Laparoscopic repair of renal artery aneurysm: a description of the technique and results in 2 cases.

BACKGROUND AND PURPOSE: Renal artery aneurysm is a rare occurrence. We report our experience in the management of 2 symptomatic renal artery aneurysms with laparoscopic approach. MATERIAL AND METHODS: Two patients, male and female, mean age 44 years (range: 43 to 45 y), diagnosed with left renal artery aneurysms during routine hypertension work-up, underwent laparoscopic aneurysm reconstruction. RESULTS: Operative time was 180 and 150 minutes with a warm ischemia time of 46 and 15 minutes and an estimated operative bleeding of 50 and 0 mL, respectively. The patients were discharged home on postoperative day 2 and 5, respectively. A selective left renal arteriography showed normal caliber of the repaired arteries in both patients. A follow-up of 45 and 7 months, respectively, has been uneventful. CONCLUSIONS: In well-selected patients, vascular surgical techniques may offer excellent results. Laparoscopy provides the advantages of the minimally invasive approach while achieving adequate vascular control. However, advance training in laparoscopic reconstructive surgical techniques is required before attempting this procedure.

Pulmonary thromboembolism secondary to left spermatic vein thrombosis: a case report.

Spermatic vein thrombosis is a particularly rare entity which can be difficult to diagnose. Pulmonary embolism associated with spermatic vein thrombosis is rarely seen. We report the diagnosis and management of a case at our institution and recommend spermatic vein ligation as the definite treatment for thrombosed spermatic veins associated with pulmonary thromboembolism. We prefer laparoscopy as a minimally invasive approach because of its clear advantages over open surgery.

Anterior transanal, transsphincteric sagittal approach for fistula repair secondary to laparoscopic radical prostatectomy: a simple and effective technique.

INTRODUCTION: To report our experience with the anterior, transanal, transsphincteric, sagittal approach in the correction of rectourinary fistula secondary to laparoscopic radical prostatectomy. TECHNICAL CONSIDERATIONS: Of the first 110 laparoscopic extraperitoneal radical prostatectomies performed from December 2001 to February 2004, 9 (8%) were complicated by rectal injury. Of the nine rectal lesions, seven were diagnosed intraoperatively and the rectal defects closed laparoscopically. Primary repair failed in 1 of the 7 patients. In 2 other patients, the rectal injuries were missed intraoperatively, and a rectourinary fistula later developed. Rectourinary fistula was confirmed in these 3 patients by cystoscopy and digital rectal examination. The procedure chosen for repair was the anterior sagittal transrectal anal approach. The time from diagnosis to fistula repair was 1 to 3 months. Fistula repair was successful in all patients. The mean follow-up was 12 to 24 months. No patient presented with fecal incontinence or anal strictures. Postprostatectomy urinary continence was not affected by the procedure. CONCLUSIONS: The transsphincteric transanal surgical approach provides many advantages for the repair of acquired urethrorectal fistulas after laparoscopic radical prostatectomy. It allows for good surgical exposure and fistula tract identification and ensures good access to well-vascularized tissue. This surgical technique is simple, effective, reproducible, and associated with minimal morbidity.