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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.
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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.
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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.
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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.
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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 .
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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.
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Objective To evaluate the feasibility of retroperitoneal laparoscopic adrenalectomy for large (≥6 cm in diameter) adrenal tumors. Methods Between June 2002 and June 2008,30 patients with large adrenal tumors underwent retroperitoneal laparoscopic adrenalectomy in our hospital. With the patients being placed in the lateral position at the uninjured side,a self-made balloon was used to dilate the retroperitoneal space. Afterwards,3 trocars were inserted via the costal margin at the posterior axillary line and the anterior axillary line,and 2 cm above the anterior superior iliac spine at the middle axillary line to remove the tumors. After resection of the tumor,an drainage tube was indwelled. Results Retroperitoneal laparoscopic surgery was performed successfully in the 30 cases without conversion to open surgery. The mean operation time was 100 min (range,65 to 185 min),and the mean blood loss was 80 ml (range,50 to 250 ml). Over a mean of 18.5-month follow-up (range,3 to 36 months) was achieved in the cases,during which no one had local recurrence. Conclusions Retroperitoneal laparoscopic adrenalectomy is feasible and safe for patients with large adrenal tumors as long as no contraindication of the surgery is found. The diameter of the tumor does not play a role when determining the surgery.
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5 cm in diameter)were enrolled in this study.Aomong the patients,17 underwent RLRN,and 14 patients received open radical nephrectomy(ORN).The outcomes of the two groups were compared.Results In both the groups,the operations were completed.The blood loss in RLRN group was less than that in ORN group [(245.9?75.5)ml vs(640.5?174.8)ml,t=-8.425,P=0.000].No significant difference was found between the two groups in operation time [(164.8?44.6)min vs(182.7?30.3)min,t=-1.277,P=0.212],postoperative hospital stay [(7.1?3.2)d vs(9.6?5.7)d,t=-1.541,P=0.134],and survival rate(Log-rank test,?2=0.243,P=0.622).Conclusion The efficacy of RLRN is similar to that of ORN.RLRN is safe and induce less blood loss.
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PURPOSE: Retroperitoneoscopy has begun to gain its acceptance for urologic surgery, the aim of this study was to assess the clinical efficacy and safety of retroperitoneal laparoscopic surgery for simple renal cysts. MATERIALS AND METHODS: Three female and five male patients ranging from 37 to 72 years in age underwent retroperitoneal laparoscopic marsupialization of symptomatic renal cysts from March 1996 to February 1998. The retroperitoneal space was created by saline-filled balloon made of middle finger of a No 8 surgical glove and 16Fr Foley catheter. Two patients had prior percutaneous cyst aspiration and sclerotherapy and two patient had a parapelvic renal cyst. We assessed the mean operative time, postoperative hospital stay and complications. RESULTS: Mean operative time was 98 minutes(range; 80-140), the average postoperative hospital stay was 2.5 days(range; 2-3). All eight patients were successfully managed and have remained pain free with no evidence of recurrence of the cyst at the 3-12months follow-up. Complications included 2 cases of subcutaneous emphysema and 1 case of peritoneal tear. CONCLUSIONS: Retroperitoneal laparoscopic unroofing is a safe, effective, and minimally invasive treatment for symptomatic or recurrent renal cyst.