M. Pérez Utrilla

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.

[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.

Lesión de los cuerpos cavernosos por arma de fuego: Presentación de un caso y revisión de la literatura

Rupture of the corpora cavernosa is a very rare lesion. It occurs most commonly during intercourse. A far more exceptional cause is a gunshot wound; in this case, there are frequently concomitant lesions to other structures. We present the case of a man who suffered a lesion to the corpora cavernosa due to a gunshot and underwent emergency surgery. We reviewed existing literature and verified that the first step in managing a genital gunshot wound is to stabilise the patient, following which we should surgically explore the affected area.

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.