Clinical efficacy of flexible ureteroscopic holmium laser lithotripsy combined with cyst wall incision in the treatment of renal calculi with ipsilateral renal cyst / 现代泌尿外科杂志

【Objective】 To investigate the efficacy of flexible ureteroscopic holmium laser lithotripsy combined with cyst wall incision and drainage in the treatment of renal calculi with ipsilateral renal cyst. 【Methods】 A total of 70 patients with renal calculi complicated with ipsilateral renal cyst (cyst diameter >40 mm, maximum diameter of stone 0.05). 【Conclusion】 Flexible ureteroscopic holmium laser lithotripsy combined with cyst incision and drainage has the advantages of short operation time, small trauma, few adverse reactions, good stone clearance effect and satisfactory efficacy. It can be used as a preferred surgical method for renal calculi complicated with ipsilateral renal cyst.

Efficacy of transurethral ureteroscopic lithotripsy versus retroperitoneal laparoscopic ureterolithotomy in the treatment of upper ureteral calculi / 中国基层医药

Objective:To explore the effects of retroperitoneal laparoscopic ureterolithotomy (RLU) and urethral ureteroscopic lithotripsy (URL) on renal function, oxidative stress, and immunoglobulin levels in patients with upper ureteral calculi.Methods:The clinical data of 78 patients with upper ureteral calculi, who received treatment in Yiwu Central Hospital from June 2017 to April 2020, were collected for this study. The patients were divided into URL group ( n = 38, URL treatment) and RLU group ( n = 40, RLU treatment) according to different surgical methods. Renal function (creatinine, urea nitrogen, neutrophil gelatinase-associated lipocalin), oxidative stress (superoxide dismutase, malondialdehyde), immunoglobulin (Ig) (IgA, IgM, IgG), and complications were compared between the two groups. Results:At 1 day after surgery, creatinine, urea nitrogen, neutrophil gelatinase-associated lipocalin in the RLU group were (79.59 ± 6.02) μmol/L,(6.93±1.17) mmol/L,(4.78±0.61) μg/L, respectively, which were significantly lower than those in the URL group [(86.98 ± 8.27) μmol/L, (7.62 ± 1.24) mmol/L, (6.03 ± 0.79) μg/L, t = 4.53, 2.53, 7.85, P < 0.001, P = 0.014, P < 0.001). At 1 day after surgery, IgA, IgM, and IgG in the RLU group were (1.94 ± 0.25) g/L, (1.55 ± 0.24) g/L, (6.59 ± 1.25) g/L, respectively, which were significantly lower than those in the URL group [(2.38 ± 0.23) g/L, (1.82 ± 0.27) g/L, (7.89 ± 1.36) g/L, t = 8.08, 4.67, 4.40, P < 0.001, 0.001, 0.001]. At 1 day after surgery, malondialdehyde level was significantly lower in the RLU group than in the URL group [(7.49 ± 1.26) mmol/L vs. (8.93 ± 1.38) mmol/L, t = 4.817, P < 0.001]. At 1 day after surgery, superoxide dismutase level was significantly higher in the RLU group than in the URL group [(72.18 ± 7.55) mg/L vs. (63.49 ± 6.69) mg/L, t = 5.37, P < 0.001). There was no significant difference in the incidence of postoperative complications [15.79% (6/38) vs. 7.50% (3/40), χ2 = 1.31, P = 0.252]. Conclusion:RLU for the treatment of upper ureteral calculi has fewer effects on renal function, oxidative stress, and immunoglobulin level in patients with upper ureteral calculi compared with URL and does not increase the incidence of complications.

Application of enhanced recovery after surgery during perioperative period of retroperitoneal laparoscopic radical nephrectomy / 国际外科学杂志

Objective:To investigate the effectiveness of enhanced recovery after surgery (ERAS) concept in perioperative period of retroperitoneal laparoscopic radical nephrectomy.Methods:The clinical data of 189 patients who underwent retroperitoneal laparoscopic radical nephrectomy from October 2015 to July 2021 were retrospectively analyzed. According to different perioperative management methods, they were divided into two groups: ERAS group ( n=97) and traditional group ( n=92). Patients of ERAS group were managed by the ERAS concept during the perioperative period, patients of traditional group were managed by the traditional method during the perioperative period. First drinking time after surgery, first exhaust time, 24 h postoperative pain score, first activity time out of bed, indwelling time of urinary catheter, indwelling time of drainage tube, postoperative hospital stay, incision length and complications of pneumonia and venous thrombosis were recorded and compared between the two groups. Measurement data were expressed as mean ± standard deviation ( Mean± SD), and independent sample t-test was used for comparison between groups; count data comparison between groups was by Chi-square test or Fisher exact probability method. Results:There were no significant differences in age, gender, body mass index, tumor side, tumor diameter, maximum diameter of samples, T stage, diabetes and hypertension from between two groups ( P >0.05). In ERAS group, the time of first drinking water after surgery was (3.8±1.4) h, the time of first anal exhaust was (10.2±2.5) h, the 24 h pain score was (2.4±1.0), the time of first activity out of bed after surgery was (18.8±3.6) h, the indwelling time of urinary catheter was (19.8±3.7) h, the indwelling time of drainage tube was (3.4±0.5) d, the surgical incision length was (7.2±0.9) cm, and the postoperative hospital stay was (5.5±0.6) d. In the traditional group, the time of first drinking water after surgery was (21.2±4.2) h, the time of first anal exhaust was (20.1±4.3) h, the 24 h pain score was (5.4±1.0), the time of first activity out of bed after surgery was (32.8±7.8) h, the indwelling time of urinary catheter was (55.7±8.0) h, the indwelling time of drainage tube was (4.2±0.5) d, the surgical incision length was (13.6±1.5) cm, and the postoperative hospital stay was (7.2±1.3) d. There were statistically significant differences in these indexes between the two groups ( P<0.05). Conclusion:The clinical application of the concept of ERAS during the perioperative period can promote the rapid postoperative recovery of patients undergoing retroperitoneal laparoscopic radical nephrectomy, and can effectively reflect the minimally invase advantages of retroperitoneal laparoscopic technology.

The learning curve of retroperitoneoscopic urologic surgery: A systematic review

INTRODUCTION@#Retroperitoneal laparoscopic (RPL) urologic surgery offers comparable surgical and functional outcomes to the traditional transperitoneal approach, with the advantage of circumventing the need to enter the intraabdominal space. This precludes the necessity to encounter small intestinal and colonic segments, encounter abdominal adhesions, and mobilize adjacent organs, translating to better peri-operative and post-operative conditions. However, RPL demands a strong knowledge of the retroperitoneal anatomy coupled with a level of laparoscopic dexterity, this results in a steep learning curve. Unfortunately, the evidence on the learning curve for RPL is diverse and scarce. The aim of this systematic review was to consolidate the available literature and determine the minimum required number of cases to efficiently and safely perform RPL.@*METHODS@#This is a systematic review of the literature via PubMed, EBSCO and Science Direct of all studies published since 2000 to 2019. The search was conducted by combining the following terms, “Retroperitoneoscopy”, “Retroperitoneoscopic”, “posterior laparoscopy”, “Learning”, “Nephrectomy”, “Adrenalectomy”, and “Ureterolithotomy”. Outcomes of interest were learning curve, mean operative time, mean intra-operative blood loss and mean hospital stay.@*RESULTS@#After the screening phase and application of the eligibility and exclusion criteria, the review included a total of 6 studies on the learning curve for RPL. The learning curve for retroperitoneoscopic adrenalectomy was 40 cases and 24 to 42 cases, based on the evidence from Uitert, et al. (2016) and Vrielink, et al. (2017), respectively. For retroperitoneoscopic nephrectomy, the minimum required number of cases is 30 – 70, based on the studies by Pal, et al. (2017), Zhu, et al. (2018) and Tokodai, et al. (2013). Ercil, et al. (2014) demonstrated the learning curve for retroperitoneoscpic ureterolithotomy to be at 30 cases. Review of each literature showed that completion of the learning curves translated to better peri-operative and post-operative conditions (i.e. shorter operative time, lesser intra-operative blood loss, shorter hospital stay). Overall, the evidence in this review suggests that for posterior retroperitoneal laparoscopy, a mean learning curve of 31 to 56 cases is required to safely and efficiently perform the procedure. @*CONCLUSION@#Retroperitoneal laparoscopic surgery is a valid alternative to the traditional transperitoneal approach. It offers comparable anatomic and functional results, albeit better peri-operative and post-operative outcomes. However, its performance requires a strong knowledge and familiarity of working within the retroperitoneum which can be achieved through progressive experience in RPL. The evidence consolidated by this review suggests a learning curve of 31 to 56 cases prior to effectively performing the procedure.

Retroperitoneal laparoscopic adrenalectomy: its role in the management of adrenal tumour and tertiary care centre experience

Background: Laparoscopic adrenalectomy for adrenal tumour has gained increased popularity worldwide. To decrease the complications of commonly used transperitoneal approach, by not entering into peritoneal cavity the retroperitoneal laparoscopic adrenalectomy (RLA) has developed. It has several advantages over the transperitoneal approach and associated with reduced morbidity and excellent outcome. The objective of this study was to report our experience with RLA for treatment of adrenal tumour.Methods: The study was done from August 2014 and December 2017, data of 44 patients who underwent RLA for adrenal tumour in the institute were retrospectively reviewed. Patient’s demographical, clinical, diagnostic and procedural data were recorded. All patients were assessed by history, physical examinations, laboratory values with biochemical marker test and imaging by computed tomography/magnetic resonance imaging. Treatment outcome was assessed in terms of operative time, haemoglobin drop, conversion rate, hospital stay and complications.Results: In 44 adrenalectomy, 24 men and 20 women, with a mean age of 47.0±8.9 years were enrolled. Mean body mass index was 23.5±2.2 kg/m2. Right adrenal tumour was seen in 26 cases and left in 18 cases. Mean adrenal mass size was 2.6±0.85 cm. Mean operative time was 109.1±21.16 minutes, mean haemoglobin drop was 0.47±0.26 gram/L. Conversion to open surgery was necessary in 2 patients. Mean postoperative hospital stay was 4.0±0.91 days. Recovery time mean value was 12.18±1.7 days postoperatively. In final histopathology result adenoma was most prevalent (25 cases) and myelolipoma was least (1 case).  Conclusions: RLA appears to be safe and effective alternative to transperitoneal adrenalectomy for moderate size adrenal tumour in particular less than 6 cm. It is associated with less blood loss, shorter hospitalization, low conversion rate, fewer complications and early recovery. RLA offers an alternative method for treating adrenal tumour with improved surgical outcomes.

Schwannoma retroperitoneal: Abordaje laparoscópico / Laparoscopic approach of a retroperitoneal schwannoma

Los tumores retroperitoneales de origen neurogénico benignos son infrecuentes; suelen ser asintomáticos y manifestarse tardíamente con síntomas imprecisos, tumor palpable o de compresión a estructuras adyacentes; cuando son funcionantes, la expresión constante es la hipertensión arterial. Debido a su rareza, ubicación y relación con grandes vasos, el abordaje laparoscópico ha sido inusual, por lo cual el empleo de esta estrategia operatoria aún no ha sido completamente aclarado. Se presenta una paciente, de 40 años, a quien en un estudio ultrasonográfico casual se le encuentra una lesión retroperitoneal, adyacente a la vena cava inferior. Se indica y describe la técnica empleada, que fue el abordaje laparoscópico transperitoneal. La duración de la intervención fue de 46 minutos, la pérdida sanguínea de 10 mL, el dolor escaso y el tiempo de internación, 48 horas. El resultado anatomopatológico confirmado por inmunohistoquímica fue de schwannoma. El control clínico y por imágenes a 14 meses es normal. Se realizan las consideraciones de esta patología tan infrecuente y se concluye que el abordaje transperitoneal laparoscópico de lesiones retroperitoneales es factible, con todas las ventajas que esta vía ofrece.

Benign neurogenic retroperitoneal tumors are rare, usually asymptomatic or present non-specific symptoms as a palpable mass or compression of the surrounding structures. Functional tumors are associated with hypertension. Due to their rarity, location and relationship with the surrounding vascular structures, the use of the laparoscopic approach to remove these tumors is unusual, and the routine use of this strategy has not been clarified yet. We report the case of a 40-year-old female patient with an ultrasound showing a retroperitoneal mass adjacent to the inferior vena cava. A transperitoneal approach was decided and the technique is described. Operative time was 46 minutes, blood loss was 10 mL, pain was minimal and hospital stay was 48 hours. The pathological examination and immunohistochemical tests revealed the presence of a schwannoma. Follow-up image tests and clinical examination at 14 months were normal. The considerations of this rare condition are made, concluding that transperitoneal laparoscopic approach for retroperitoneal masses is feasible with all the advantages provided by this method.

Feasibility and safety of modified retroperitoneal laparoscopic surgery in the treatment of upper urinary tract urothelial carcinoma / 中国内镜杂志

Objective?To evaluate the application of two kinds of retroperitoneal laparoscopic nephroureterectomy in upper urinary tract urothelial carcinoma and select the best operative approaches.?Methods?The clinical data of 40 cases of retroperitoneal laparoscopic surgery in patients with upper urinary tract tumor were analyzed. Among the 40 patients, 21 cases (14 males and 7 females) underwent modified retroperitoneal laparoscopic nephroureterectomy combined with transurethral incision of the ureteral orifice (group A), and 19 cases (13 males and 6 females) underwent retroperitoneal laparoscopic nephroureterectomy combined with hypogastrium minor incision and transurethral incision of the ureteral orifice (group B). The operative time, the blood loss, the retention time of drainage tube, the first exhaust time of postoperative and the hospital stay were compared between the two groups.?Results?The operation was successfully completed in all the 40 cases without conversion to open surgery. The operative time in group A was significantly shorter than that in group B (P < 0.01), and the hospital stay was significantly shorter than that in group B (P < 0.05). There were no statistical differences in blood loss, the retention time of drainage tube, and the first exhaust time of postoperative between the two groups (P > 0.05).?Conclusions?Compared with the retroperitoneal laparoscopic nephroureterectomy combined with hypogastrium minor incision, the modified retroperitoneal laparoscopic nephroureterectomy is safe and effective, which can shorten the operative time and reduce hospital saty. Tumor located in renal pelvis and the proximal &middle part of ureter, modified retroperitoneal laparoscopic nephroureterectomy combined with transurethral incision of the ureteral orifice is the most effective method.

Comparison of the effect between percutaneous nephrolithotomy and retroperitoneal laparoscopic pyelolithotomy in the treatment of renal pelvis calculus / 新乡医学院学报

Objective To compare the clinical effect between percutaneous nephrolithotomy (PCNL) and retroperitoneal laparoscopic pyelolithotomy (RLP) in the treatment of renal pelvis calculus,so as to provide evidence for the treatment of renal pelvis calculus.Methods A total of 108 patients with renal pelvis calculus were selected from January 2012 to December 2016 in Zhumadian Central Hospital.The patients were divided into PCNL group (n =59) and RLP group (n =49) according to the therapeutic method.The operation time,intraoperative blood loss,intraoperative blood transfusion rate,operative success rate,stone clearance rate,postoperative hemoglobin reduction,postoperative analgesia time,postoperative hospitalization time and the incidence of complications were compared between the two groups.Results The success rate of operation in PC-NL group and RLP group was 94.9％ (56/59) and 100.0％ (49/49) respectively,there was no significant difference in the success rate of operation between the two groups (x2 =1.026,P ＞ 0.05).The stone clearance rate in PCNL group and RLP group was 94.9％ (56/59) and 98.0％ (48/49) respectively,there was no significant difference in the stone clearance rate between the two groups (x2 =0.140,P ＞ 0.05).The intraoperative blood transfusion rate in PCNL group and RLP group was 5.1％ (3/59) and 2.0％ (1/49) respectively,there was no significant difference in the intraoperative blood transfusion rate between the two groups (x2 =0.105,P ＞ 0.05).There was no significant difference in operation time and postoperative analgesia time between the two groups (P ＞ 0.05).Compared with the PCNL group,the blood loss and postoperative hemoglobin reduction were less,and the postoperative hospitalization time was shorter in the RLP group (P ＜ 0.05).The incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage in PCNL group was 3.4％ (2/59),8.5％ (5/59)and 6.8％ (4/59) respectively;the incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage in RLP group was 8.2％ (4/49),4.1％ (2/49) and 4.1％ (2/49) respectively;there was no significant difference in the incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage between the two groups (x2 =2.975,1.064,1.811;P ＞ 0.05).Conclusion The clinical effect of PCNL and RLP in the treatment of renal pelvis calculus is fairly,and their safety is high.However,RLP has the advantages of less intraoperative bleeding,quick postoperative recovery and short hospitalization time.

"Clinical application of retroperitoneal laparoscopic surgery combined with mini-flank incision ""hybrid surgery"" for partial nephrectomy of complex renal tumors" / 北京大学学报(医学版)

Objective: To evaluate the clinical effect and safety of retroperitoneal laparoscopic surgery combined with mini-flank incision hybrid surgery for partial nephrectomy of complex renal tumors.Methods: Between April 2015 and December 2016, the clinical data from 16 patients with complex renal tumors who underwent the hybrid surgery, including 10 males and 6 females, were retrospectively reviewed.The average age was (50.2±10.7) years, 9 cases were located in the left side and 7 cases in the right side, the mean tumor size was (6.1±1.0) cm, and the mean R.E.N.A.L.nephrometry score was 9.3±1.3.All the patients received the hybrid surgery, the first step was to adequately mobilize the kidney and tumor, prepared the renal artery by retroperitoneal laparoscopy, and then the incision about 10-12 cm was done under the twelve rib to convert to open surgery.After the renal artery was clamped, the tumor was removed and the wound was closed under direct vision.The operative time, ischemia time, estimated blood loss, intraoperative and postoperative complications and short-term renal function were recorded.Results: All the 16 patients'' hybrid surgeries were successfully performed.The mean operative time was (164.9±23.6) min, mean ischemia time was (32.4±6.2) min, and mean estimated blood loss was (204.0±125.1) mL.The mean drainage tube removal time was (4.1±1.0) d, and the mean postoperatively hospital stay was (6.9±1.5) d.There were 2 patients with Clavien Ⅲ grade complications.One patient was injured with collecting system, and 1 patient received a second emergency surgery for acute postoperative bleeding.The mean 1 day postoperative serum creatinine level was (126.3±26.4) μmol/L, which was statistically significant (P0.05) in comparing the 1 month postoperative serum creatinine level(92.6±18.2) μmol/L, 3 months postoperative serum creatinine level (80.8±18.4) μmol/L with the preoperative serum creatinine level.During 3 to 20 months follow-up periods, no local recurrence or distant metastasis occurred.Conclusion: This hybrid surgery combined retroperitoneal laparoscopic surgery with mini-flank incision for partial nephrectomy is safe and effective.It could decrease the operative difficulty and be worthy of further application for some selected complex renal tumor patients.

Clinical observation on modified adrenalectomy in treatment of pheochromocytoma / 中国内镜杂志

Objective To observe the clinical effect of modified laparoscopic adrenalectomy for adrenal pheochromocytoma. Methods 23 patients with adrenal pheochromocytoma were treated with modified posterior laparoscopic adrenalectomy. The changes of blood pressure, heart rate, operation time and blood loss during and after operation were observed. Results 23 patients were successfully operated, the operation time was (62.3 ± 11.7) min, the intraoperative blood loss was (34.4 ± 17.7) ml, there has no hemorrhage occurred while 3 cases were transferred to ICU for intraoperative blood pressure and heart rate fluctuation significantly, and back to general ward after 2 days, while there was no significant difference in blood pressure and heart rate preoperatively. Conclusion Modified laparoscopic adrenalectomy is safe and effective for pheochromocytoma and holds the advantages of clear anatomy, short operative time, less bleeding and less change in blood pressure and heart rate.

Clinical investigation on minimal invasive surgery for Cushing syndrome caused by adrenocortical adenoma: experience of 121 cases in a single center / 中华泌尿外科杂志

Objective To explore the efficacy and safety of minimal invasive adrenal sparing surgery for the treatment of Cushing syndrome caused by adrenocortical adenoma.Methods Patients who underwent minimal invasive adrenal surgery for adrenocortical adenoma in our institution from January 2010 to December 2015 were retrospectively analyzed.Preoperative, intraoperative, and postoperative variables were reviewed from the database.The mean patient age at diagnosis was 39 years and male:female ratio was 10:111.Of the 121 adenomas, 50 were located in the right adrenal and 71 in the left.The mean tumor size was 2.6 cm.84 cases had hypertension (69.4％), 36 cases had diabetes mellitus (29.8％), and 45 cases had obesity (37.2％).Postoperative follow-up was performed by evaluating adrenal gland function and imaging.Results Mininal invasive partial adrenalectomy was performed in 121 cases and the success rate of operation was 99.2％ (120/121).Sixty-two cases received operation through retroperitoneal approach,and 59 cases were through transperitoneal approach.The median operative time was 50 min with a median blood loss of 50 ml.The mean postoperative hospital stay were (5.0 ± 3.2) days.The vascular injury occurred in 2 cases (1 case in each surgical approach), while the abdominal organ injury occurred in 2 cases with 1 case of spleen injury and 1 case of liver injury (both in transperitoneal approach).Postoperative complications were observed in 6 cases:1 case of deep venous thrombosis, 1 case of wound hematoma, 4 cases of wound infection.Cortisol substitution was given in 2 to 12 months (mean 6.2 months)postoperatively.One year after operation, the remission rate of hypertension, diabetes and obesity was 58.3％ (49/84), 30.6％ (11/36) and 60.0％ (30/45), respectively.Conclusions Minimal invasive adrenal surgery using retroperitoneal and transperitoneal laparoscopic technique can be performed with low morbidity and achieve an excellent outcome.The perioperative hormone therapy may also play an important role.

The comparative study of retroperitoneal laparoscopic pyelolithotomy and percutaneous nephrolithotomy in treating renal pelvic stone / 中华泌尿外科杂志

Objective To evaluate the efficacy of the retroperitoneal laparoscopic pyelolithotomy (RLP) and the percutaneous nephrolithotomy (PCNL) in treating renal pelvic stone.Methods The data of 89 patients diagnosed as renal pelvic stone were retrospectively reviewed from January 2009 to July 2016,of whom 43 patients underwent RLP and 46 underwent PCNL.Statistical analysis was performed regarding operation time,blood loss,mean hospital stay,complication rate,and stone-free rate.Results The operation time in RLP group and PCNL group was (117.5 ± 16.7) min and (118.3 ± 16.6) min,respectively,and there was no significant difference (P =0.547).For the two groups,the mean hospital stay was (4.5 ± 0.5) d and (6.1 ± 0.9) d,the mean hemoglobin decrease was (4.5 ± 1.2) g/L and (18.1 ± 3.4) g/L,the post-operative blood transfusion rate was 2.3％ and 14.0％,the post-operative septic shock rate was 0 and 9.3％,respectively,with significant difference between the two groups (P ＜ 0.05).The stone-free rate in both groups was 97.7％ and 95.3％ with no significant difference (P =0.557).Conclusions RLP has the advantages of quick recovery,less blood loss and lower complication rate than PCNL.It could be a minimally invasive option for the treatment of renal pelvic stone.

Investigation of postoperative extubation time and length of PACU retention after retroperitoneal laparoscopic unilateral adrenal pheochromocytoma resection / 临床麻醉学杂志

Objective To compare the postoperative extubation time and length of PACU retention between patients who had undergone retroperitoneal laparoscopic unilateral adrenal pheochromocytoma resection and other adrenal tumor resection.Methods A retrospective study of 57 hypertensive patients who had undergone retroperitoneal laparoscopic unilateral adrenal tumor resection under the general anesthesia was conducted.Nineteen patients with adrenal pheochromocytoma were assigned to group S,and other 38 patients were assigned to group D.We recorded and compared the gender ratio,ASA grade,age,weight,height,duration of operation and anesthesia,dosage of anes thetics,extubation time,and length of PACU retention between the two groups.Results There were no significant differences in gender ratio,ASA grade,age,weight,height,duration operation and anesthesia,as well as doses of propofol,midazolam,fentanyl and muscle relaxants between the two groups.As to extubation time and length of PACU retention,those of group S were both significantly longer than those of group D [30.0(25.0-42.5)min vs 20.0(15.0-20.0)min;70.0(57.5-82.5)min vs 45.0(33.5-55.0) min,P＜0.05,respectively].Conclusion Retroperitoneal laparoscopic unilateral adrenal pheochromocytoma resection might lead to postoperatively longer extubation time and length of PACU retention.It does not relate to the dosage of anesthetics used perioperatively.

Retroperitoneal Laparoscopic Surgery for Giant Adrenal Myelolipoma / 中国微创外科杂志

Objective To explore the surgical features of retroperitoneoscopic excision of adrenal myelolipoma with diameter larger than 6 cm. Methods We retrospectively analyzed clinical data of 28 cases of giant adrenal myelolipoma from March 2010 to December 2015.The diameter of tumor was 6.0-13.7 cm (mean, 8.5 cm).There were 10 left-sided cases and 18 right-sided cases. During the retroperitoneoscopic excision of adrenal myelolipoma , four trocars were used .Two silk sutures were twisted as a loop to entangle one side of the tumor and then pulled it .Blood vessel on the surface of tumor was sealed and cut by ultrasonic scalpel . Adrenal gland was totally or partially removed and the tumor was resected completely . Results The operations were successful in all the 28 cases without hemorrhage during or after the surgery , conversion to open surgery , or injury of adjacent organs .The operation time was 52-117 min (mean, 67.5 min) and the blood loss was 45-110 ml during operation (mean, 60.5 ml).Patients took food 1-2 days after operation and ambulated 3-5 days after operation .The indwelling time of retroperitoneal drainage tube was 3-6 d (mean, 4.1 d).The postoperative hospitalization time was 6 -9 d (mean, 7.5 d). Conclusions Giant myelolipoma leads to seriously changed normal anatomy and is hard to be exposed during operation .Only when the important anatomical landmarks , large blood vessels and adrenal glands are focused , can the operation be safe and controllable .

Retroperitoneal laparoscopic partial nephrectomy combined with four points location in 3D model or 3Dimensional CT for completely endophytic renal tumours / 中华泌尿外科杂志

Objective To evaluate the safety,efficiency of retroperitoneal laparoscopic partial nephrectomy combined with four points location in 3D model or 3Dimensional CT for completely endophytic tumors,and summarize the surgical experience.Methods From Jan 2015 to Jan 2016,5 patients with completely endophytic tumors,who underwent retroperitoneal laparoscopic partial nephrectomy were recruited.one patient underwent 3D printing kidney model,and another 4 patients underwent 3Dimensional CT and locating four projection positions of the tumor on the surface,in order to guide the tumor resection in laparoscopic partial nephrectomy.Perioperative,operative,and postoperative,as well as oncological outcomes were analyzed.Results In all 5patients,preoperative four points location in 3D model or 3Dimensional CT for completely endophytic tumors is feasible and accurate in term of locating the tumor.The mean operative time was(129.0 ± 19.5) min,mean warm ischaemia time was (19.6 ± 5.4) min and mean estimated blood loss was(100 ± 83) ml.Pathological examination showed cell renal cell carcinoma.All the patients had a negative surgical margin,and no tumor recurrence or metastasis during 6-18months of follow up.Conclusions In experienced institutes,retroperitoneal laparoscopic partial nephrectomy combined with four points location in 3D model or 3Dimensional CT for completely endophytic tumors is a feasible and safe procedure in terms of accurate locations,low complication rates,reasonable functional and oncologic outcomes after an intermediate-term follow-up

The efficacy of retroperitoneal laparoscopic and open surgery in the treatment of adrenal adenoma：a randomized controlled study / 中华内分泌外科杂志

Objective To compare the advantages and disadvantages of retroperitoneal laparoscopic sur -gery and open surgery in treatment of adrenal adenoma , in order to provide the clinical evidence for the selection of surgical treatment of adrenal adenoma .Methods 120 cases undergoing surgical treatment from Jan .2005 to Dec.2010 were randomly divided into laparoscopic group and open surgery group .Operation indicators , postop-erative recovery indicators , postoperative clinical manifestations , success of operation , complications and follow-up data were evaluated and compared between the 2 groups.Results 3 cases in laparoscopic group and 4 cases in open surgery group withdrew.The operation time, intraoperative blood loss, and blood transfusion cases were (89.6 ±18.4)min vs (124.2 ±27.3)min, (70.2 ±17.2)ml vs (205.7 ±51.9)ml, and 8 cases vs 20 cases in laparo-scopic group and open surgery group .Extubation time, starting feeding time, time of getting out of bed, and length of hospital stay were (2.8 ±1.3)d vs (4.2 ±2.0)d, (1.7 ±1.1)d vs (2.9 ±1.4)d, (2.6 ±1.2)d vs (5.1 ± 3.1)d and (6.2 ±3.1)d vs (13.5 ±5.4)d in laparoscopic group and open surgery group .Postoperative analge-sic using cases and drainage volume were 11 cases vs 43 cases, and(15.4 ±4.2)ml vs(45.1 ±12.7)ml in lapa-roscopic group and open surgery group .The difference had statistical significance (P＜0.01).The cost was simi-lar between the 2 groups(P>0.05).The open surgery group had no death or relapse within 1 year, while 5 cases in laparoscopic group converted to laparotomy , with 1 case of death and 2 cases of relapse within 1 year.The complications incidence was 3.51%(2/57)in laparoscopic group, obviously lower than 16.07%(9/56)in open surgery group(P＜0.01).Conclusions Compared to the traditional open surgery, retroperitoneal laparoscopic sur-gery has advantages of less trauma, fewer complications, and faster postoperative recovery in treatment of adrenal ade-noma.Experience and skills of surgeon need to be improved to reduce the possibility of failure or recurrence .

Application of fast track surgery strategy in retroperitoneal laparoscopic adrenalectomy / 医学研究生学报

Objective Studies on the application of fast track surgery ( FTS) are comparatively limited in urologic proce-dures.This randomized controlled study was to evaluate the impact of FTS on recovery after retroperitoneal laparoscopic adrenalectomy . Methods Eighty patients undergoing retroperitoneal laparoscopic adrenalectomy were randomly assigned to an FTS and a control group of equal number to receive an FTS recovery program and conventional perioperative care , respectively .Comparisons were made between the two groups in the time of the first flatus , first oral nutrition , and first mobilization , the incidence of gastrointestinal tract complica-tions, the time of drainage and transurethral catheterization , the length of postoperative hospital stay , hospitalization expenses , visual analogue scale (VAS) pain scores, and general state of the patients . Results The FTS group, in comparison with the control, showed significantly earlier time of first flatus ([20.6 ±8.3] vs [39.8 ±18.3]h, P0.05), nor in the incidence of gastrointesti-nal tract complications between the FTS and control groups ( P >0.05). Conclusion By improving the general state and accelera-ting the recovery of the patients , FTS can be applied safely and effectively in retroperitoneal laparoscopic adrenalectomy .

Retroperitoneal laparoscopic adrenalectomy in 66 cases / 中华内分泌外科杂志

Objective To summarize the operative experience and to study the value and efficacy of retroperitoneal laparoseopie adrenaleetomy.Methods Clinical data of 66 cases undergoing retroperitoneal laparoscopic adrenalectomy in Yijishan Hospital were retrospectively reviewed.There were 22 cases with adrenal adenoms located at left side and 44 cases at fight side.Tumor diameter was from 1.2 to 6.4 cm,with 3.3 cm as the average.There were 36 cases of nonfunctional adrenal adenoma,13 cases of primary hyperaldosteronism,10 cases of adrenal pheochromocytoma,6 cases of adrenal myelolipoma,and 1 case of adrenal cyst.Results 4 cases were converted to open surgery while the other 62 cases were completed successfully.The operation duration was from 35 to 190 min,with 90 min as the average.Intraoperative blood loss was from 20 to 800 ml,with 70 ml as the average.5 cases received blood transfusion because of massive hemorrhage.All cases were followed up for 3to 36 months.None of them had long-term complications or recurrence.Conclusion Retroperitoneal laparoscopic adrenalectomy has advantages of safety,less trauma,short hospitalization time,and quick recovery,making it the flint choice for patients with benign adrenal neoplasms.

Retroperitoneal laparoscopic surgery versus open adrenalectomy: report of 149 cases / 中华内分泌外科杂志

Objective To evaluate and compare open and retroperitoneal laparoscopic adrenalectomy.Methods Clinical data of 30 cases undergoing open adrenalectomy and 119 cases undergoing retroperitoneal laparoscopic surgery were retrospectively analyzed. The 2 groups were compared in terms of these aspects: operation duration, intraoperative blood loss, postoperative analgesic use, time to remove drainage tube, time to resume eat, postoperative hospitalization time, complications, and tumor recurrence. In open surgery group, tumor diameter was between 0.5 cm -10.8 cm, 4.57 cm in average. 18 tumors were located on the left side and 12 tumors on the right side. In laparoscopic group, tumor diameter was between 0.8 cm -14.5 cm, 2.78 cm in average. 59tumors were located on the left side and 60 tumors on the right side. Patients in open surgery group were followed up for 6-72 months and retroperitoneal laparoscopic group 4-20 months. Results Open adrenalectomy were successful in all the 30 cases. 12 cases in laparoscopic surgery group converted to open surgery among whom 8 cases were due to poor visibility, 1 case due to renal artery injury, 1 case due to large tumor size, 1 case because of diaphragmatic injury and 1 case because of pleural injury. Laparoscopic surgery was superior to open surgery in terms of operation duration, intraoperative blood loss, postoperative analgesic use, time to start food taking, time to remove drainage tube, and postoperative hospitalization time. The difference had statistical significance (P ＜0.05 ). Conclusion Retroperitoneal laparoscopic adrenalectomy has advantages such as less trauma, less blood loss, and shorter recovery time, which make this procedure the modern golden standard for treatment of benign adrenal neoplasm.

Videomimicography in displaying skills of retroperitoneal laparoscopic radical nephrectomy in a self control manner / 第二军医大学学报

Objective: To use videomimicography to display the skills of retroperitoneal laparoscopic radical nephrectomy in a self control manner, so as to help the beginners to learn the skills quickly. Methods: The videos of 147 cases of retroperitoneal laparoscopic radical nephrectomy for renal-cell carcinomas (T1 N0 M0), which were performed by a surgeon in our department from Jan. 1, 2002 to Dec. 31, 2006, were retrospectively analyzed. The first 30 cases were compared with the last 30 cases in terms of operative manipulation, outcomes, problems in operation, and complications after operation. The difficulties in learning retroperitoneal laparoscopic radical nephrectomy from videos were discussed. Results: There were no differences between the two patient groups in age, gender, the location or size of the tumors. The bleeding volumes, operation time, frequencies of transferring to open surgery, and addition of Trocar in the first 30 patients were significantly more than those in the last 30 patients (all P<0.01). Results of videomimicography demonstrated that the beginners had a poor anatomic knowledge, the exposure and tissue isolation were not enough, and they had a poor basic skill in manipulating laparoscope. Conclusion: Videomimicography can better display the difficulties in retroperitoneal laparoscopic radical nephrectomy in a self control manner, which can help the beginner to understand the operating skills; the method is worth popularizing.