ABSTRACT
Greater splanchnic nerves (GSNs) and lesser splanchnic nerves (LSNs) are the dominant nerves in the pain of advanced cancer patients, which provides the base of retroperitoneal laparoscopic splanchnicectomy. We dissected 25 cadavers to provide anatomic basis for the surgery. Most GSNs entered the abdominal cavity close to the medial crus of the diaphragm while most LSNs the middle one. The number of the branch varies from 1 (which was 80 %) 3. The abdominal segment length of LSNs and GSNs was 26 mm and 20 mm respectively. The mean diameter of the nerves was about 2 mm. The laparoscope was put through abdominal wall beneath the 12th rib at the posterior axillary line, best angles and distances for the surgery were 50 ° and 80-110 mm respectively. The anatomic parameters of splanchnic nerves in the abdominal cavity as well as the angle and distance for the retroperitoneal laparoscopic splanchnicectomy and the anatomic landmarks were presented by the study. Besides the advantages of small incision, less pain and quick recovery, the anatomic parameters provided a practicable approach for the retroperitoneal laparoscopic splanchnicectomy.
Los nervios esplácnicos mayores (NEM) y los nervios esplácnicos menores (NEm) son los nervios dominantes en el dolor de los pacientes con cáncer avanzado, que proporciona la base de la esplacnicectomía laparoscópica retroperitoneal. Se disecaron 25 cadáveres para proporcionar base anatómica para la cirugía. La mayoría de los NEM entraron en la cavidad abdominal cerca del pilar medial del diafragma, mientras que la mayoría de los Nem lo hicieron cerca del pilar medio. El número de ramas varía de 1 (que era del 80 %) - 3. La longitud del segmento abdominal de NEm y NEM fue de 26 mm y 20 mm, respectivamente. El diámetro medio de los nervios era de aproximadamente 2 mm. El laparoscopio se colocó a través de la pared abdominal debajo de la 12 costilla en la línea axilar posterior, los mejores ángulos y distancias para la cirugía fueron de 50° y 80-110 mm, respectivamente. Los parámetros anatómicos de los nervios esplácnicos en la cavidad abdominal, así como el ángulo y la distancia para la esplacnicectomía laparoscópica retroperitoneal y los puntos de referencia anatómicos fueron presentados por el estudio. Además de las ventajas de la incisión pequeña, menos dolor y recuperación rápida, los parámetros anatómicos proporcionaron un enfoque práctico para la esplacnicectomía laparoscópica retroperitoneal.
Subject(s)
Humans , Splanchnic Nerves/anatomy & histology , Splanchnic Nerves/surgery , Laparoscopy/methods , Retroperitoneal Space , CadaverABSTRACT
Objective To study the safety and efficacy of retroperitoneal laparoscopic resection of adrenal neurilemmoma.Methods The data of 7 cases with adrenal neurilemmoma undergoing retroperitoneal laparoscopic resection were analyzed.2 cases were diagnosed by ultrasound scan,3 cases had blood pressure elevation,and 2 cases had pain in waist and abdomen.All cases underwent ultrasound and CT scan.The neurilemmoma was located in left adrenal area in 2 cases and located in right adrenal area in 5 cases.Results All the 7 cases were successfully operated.No conversion or severe blood loss happened.The average tumor size was 5.0 cm,ranging from 3.0 to 7.0 cm.The average operation time was 75 min,ranging from 45 to 120 min.The estimated blood loss was 50 ml,ranging from 20 to 100 ml.The patients were discharged 7-8 day after the operation.During the 2-12 months of follow-up,no recurrence or metastasis was found.Conclusion Retroperitoneal laparoscopic resection offers an effective and better treatment for adrenal neurilemmoma,with the advantages of less blood loss,less trauma,and faster recovery.
ABSTRACT
Objective To explore the therapeutic effect and application value of retroperitoneal laparoscopic combined with resectoscopic radical nephroureterectomy for upper tract urothelial carcinoma Methods From Jan.2006 to Jul.2009,fifteen upper tract urothelial carcinoma patients underwent excision of bladder cuff with resectoscope at first,and then retroperitoneal laparoscopic radical nephroureterectomy.All tumors were confirmed to be localized,stage T1-T3.Clinical outcomes of the patients were retrospectively analyzed.Results Mean operative time was 150 (range:120-180) minutes and blood loss volume was 200 (range:100-400)ml.The function of intestinal canal recovered after 24-48 hours,the drainage tube could be removed after 3-4 days.Catheter was kept for 7-10 days.During the follow up for 1-40 months,all the 15 patients survived with one retroperitoneal lymphatic metastasis.There were no severe complications in perioperative and postoperative period.Conclusions Retroperitoneal laparoscopic combined with resectoscopic radical nephroureterectomy may be a practical surgical procedure for upper tract urothelial carcinoma patients with less intraoperative blood loss and early recovery.