Hand-assisted laparoscopic nephrectomy as a minimally invasive option in the treatment of large renal specimens

INTRODUCTION: We describe our experience with hand-assisted laparoscopy (HAL) as an option for the treatment of large renal specimens. MATERIALS AND METHODS: Between March 2000 and August 2004, 13 patients candidate to nephrectomies due to benign renal conditions with kidneys larger than 20 cm were included in a prospective protocol. Unilateral nephrectomy was performed in cases of hydronephrosis (6 patients) or giant pyonephrosis (4 patients). Bilateral nephrectomy was performed in 3 patients with adult polycystic kidney disease (APKD) with low back pain refractory to clinical treatment previous to kidney transplant. The technique included the introduction of 2 to 3 10 mm ports, manual incision to allow enough space for the surgeon's wrist without a commercial device to keep the pneumoperitoneum. The kidney was empty, preferably extracorporeally, enough to be removed through manual incision. We have assessed operative times, transfusions, complications, conversions, hospital stay and convalescence. RESULTS: The patients mean age (9 women and 4 men) was 58 years. Mean operating time was 120 n 10 min (hydronephrosis), 160 n 28 min (pyonephrosis) and 190 n 13 min (bilateral surgery for APKD). There was a need for a conversion in 1 case and another patient needed a transfusion due to a lesion in the renal vein; 2 patients had minor complications. CONCLUSION: HAL surgery is a minimally invasive alternative in the treatment of large renal specimens, with or without significant inflammation.

Laparoscopic surgery for treatment of incisional lumbar hernia

OBJECTIVE: To present results obtained with laparoscopic correction of incisional lumbar hernia in patients with minimum follow-up of 1 year. MATERIALS AND METHODS: We prospectively studied 7 patients diagnosed with incisional lumbar hernia after physical examination and computerized tomography. We used laparoscopic transperitoneal access through 3 ports. One polypropylene mesh was introduced in the abdominal cavity and fixed by titanium clamps to the margins of the hernia ring following release of the peritoneum. RESULTS: All cases were successfully completed with no conversion required. Mean surgical time was 120 minutes and discharge from hospital occurred between the 1st and the 2nd postoperative days. There were no intraoperative complications or hernia recurrence in any case. Postoperatively, we had 2 minor complications: one case of seroma that resolved spontaneously after 60 days and one patient presenting lumbar pain that persisted until the 3rd postoperative month. The return to usual activities occurred on average 3 weeks following intervention. Of the 7 patients, 6 were satisfied with the esthetical and functional effect produced by the procedure. CONCLUSIONS: The surgical correction of incisional lumbar hernia by laparoscopic access is an excellent option for a minimally invasive treatment, with adequate long-term results.

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.