J. Cisneros Ledo

Suprarrenalectomía abierta y laparoscópica: Revisión de 10 años

OPEN AND LAPAROSCOPIC ADRENALECTOMY. 10 YEARS REVIEW We present a 10 years open adrenalectomy review in our Service and the beginning of laparoscopic adrenalectomy in the last year as a part of the retroperitoneal laparoscopic program at the Hospital Universitario La Paz . The first laparoscopic adrenalectomy was done after 21 retroperitoneal laparoscopic surgeries. Our initial experience has been so good that we have reduced the contraindications for this technique and we have increased the number of laparoscopic surgery cases.

Suprarrenalectomía laparoscópica: Experiencia de 5 años

Objetivo: la patologia adrenal susceptible de indicacion quirurgica es poco frecuente y normalmente se encuentra dividida entre varios servicios quirurgicos. Presentamos nuestra experiencia en el manejo laparoscopico tras casi 5 anos de implantacion de la laparoscopia en la patologia retroperitoneal en nuestro centro. Material y metodos: en 53 meses se han realizado un total de 37 suprarrenalectomias por patologia benigna y maligna. El abordaje mas frecuentemente empleado es el transperitoneal (97%) debido a la mayor experiencia del cirujano con esta via. La paciente embarazada y la sospecha de infiltracion periadrenal se han tomado como contraindicaciones absolutas. Resultados: el tiempo quirurgico medio es de 90 minutos, sangrado intraoperatorio de 80 cc, estancia media postoperatoria de dos dias y la principal complicacion ha sido un exitus. En 4 ocasiones la patologia es maligna (10%), el resto (90%) benigna, con 8 feocromocitomas. Conclusiones: la laparoscopia se considera el patron oro para la patologia benigna adrenal. Cuando la lesion es de naturaleza maligna, en caso de ser una metastasis unica procedente de otro tumor primario, parece que el abordaje laparoscopico es fiable. Cuando la lesion maligna es primaria adrenal existe mas controversia en este tipo de abordaje, si bien es cierto que en series de cirujanos experimentados los resultados parecen adecuados.

Derivaciones urinarias laparoscópicas

Resumen Introduccion El tratamiento del cancer vesical infiltrante y el carcinoma superficial de alto grado recidivante esta claramente establecido en la cistectomia radical y linfadenectomia pelviana. Uno de los campos que mas dudas plantea en su abordaje por via laparoscopica es el tratamiento radical del cancer vesical, que exige experiencia en cirugia laparoscopica pelviana y en el que la derivacion urinaria presenta grandes dificultades tecnicas a su abordaje laparoscopico. Objetivos El objetivo fundamental de este articulo es comunicar nuestros resultados con las derivaciones urinarias tras cistectomia radical laparoscopica en las que hemos llevado a cabo las anastomosis ureteroileales por via laparoscopica. Material y Metodos Desde enero del 2005 hasta diciembre 2007 hemos completado 67 cistectomias radicales laparoscopicas. Hemos realizado un total de 28 derivaciones urinarias laparoscopicas segun nuestra tecnica, siendo en 7 pacientes enterocistoplastias de sustitucion con una edad media de 54,85 anos y en 21 pacientes ureteroileostomia cutanea con una edad media de 69,15 anos. Resultados El tiempo quirurgico medio de la enterocistoplastia con anastomosis uretral y ureteral laparoscopicas es de 5 h y 30 min. Para la ureteroileostomia cutanea con anastomosis ureteral laparoscopica el tiempo quirurgico medio ha sido de 4hs. y 30 min. Hemos tenido 1 caso de fuga urinaria en las neovejigas laparoscopicas y 3 casos en los conductos ileales laparoscopicos (14%). No hemos tenido ningun caso de dehiscencia intestinal ni de estenosis ureteroileal. La estancia media de las neovejigas es de 13,6 dias para el 85% de los casos y de 11,8 dias para el 77,7% de las ureteroileostomias laparoscopicas. Discusion La cistectomia radical laparoscopica constituye un procedimiento todavia relegado a centros con gran experiencia en cirugia laparoscopica. El procedimiento mas aceptado por la mayoria de los grupos incluye realizar la cistectomia por via laparoscopica y la derivacion urinaria por via abierta. No existen evidencias sobre las posibles ventajas de las derivaciones urinarias por via laparoscopica. En cualquier caso, son necesarios estudios comparativos para definir claramente el papel de la cirugia laparoscopica en las derivaciones urinarias.

A review of penile cancer

Cancer of the penis is a rare tumour in Europe and mainly affects the elderly patient population. The aim of this paper was to analyse and study the characteristics of this tumour, in our patient population. Materials and Methods. A retrospective study was conducted on penile tumours diagnosed and treated in the Urology Department of the Hospital Universitario La Paz, Madrid, in the last ten years. Results. A total of 34 patients were diagnosed and treated. The mean age at presentation was 71.27 years. The mean time between symptoms and the first consultation was 12.54 months with a median of 6 months. The most common form of presentation was balanoposthitis (32%) and the most common site in our series was the glans. Partial penectomy was performed in 22 cases, total amputation in 8, and local excision in 3. Discussion. Carcinoma of the penis is a pathology which mostly affects elderly patients; in our series, the highest incidence was observed in patients in the group aged 75–84 years. The most common histological type was epidermoid carcinoma in its various forms of presentation. We recorded a mortality of 23%. Conclusion. Penile carcinoma is a rare pathology which affects elderly persons and is diagnosed late.Cancer of the penis is a rare tumour in Europe and mainly affects the elderly patient population. The aim of this paper was to analyse and study the characteristics of this tumour, in our patient population. Materials and Methods. A retrospective study was conducted on penile tumours diagnosed and treated in the Urology Department of the Hospital Universitario La Paz, Madrid, in the last ten years. Results. A total of 34 patients were diagnosed and treated. The mean age at presentation was 71.27 years. The mean time between symptoms and the first consultation was 12.54 months with a median of 6 months. The most common form of presentation was balanoposthitis (32%) and the most common site in our series was the glans. Partial penectomy was performed in 22 cases, total amputation in 8, and local excision in 3. Discussion. Carcinoma of the penis is a pathology which mostly affects elderly patients; in our series, the highest incidence was observed in patients in the group aged 75–84 years. The most common histological type was epidermoid carcinoma in its various forms of presentation. We recorded a mortality of 23%. Conclusion. Penile carcinoma is a rare pathology which affects elderly persons and is diagnosed late.

Cirugía retroperitoneal laparoscópica: experiencia de los 6 primeros meses del Hospital La Paz

RETROPERITONEAL LAPAROSCOPIC SURGERY; INITIAL EXPERIENCE IN THE HOSPITAL LA PAZ We present the initial results of retroperitoneal laparoscopic surgery in the Hospital Universitario La Paz from july 2004 to december 2004. The program started after 2 years of pelvic laparoscopy surgery practice. The initial experience has been so good that we have reduced the contraindications for this technique and we have increased the number of laparoscopic surgery cases.

Autotrasplante renal laparoscópico experimental como modelo de aprendizaje de técnica laparoscópica

Resumen Introduccion La cirugia laparoscopica requiere un largo proceso de aprendizaje en el que se va aumentando progresivamente el grado de complejidad. Objetivo La tecnica aqui presentada se ha realizado buscando un modelo experimental que nos permita realizar sutura vascular laparoscopica, de manera que el objetivo inmediato no es conseguir un autotrasplante funcionante, sino realizar con exito anastomosis vasculares. Presentamos nuestra experiencia en los dos primeros casos realizados. Material y metodo Se realizo el autotrasplante renal laparoscopico en hembras de cerdo de entre 15 y 20 kg. El Servicio de Cirugia Experimental del Hospital Universitario La Paz reviso y aprobo los protocolos del experimento, tal como exigen los Dictamenes Europeos para la proteccion de los animales utilizados con fines cientificos y experimentales (86/609/EEC). Resultados Al sacrificar a los animales, solo observamos un caso con trombosis vascular arterial. El resto de animales presentaban buen flujo arterial y venoso. Conclusiones El autotrasplante renal laparoscopico experimental proporciona un buen modelo para aprendizaje de cirugia laparoscopica. Creemos que aporta recursos laparoscopicos adecuados para cirugia retroperitoneal y pelvica. No proponemos, en el momento actual, su aplicacion a la cirugia laparoscopica en humanos.

Autotransplante renal laparoscópico experimental

EXPERIMENTAL LAPAROSCOPIC RENAL AUTOGRAFT Laparoscopic surgery requires a long training period of time in which the complexity of the training is increased. The technique presented in this paper has been developed in order to find an experimental model that allows us to improve the learning of the vascular suture. Our main goal was to evaluate this technique as an experimental model for the vascular anastomosis, not to obtain a functional autotransplant. In this regard, here we summarize our experience during the first two cases performed.

[Laparoscopic adrenalectomy. Five-year experience].

OBJECTIVE Adrenal conditions requiring surgery are uncommon and are usually seen in several surgical departments. Our experience in laparoscopic management of adrenal pathology after almost five years of use of laparoscopy for retroperitoneal conditions at our center is reported. MATERIALS AND METHODS A total of 37 laparoscopic adrenalectomies were performed over 53 months for benign and malignant conditions. The transperitoneal approach was used in most cases (97%) because of the greater surgeon experience with this route. Pregnancy and suspected periadrenal infiltration were considered as absolute contraindications. RESULTS Mean operating time was 90 minutes, mean intraoperative bleeding 80 ml, and mean hospital stay was 2 days. The main complication was one death. A malignancy was found in 4 patients (10%), while all other patients (90%) had a benign condition, including 8 pheochromocytomas. CONCLUSIONS Laparoscopy is considered to be the gold standard for benign adrenal conditions. When the malignant mass is a single metastasis from a primary tumor, the laparoscopic approach appears to be reliable. When the malignant lesion is a primary adrenal tumor, laparoscopic management is more controversial, although the results reported by experienced surgeons in their series appear to be adequate.

Cirugía retroperitoneal laparoscópica: Experiencia del Hospital Universitario La Paz

Resumen es: Objetivo: Con la popularizacion de la prostatectomia radical laparoscopica, dicha tecnica vuelve a tomar un papel importante en el funcionamiento de los ...

Cirugía renal laparoscópica conservadora de parénquima: Experiencia inicial

We present our initial experience in laparoscopic nephron sparing surgery. Its a technically advanced procedure requiring considerable minimally invasive expertise. This technique is particularly attractive compared to an open conventional procedure with its larger incision and associated morbidity.