Technical modification for laparoscopic donor nephrectomy to minimize testicular pain: a complication with significant morbidity.

The laparoscopic approach to donor nephrectomy is becoming increasingly common. While it is felt that the recovery from laparoscopic nephrectomy is quicker and less painful, a number of complications have been reported. A rarely reported on complication in the literature with significant morbidity is ipsilateral orchalgia. From 1998 to 2008, 257 hand-assisted laparoscopic donor nephrectomies were performed at our institution. Eight of 129 (6.2%) men complained of de novo ipsilateral orchalgia postoperatively. The average duration of pain was 402 days. Patients reported significant morbidity related to this complication. None, however, required further treatment. Three patients reported that they would reconsider organ donation as a result of testicular pain. Our technique originally included dissection and ligation of the gonadal vein en bloc with the ureter at the level of the left common iliac artery. Since recognizing this complication, we have adopted a gonadal vein sparing approach so as not to disturb the vessel below its point of ligation at the renal vein. To date, 50 patients have undergone the modified technique without experiencing orchalgia. In conclusion, ipsilateral testicular pan is a relatively frequent complication of laparoscopic donor nephrectomy and may be a source of significant morbidity. Using a modified surgical technique, this complication can be reduced or eradicated.

Open or laparoscopic nephrectomy and extracoroporeal repair of complicated renal artery aneurysms: techniques for renal salvage.

Renal artery aneurysm is an infrequently seen disease. The most feared symptom is rupture, which is often rapidly fatal. Indications for intervention include size, intractable symptoms and pregnancy. Many cases are managed by endovascular techniques; however, very complex cases often are referred to the urologist. We report our experience with the rarely used technique of renal artery aneurysms repair comprised of nephrectomy, extracorporeal vascular reconstruction with aneurysmectomy, and autotransplant.

[Multivisceral organ procurement for transplantation derived mobilization maneouvres: very helpful auxiliary techniques in the excision of large retroperitoneal masses]. / Maniobras de movilización derivadas de la extracción multivisceral para trasplante: técnicas auxiliares de gran ayuda en la exéresis de grandes masas retroperitoneales.

The excision of large retroperitoneal masses poses a challenge for every surgeon. Sometimes the urologist must face situations that do not fit to any conventional approach or technique previously described. Obtaining adequate exposure for safe and oncologically correct management of these masses is based, on many cases, in the mobilization of anatomical adjacent structures to generate a sufficient field in abdominal areas of difficult access. Complex visceral mobilization maneuvers derived from multivisceral transplantation organ procurement surgery provides ancillary techniques that used properly facilitate their successful resolution. The main purpose of this paper is the description of these surgical maneuvers essential to increase both exposure and vascular control in addressing the ever-dreaded high-volume retroperitoneal masses.

Nefrectomía abierta o laparoscópica y reparación extracorpórea de aneurismas de arteria renal complejos: técnicas para la recuperación renal / Open or laparoscopic nephrectomy and extracoroporeal repair of complicated renal artery aneurysms: techniques for renal salvage

El aneurisma de la arteria renal constituye una enfermedad infrecuentemente observada. Su síntoma más temido es la ruptura, que habitualmente suele ser fatal rápidamente. Las indicaciones para realizar su intervención incluyen su tamaño, la refractariedad de su sintomatología y la gestación. Muchos de los casos generalmente se tratan mediante técnicas endovasculares; sin embargo, los casos más complejos a veces se remiten al urólogo para su tratamiento. En este artículo comunicamos nuestra experiencia con la infrecuentemente empleada técnica de reparación de aneurismas que incluye la nefrectomía, la aneurismectomía con reconstrucción vascular extracorpórea y el autotransplante(AU)

Renal artery aneurysm is an infrequently seen disease. The most feared symptom is ruptu-re, which is often rapidly fatal. Indications for interven-tion include size, intractable symptoms and pregnancy. Many cases are managed by endovascular techniques; however, very complex cases often are referred to the urologist. We report our experience with the rarely used technique of renal artery aneurysms repair comprised of nephrectomy, extracorporeal vascular reconstruction with aneurysmectomy, and autotransplant(AU)

Maniobras de movilización derivadas de la extracción multivisceral para trasplante: técnicas auxiliares de gran ayuda en la exéresis de grandes masas retroperitoneales / No disponible

La exéresis de grandes masas retroperitoneales constituye un reto para todo cirujano. En algunas ocasiones el urólogo debe enfrentarse a situaciones que no se ajustan a un abordaje o técnica convencional descrita. La obtención de una adecuada exposición con la que abordar de forma segura y oncológicamente correcta estas masas, se basa en muchos casos en la movilización de las estructuras anatómicas adyacentes para generar un campo suficiente en áreas abdominales de difícil acceso.Las maniobras de movilización visceral complejas derivadas de la cirugía de la extracción multivisceral de órganos para transplante proporciona maniobras accesorias que correctamente empleadas facilitan su resolución exitosa.El propósito principal de este artículo consiste en la descripción de las maniobras quirúrgicas esenciales para aumentar, tanto la exposición, como el control vascular en el abordaje de las siempre temidas masas retroperitoneales de gran volumen(AU)

The excision of large retroperitoneal mas-ses poses a challenge for every surgeon. Sometimes the urologist must face situations that do not fit to any con-ventional approach or technique previously described. Obtaining adequate exposure for safe and oncologi-cally correct management of these masses is based, on many cases, in the mobilization of anatomical adjacent structures to generate a sufficient field in abdominal areas of difficult access.Complex visceral mobilization maneuvers derived from multivisceral transplantation organ procurement surgery provides ancillary techniques that used properly facilita-te their successful resolution.The main purpose of this paper is the description of the-se surgical maneuvers essential to increase both exposu-re and vascular control in addressing the ever-dreaded high-volume retroperitoneal masses(AU)