Laparoscopic vesicovaginal fistula repair.

OBJECTIVES: Vesicovaginal fistulas are uncommon and remain a surgical challenge. Abdominal hysterectomy remains their main cause. We present our experience in laparoscopic repair of vesicovaginal fistula. METHODS: Between January 2006 and January 2008, 8 laparoscopic transvesical procedures for VVF repair were performed at our institution (O'Connor technique). For each case we analyzed demographic and surgical variables as well as the outcome. Surgical technique is also described. RESULTS: Average patient age was 45 years. All patients had past history of hysterectomy and subsequent history of urine leak through vagina, with a mean evolution time of 22 months. The average operative time was 150 minutes and the mean hospital stay 4.7 days. All patients evolved without complications except one who had urinary tract infection (Pseudomonas aeruginosa) that was treated with antibiotics. After a mean follow up of 32 months, there were no recurrences. CONCLUSION: In experienced hands, transvesical transabdominal laparoscopic vesicovaginal fistula repair is a feasible and safe procedure, preserving all the advantages of minimally invasive surgery.

Bladder hemangioma: case report.

OBJECTIVE: Bladder hemangioma is a benign rare lesion. There are no pathognomonic clinical signs and management is controversial due to the bleeding risk. We report a bladder cavernous hemangioma resolved using bipolar transurethral resection. METHODS: We review the case of a female patient who presented with asymptomatic hematuria. On cystoscopy we discovered a reddish sessile lesion compatible with bladder hemangioma. We describe the diagnostic work up, surgical management and review other therapeutic alternatives for these lesions. RESULTS: Fifty five year old healthy female patient consulting for total painless hematuria. Cystoscopic evaluation revealed a 1 cm diameter sessile reddish elevated lesion near the bladder neck. We performed a transurethral endoscopic resection using the Gyrus Bipolar resectoscope®. Pathologic report concluded cavernous angioma. CONCLUSION: Bladder hemangiomas are benign and rare lesions. Clinical presentation has no pathognomonic signs although gross painless hematuria is the most frequent complain. Management is controversial due to the bleeding risk of this highly vascularized lesion. However, it appears that small lesions could be treated using transurethral resection. Although they have a benign course, follow up is mandatory to detect recurrence or residual disease.

Laparoscopic heminefrectomy for crossed fused kidney with inferior ectopia.

OBJECTIVES: Crossed fused renal ectopia is a rare congenital anomaly. We report the case of a 3 year old boy with diagnosis of right crossed fused renal ectopia, history of recurrent urinary tract infection and previous failure of surgical treatment. METHODS: Three year old boy with diagnosis of right crossed fused renal ectopia of the inferior moiety underwent a laparoscopic heminephrectomy of the inferior renal unit, due to severe hydronephrosis and recurrent urinary tract infections. RESULTS: A laparoscopic right heminephrectomy of the inferior renal moiety was performed uneventfully. Operation room time was 200 minutes and there were no perioperative complications. Patient was discharged 18 hours after the procedure. After 5 years of follow up patient remains asymptomatic with good renal function. CONCLUSIONS: The laparoscopic approach is an acceptable option to treat this anomaly, with all the advantages of minimally invasive surgery.

[Laparoscopic simple nephrectomy with transvaginal notes assistance and the use of standard laparoscopic instruments]. / Nefrectomía laparoscópica simple con asistencia de notes transvaginal y uso de instrumentos laparoscópicos estándar.

INTRODUCTION: Natural orifice transluminal endoscopic surgery (NOTES) is an emerging technique, which allows to performed surgical procedures avoiding any surgical scars. However there are some problems due to the lack of equipment available for these procedures. The aim of these study is to present our initial experience with the transvaginal nephrectomy NOTES using standard laparoscopic instruments. MATERIAL AND METHODS: Two female patients 23 and 29 years old, both of them with diagnosis of recurrent urinary tract infection and renal atrophy. A transvaginal simple nephrectomy was performed using a transvaginal Access for the camera port and two abdominal work ports of 10 and 3 mm. RESULTS: Total operation room time was 120 min in the first case and 40 min. in the second with an average blood loss of 200 cc. There were no perioperative complications, and both patients was discharged 36 hours after the surgery CONCLUSION: Laparoscopic nephrectomy with transvaginal NOTES assistance is technically feasible with the use of standard laparoscopic instruments. Special Access trocars and instruments development for this procedure will allow to perform a pure technique without the use of abdominal incisions.

Laparoscopy-assisted ureter interposition by ileum.

PURPOSE: To report our experience with the laparoscopic approach to managing ileal ureter substitution for extensive ureteral stenosis. PATIENTS AND METHODS: Two patients, one man and one woman, ages 38 and 51 years, respectively, underwent laparoscopic ileal substitution between March 2004 and December 2005 because of extensive ureteral stenosis after stone disease management. A three-port technique was used. The ileal segment was managed extracorporeally through a McBurney incision. Pyeloileal or ileoureteral anastomosis was performed intracorporeally. Follow-up included clinical evaluation, nuclear renography, intravenous urography. and serum chemistry analysis. RESULTS: There were no complications, and there was minimal blood loss. Mean operative time was 195 minutes (range 180-210 min). Both patients remain without any symptoms or complaints at a median of 18.5 months follow-up (range 8-29 months). Postoperative pyelography verified adequate excretion from the renal unit. Nuclear renography showed no evidence of loss of renal function. No evident variations of preoperative and postoperative serum chemistry values were noted. None of the patients had any complaint or symptoms of urinary-tract infection or urolithiasis. CONCLUSIONS: The laparoscopic approach appears to be a safe and effective alternative to open surgery for ileal ureter substitution. Extracorporeal management of the ileal segment would appear advantageous because it reduces operative time and morbidity.

Bilateral simultaneous laparoscopic adrenalectomy for congenital adrenal hyperplasia: initial experience.

OBJECTIVE: Congenital adrenal hyperplasia (CAH) is an uncommon syndrome which represents a therapeutic challenge. We analyzed the role of bilateral simultaneous laparoscopic adrenalectomy in the management of CAH. MATERIAL AND METHODS: : Between October 2004 and September 2006, three female patients underwent bilateral simultaneous laparoscopic adrenalectomy for CAH. Data were retrospectively collected. Variables analyzed were persistence of CAH clinical signs, variations in 17 OH progesterone level and corticoid medication, operative time, median blood loss, postoperative pain, hospital stay, and body image perception after surgery. RESULTS: Median age was 16.3 years. Complete regression of virilization signs, acne and hyperpigmentation was achieved in one case. The other two cases showed partial regression of signs. Levels of 17 OH progesterone reached normal parameters in all cases. Steroids doses were lowered and given only for replacement purposes. Mean operative time was 125, 65 and 60min for whole, right and left procedure, respectively. Median blood loss remained under 50ml in all cases and there were no complications. Median postoperative pain level was 5 according to visual analog pain scale. Median hospital stay was 4 days. CONCLUSION: Bilateral simultaneous laparoscopic adrenalectomy shows all the advantages of minimally invasive surgery, and appears a viable alternative to medical management, which is not exempt from complications.

[Transumbilical laparoscopic simple nephrectomy using a flexible cystoscope and standard laparoscopic instruments]. / Nefrectomía simple laparocópica transumbilical con el uso de cistoscopio flexible e instrumentos laparsocópicos estándar.

OBJECTIVES: We present our initial experience with transumbilical surgery in a simple nephrectomy performed with a flexible cystoscope and standard laparoscopic instruments. METHODS: A 15 year-old child, with severe left renal parenchyma atrophy, secondary to recurrent urinary tract infection (UTI) complicated with left pyelonephritis. Decision for simple nephrectomy was taken and we planned to perform a single port laparoscopic nephrectomy. In the lumbotomy position, two 5mm ports were insertend through a 3 cm umbilical incision. One trocar permitted the progression of the flexible cystoscope (Olympus) and the other the entrance of the PKS Plasma Trissector. The latter was then changed for a 10mm port to allow the entrance of the Weck clips. A Maryland grasper for countertraction was placed without port in the lef-upper quadrant and progressed directly into de peritoneal cavity under direct vision. RESULTS: The standard laparoscopic steps were duplicated uneventfully. Mean operative time was 90 minutes and mean blood loss was 200 mL. Hospital stay was 18 hours. No transfusion was needed. CONCLUSION: Single port urologic surgery will expand in the future. There is lack of commercial availability of the ideal hardware needed for the procedures. Versatility of urologic instruments allow for its use in different settings.

Bladder leiomyoma: case report.

OBJECTIVE: Leiomyoma is a benign lesion which represents 0.04-0.5% of bladder tumors. It is more common in females and its peak incidence is between 4th and 5th decades. Surgery is the treatment of choice and adequate results have been previously reported. METHODS: 38 years old male patient who consulted for chronic pelvic pain syndrome. CT scan showed a 2 cm diameter exophitic lesion at the anterior left lateral bladder wall, which protruded into the perivesical fat. We performed a laparoscopic partial cistectomy locating the tumor and resecting it with simultaneous cystoscopic control, obtaining negative margins. The operative time was 70 minutes with an intraoperative blood loss of 50 ml. Postoperative period was uneventful. Final pathology reported: Bladder wall leiomyoma, without mitosis or atypia. Immunohistochemistry was positive for Actine and Vimentine stablishing diagnosis. Cd 1 17 (c-kit) was negative and ruled out a Gastrointestinal Stromal Tumor. CONCLUSIONS: Leiomyoma is bladder's most common benign non epithelial tumor. It represents 35-46% of these lesions with a 2:5 male/female ratio. It origins from the smooth muscle bundles and at the urinary tract the most common localizations are kidney and bladder. Clinical presentation depends on tumor size and localization. Ultrasound is the most useful diagnostic tool and the pathological diagnosis is mandatory. Surgery is the treatment of choice and technique depends on tumor size and localization. The laparoscopic approach seems to be an effective alternative in this group of tumors. Prognosis is good and recurrence is rare.

[Laparoscopic treatment of symptomatic simple renal cysts]. / Tratamiento laparoscópico de quistes renales simples sintomáticos.

OBJECTIVES: Simple renal cysts (SRC) are usually asymptomatic and do not require any kind of treatment. Laparoscopy is a reasonable minimally invasive surgical option for symptomatic cysts. Herein, we present the results of the laparoscopic technique for the treatment of symptomatic renal cysts performed in our institution. METHODS: Between November 1992 and May 2006, 41 patients with symptomatic renal cysts were laparoscopically treated. The surgical techniques employed were transperitoneal and retroperitoneal. Demographic and surgical data was prospectively collected and analysis retrospectively performed. RESULTS: 41 patients were treated for symptomatic renal cysts in a fourteen year period. 23 (56%) women and 18 (44%) men, with a median age of 54 years. (Range 27-74 years.). All patients in the series were symptomatic. Pain was the most frequent symptom. Median cyst size was 10 cm. (range 5-16 cm.). Transperitoneal approach was performed in 24 patients (58%) and retroperitoneal in 17(42%). No differences were verified between these approaches. 16 lesions were located at the left renal unit, 24 in the right renal unit (54%) and one case presented bilateral lesions (3%). Median operative time was 52 min. (range 20-150 min.), median hospital stay was 42 hours (range 12-96 h.). 39 cysts (95.2%) were classified as Bosniak's type I lesions, 2 lesions (4.8%) were type II based on Bosniak's description. Final pathology confirmed every lesion as a simple renal cyst. There was only one relapse in the series. The latter was treated percutaneously. CONCLUSIONS: Laparoscopy is a feasible, safe and advantageous surgical therapeutic option for symptomatic renal cysts.

[Perirenal myxoliposarcoma. Case report with laparoscopic approach]. / Mixouposarcoma perirenal: comunicacion de un caso resuelto por via laparoscopica.

OBJECTIVE: To report our experience in the management of one case of perirenal myxoliposarcoma. METHODS: We report the case of an 86-year-old male consulting for occasional dizziness. Examination revealed a left flank abdominal mass. CT scan reported the presence of a 12 cm multiloculated cystic mass at the lower pole of the right kidney Hand-assisted right laparoscopic nephrectomy was carried out. RESULTS: The operation was uneventful and the pathologic study reported a kidney with preserved architecture and a tumor showing characteristics of grade 1-2 myxoliposarcoma with undifferentiation to grade 3 myxofibrosarcoma in intimate contact with the lower pole. CONCLUSIONS: We believe that laparoscopic surgery permits the surgical solution of this type of lesion without compromising the oncological principles, and offers the well-known advantages of a minimally invasive approach.

[Partial cystectomy. Our series]. / Cistectomía parcial laparoscópica: nuestra serie.

OBJECTIVES: Partial cystectomy is a recognized bladder sparing surgical technique. Patient selection is essential in order to optimize long term results. We present our initial experience with laparoscopic partial cystectomy performed in a selected group of patients that includes both benign and malignant lesions. METHODS: Nine patients were surgically treated with laparoscopic partial cystectomy between July 2002 and September 2006 in our institution. Partial cystectomy was indicated for the treatment of a foreign body, endometriosis, urachal adenocarcinoma, trancisional cell carcinoma, acquired lesions of urachus and extravesical tumor. Analyzed surgical variables were operative time, conversion rate, blood loss, hospital stay and catheterization period. RESULTS: Nine patients with bladder lesions were laparoscopically operated for partial cystectomy. Transperitoneal technique was employed and no conversion to open surgery was performed. Median operative time was 77.77 min (range 30-120 min.). No patient received any transfusion. No intraoperative lesions were verified. Median hospital stay was 4.22 days (range 3-5 d.), median catheterization period was 7 days (range 5-10 d.). CONCLUSIONS: Laparoscopic partial cystectomy is a doable surgical procedure. It is a useful technique for both benign and malignant bladder disease. In TCC and urachal carcinoma oncological safety prevails. Patient selection is essential for this procedure.

Heminefrectomía laparoscópica en ectopia renal cruzada con fusión inferior de unidades renales / Laparoscopic heminefrectomy for crossed fused kidney with inferior ectopia

OBJETIVO: La ectopia renal cruzada es una anomalía congénita infrecuente. Presentamos el caso de un niño de 3 años de edad con una ectopia renal cruzada derecha, con fusión de unidades renales y con historia previa de infecciones urinarias recurrentes y procedimientos quirúrgicos fallidos. MÉTODOS: Paciente de 3 años con diagnóstico de ectopia renal cruzada y fusión inferior de unidades renales se sometió a una heminefrectomía laparoscópica de la unidad renal inferior, producto de una hidronefrosis severa de la unidad inferior e infecciones urinarias a repetición: RESULTADOS: Se realizo una heminefrectomía laparoscópica de la unidad renal inferior sin incidentes. El tiempo operatorio fue de 200 minutos El postoperatorio transcurrió sin incidentes. El paciente fue dado de alta a las 18 horas post cirugía. Después de un seguimiento de 5 años el paciente permanece asintomático, sin infecciones urinarias y con buena función de la unidad renal remanente. CONCLUSIONES: El abordaje laparoscópico es una alternativa viable para el manejo de esta patología entregando todas las ventajas de la cirugía mínimamente invasiva(AU)

OBJECTIVES: Crossed fused renal ectopia is a rare congenital anomaly. We report the case of a 3 year old boy with diagnosis of right crossed fused renal ectopia, history of recurrent urinary tract infection and previous failure of surgical treatment. METHODS: Three year old boy with diagnosis of right crossed fused renal ectopia of the inferior moiety underwent a laparoscopic heminephrectomy of the inferior renal unit, due to severe hidronefrosis and recurrent urinary tract infections. RESULTS: A laparoscopic right heminephrectomy of the inferior renal moiety was performed uneventfully. Operation room time was 200 minutes and there were no perioperative complications. Patient was discharged 18 hours after the procedure. After 5 years of follow up patient remains asymptomatic with good renal function. CONCLUSIONS: The laparoscopic approach is an acceptable option to treat this anomaly, with all the advantages of minimally invasive surgery(AU)

Nefrectomía laparoscópica simple con asistencia de notes transvaginal y uso de instrumentos laparoscópicos estándar / Laparoscopic simple nephrectomy with transvaginal notes assistance and the use of standard laparoscopic instruments

Introducción: La cirugía endoscópica transluminal a través de orificios naturales (NOTES™) es una tecnología emergente, que permite realizar procedimientos quirúrgicos sin el uso de incisiones abdominales. Sin embargo existen limitaciones respecto al equipamiento disponible para simular la cirugía tradicional. Nuestro objetivo es presentar nuestra experiencia con la técnica de nefrectomía transvaginal NOTES con el uso de instrumentos laparoscópicos estándar. Materiales y Métodos: Presentamos dos pacientes de sexo femenino de 23 y 26 años, ambas con diagnóstico de infecciones urinarias recurrentes y atrofia renal secundaria. Se les realizó una nefrectomía simple con asistencia de NOTES, utilizando un puerto de trabajo transvaginal para la cámara y dos puertos adicionales de 10 (umbilical) y 3 mm en el abdomen. Resultados: El procedimiento total duró 120 min en el primer caso y 40 minutos en el segundo, con una pérdida sanguínea promedio de 200 cc. (0-200). No se reportan complicaciones, siendo ambas pacientes dadas de alta 36 horas después de su cirugía. Conclusión: La nefrectomía laparoscópica con asistencia de NOTES transvaginal es técnicamente posible con el uso de instrumentos laparoscópicos estándar. El desarrollo y acceso a trócares y pinzas especiales para la técnica NOTES™, permitirá realizar una técnica pura sin el uso de incisiones abdominales (AU)

Introduction: Natural orifice transluminal endoscopic surgery (NOTES) is an emerging technique, which allows to performed surgical procedures avoiding any surgical scars. However there are some problems due to the lack of equipment available for these procedures. The aim of these study is to present our initial experience with the transvaginal nephrectomy NOTES using standard laparoscopic instruments. Material and Methods: Two female patients 23 and 29 years old, both of them with diagnosis of recurrent urinary tractinfection and renal atrophy. A transvaginal simple nephrectomy was performed using a transvaginal. Access for the cameraport and two abdominal work ports of 10 and 3mm.Results: Total operation room time was 120 min in the first case and 40 min. in the second. With an average blood loss of 200 cc. There were no perioperative complications, and both patients was discharged 36 hours after the surgery. Conclusion: Laparoscopic nephrectomy with transvaginal NOTES assistance is technically feasible with the use of standard laparoscopic instruments. Special Access trocars and instruments development for this procedure will allow to performa pure technique without the use of abdominal incisions (AU)

Nefrectomía simple laparoscópica transumbilical con el uso de cistoscopio flexible e instrumentos laparoscópicos estándar / Transumbilical laparoscopic simple nephrectomy using a flexible cystoscope and standard laparoscopic instruments

Objetivo: Presentar nuestra experiencia inicial con la cirugía transumbilical en una nefrectomía simple realizada con un cistoscopio flexible e instrumentos laparoscópicos estándar.MÉTODOS: Paciente de 15 años de edad, con diagnóstico de atrofia renal izquierda, secundaria a infección urinaria recurrente. Se decidió una nefrectomía simple y se planeó realizarla por vía laparoscópica a través de un puerto único. En posición de lumbotomía y a través de una incisión transumbilical de 3 cm., dos puertos de 5mm fueron colocados en el ombligo. Un trócar permite la progresión del cistoscopio flexible (Olympus ®) y el otro la entrada del disector bipolar Este último fue cambiado por un puerto de 10 mm para permitir la entrada de los clips de Weck. Se introdujo un grasper Maryland en el cuadrante superior izquierdo, sin puerto, para la contra tracción, el cual fue avanzado directamente en la cavidad peritoneal bajo visión directa.RESULTADO: Los pasos estándar de la cirugía laparoscópica se replicaron sin inconvenientes. El tiempo quirúrgico fue de 90 minutos y la pérdida sanguínea de 200 ml. La estadía hospitalaria fue de 18 horas. No se necesitó transfusión.CONCLUSIONES: La cirugía urológica de puerto único se ampliará en el futuro. Hay una falta de disponibilidad comercial de los insumos ideales para el desarrollo de esta cirugía. La versatilidad de los instrumentos urológicos permitirá su uso en diferentes contextos(AU)

Summary.- OBJECTIVES:We present our initial expe-rience with transumbilical surgery in a simple nephrec-tomy performed with a flexible cystoscope and standard laparoscopic instruments.METHODS: A 15 year-old child, with severe left renal parenchyma atrophy, secondary to recurrent urinary tract infection (UTI) complicated with left pyelonephritis. Decision for simple nephrectomy was taken and we planned to perform a single port laparoscopic nephrectomy. In the lumbotomy position, two 5mm ports were insertend through a 3 cm umbilical incision. One trocar permitted the progression of the flexible cystoscope (Olympus®) and the other the entrance of the PKS Plasma Trissecdificultator®. The latter was then changed for a 10mm port to allow the entrance of the Weck clips. A Maryland grasper for countertraction was placed without port in the left-upper quadrant and progressed directly into de peritoneal cavity under direct vision.RESULTS: The standard laparoscopic steps were dupli-cated uneventfully. Mean operative time was 90 minutes and mean blood loss was 200 mL. Hospital stay was 18 hours. No transfusion was needed.CONCLUSION: Single port urologic surgery will ex-pand in the future. There is lack of commercial availa-bility of the ideal hardware needed for the procedures. Versatility of urologic instruments allow for its use in di-fferent settings(AU)

Bladder leiomyoma: case report / Leiomioma vesical: comunicación de un caso

Objective: Leiomyoma is a benign lesion which represents 0,04-0,5% of bladder tumors. It is more common in females and its peak incidence is between 4th and 5th decades. Surgery is the treatment of choice and adequate results have been previously reported. Methods: 38 years old male patient who consulted for chronic pelvic pain syndrome. CT scan showed a 2cm diameter exophitic lesion at the anterior left lateral bladder wall, which protruded into the perivesical fat. We performed a laparoscopic partial cistectomy locating the tumor and resecting it with simultaneous cystoscopic control, obtaining negative margins. The operative time was 70 minutes with an intraoperative blood loss of 50 ml. Postoperative period was uneventful. Final pathology reported: Bladder wall leiomyoma, without mitosis or atypia. Immunohistochemistry was positive for Actine and Vimentine stablishing diagnosis. Cd 117 (ckit) was negative and ruled out a Gastrointestinal Stromal Tumor. Conclusions: Leiomyoma is bladder’s most common benign non epithelial tumor. It represents 35-46% of these lesions with a 2:5 male/female ratio. It origins from the smooth muscle bundles and at the urinary tract the most common localizations are kidney and bladder. Clinical presentation depends on tumor size and localization. Ultrasound is the most useful diagnostic tool and the pathological diagnosis is mandatory. Surgery is the treatment of choice and technique depends on tumor size and localization. The laparoscopic approach seems to be an effective alternative in this group of tumors. Prognosis is good and recurrence is rare (AU)

Objetivo: El leiomioma es una lesión benigna que representa entre el 0,04-0,5% de los tumores vesicales no editoriales. Es más frecuente en mujeres y su pico de incidencia está entre la 4ª y 5ª décadas. La cirugía es el tratamiento de elección, habiéndose comunicado previamente resultados adecuados. Métodos: Paciente varón de 38 años de edad que consultó por síndrome de dolor pélvico crónico. La tomografía axial computarizada mostraba una lesión exofítica de 2 cm. de diámetro en la parte anterior de la pared vesical lateral izquierda, que protruía en la grasa perivesical. Realizamos una cistectomía parcial laparoscópica con localización y resección del tumor bajo control con cistoscopia, obteniendo márgenes negativos. El tiempo operatorio fue de 70 minutos con un sangrado estimado de 50 ml. El postoperatorio curso sin complicaciones. El estudio anatomopatológico final informó: leiomioma de la pared vesical sin mitosis ni atipias. El estudio inmunohistoquímico fue positivo para actina y vimentina, estableciendo el diagnóstico. El Cd 117(cKit) fue negativo y descartó un tumor estromal gastrointestinal. Conclusiones: El leiomioma es el tumor benigno no epitelial más frecuente en la vejiga. Representa entre 35-46% de estas lesiones con una revelación hombre/mujer de 2:5. Se origina a partir de los fascículos de músculo liso y en el aparato urinario las localizaciones más frecuente son riñón y vejiga. La presentación clínica depende del tamaño y la localización del tumor. La ecografía es la prueba diagnóstica más útil y el diagnóstico anatomopatológico es obligatorio. La cirugía es el tratamiento de elección, dependiendo la técnica del tamaño y la localización del tumor. El abordaje laparoscópico parece ser una alternativa eficaz en este grupo de tumores. El pronóstico es bueno y la recidiva rara (AU)

Manejo laparoscópico de las fístulas vesico vaginales / Laparoscopic vesicovaginal fistula repair

OBJETIVO: La Fístula Vesicovaginal (FVV) es una patología infrecuente y de difícil manejo, siendo la histerectomía abdominal su principal causa. Presentamos nuestra experiencia en la reparación laparoscópica con sutura intracorpórea de las FVV.MÉTODOS: Entre enero de 2006 y enero del 2008 se realizaron 8 reparaciones por vía laparoscopia de FVV. Se describe la técnica quirúrgica (O'Conor transperitoneal) y se analizan variables demográficas, quirúrgicas y resultados de la serie. RESULTADOS: La edad media de las pacientes fue de 45 años. El tiempo medio entre la histerectomía y la reparación laparoscópica fue de 22 meses. El tiempo quirúrgico medio total (vesical y laparoscópico) fue de 123 minutos. El tiempo medio de hospitalización fue de 4.7 días y el tiempo medio de cateterización vesical fue de 10 días. Se registró una complicación postoperatoria. El control radiológico mediante una cistografía reveló indemnidad de la reparación en todos los casos. No hubo recurrencia de la fístula, con un tiempo promedio de seguimiento de 32 meses. CONCLUSIÓN: En nuestra opinión, el abordaje laparoscópico permite cumplir con todos los principios para la reparación de fístulas vesicovaginales. La reducción de la morbilidad y la eficacia del procedimiento, lo transforman en una excelente alternativa en manos de cirujanos experimentados(AU)

OBJECTIVES: Vesicovaginal fistulas are uncommon and remain a surgical challenge. Abdominal hysterectomy remains their main cause. We present our experience in laparoscopic repair of vesicovaginal fistula. METHODS: Between January 2006 and January 2008, 8 laparoscopic transvesical procedures for VVF repair were performed at our institution (O'Connor technique). For each case we analyzed demographic and surgical variables as well as the outcome. Surgical technique is also described. RESULTS: Average patient age was 45 years. All patients had past history of hysterectomy and subsequent history of urine leak through vagina, with a mean evolution time of 22 months. The average operative time was 150 minutes and the mean hospital stay 4.7 days. All patients evolved without complications except one who had urinary tract infection (Pseudomonas aeruginosa) that was treated with antibiotics. After a mean follow up of 32 months, there were no recurrences. CONCLUSION: In experienced hands, transvesical transabdominal laparoscopic vesicovaginal fistula repair is a feasible and safe procedure, preserving all the advantages of minimally invasive surgery(AU)

Hemangioma vesical: presentación de un caso / Bladder hemangioma: case report

OBJETIVO: El hemangioma vesical es una patología benigna de baja incidencia y difícil diagnóstico. Su manejo es controversial principalmente debido al riesgo de sangrado que este presenta. Presentamos el caso de un hemangioma vesical cavernoso manejado mediante una resección transuretral. MÉTODO: Revisamos el caso de una paciente de sexo femenino que consulto por hematuria asintomatica asociada a lesión sesil vesical, compatible con un hemangioma vesical. Describimos el estudio y manejo quirurgico, discutiendo además las alternativas terapeuticas para este tipo de lesiones. RESULTADOS: Paciente de sexo femenino de 55 años de edad, sana, consulta por cuadro de hematuria macroscópica asintomática. La cistoscopia revela la presencia de una lesión sésil rojiza de 1 cm de diámetro próxima al cuello vesical. Realizamos una resección transuretral utilizando un resectoscopio bipolar Gyrus®. El estudio anatomopatológico reveló un hemangioma cavernoso. CONCLUSIÓN: Los hemangiomas vesicales son lesiones benignas de baja incidencias. Si bien no existen características clínicas especificas para esta patología, la hematuria suele ser el signo clínico más frecuente. El manejo es controversial principalmente debido a su gran vascularización y el consecuente riesgo de sangrado intraoperatorio. Para lesiones de pequeño tamaño la resección transuretral representa una buena alternativa(AU)

OBJECTIVE: Bladder hemangioma is a benign rare lesion. There are no pathognomonic clinical signs and management is controversial due to the bleeding risk. We report a bladder cavernous hemangioma resolved using bipolar transurethral resection. METHODS: We review the case of a female patient who presented with asymptomatic hematuria. On cystoscopy we discovered a reddish sessile lesion compatible with bladder hemangioma. We describe the diagnostic work up, surgical management and review other therapeutic alternatives for these lesions. RESULTS: Fifty five year old healthy female patient consulting for total painless hematuria. Cystoscopic evaluation revealed a 1 cm diameter sessile reddish elevated lesion near the bladder neck. We performed a transurethral endoscopic resection using the Gyrus Bipolar resectoscope®. Pathologic report concluded cavernous angioma. CONCLUSION: Bladder hemangiomas are benign and rare lesions. Clinical presentation has no pathognomonic signs although gross painless hematuria is the most frequent complain. Management is controversial due to the bleeding risk of this highly vascularized lesion. However, it appears that small lesions could be treated using transurethral resection. Although they have a benign course, follow up is mandatory to detect recurrence or residual disease(AU)

Mixoliposarcoma perirenal: comunicacion de un caso resuelto por via laparoscopica / Perirenal myxoliposarcoma. Case report with laparoscopic approach

Objetivo: Presentar nuestra experiencia en el manejo de un caso de mixoliposarcoma perirenal. Métodos: Presentamos el caso de un paciente de 86 años que consultó por mareos ocasionales, verificándose al examen físico una masa abdominal en flanco derecho. La TC informó la presencia de una masa quística multilocular de 12 cm a nivel del polo inferior del riñón derecho, motivo por el cual se realizó nefrectomía laparoscópica mano asistida. Resultados: La cirugía se realizó sin eventualidades y la biopsia final reportó riñón de parénquima con arquitectura conservada que en su polo inferior se encuentra en íntimo contacto con una tumoración con características de un mixoliposarcoma grado 1-2 con indiferenciación hacia mixofibrosarcoma grado 3. Conclusión: Creemos que la cirugía laparoscópica permite la resolución quirúrgica de este tipo de lesión sin comprometer los preceptos oncológicos del tratamiento y ofreciendo las conocidas ventajas de un abordaje mínimamente invasivo (AU)

Objetive: To report our experience in the management of one case of perirenal myxoliposarcoma. Methods: We report the case of an 86-year-old male consulting for occasional dizziness. Examination revealed a left flank abdominal mass. CT scan reported the presence of a 12 cm multiloculated cystic mass at the lower pole of the right kidney. Hand-assisted right laparoscopic nephrectomy was carried out. Results: The operation was uneventful and the pathologic study reported a kidney with preserved architecture and a tumor showing characteristics of grade 1-2 myxoliposarcoma with undifferentiation to grade 3 myxofibrosarcoma in intimate contact with the lower pole. Conclusions: We believe that laparoscopic surgery permits the surgical solution of this type of lesion without compromising the oncological principles, and offers the well-known advantages of a minimally invasive approach (AU)

Cistectomía parcial: nuestra serie / Partial cystectomy. Our series

Objetivo: La cistectomía parcial es un procedimiento establecido de preservación vesical. En el campo de la oncología, la selección del paciente es fundamental para obtener resultados óptimos. Presentamos nuestra experiencia inicial de cistectomía parcial laparoscópica en un grupo seleccionado de pacientes portadores de diferentes patologías vesicales tanto benignas como malignas. Métodos: Entre julio del 2002 y septiembre del 2006, 9 pacientes fueron sometidos a una cistectomía parcial laparoscópica en nuestra institución. Las patologías que indicaron la cirugía fueron; presencia de cuerpo extraño intravesical, endometriosis, adenocarcinoma del uraco, carcinoma vesical de células transicionales, lesiones adquiridas del uraco y un tumor extravesical. Se analizaron la variables de tiempo quirúrgico, tasa de conversión, sangrado, días de permanencia de sonda vesical y estadía hospitalaria. Resultados: Todos los pacientes fueron operados en su totalidad por vía laparoscópica transperitoneal sin registrarse conversiones a cirugía abierta. El tiempo operatorio promedio fue de 77.7 min (rango 30-120 de minutos). Ningún paciente requirió transfusión sanguínea. No se presentaron complicaciones intraoperatorias. La estadía promedio de hospitalización fue de 4 días (rango 3-5 días), con un tiempo promedio de permanencia de sonda vesical de 7 días (rango 5-10 días). Conclusiones: La cistectomía parcial laparoscópica es un procedimiento quirúrgico realizable y aplicable para patología tanto benigna como maligna. En los tumores de células transicionales y carcinomas del uraco el resultado y seguridad oncológica deben prevalecer y esto se logra con la selección adecuada de pacientes (AU)

Objectives: Partial cystectomy is a recognized bladder sparing surgical technique. Patient selection is essential in order to optimize long term results. We present our initial experience with laparoscopic partial cystectomy performed in a selected group of patients that includes both benign and malignant lesions. Methods: Nine patients were surgically treated with laparoscopic partial cystectomy between July 2002 and September 2006 in our institution. Partial cystectomy was indicated for the treatment of a foreign body, endometriosis, urachal adenocarcinoma, trancisional cell carcinoma, acquired lesions of urachus and extravesical tumor. Analyzed surgical variables were operative time, conversion rate, blood loss, hospital stay and catheterization period. Results: Nine patients with bladder lesions were laparoscopically operated for partial cystectomy. Transperitoneal technique was employed and no conversion to open surgery was performed. Median operative time was 77.77 min (range 30-120 min.). No patient received any transfusion. No intraoperative lesions were verified. Median hospital stay was 4.22 days (range 3-5 d.), median catheterization period was 7 days (range 5-10d.). Conclusions: Laparoscopic partial cystectomy is a doable surgical procedure. It is a useful technique for both benign and malignant bladder disease. In TCC and urachal carcinoma oncological safety prevails. Patient selection is essential for this procedure (AU)

Linfoma testicular: incidencia, descripción epidemiológica y manejo durante el período 2005-2011 / Testicular lymphoma: incidence, epidemiologic description and management during the 2005-2011 period

El linfoma testicular es una patología infrecuente, correspondiendo al 9 por ciento de los cánceres testiculares, presentándose más frecuentemente entre los 60 a 80 años (25-50 por ciento). La presentación clínica más frecuente es el aumento de volumen unilateral e indo/oro. El tipo histológico más común es linfoma difuso de células grandes B (60-90 por ciento). La orquidectomía radical asociada a quimioterapia y radioterapia es la primera línea de tratamiento para los pacientes con enfermedad limitada. Material y método: Estudio retrospectivo descriptivo. Se revisó y filtró la lista de pacientes ingresados al SIGGES como tumor testicular entre enero 2005 a abril 2011. De los pacientes con diagnóstico histológico e inmunohistoquímico compatible, se registraron las características epidemiológicas, estudio, manejo y sobrevida. Posteriormente se realizó un análisis de la base de datos con el programa estadístico SPSS 13. 0. Resultados: De un total de 299 pacientes con el diagnóstico histológico de cáncer testicular, 8 pacientes fueron diagnosticados como linfoma testicular confirmado por histología e inmunohistoquímica. El promedio y mediana de edad fue 52 años y 63 años (18-73) respectivamente. Tres casos (37,5 por ciento) correspondieron a presentaciones secundarias. En 6 de los casos (75 por ciento) el testículo afectado fue el derecho. Histológicamente, el 63 por ciento correspondió a Linfoma difuso de células grande B. Clínicamente, el todos los casos se presentaron con aumento de volumen y con marcadores en rango normal. En 7 casos (8 7, 5 por ciento) el diagnóstico y manejo inicial fue mediante orquidectomía radical, y en un caso por biopsia testicular, con orquidectomía posterior 3 casos presentaron diseminación...

esticular lymphoma is a rare disease, happening in 9 percent of testicular cancers, most commonly between the ages 60 to 80 years (25 percent-50 percent). The most common presentation is unilateral indolent testicular growth. Histology shows a diffuse big B cell lymphoma in most of the cases (60 percent-90 percent). Radical orchiectomy, chemotherapy and radiation are the first line therapy for patients with limited disease. Materials and methods: Retrospective clinical study. We included and filtered the SIGGES list of patients admitted for Testicular Tumor from January 2005 to April 2011. Patients with a compatible diagnosis were analyzed, using SPSS 13.0® as statistical software. Result: Of a total number of 299 testicular cancer patients 8 presented with a histological and inmunnohistochemical testicular lymphoma. Mean age was 52 years and the median 63 years (18-73). ln three cases (37.5 percent) it was a secondary localization. ln 6 cases ( 75 percent) the affected testicle was the right one. 63 percent corresponded to a diffuse big cell B cell Lymphoma. All patients presented normal tumor markers. ln 7 (87,5 percent) cases the initial treatment was radical orchiectomy in one patient the diagnosis was don through a testicular biopsy, and the orchidectomy was differed. 3 cases presented dissemination. In 7 patients adjuvant chemotherapy was performed. Mortal/ty was 38 percent with a 1 7-month follow-up. Conclusion: Testicular lymphoma is a rare condition with bad prognosis. Histology is fundamental for treatment, an in this sense inmunohystochemcal analysis is especially helpful...