Shigenori Kurumada

Retroperitoneal Laparoscopic Adrenalectomy for Functioning Adrenal Tumors: Comparison With Conventional Transperitoneal Laparoscopic Adrenalectomy

PURPOSE We attempted to confirm the possibility and feasibility of laparoscopic adrenalectomy via the retroperitoneal approach, and to compare results of the transperitoneal and retroperitoneal approaches. MATERIALS AND METHODS Three men and 8 women (mean age 39.6 years) with functioning adrenocortical tumors (primary aldosteronism in 5 and Cushings syndrome in 6) underwent laparoscopic adrenalectomy via the retroperitoneal approach using a balloon dissection technique and a newly developed ultrasonic aspirator. Results were compared to those of 27 cases of transperitoneal laparoscopic adrenalectomy. RESULTS Although the retroperitoneal approach was successful in all 5 patients with primary aldosteronism, it succeeded in only 2 of the 6 cases of Cushings syndrome. In 3 Cushings syndrome cases the retroperitoneal approach was changed to the transperitoneal laparoscopic approach due to difficulty in exploration. Open laparotomy was required in 1 case of left Cushings syndrome because of an inadvertent pancreatic injury. Subcutaneous emphysema developed in 6 patients without hypercapnia or prolonged postoperative symptoms. Mean operative time and blood loss, and time to oral intake and ambulation were 248.3 minutes, 151.4 ml., and 1.55 and 2 days, respectively. There was no difference between retroperitoneal and conventional transperitoneal laparoscopic adrenalectomy in regard to these factors or to convalescence. CONCLUSIONS Retroperitoneal laparoscopic adrenalectomy is feasible for primary aldosteronism. However, Cushings syndrome is presently a much more difficult indication than primary aldosteronism for this new operative technique.

Spontaneous hemorrhage of an adrenal cortical adenoma causing Cushing's syndrome

We report the case of a spontaneously ruptured adrenal adenoma which caused Cushings syndrome. The 34-year-old female patient had severe left-side back pain and anemia. Computerized tomography disclosed a retroperitoneal hemorrhage and a 4-cm mass on the left which was considered to be an adrenal tumor. An operation was successfully performed, and the patient is well 12 months after surgery.

Gasless laparoscopy-assisted live donor nephrectomy.

(Purpose) We evaluated both efficacy and feasibility of laparoscopy-assisted live donor nephrectomy. (Materials and Methods) Since September 2000, 11 living kidney donors (2 males and 9 females) underwent laparoscopy-assisted live donor nephrectomy. All of sides were left. Gasless surgery was performed with a 7 cm pararectal upper abdominal incision and three trocars via a retroperitoneal approach, After creating the working space using balloon dissection technique, the abdominal wall was lifted using a metal retractor attached to the margin of the abdominal incision. Additionally, a metal plate, which was attached to the abdominal wall inside, was raised. The surgeon dissected left kidney from the skin incision under both direct vision and magnificated view on the monitor. (Results) The operating time, estimated blood loss and warm ischemic time were a mean of 209 minutes, 219g, and 4. 2 minutes, respectively. The mean times for the return to a normal diet and unassisted ambulation were 1. 3 and 1. 8 days, respectively. One case required blood transfusion due to subcutaneous hematoma at trocar entry site on the second day after surgery, in the remaining 10 cases there were no complications. All of donated kidneys achieved immediate function after engraftment. (Conclusions) Gasless laparoscopy-assisted donor nephrectomy is recommended and advantageous for healthy kidney donors as a minimally invasive method.

Bladder Neck Suspension Using Percutaneous Bladder Neck Stabilization to the Pubic Bone with a Bone-Anchor Suture Fixation System:A New Extraperitoneal Laparoscopic Approach

A 39-year-old woman with type 1 genuine stress urinary incontinence was treated using a novel extraperitoneal laparoscopic bladder neck suspension procedure with a bone-anchor suture fixation system. Operative time and blood loss were 2.5 and 50 g, respectively. The patient showed a remarkable improvement on chain cystography and in subjective and objective well-being with no complications, even 12 months after surgery. Extraperitoneal laparoscopic bladder neck suspension using the bone-anchor suture fixation system is an easy and feasible procedure.

Endoscopic renal biopsy in pediatric patients: comparison of retroperitoneoscopy-assisted and retroperitoneoscopic methods.

Accessible online at: www.karger.com/journals/nef Dear Sir, Laparoscopic surgery including retroperitoneoscopy has been widely used in various urological disorders because of its advantage of being less invasive than open surgery [1– 3]. We have already reported our experience with laparoscopic renal biopsy via the retroperitoneal approach [4]. In this paper, retroperitoneoscopy-assisted renal biopsy (ASSIST) and retroperitoneoscopic renal biopsy (RETRO) were reported and compared. Eleven pediatric patients with the nephrotic syndrome or hematoproteinuria were included. The inclusion criteria were difficulties with needle renal biopsy because of poor detection of the kidneys by ultrasonography. Six (cases 1–6) underwent RETRO, and the other 5 (cases 7–11) underwent ASSIST. The patient’s age was between 2 and 15 years (mean: 6.17 years for RETRO and 4.4 years for ASSIST; table 1). The backgrounds of the two groups were comparable. Regarding RETRO, the method was similar to Gaur’s retroperitoneoscopic approach [5]. After full induction of a general anesthesia with endotracheal intubation, a 2-cm transverse skin incision was made at two-finger breadths below the tip of the 12th rib, and a small retroperitoneal space was created by blunt finger dissection. A dissecting balloon was inserted into the retroperitoneal space and was fully inflated. After removal of the dissection balloon, a 10-mm trocar was inserted by the initial wound, and CO2 insufflation with a pressure of not more than 8 mm Hg was begun. Then, a second trocar was inserted under endoscopic monitoring about 3 cm below the first trocar port. The lower pole of the kidney was easily identified, and renal biopsy was performed by a single stroke of a laparoscopic cup forceps through the second trocar port. Hemostasis was obtained using the Argon-Beam-Coagulator (Kobayashi Medical, Osaka Japan). For ASSIST, retroperitoneal space was dissected by the same procedure as for RETRO. Then, retractors for open surgery were inserted to widen the wound space, and a 0 or 12° urethrocystoscope was inserted into