Retroperitoneal lymphadenectomy by videolaparoscopic transperitoneal approach in patients with non-siinomatous testicular tumor

OBJECTIVE: The present study aims to report the preliminary experience with videolaparoscopic retroperitoneal lymphadenectomy in the treatment of patients with non-siinomatous testicular tumor. MATERIALS AND METHODS: Seven surgeries were performed in order to access retroperitoneal lymph nodes in patients with non-siinomatous testicular cancer. We performed the videolaparoscopic retroperitoneal lymphadenectomy (LRL) technique in 5 patients with stage I disease and laparoscopic resection of residual mass (LRRM), following chiotherapy (ChT), in 2 patients with stage II disease. Initial approach was obtained through 4 trocars, using an incision in supra-umbilical midline when manual assistance was required. Surgical time was analyzed, as well as blood loss, need for analgesic drugs postoperatively, hospital stay, complications, need for blood transfusion, histopathological data and tumor control in a mean follow-up of 18 months. RESULTS: Mean surgical time was 200 to 260 minutes in LRL and LRRM groups respectively, mean blood loss was 300 mL for the LRL group and 400 mL for the LRRM group, without need for transfusions. There was a lesion in the vena cava in the LRL group, which was managed with manual assistance and one conversion in the LRRM group, due to a 10-cm tumor mass that was adhered to the aorta. Mean hospital stay was 3 days, excluding the converted case, and the use of analgesic drugs was needed until the second postoperative day. Of the stage I patients, 2 had active disease in retroperitoneum, and underwent adjuvant ChT. The 2 residual masses were teratomas. There was no recurrence during the follow-up period. CONCLUSIONS: Videolaparoscopic retroperitoneal lymphadenectomy is a procedure with high technical complexity and a higher potential for conversion when performed following chiotherapy.

Laparoscopic radical prostatectomy by extraperitoneal access with duplication of the open technique

INTRODUCTION: The laparoscopic radical prostatectomy is a continually developing technique. Transperitoneal access has been preferred by the majority of centers that employ this technique. Endoscopic extraperitoneal access is used by a few groups, nevertheless it is currently receiving a higher acceptance. In general, the antegrade technique is used, with dissection from the bladder neck to the prostate apex. The objective of the present paper is to describe the extraperitoneal technique with reproduction of the open surgery's surgical steps. SURGICAL TECHNIQUE: With this technique, the dissection of the prostate apex is performed and, following the section of the urethra while preserving the sphincteric apparatus, the Foley catheter is externally tied and internally recovered, which allows cranial traction, similarly to the way it is performed in conventional surgery. The retroprostatic space is posteriorly dissected and the seminal vesicles are identified by anterior and posterior approach, obtaining with this method an optimal exposure of the posterolateral pedicles and the prostate contour. The initial impression is that this technique does not present higher bleeding rate or difficulty level when compared with antegrade surgery. Potential advantages of this technique would be the greater familiarity with surgical steps, isolated extraperitoneal drainage of urine and secretions and a good definition of prostate limits and lateral pedicles, which are critical factors for preserving the neurovascular bundles and avoiding positive surgical margins. A higher number of cases and a long-term follow-up will demonstrate its actual value as a technical option for endoscopic access to the prostate.