORGIO GUAZZONI
- From the Departments of Urology and Medicine, Università Vita e Salute, San Raffaele Hospital, Milan, Italy
| | - ANDREA CESTARI
- From the Departments of Urology and Medicine, Università Vita e Salute, San Raffaele Hospital, Milan, Italy
| | - FRANCESCO MONTORSI
- From the Departments of Urology and Medicine, Università Vita e Salute, San Raffaele Hospital, Milan, Italy
| | - ROBERTO LANZI
- From the Departments of Urology and Medicine, Università Vita e Salute, San Raffaele Hospital, Milan, Italy
| | - LUCIANO NAVA
- From the Departments of Urology and Medicine, Università Vita e Salute, San Raffaele Hospital, Milan, Italy
| | - ANTONELLA CENTEMERO
- From the Departments of Urology and Medicine, Università Vita e Salute, San Raffaele Hospital, Milan, Italy
| | - PATRIZIO RIGATTI
- From the Departments of Urology and Medicine, Università Vita e Salute, San Raffaele Hospital, Milan, Italy
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Prager G, Scheuba C, Passler C, Heinz-Peer G, Vierhapper H, Niederle B. Minimal invasive (endoskopische) Adrenalektomie. ACTA ACUST UNITED AC 1999. [DOI: 10.1007/bf02619995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Norman J, Baker KD. Laparoscopic Adrenal Resection: Changing Techniques for Established Indications. Cancer Control 1999; 6:96-101. [PMID: 10758539 DOI: 10.1177/107327489900600111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Norman
- Department of Surgery, University of South Florida, Tampa, Florida 33601, USA
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Abstract
PURPOSE A retroperitoneal access is commonly used for open urological procedures. Since the introduction of the balloon dissecting technique by Gaur this anatomical route has also been used for laparoscopic surgery. We present our experience with retroperitoneoscopy in 200 cases. MATERIALS AND METHODS From December 1992 to October 1997 a total of 200 retroperitoneoscopic procedures were performed in 197 patients 4 to 82 years old, comprising 78 nephrectomies, 50 renal cyst resections, 14 nephropexies, 11 ureterolyses, 8 retroperitoneal lymph node dissections, 8 renal biopsies, 6 adrenalectomies, 6 heminephrectomies, 6 pyeloplasties, 5 ureterolithotomies, 6 ureterocutaneostomies and 2 others. Of the patients 38 (19%) and 22 (11%) had undergone previous abdominal surgery, and kidney and ureter operations, respectively. Dissection of the retroperitoneal space was enabled by the use of a balloon catheter in 14, balloon trocar system in 93 and finger dissection technique in 93 cases. RESULTS We classified 76 procedures (38%) as simple (renal biopsy, renal cyst resections, ureterocutaneostomy), 102 (51%) as difficult (adrenalectomy, nephrectomy, nephropexy) and 22 (11%) as very difficult (pyeloplasty, heminephrectomy, lymphadenectomy). There was a significant learning curve during the first 50 cases reflected by longer operating time, and higher complication, conversion to open surgery and open reintervention rates (14, 10 and 6%, respectively). In addition to the learning curve, mean operating time depended on the difficulty of the procedure, averaging 45 to 100 minutes for a simple, 95 to 185 for a difficult and 185 to 240 for a very difficult retroperitoneoscopy. In the last 50 cases the complication, conversion and reintervention rates (2, 4 and 2%, respectively) were acceptable for routine clinical application. CONCLUSIONS After experience with more than 200 cases of retroperitoneoscopy the access technique has been significantly simplified. The procedure is standardized, safe and reproducible.
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Affiliation(s)
- J J Rassweiler
- Department of Urology, Stadtkrankenhaus Heilbronn and Klinikum Mannheim, Clinical Faculty of Medical School, University of Heidelberg, Germany
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Bannenberg JJ, Garibiyan H, Vijverberg P, De Wit L, Meijer DW, Kurth KH, Rademaker BP. Initial experiences with the retroperitoneal approach for endoscopic nephrectomy with the patient in the prone position. J Laparoendosc Adv Surg Tech A 1998; 8:25-32. [PMID: 9533803 DOI: 10.1089/lap.1998.8.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Retroperitoneal endoscopic nephrectomy with the patient in the prone position was performed in 12 patients. Indications for this procedure were end-stage kidneys with ureteropelvic junction stenosis or distal ureteric obstruction, nonfunctional kidneys with drug resistant renin-mediated hypertension, and distal ureter malignancy. The retroperitoneal area was exposed using an open surgical technique in combination with the use of a liquid-filled dissection balloon. Removal of kidney tissue was performed with a morcellator through one of the ports. On average, the operating time was 210 min (range 160-480 min) to complete a one-sided nephrectomy. No major complications occurred. Mean hospital stay in this series was 6.6 days, and the follow-up period was uncomplicated in all cases. Retroperitoneal endoscopic nephrectomy with the patient in the prone position is an acceptable alternative to open nephrectomy in selected indications.
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Affiliation(s)
- J J Bannenberg
- Department of Surgical Research, Academic Medical Center University of Amsterdam, The Netherlands
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Radovic N, Popovic D, Spisic D, Hrmic I. Retroperitoneoscopic uretero-cutanostomy — our method of creating a pneumoretroperitoneum. MINIM INVASIV THER 1998. [DOI: 10.3109/13645709809152858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Miccoli P, Bendinelli C, Materazzi G, Iacconi P, Buccianti P. Traditional versus laparoscopic surgery in the treatment of pheochromocytoma: a preliminary study. J Laparoendosc Adv Surg Tech A 1997; 7:167-71. [PMID: 9448128 DOI: 10.1089/lap.1997.7.167] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Laparoscopic removal of adrenal masses has been successfully accomplished by many authors, but some doubts still remain about the surgical treatment of pheochromocytomas by the laparoscopic approach. The outcome of 6 patients who had laparoscopic removal of pheochromocytoma, 1 of which bilateral, was compared with that of 20 patients with pheochromocytoma who underwent open surgery. The following parameters were evaluated: frequency of hypertensive crises, time required for surgery, total volume of infused fluids, severity of postoperative pain, hospital stay, wound suppuration, or occurrence of incisional hernia, persistence or recurrence of hypertension. Laparoscopic patients had shorter hospitalizations, less postoperative fever, less fluid infusion, and absence of scar complications. There was no evident difference in the frequency of intraoperative hypertensive crises between patients who were treated by laparoscopic versus those treated by open procedure. The laparoscopic approach seems to be as safe as the open approach. However, it causes less postoperative distress, better cosmetic results, and permits a faster recovery.
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Affiliation(s)
- P Miccoli
- Dipartimento di Chirurgia Università di Pisa, Italy
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Ono Y, Katoh N, Sahashi M, Matsuura O, Ohshima S, Ichikawa Y. Laparoscopic adrenalectomy via the retroperitoneal approach: first five cases. J Endourol 1996; 10:361-5. [PMID: 8872735 DOI: 10.1089/end.1996.10.361] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Between February and November 1994, we performed laparoscopic retroperitoneal adrenalectomy in five patients with benign adrenal tumors to confirm the efficacy of this operation. Using digital dissection and a balloon, we created a working space in the retroperitoneal cavity before we dissected the adrenal gland and removed it under laparoscopic observation. The adrenal glands of all five patients were removed without any complications. The mean operative time was 3.4 hours, and the mean estimated blood loss was 148 mL. The average postoperative hospital stay was 10 days, and the average full recovery time was 19 days. We concluded that the retroperitoneal approach is an advantageous and safe procedure in the laparoscopic removal of the adrenal gland with benign tumor.
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Affiliation(s)
- Y Ono
- Department of Urology, Komaki Shimin Hospital, Japan
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Chiu AW, Chen KK, Wang JH, Huang WJ, Chang LS. Direct needle insufflation for pneumoretroperitoneum: anatomic confirmation and clinical experience. Urology 1995; 46:432-7. [PMID: 7660527 DOI: 10.1016/s0090-4295(99)80238-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The feasibility and safety of direct needle insufflation to create pneumoretroperitoneum was assessed by an imaging study and clinical experience. METHODS A total of 10 patients without previous retroperitoneal surgery or diseases received computed tomography scans of the retroperitoneum 2 cm above the iliac crest. Distances between quadratus lumborum and colon (Q-C distance) were measured in the supine and lateral positions. Changes of Q-C distance were calculated when the patient was changed from the supine to the lateral position. Operative charts on 38 retroperitoneoscopic procedures were collected prospectively to assess complications related to direct needle insufflation, which was performed by inserting a 14 G Veress needle blindly along the posterior axillary line 2 cm above the iliac crest. RESULTS Q-C distance increased from 8.7 to 27.3 mm (left side) and 4.6 to 18.1 mm (right side) when the patient was changed from the supine to the lateral position, both P values < 0.05. An average distance of 23 mm between colon and quadratus lumborum was found when patients were lying laterally. The misplacement of a Veress needle was encountered in 1 patient, in which a prefascia insufflation resulted in conversion of the endoscopic procedure. Needle puncture caused no visceral or great vessel injury. CONCLUSIONS Significant anterior movement of the colon was found when patients were changed from the supine to the lateral position. It provided a window for inserting the Veress needle blindly into the retroperitoneum. The high success rate (97%) and low complication rate of direct needle insufflation were found in actual clinical applications. We considered needle insufflation a safe and effective method of establishing a pneumoretroperitoneum for any retroperitoneoscopic procedure.
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Affiliation(s)
- A W Chiu
- Department of Surgery, Veterans General Hospital-Taipei, National Yang-Ming University, School of Medicine, Taiwan, Republic of China
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Transperitoneal Laparoscopic Versus Open Adrenalectomy for Benign Hyperfunctioning Adrenal Tumors: A Comparative Study. J Urol 1995. [DOI: 10.1016/s0022-5347(01)67471-8] [Citation(s) in RCA: 132] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Editorial. J Urol 1995. [DOI: 10.1097/00005392-199505000-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bannenberg JJ, Rademaker BM, Gründeman PF, Kalkman CJ, Meijer DW, Klopper PJ. Hemodynamics during laparoscopy in the supine or prone position. An experimental study. Surg Endosc 1995; 9:125-7. [PMID: 7597578 DOI: 10.1007/bf00191951] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
During laparoscopy elevations in arterial pressure and a decrease in cardiac output have been reported. Laparoscopic surgery performed in the prone position may be advantageous for some surgical procedures, but the hemodynamic effects of pneumoperitoneum in this position have not been studied. We studied the effects of different levels of increased intraabdominal pressure on hemodynamics and oxygen transport in eight pigs in the prone and the supine position. Increases in intraabdominal pressure did not result in decreased cardiac output or in a reduction of oxygen transport and consumption in either position. These results suggest that laparoscopy in the prone position does not result in more severe hemodynamic depression than laparoscopy in the supine position.
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Affiliation(s)
- J J Bannenberg
- Department of Experimental Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
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