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Objective To explore the technique and clinical efficacy of retroperitoneoscopic nephrectomy (RN) at different anatomical plane for benign non-functioning kidneys. Method We retrospectively reviewed the clinical data of 84 patients who underwent RN for benign non-functioning kidneys from February 2010 to November 2016. Various anatomical plane was performed for differing etiology, image and plane, included radical nephrectomy (A group, n = 35), simple nephrectomy (B group, n = 27) and subcapsular nephrectomy (C group, n = 22). Clinical data and preoperative information was collected and analyzed. Result Nephrectomy was performed successfully in 84 patients. There are significantly longer mean operative time and more estimated blood loss in the C group than that in A group and B group (P < 0.05), however, postoperative hospital stay, complications and recovery time were significantly less in the three groups. There was longer mean operative time and more estimated blood in specific and nonspecific infection group compared with the other two groups (P < 0.05). Conclusion Retroperitoneoscopic nephrectomy, although challenging, is safe, reliable, and successful for treatment of benign non-functioning kidneys.Anatomical plane of avascular zone should be offered as the choice of modality to all patients with benign non-functioning kidney.
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Objective To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy for a tuberculous non-functional kidney. Methods A total of 15 individuals diagnosed with unilateral non-functional kidney secondary to tuberculosis were encountered from January 2013 to January 2016. There were 12 male and 3 female patients with an average age of 47 (range 36~64 years old) in the cohort. All patients had normal renal function on the contralateral side and underwent the standard three-drug antituberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the enlarged section of the distal ureter was managed using different auto-suture techniques. Results All the operations were successfully performed without conversion. The median operative time was 109 min (range, 75~138 min), the median blood loss was 157 ml (range, 70~230 ml), and the median hospitalization time was 7 days (range, 5~11 days). Renal vein injury, lumbar vein injury and rupture of distal ureter occurred in 1 patient, respectively. Peritoneum injury was observed in 3 patients. No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting five months. No recurrenceof tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 25 months. Conclusion Total retroperitoneal laparoscopic nephroureterectomy is a safe and feasible approach for the treatment of tuberculous non-functional kidneys, and it is minimal and rapid recuperation.
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Objective To investigate the feasibility and efficacy of posterior retroperitoneoscopic adrenalectomy (PRA).Methods To review the clinical data of 35 patients who underwent posterior retroperitoneoscopic adrenalectomy from September 2013 to September 2015.There were 14 males and 21 females, aged 15-70 years, with an average of 45.8 years.Preoperative CT scan was performed to determine the size, shape and location of the tumor.Tumor diameter 10-60 mm, average 31 mm.Results 35 operations were successfully accomplished via the posterior approach.The operation time was 38-138 min (mean 70.1 min) ,and the drainage tube indwelling time was 1-5 d(average 2.1 d) ,the hospital stay was 2-6d(average 3.7 d).Total hospital costs were 14 789-31 992 yuan, average of 21 239 yuan.No complications occurred during the perioperative period.Conclusions Posterior retroperitoneoscopic adrenalectomy might provide clear anatomical views.It could be a safe and effective operation for the clinical treatment of adrenal tumors.
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PURPOSE: Posterior retroperitoneoscopic adrenalectomy (PRA) for small adrenal tumors has recently been in the spotlight due to its several benefits. Compelling advantages for endoscopic surgeons include direct, safe, and fast approach to the adrenal gland without trespass to the intraperitoneal organ. This study reports our initial experiences of PRA for the management of adrenal tumors. METHODS: From December 2009 to August 2011, 63 patients underwent PRA for the management of adrenal tumor. Among these patients, laparoscopic adrenalectomy and robotic adrenalectomy were performed in 54 and nine patients, respectively. We retrospectively reviewed records of all surgical outcomes. RESULTS: Of the 54 patients, 22 were male and 32 were female, and mean age was 51.7±14.0 years. Mean body mass index was 24.6±3.6 kg/m² and mean dimension of the tumors was 2.66±1.36 cm. Six patients were diagnosed with Cushing's disease, 22 patients with primary aldosteronism, seven patients with pheochromocytoma, one patient with metastatic adrenal gland cancer, and 18 patients with nonfunctioning adrenal tumors. Mean operative time was 88.5±27.1 min, mean blood loss was 17.4±37.4 ml, and mean duration to first oral intake was 0.83±0.4 days. Mean number of postoperative analgesics used was 2.28±2.54, and mean postoperative hospital stay was 2.85±1.43 days. There was no open conversion during the operation and no post-operative complication. CONCLUSION: PRA is a safe and fast procedure. In experienced hands, PRA represents one of the ideal approaching methods in the adrenal gland surgery.
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Female , Humans , Male , Adrenal Gland Neoplasms , Adrenal Glands , Adrenalectomy , Analgesics , Body Mass Index , Hand , Hyperaldosteronism , Length of Stay , Operative Time , Pheochromocytoma , Retrospective Studies , SurgeonsABSTRACT
Objective To investigate the efficacy of retroperitoneal laparoscopic heminephroureterectomy for duplex kidney anomalies.Methods Retroperitoneoscopic heminephroureterectomy was performed on nine patients, six males and three females.The average age of the study group was 37 years ( range 13 to 58).Seven cases had anomalies on the upper kidney pole, two cases had anomalies on the lower kidney pole.Five anomalies were on the left side, two were on the right side and two were in bilateral sides (one special case had three ureters on the left side and two ureters on the right side ).Three cases complained of flank pain; two cases were found hydronephrosis by physical routine examination;Three cases complained of flank pain and fever; one cases complained of hematuria and kidney atones.All the cases were preoperatively diagnosed by color doppler ultrasound, MRU, IVP or CTU.Retroperitoneal laparoscopic heminephroureterectomy was performed on all patients.The operation time, blood loss, hospital stay, intraoperative and postoperative complications and efficacy were observed.Results All the retroperitoneal laparoscopic procedures were successfully completed.No intraoperative complications were found.The average operation time was 87 min (range, 65 to 125).The average blood loss was 112 ml (range, 30 to 600).The recovery times of intestinal function was 1.6 days ( range, 1 to 3 ).The average postoperative hospital stay was 7 days (range, 5 to 12).The syndrome disappeared and kidney function was normal at a mean followup of 18 monthes.Conclusions Retroperitoneal laparoscopic surgeries for duplex kidney has the benefits of being minimally invasive, fewer complications, quick recovery and certainty of efficacy.Retroperitoneal laparoscopic surgeries can be considered as a first operation method to treat duplex kidney anomalies.
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Objective To discuss the feasibility and safety of retroperitoneal laparoscopic nephrectomy for treatment of kidney tuberculosis. Methods From March 2005 to February 2009, 28 patients with kidney tuberculosis underwent retroperitoneal laparoscopic nephrectomy. The patients′ data were reviewed and analyzed. Results There were 18 men and tencwomen with an average age of 36 (26-51) in the cohort. Sixteen patients had lesions on the left kidney and 12 on right kidney. All patients had a normal renal function on the contra lateral side. The severely impaired renal function of the lesion side was confirmed before operation. Anti-tuberculosis chemotherapy was administered to patients for two weeks to six months in advance of the surgery. No active lesion of tuberculosis was found and ESR level was normal before operation. All the operations were successfully performed without switching to open surgery. The average operative time was 170 (121-258) minutes, blood loss was 110 (70-250) ml and average postoperative hospital stay was 5.7 (5-14) days. Peritoneum injury was seen in three patients and incision infection in two patients. No severe complications were observed. Anti-tuberculosis chemotherapy was continued for three months. Twenty-four patients were followed-up, and the average follow-up time was 12.5 (6-20) months. All patients recovered without any lesion remaining. Conclusions Retroperitoneal laparoscopic nephrectomy could be a safe and reliable method for the treatment of non-functioning kidney due to tuberculosis.
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An 11 years old male patient hospitalized with a left nates pain constantly from a baby. Sometimes he had fevers with hematocyturia. Belly examination had without tumor. Laparoscopy discovered a whole left kidney with water. Some cysts had turbid liquid. The level of creatinin serum was 7mg/L. Netroperitoneoscopic nephrectomy had been operated for this patient on September 1st 2004. The operating time was 100 minutes, and blood loss was 20 ml. The patient was discharged 4 days after surgery. Netroperitoneoscopic nephrectomy could been performed in children. Surgery had few invasion, the operating time was no longer than open surgery, but the recover progresion was shorter after operation
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Child , Nephrectomy , Fever , KidneyABSTRACT
PURPOSE: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. METHODS: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1?? cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. RESULTS: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21 cases. CONCLUSION: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience.
Subject(s)
Humans , Adenoma , Adrenalectomy , Angiomyolipoma , Hemorrhage , Hyperplasia , Kidney , Length of Stay , Mortality , Nephrectomy , Prone Position , Subcutaneous EmphysemaABSTRACT
PURPOSE: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. METHODS: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1?? cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. RESULTS: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21 cases. CONCLUSION: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience.
Subject(s)
Humans , Adenoma , Adrenalectomy , Angiomyolipoma , Hemorrhage , Hyperplasia , Kidney , Length of Stay , Mortality , Nephrectomy , Prone Position , Subcutaneous EmphysemaABSTRACT
PURPOSE: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. METHODS: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1-6 cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. RESULTS: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21cases. CONCLUSION: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience.
Subject(s)
Humans , Adenoma , Adrenalectomy , Angiomyolipoma , Hemorrhage , Hyperplasia , Kidney , Length of Stay , Mortality , Nephrectomy , Prone Position , Subcutaneous EmphysemaABSTRACT
PURPOSE: We tried to evaluate the safety, feasibility and the clinical usefulness of the retroperitoneoscopic surgery for the treatment of variable renal diseases. MATERIALS AND METHODS: Between June 1998 and March 1999, a total of 18 patients (9 nonfunctioning kidneys, 1 ureter tumor, 3 simple renal cysts, 1 polycystic kidney, 3 ureter stones, 1 UPJ obstruction) underwent retroperitoneoscopic surgery (9 nephrectomies, 1 nephroureterectomy, 4 cyst marsupialization, 3 ureterolithotomy, 1 pyeloplasty) in our hospital. We analyzed the results of each operations. RESULTS: Out of total 18 cases, 15 retroperitoneoscopic surgeries were performed successfully as planed. Mean operative time was 194 minutes(ranged from 100 to 355 minutes) and mean postoperative hospital stay was 4.1 days(2-7 days). There was no significant intraoperative or postoperative complication in successfully completed cases. Open conversion was needed in three patients, all of them were not in an emergent condition, and there was no significant complication. Transfusion was not required in all cases. CONCLUSIONS: Retroperitoneoscopic surgery is a safe and feasible procedure for benign renal diseases, and there seems to be enough rooms for malignant diseases also.