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Objective To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic adrenalectomy for the treatment of Cushing disease.Methods Clinical data collected from 38 cases retroperitonel laparoscopic adrenalectomy for Cushing disease,from February 2006 to February 2017 were analyzed retrospectively.Among them,there were 6 males and 32 females aged from 13 to 66 years old,with an average age of 38 years old.The disease history ranged from 2 to 96 months,with an average of 28.3 months.Besides,there were 32 cases that had previous history of transsphenoidal pituitary tumor surgery and or radiotherapy.All 38 cases underwent retroperitoneal laparoscopic adrenalectomy therapy.There were 8 cases accepted right adrenalectomy and left subtotal adrenalectomy at the same time,24 cases accepted unilateral adrenalectomy,another 6 cases of pituitary tumors without lesions in medical imaging underwent unilateral adrenalectomy.Results All operations were completed sucessfully without conversion to open surgery and mortality.There was no blood transfusion during the period of operation.The operation time ranged from 30 min to 270 min (mean 88.3 min),the amount of bleeding was among the range of 10 ml to 200 ml (mean 38.33 ml).During 2 to 13 years of the follow up (mean 7 years),the 24 h urine cortisol concentration in the first day after surgery of piatients with subtotal resection was 90.35-220.84 μg/24h (mean 102.83 μg/24h),and 6 cases were in the normal range.After surgery 6-11 months,the clinical symptoms completely disappeared.The hormone replacement therapy was discontinued 1-3 months after surgery.However,There were 3 cases treated with residual adrenalectomy because of the recurrence after 1,3.5,5.0 years respectively.30 cases underwent unilateral adrenalectomy,whose 24 h urine cortisol concentration in the first day after surgery was 99.80-550.84 μg/24h (mean 372.83 μg/24h),among which 24 cases were beyond normal range,and another 6 cases were within the normal range.Reviewing 24 h urine cortisol concentration one month later after operation,it was 382.16-520.34 μg/24h (mean 461.62 μg/24h),with the results of all cases being higher than the normal range,the clinical symptoms were not relieved satisfactorily.During 2 to 7 months after surgery,there were 22 cases further underwent contralateral subtotal adrenalectomy (80％),the remaining 8 cases underwent contralateral adrenalectomy and autologous transplantation of adrenal tissue.Immediately one day after surgery,the 24 h urine cortisol concentration level of patients was ranged from 62.58 to 182.34 μg/24h (mean 92.83 μg/24h),and all 22 cases were within the normal range.The clinical symptoms completely disappeared during next 6 to 9 months after surgery,and hormone replacement therapy was discontinued 3 months after surgery.There were 2 cases received residual adrenalectomy because of the recurrence.Lifelong hormone replacement therapy after surgery occurred in 13 cases and 5 cases developed Nelson syndrome.Conclusions Retroperitoneal laparoscopic of unilateral adrenalectomy and contralateral subtotal adrenalectomy for the treatment of Cushing disease was safe and effective.The contralateral adrenal subtotal resection could be performed at an appropriate time in the case of that the clinical symptoms not obvious.By doing so,it could significantly alleviate the clinical symptoms as well as avoiding lifelong hormone replacement therapy.Once recurrence,residual adrenalectomy can be considered.
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Objective To discuss the optimal operation mode and operation path in minimally invasive technique for living donor nephrectomy.Methods From September 2013 to August 2015, 68 living donor nephrectomy was retrospectively reviewed. Thirty-one patients were performed with robotic-assisted laparoscopic living donor nephrectomy(robotic group), twenty-nine patients underwent totally retroperitoneal laparoscopic living donor nephrectomy(non hand assisted group),and eight patients were performed with hand assisted retroperitoneal laparoscopic living donor nephrectomy(hand assisted group). Operation time, warm ischemia time, intraoperative hemorrhage volume, hospitalization time, complications and preoperative and postoperative serum creatinine value of the recipients between the two groups were compared.Results The operations of three groups were all performed successfully. Intraoperative hemorrhage volume in the three groups were(39±15)ml,(62±37)ml and(53±19)ml, and there were significant differences between these groups(P<0.05). But hospitalization time ,operation time, warm ischemia time and complications occurred rate in the three groups had no significant difference(P>0.05). In robotic group,2 donors occurred with splenic injury during operation and 1 donor was detected with hemorrhage after operation. In non-hand assisted group, 1 donor occurred with urinary tract infection, 1 donor occurred with external iliac vein thrombosis. In hand assisted group 1 donor was detected with wound fat liquefaction after operation. All the donors were followed up for more than 9 months, no hypertension, proteinuria and renal dysfunction complications were detected. The blood creatinine in three groups of recipients after operation of 5th day and 28th day were(118±26)μmol/L, (130±33)μmol/L,(128±41)μmol/L and(114±17)μmol/L,(116±34)μmol/L,(115±29)μmol/L, respectively, and there was no statistical difference(P>0.05).Conclusions Minimally invasive technique for living donor nephrectomy is beneficial to patients' recovery. Surgery doctors should combine personal experience and the hospital's hardware conditions and other factors. The principle is to ensure the donor's safety and to balance the interests of the donor and the recipient, to choose their own most skilled way of surgery.
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The application of endoscopy in pediatric surgery began in 1970s,and it was used for diagnosis of disease at first.After that,laparoscopy and thoracoscopy were widely applied in pediatric general surgery,urology and thoracic surgery.Nowadays,most pediatric abdominal and thoracic diseases could be treated by endoscopic minimally invasive surgery,including pediatric congenital malformation,acute abdominal disease,tumor,and so on.Neonatal laparoscopy has developed rapidly in recent years,which could be performed in most neonatal surgeries.With the development of technology,the application of 3D laparoscopy and surgical robot bring laparoscopy into a new era.Predictably,with the updates of endoscopic devices and the technical improvement,endoscopy could be more popular and used for more difficult surgery and younger children.
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Objective To discuss the clinic characters of clear cell papillary renal cell carcinoma ( CCPRCC) and the efficacy of related laparoscopic surgery.Methods From October 2013 to December 2015, 4 cases were treated as CCPRCC including 3 male and 1 female.Their age ranged from 34 to 67 years old ( mean 53 years old) .The duration of illness ranged from 7 days to 3 months, which the average duration was 1.5 months.The location of tumor included left side in 2 cases and right side in other 2 cases.All tumors were found incidentally, without symptoms or positive sign.Ultrasound showed that 2 cases were solid, and the other 2 cases were cystic solid with low, high or mixed echo and rich blood flow signals.The tumors were enhanced in CT arterial phase, and calcification showed in one case.MRI showed heterogeneous signal.The mean size of tumor was 3.0 cm,ranging 2.3 to 4.5 cm.After preoperative examination, all cases underwent retroperitoneal laparoscopic partial nephrectomy.During the operation, 2 cases were confirmed as cystic solid tumors, and the other 2 cases were solid tumors.Renal artery and renal mass were dissociated , then the artery was blocked.The tumor was complete resected, and kidney was sutured. Results All surgery was performed successfully without conversion.The operation time was 137-191 min (average 157 min).The blood loss was 10-100 ml (average 45 ml) without blood transfusion.The warm ischemia time was 15-35 min ( mean 22 min) .The postoperative hospitalization time stay 6-8 d ( average 7 d).Pathologic report was CCPRCC, including 3 cases of WHO/ISUP grade 1, and 1 case of WHO/ISUP grade 2.2 cases were cystic solid tumor, and other 2 cases were solid tumor.Bland-appearing tubules and occasional small papillae, and uniform small nuclei are arranged in a linear manner away from the basal aspect of the tubules in microscope.Immunohistochemistry showed that CA IX, CK7, 34 E12 were positive, but CD10 , P504S and CD117 were negative.The mean duration of postoperative follow-up was 14 months, ranging 4 to 30 months.No recurrence was found in those patients.Patients were followed up for 4-30 months ( average 14 months) without recurrence or metastasis.Conclusions CCPRCC is a rare subtype of renal tumor, which mainly diagnosed by pathological diagnosis . Retroperitoneal laparoscopic partial nephrectomy is an effective method for the treatment with good prognosis.
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Objective To explore the diagnosis and treatment of adrenal black adenoma . Methods From June 2002 to July 2014, 7 patients with adrenal tumors were treated with retroperitoneal laparoscopic partial adrenalectomy in our hospital .During the operation all the patients were placed in healthy lateral decubitus position .Three trocars were introduced into the lumbar region:below the 12th rib along the anterior and posterior axillary lines , and 2 cm beyond superior iliac spine on the middle axillary line .The retroperitoneal space was established with homemade balloon-expanding devices .Afterwards , the tumors were removed by using a harmonic scalpel. Results All the tumors were resected completely .The average operation time was 60 min (range, 34-90 min) and the average blood loss in the operation was 70 ml (range, 20 -200 ml) without blood transfusion.The drainage tubes were removed on the 3rd or 4th postoperative day and the patients were discharged on the 6th or 7th postoperative day .They were pathologically diagnosed as adrenal black adenoma . Two patients manifested the Cushing ’ s syndrome and 3 patients showed hypertension , all of which were recovered to normal postoperatively .No recurrence or metastasis was noted during a follow-up for 12-24 months (mean, 18 months). Conclusions Adrenal black adenoma, without specific clinical features, is a rare kind of adrenocortical adenoma .The confirmative diagnosis depends on pathological results .Retroperitoneal laparoscopic surgery is a minimally invasive, safe and effective technique for adrenal black adenoma , which provides favorable prognosis .
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Objective To review our clinical experience on 12 patients with retroperitoneal infection who were treated with retroperitoneal laparoscopic debridement.Method This retrospective study included 12 patients with retroperitoneal infection who were treated with retroperitoneal laparoscopic dehridement and drainage.Results All the 12 patients recovered well and were finally discharged home.Conclusions Retroperitoneal laparoscopic debridement and drainage for retroperitoneal infection is a mini-invasive procedure.It was found to be safe,produced minimal bleeding and resulted in rapid postoperative recovery.It can be used as the first choice treatment in properly selected patients.
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Objective To evaluate the safety and clinical efficacy of retroperitoneal laparoscopic partial nephrectomy (LPN) in patients with incidental renal cell carcinoma.Methods Twenty-six patients with T1 incidental renal cell carcinoma treated with retroperitoneal LPN from Dec.2011 to Oct.2013 were analyzed retrospectively.The operation time,warm ischemia time,intraoperative blood loss,complications and prognosis of perioperative periods were collected.Results All 26 cases were operated successfully without conversion to open or other surgery.The operation period was 90-190 minutes.Blockage of renal artery was applied in all 26 cases,and the warm ischemia time was 15-30 minutes.The intraoperative blood loss was 100-360 ml.The drainage was removed 3-7 days postoperatively,and the hospitalization period was 7-12 days.All cases were clear cell renal cell carcinoma by pathological examinations,and showed negative surgical margins.No complications such as postoperative bleeding,inflammation and leakage of urine were occurred.All cases had normal renal function during the follow-up of 3-25 months without local recurrence or distant metastasis.Conclusion Retroperitoneal LPN for the treatment of T1 incidental renal cell carcinoma is worthy of application with the advantages of safety,minimal invasiveness,fewer complications,quick recovery and good nephron-sparing functional recovery.
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Objective To evaluate the clinical effect and safety of retroperitoneal laparoscopic partial nephrectomy in treatment of patients with T1b renal carcinoma.Methods Fourteen patients (11 males and 3 females) with T1b renal carcinoma were retrospectively performed.The age of patients was (54.5 ± 9.2)years old,with 8 cases on the left side and 6 cases on the right side.Tumor diameter was (5.1±1.3) cm.All the patients received retroperitoneal laparoscopic partial nephrectomy.Results None of the 14 cases was converted to open surgery.The operation time was (112.0 ± 24.7) min,the intraoperative blood loss was (64.6 ± 15.9) ml,the warm ischemia time was (26.5 ± 9.3) min.The 14 patients were not blood transfusion in intraoperative and postoperative.Postoperative negative pressure drainage placement time was (3.1 ± 1.5)d,lying in bed time was 72 h.Serum creatinine increase was found in 1 case postoperative 12 h,others were no severe complications.Postoperative pathology:the incisal margin of 14 cases were all negative,clear cell carcinoma was in 13 cases,the pathology stage was T1bNoM0;angiomyolipoma of kidney was in 1 case.All the patients were follow-up 3-16 (21.4 ± 9.6) months,all the patients had normal renal function and had no tumor recurrence or metastasis.Conclusion Retroperitoneal laparoscopic partial nephrectomy is safe and reliable for treatment of patients with T1b renal carcinoma.
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Objective:To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic nephronsparing surgery for renal cell carcinoma of the early stage.Methods:Between June 2003 and June 2008,53 patients (31 males and 22 females) with renal mass were selected to undergo wedge resection of the tumor through retroperitoneal laparoscopy.Spiral computerized tomography (CT) and color Doppler ultrasound were used to provide information for nephron-sparing surgery (NSS).Patients with small (≤3 cm),peripheral,shallow and exophytic tumors,at a distance which exceeded approximately 10 mm between the tumor and renal collecting system,were enrolled into our studies.Surgical resection was performed along a resection line about 0.5 cm from the tumors.Results:All procedures were technically successful.Mean operating time was 96 min (ranging from 75 to 110 min).Mean warm ischemia time was 15 min (ranging from 10 to 21 min).Mean estimated blood loss was 70 m L (ranging from 40 to 120 mL).Mean hospital stay after the surgery was 4.2 days (ranging from 3 to 6 days).No intraoperative or postoperative complications occurred.Of 53 patients,52 had negative surgical margins and a 63-year male patient had a positive surgical margin.Neither local recurrence nor trocar-site metastasis was observed in the 53 patients during followups averaging 39 months (ranging from 11 to 83 months).Conclusion:Under the modified techniques of the surgery and conservative criteria for patient selection,laparoscopic partial nephrectomy can be safely and effectively performed and satisfactory outcomes are achievable.
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Objective To evaluate the value of retroperitoneal laparoscopic adrenalectomy for benign adrenal tumors.Methods From Mar.2009 to Oct.2011,36 patients with adrenal tumors received retroperitoneal laparoscopic adrenalectomy in the First People's Hospital of Shangqiu.During the operation,3 trocars were introduced into the lumbar region to establish retroperitoneal space.Afterwards,the tumor was removed by using a harmonic scalpel.Results The procedures were successfully completed in 19 cases of adrenocortical adenoma,14 cases of pheochromocytoma,2 cases of adrenal cyst and 1case of adrenocortical carcinoma without blood transfusion.The median operation time was 90 min,ranging from 45 min to 180 min.The median intraoperative blood loss was 76 ml,ranging from 30 ml to 700 ml.Drainage tubes were removed 2 days after the operation and the patients were discharged from hospital 3 to 5 days after operation.2 cases were converted to open surgery ( one because of the adhesion between the tumor and vena cava,the other because of the size (about 6.0 cm) of the tumor).The median follow-up time was 12 months,ranging from 3 to 24 months.One patient showed regional subcutaneous emphysema after the surgery and was cured spontaneously.The patients were followed up for 3 to 24 months with the medium of 12 months.Normal blood pressure was achieved in 30 patients in 3 months,while oral antihypertension drugs were still needed for the other 6 patients (2 patients converted to open surgery included).No regional recurrence or death happened during the follow-up.Conclusion Retroperitoneal laparoscopic adrenalectomy can be a safe and effective choice for adrenal tumors,with advantages of small trama,quick recovery,short postoperative hospital stay etc.
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Objective To introduce the clinical experience and effects of retroperitoneal laparoscopic partial nephrectomy in treatment of patients with Tib renal cell carcinoma. Methods Fifteen patients (10 males and 5 females) with Tib renal cell carcinoma who were treated from Nov. 2007 to Jun. 2011 were retrospectively analyzed. The patients had a mean age of (56.2±9.8) years old and a mean tumor size of (5.5±1.4) cm in diameter, with 8 cases on the left side and 7 cases on the right side. All of the 15 patients received retroperitoneal laparoscopic partial nephrectomy. Results All the 15 cases were operated successfully without conversion to open surgery, and there were no severe perioperative complications. The mean operation time was (100±23.6) min, mean warm ischemia time (WIT) was (21.3±8.6) min, and the mean blood loss was (35.3±11.6) ml. Postoperative urinary leakage was found in one case and serum creatinine transient increase was found in one case. The mean postoperative hospital stay was (5.7±1.8) d. All patients had normal renal function and had no tumor recurrence or metastasis during a mean follow-up of (21.2±10.1) months. Conclusion Retroperitoneal laparoscopic partial nephrectomy is safe and effective for treatment of patients with Tib renal cell carcinoma, with less trauma and faster recovery; however, the long-term effects still need large sample studies and long-term follow-up.
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pful in decision making of retroperitoneal laparoscopic NSS.
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Objective To evaluate modified retroperitoneal laparoscopic resection of renal cyst. Method Thirty-six patients with renal cyst were treated by modified retroperitoneal laparoscopic resection of renal cyst,summarized the clinic data and follow-up the effect. Results All 36 cases were operated suc-cessfuUy without changing to opening operation,average operation time (50 ± 35)min,no complications oc-curred and no recurrence was found. Conclusions The modified retroperitoneal laparoscopic resection of renal cyst with two 5 mm-trocars and one 10 mm-trocar has less trauma than classic laparoscopic operation. It is one of mini-trauma operation method which is worth to be popularized in clinic.
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Objective To evaluate the value of retroperitoneal laparoscopic adrenalectomy for benign adrenal tumors.Methods From March 2003 to May 2008,78 patients with adrenal tumors received retroperitoneal laparoscopic adrenalectomy in our hospital. During the operation,three trocars were introduced into the lumbar region to establish retroperitoneal space by blunt dissection with the camera. Afterwards,the tumor was removed by using a harmonic scalpel. Results The procedures were successfully completed in all the 78 cases without blood transfusion,the operation time ranged from 45 to 180 min (mean,90 min). Drainage tubes were removed 24 hours after the operation. And the patients were discharged from hospital in 3 to 5 days postoperation. One patient showed regional subcutaneous emphysema after the surgery and was cured spontaneously. The patients were followed up for 3 to 24 months with a mean of 10 months,during which 36 patients achieved normal blood pressure in 3 months,while in the other 7 patients,oral antihypertension drugs were still needed. No patients had recurrent tumor during the follow-up. Conclusions Retroperitoneal laparoscopic can be the first choice for adrenal tumors,as it is safe and effective with minimal invasion,quick recovery,and short postoperative hospital stay.
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Objective To explore the efficacy of retroperitoneal laparoscopy in the treatment of parapelvic cyst.Methods From August 2005 to December 2008,16 cases of parapelvic cyst were treated by retroperitoneal laparoscopic deroofing and decompressing in our hospital.Under general anaesthesia,an operational space was established via retroperitoneal route.And then,along the urethra,the parapelvic cyst was explored.Afterwards,the cyst was unroofed 3 to 5 mm from the normal renal tissues.Results The operation was completed in 15 of the patients with a mean operation time of(75?20) minutes and mean blood loss of(28?8) ml.No injuries to the kidney pedicle or pelvis occurred.Another patient was converted to open surgery because of difficulty in exposure of the cyst.This series were followed up for a mean of 13 months(range,6 to 20 months).No one had recurrence during the period.Conclusions Retroperitoneal laparoscopic deroofing is minimally invasive,safe and effective or parapelvic cyst.It should be the first choice for the disease.
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Objective To evaluate the clinical value of retroperitoneal laparoscopic and open radical nephrectomy.Methods Clinical data of 12 cases of retroperitoneal laparoscopic radical nephrectomy(Retroperitoneal Group) and 13 cases of open radical nephrectomy(Open Group) from March 2004 to March 2005 in this hospital were retrospectively analyzed and compared in respect of operation time,hemorrhage volume in operation,postoperative hospitalization,and occurrence of complications.Results The two groups of procedure were successfully completed.The operation time was significantly longer in the Retroperitoneal Group(111.1?20.9 min) than in the Open Group(90.1?10.2 min)(t=3.234,P=0.004).The intraoperative hemorrhage volume was significantly less in the Retroperitoneal Group(96.3?15.5 ml) than in the Open Group(150.0 ?25.8 ml)(t=-6.240,P=0.000).The length of postoperative hospital stay was significantly shorter in the Retroperitoneal Group(8.3?2.0 d) than in the Open Group(11.7?2.2 d)(t=-4.031,P=0.000).Conclusions Retroperitoneal laparoscopic radical nephrectomy has advantages oves open nephrectomy in intraoperative hemorrhage volume and postoperative recovery,but operation time is longer and the cost is more expensive.
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Objective To introduce the experience for managing the renal artery and vein during retroperitoneal laparoscopic nephrectomy. Methods A series of 52 consecutive patients underwent retroperitoneal laparoscopic nephrectomy. The operation was performed under a general anesthesia. Patients were maintained in the lateral decubitus position. Two 10 mm trocars and one 5 mm trocar were introduced into the lumbar part. A self-made water-filled balloon was used to dilate the retroperitoneal cavity. In the performance of dissection of the renal artery, the renal hilum should be kept away from as much as possible. When the artery had been separated for 1~2 cm in length, a linear cutter was utilized to sever it. The management of the renal vein was identical with that for the artery. During the management of the renal artery and vein, utmost care should be exercised to dissect the vessels longitudinally; else they were liable to be ruptured. Results All procedures were completed smoothly. A double artery supply was found in 6 patients and a triple artery supply in 1. Five patients had a double venous return-flow. A conversion to open surgery was required in 1 patient for spermatic vein injuries. No postoperative vascular complications were observed. Conclusions Use of a linear cutter to sever the renal artery and vein under retroperitoneal laparoscope is safe and reliable.
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0.05). Conclusions Following retroperitoneal laparoscopy, the cerebral blood flow is increased and no cerebral anoxia is found.
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Objective To discuss the techniques and indications of retroperitoneal laparoscopic nephrectomy. Methods Retroperitoneal laparoscopic nephrectomy was carried out in 21 cases from March to December in 2003, including 12 cases of renal calculus associated with severe hydronephrosis, 1 case of renal tuberculosis, 6 cases of renal carcinoma and 2 cases of renal pelvis carcinoma . Results All the operations were successfully completed and no serious complications were observed. The operation time was 2 hours ～ 3 5 hours (mean, 3 hours) and the blood loss was 10 ml ～ 300 ml (mean, 178 ml). Follow-up for 1 months ～ 9 months in 8 cases of renal carcinoma showed no recurrence or metastasis. Conclusions Retroperitoneal laparoscopic nephrectomy has advantages of minimal invasion, short hospital stay and rapid recovery, indicated for many kinds of benign or malignant renal diseases .
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Objective To compare the efficacies of mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy and routine retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction(UPJ) obstruction.MethodsThe clinical data of 47 patients with UPJ obstruction,who underwent dismembered pyeloplasty from January 2004 to November 2006 in our hospital,were retrospectively analyzed.Of the patients,22 were treated by mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy(group A),in whom a 4-cm incision was made under the costal margin at the posterior axillary line;and the other 25 cases underwent retroperitoneal laparoscopic dismembered pyeloplasty(group B).The clinical data of the two groups,including the operation time,blood loss,average airway resistance and partial pressure of carbon dioxide,recovery of intestinal function,length of drainage and hospital stay,incidence of urinary leakage,and remission rate of hydronephrosis and improvement of GFR,were statistical analyzed by SPSS 13.0.ResultsNo intra-operative complications occurred in either group.Compared with Group B,Group A had shorter operation time [(92.9?16.3) min vs(155.8?18.6) min,t=-12.251,P=0.000],more blood loss [(18.9?6.3) ml vs(13.6?6.7)ml,t=2.782,P=0.008],lower average airway resistance [(15.6?2.6) cm H2O vs(26.9?4.3) cm H2O,t=-10.715,P=0.000] and partial pressure of carbon dioxide [(36.0?6.9) cm H2O vs(51.6?6.7) cm H2O,t=-7.855,P=0.000].No statistical differences were detected in the recovery of intestinal function,postoperative length of drainage and hospital stay,incidence of urinary leakage,and remission rate of hydronephrosis and improvement of GFR.ConclusionMini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy is a safe,effective,and minimally invasive therapy for UPJ obstruction.