ABSTRACT
Development of laparoscopic techniques has converted lymphadenectomy into a real alternative to current laparotomy technique. The limitation of diagnostic imaging methods to know ganglion involvement in prostate cancer as well the high incidence of false negatives in frozen intrasurgical biopsies following open-surgery lymphadenectomy has pushed us since november of 1990 to develop laparoscopic lymphadenectomy with staging. This study analyses the diverse diagnostic imaging methods and continues with a precise description of the laparoscopic technique. The authors summarize the results of our series and finish the article with a review of the most controversial aspects as well as the diagnostic value, advantages and disadvantages with respect to open surgery techniques, complications and indications of this technique at the present moment.
Subject(s)
Laparoscopy , Lymph Node Excision , Prostatic Neoplasms/surgery , Aged , Humans , Iliac Artery/pathology , Laparoscopes , Laparoscopy/adverse effects , Laparoscopy/methods , Length of Stay , Ligaments/pathology , Lymph Node Excision/adverse effects , Lymph Node Excision/instrumentation , Lymph Node Excision/methods , Lymphatic Metastasis/pathology , Male , Middle Aged , Neoplasm Staging , Pelvis , Peritoneum/surgery , Prostatic Neoplasms/pathology , Spermatic Cord/pathology , Umbilicus , Vas Deferens/pathologyABSTRACT
More than four years have elapsed since the first laparoscopic pelvian lymphadenectomy for the staging of prostate cancer was performed. The early impact of the procedure involved the broadening and gradual application of laparoscopy to the group of organs and diseases of our specialty, mainly with therapeutical purposes. Urologists are able to reproduce nowadays many of the traditional surgical procedures through these methods. The present paper tries to conduct an update of the different techniques applied up to now on the different structures (genitalia, prostate, bladder, ureter, kidney, adrenals, pelvian nodes and other) and to analyze objectively some specific indications based on the experience gathered by several authors and our own.
Subject(s)
Laparoscopy , Prostatic Diseases/surgery , Testicular Diseases/surgery , Urologic Diseases/surgery , Humans , Laparoscopy/methods , Lymph Node Excision , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgeryABSTRACT
Today the urologist can perform many of the conventional surgical procedures by laparoscopic methods, which could not have been developed and improved without technological support. Industry has continued to provide solutions to each new requirement of laparoscopic surgery through more ergonomic materials and instruments. The different equipment and instruments for performing laparoscopic procedures are analyzed and described in the present article.
Subject(s)
Laparoscopes , Equipment Design , Humans , Laparoscopy/methodsABSTRACT
The limitations of the diagnostic imaging methods in determining lymph node involvement in pelvic tumors (prostatic cancer) and the high incidence of false negatives in the intraoperative frozen biopsies done during open lymphadenectomy have prompted us to develop laparoscopic staging lymphadenectomy since November, 1990. The different imaging and invasive diagnostic methods are briefly analyzed in the present article. The laparoscopic lymphadenectomy procedure is described in detail and a summary of our series is presented.
Subject(s)
Laparoscopy/methods , Lymph Node Excision/methods , Neoplasm Staging/methods , Prostatic Neoplasms/pathology , Aged , Humans , Laparoscopes , Lymphatic Metastasis , Male , Prostatic Neoplasms/secondaryABSTRACT
Presentation and clinical picture outline of a patient who underwent transperitoneal laparoscopy-assisted nephrectomy. The procedure lasted 4 hours and the patient was discharged 72 hours later without incidence or complications. The paper describes the technique (presently unique and for selective indications), as well as the resources that the extensive laparoscopic experience of our group put into practice to perform the first successful laparoscopic nephrectomy in humans in our country.
Subject(s)
Laparoscopy , Nephrectomy/methods , Tuberculosis, Renal/surgery , Female , Humans , Middle AgedABSTRACT
The current diagnostic methods, primarily transrectal ultrasound scanning (supported with ultrasound-directed biopsy), CAT and tumoral markers, allow an earlier and more reliable diagnosis of prostatic neoplasias. The chances of diagnosing these tumours while in low stages (A, B, and C without affecting the seminal vesicle) imply a higher indication for radical surgery (prostatectomy) with an intention to cure. However, the prognosis and therefore the indication will be determined by the presence of regional nodular affectation. Imaging diagnostic methods (lymphography, CAR, NMR) have been proven incapable of providing an acceptable degree of diagnostic safety, therefore staging lymphadenectomy continues to be mandatory. Laparoscopic lymphadenectomy allows to meet requirements of surgical radicality comparable to those of traditional open surgery while showing an irrefutable decrease of morbidity and being more convenient for the patient. Our early experience with this surgical technique of staging in prostatic neoplastic pathology is illustrated.
