Oscar Cortes

Laparoscopic adrenalectomy for adrenal myelolipoma

OBJECTIVE [corrected] To evaluate the results of laparoscopic adrenalectomy for adrenal myelolipoma in a single center. METHODS Between November 1999 and February 2006, 226 laparoscopic adrenalectomies were performed at our institution. 19 specimens corresponded with adrenal myelolipomas (8%). Mean patient age was 53.8 years (range 35 to 75) with male-to-female ratio 2:1. Clinical data was prospectively collected. Patient characteristics, lesion size evaluated by CT scan or MRI, surgical technique, operative time, operative blood loss, complications, conversion to open surgery and hospital stay were reviewed. RESULTS Nineteen adrenal myelolipomas were laparoscopically treated in eighteen patients. 16 lesions were located on the right adrenal gland (84%). Mean surgical time was 84.7 minutes (range 45 to 150). Average bleeding was 25.8 ml (range 0 to 300). Only one patient required a blood transfusion. There were no intraoperative complications or conversions to open surgery. Average hospital stay was 2.1 days (range 1 to 4); no complications were registered during the immediate postoperative period. Pathology reports confirmed all specimens as myelolipomas. Mean maximum tumor diameter was 8.6 cm (range 4.5 to 14). CONCLUSIONS Adrenal myelolipoma is an infrequent, benign entity which can occasionally become symptomatic due to spontaneous hemorrhage. Typical radiographic presentation permits conservative management in asymptomatic small masses. In cases where surgical treatment is advocated, laparoscopic surgery is a safe and feasible technique with reasonable operating time as well as limited blood loss, hospital stay and convalescence.

Complicaciones en cirugía laparoscópica urológica

Resumen La cirugia laparoscopica urologica ha tenido un considerable crecimiento en la ultima decada, trayendo consigo un incremento en el numero y espectro de complicaciones. Los informes de los centros con experiencia en esta tecnica permiten prevenir y reconocer oportunamente las complicaciones propias de cada cirugia, asi como manejarlas de manera segura y eficiente. Presentamos las complicaciones de nuestras cirugias laparoscopicas a partir de un registro prospectivo de todos los pacientes operados por laparoscopia en nuestra Unidad desde noviembre de 1992 a junio del 2005. Para la presentacion de las complicaciones clasificamos los procedimientos por grados de complejidad y hacemos una revision de la literatura dirigida a las complicaciones de cada cirugia.

Inferior vena cava anomalies during laparoscopic retroperitoneal lymph node dissection.

PURPOSE To report our experience with congenital inferior vena cava (IVC) anomalies found during laparoscopic retroperitoneal lymph node dissection (LRPLND). PATIENTS AND METHODS Two men with a mean age of 31.5 years (range 26-37 years) underwent LRPLND because of nonseminomatous germ-cell tumors (NSGCT) between December 2003 and July 2004. A four-port technique was used. A left IVC anomaly was found in both patients. The two operations were performed with no serious immediate complications and minimal blood loss. Congenital IVC anomalies were identified intraoperatively. A left-sided template modified because of anatomic variation was used. RESULTS Mean operative time was 95 minutes (range 60-130 min). Both patients remain without tumor recurrence at a median of 24.5 months of follow-up (range 15-34 months). CONCLUSION Although uncommon, IVC anomalies must be considered when performing LRPLND because of potential complications. Preoperative studies are essential in surgical planning.

Cirugía laparoscópica en el tratamiento de enfermedades adrenales:experiencia en 200 casos

Resumen Objetivo Presentamos nuestra experiencia en adrenalectomia laparoscopica, luego de 10 anos de adoptar la tecnica laparoscopica como primera opcion en la cirugia suprarrenal. Metodos Se incluyeron 200 cirugias adrenales laparoscopicas realizadas en forma consecutiva en 183 pacientes con patologia quirurgica suprarrenal entre noviembre de 1994 y noviembre de 2005. Fueron 67 (36,6%) hombres y 116 (63,4%) mujeres con una edad promedio de 49,1 anos (rango: 8 meses – 78 anos). Resultados Los diagnosticos clinicos mas frecuentes fueron hiperaldosteronismo (17,5%), cancer metastasico (15,8%), feocromocitoma (15,3%), sindrome de Cushing (7,1%), quiste adrenal (4,9%) y mielolipoma (2,7%). Se realizaron 164 adrenalectomias totales, 29 adrenalectomias parciales y 7 marsupializaciones de quistes adrenales. El tiempo operatorio promedio fue de 82,6 minutos (rango: 25-240 minutos) y el tiempo de hospitalizacion fue de 2,5 dias (rango: 1- 10 dias). El tamano de la glandula y/o tumor suprarrenal vario entre 1 y 14 cm (promedio: 5,6 cm). La tasa de complicaciones fue del 6%. En 8 pacientes ademas de la cirugia adrenal, se realizo otro procedimiento quirurgico laparoscopico: colecistectomia (2), marsupializacion de quiste renal (2), nefrectomia en bloque (2), nefrectomia parcial por tumor (1) y quistectomia pancreatica (1). A un paciente a quien se le realizo adrenalectomia laparoscopica derecha, se le practico nefrolitotomia percutanea ipsilateral en el mismo acto quirurgico. Conclusion La experiencia acumulada en 200 cirugias adrenales laparoscopicas nos ha permitido manejar satisfactoriamente patologias endocrinas como aldosteroma, feocromocitoma, sindrome de Cushing, y entidades raras como quistes y mielolipomas; ademas, extender los beneficios de un procedimiento minimamente invasivo para grandes masas adrenales y casos oncologicos seleccionados.

Management of diaphragmatic injury during transperitoneal laparoscopic urological procedures

INTRODUCTION Carbon dioxide pneumothorax is a rare complication in laparoscopic urology, but with the widespread use of laparoscopy and the increasing surgical pathologies managed by this technique this infrequent complication has become a potential risk. MATERIALS AND METHODS A total of 786 laparoscopic transperitoneal urologic operations were reviewed at our institution. All procedures were performed by the same surgeon and included 213 adrenalectomies, 181 simple nephrectomies, 143 lymphadenectomies, 118 radical nephrectomies, 107 partial nephrectomies and 24 nephroureterectomies. Mean patient age was 53.2 years (range 24 to 70). Mean BMI was 28.15 Kg/m2 (range 20 to 48.9). RESULTS A total of 6 cases (0.7%) of diaphragmatic injury were found. All reported patients had additional factors that may have contributed to diaphragmatic injury. Diaphragmatic repair was always carried out by intracorporeal suturing and only one case required chest tube placement. All patients evolved uneventfully. CONCLUSIONS Repair of diaphragmatic injuries should always be attempted with intracorporeal suture since this is a feasible, reproducible and reliable technique.

Complicaciones de la nefrectomía laparoscópica

Resumen Objetivos Presentamos las complicaciones en nuestra serie de nefrectomia laparoscopica y el manejo dado a cada una de ellas. Metodos Entre noviembre de 1992 y marzo de 2004, 319 pacientes fueron llevados a cirugia renal ablativa con tecnica laparoscopica: 152 mujeres y 167 hombres, con edad promedio de 45 anos (rango: 0,5 - 82 anos). Se realizaron 70 nefrectomias radicales, 16 nefroureterectomias radicales, 63 nefrectomias parciales, 124 nefrectomias simples, 15 nefroureterectomias simples, 8 heminefrectomias y 23 nefrectomias de donante vivo para trasplante. Resultados La tasa de complicaciones fue del 5,64%. Las complicaciones mas frecuentes fueron sangrado (2,5%) y hematoma retroperitoneal (1,2%). No hubo diferencia estadisticamente significativa en la tasa de complicaciones por sexo, edad o via de abordaje: transperitoneal o lumboscopica. El realizar una tecnica laparoscopica pura o con asistencia manual, no represento cambio en la tasa de complicaciones. No hubo casos de mortalidad en la serie. Conclusiones Nuestra serie de nefrectomia laparoscopica muestra una baja tasa de complicaciones. Consideramos que en manos experimentadas, la laparoscopia es una tecnica segura en pacientes que requieren cirugia renal ablativa.