[Development and validation of a model of training at home to the laparoscopy]. / Mise au point et validation d'un modèle d'entraînement à domicile à la laparoscopie.

INTRODUCTION AND OBJECTIVES: Practice on a Pelvitrainer training is an essential part of the training of surgeons in laparoscopy. Most university departments are equipped with this type of model, but this equipment is expensive, cumbersome and often poorly accessible. The authors propose a new laparoscopy home training model and compare its performances with those of the reference training model. MATERIAL AND METHOD: The laparoscopy home training model is composed of a laptop computer; a Web Cam and a translucent plastic box. Ten operators with various levels of training were timed during 4 simple exercises performed on the home training model and were then timed when performing 6 interrupted sutures with this model and with a Pelvitrainer RESULTS: All operators successfully performed the proposed exercises. The mean operating time was correlated with the level of training (35 minutes versus 15 minutes for the 3 most experienced operators). The suture time was comparable with the home trainer (14 minutes) and the Pelvitrainer (13 minutes). The home training model is less expensive (75 euros), more accessible and easier to install (3 minutes) than the Pelvitrainer and can be used outside of medicalized structures. CONCLUSION: Trainee operators can practice laparoscopy at home. The manufacture of a Home-trainer requires simple material. The training capacities of this model are similar to those of a Pelvitrainer, but it is less cumbersome, less expensive and more readily available. This type of model could be used by each operator at home to improve his/her performances and to accelerate training.

[Laparoscopy in the management of upper urinary tract stones based on a series of 18 cases]. / La laparoscopie dans la prise en charge des lithiases de la voie excrétrice supérieure. A propos de 18 cas.

OBJECTIVE: To evaluate the efficacy and morbidity of laparoscopic surgery in the management of upper urinary tract stones. MATERIAL AND METHOD: Between January 1998 and July 2004, 18 patients (14 males, 4 females) underwent laparoscopic extraction of an upper urinary tract stone. Stones were lumbar (n=13), ureteropelvic (n=2), iliac (n=1), inferior caliceal (n=1), and intradiverticular (n=1) with a mean diameter of 15 mm (range: 8-25 mm). Fifteen stones were obstructive. Laparoscopy was performed after failure of one or several previous treatments in 9 cases: ESWL (n=2), retrograde (n=1), anterograde ureteroscopy (n=6). A retroperitoneal approach (n=15) was used for caliceal and lumbar stones and a transperitoneal approach (n=3) was used for pyeloureteric and iliac stones. RESULTS: The mean operating time was 80 minutes (range: 40-150 min). The mean blood loss was 50 cc (range: 0-250 cc). The mean length of stay was 3.86 days (range: 2 to 7 days). Fifteen patients were drained by a double J stent for one month. The stone was removed by laparoscopy in every case. One patient developed a urinoma requiring surgical repair via a lumbar incision. CONCLUSION: Laparoscopy currently constitutes an attractive alternative for the treatment of upper urinary tract stones and, in this study, was indicated for first-line treatment of obstructive stones larger than 12 mm impacted in the ureter or after failure of previous treatments.

[Morbidity of unilateral and bilateral laparoscopic adrenalectomy according to the indication. Report of a series of 100 consecutive cases]. / Morbidité de la surrénalectomie laparoscopique uni et bilatérale selon l'indication: a propos de 100 cas consécutifs.

INTRODUCTION: Laparoscopic adrenalectomy is the reference technique for the treatment of adrenal tumours. This retrospective study reports the experience of 100 consecutive laparoscopic adrenalectomies, in order to assess its indications, the incision, the morbidity and to determine the limitations of this procedure. MATERIAL AND METHODS: Between April 1994 and June 2004, 100 laparoscopic adrenalectomies were performed in 92 patients via a transperitoneal (n = 93) or retroperitoneal (n = 7) approach, with 84 unilateral and 8 bilateral adrenalectomies. The mean age was 52 years. The operative and postoperative characteristics and the functional results were evaluated. RESULTS: The mean operating time was 112 min [70-175] via the retroperitoneal approach, 101 min [40-215] via the transperitoneal approach, and 135 min [120-270] for bilateral adrenalectomies. The mean tumour diameter was 44 mm [10-120 mm]. The mean blood loss was 215 ml [0-1210 ml]. Ten patients were transfused. The mean hospital stay was 3 days. Histology revealed 25 Conn adenomas, 20 cortisol-secreting adenomas and Cushing syndrome, 22 phaeochromocytomas, 20 metastases, 2 adrenal cortical adenomas, and 11 incidentalomas. Conversion to "open" surgery were necessary for technical difficulties in 6% of cases. There were 7 minor postoperative complications (7%) and 4 late complications (4%) (deep vein thrombosis, effusion, 2 local recurrences). Four patients in the group with secondary adrenal tumours were alive without recurrence 18, 20, 44 and 48 months after adrenalectomy. Antihypertensive treatment was stopped in 16 of the 25 patients operated for Conn adenoma. The mean follow-up was 31 months [5-98 months]. CONCLUSION: This technique has a low morbidity, requires minimal postoperative analgesia and a short hospitalisation. The retroperitoneal or transperitoneal approach must be chosen as a function of the patient's history and the surgeon's habits. Tumours larger than 8 cm can be resected, but with a higher morbidity. Laparoscopic adrenalectomy for malignant tumours is associated with higher morbidity.

[Severe hemorrhagic cystitis following allogenic bone marrow transplantation]. / Cystite hémorragique grave à distance d'une allogreffe de moelle.

The authors report the case of a 25-year-old woman with a history of acute lymphoblastic leukaemia in complete remission after being treated, three years previously, by chemotherapy, radiotherapy and allogeneic bone marrow transplantation, who was admitted to the urology department following an episode of haematuria with severe anaemia. This clinical case report illustrates the diagnostic and therapeutic approach adopted in relation to the severity of the haematuria, in which haemostatic surgery was only considered as a last resort.

Laparoscopic surgery for pheochromocytoma.

OBJECTIVE: To evaluate the feasibility of laparoscopic adrenalectomy for pheochromocytoma. MATERIAL: Between January 1998 and March 2002, 12 patients aged from 19 to 76 (average age 54 years) underwent 13 adrenalectomies (7 right and 6 left, 1 bilateral) using laparoscopic surgery. A specific anti-hypertensive preparation was begun prior to the operation. Peaks of blood pressure were treated by bolus Nicardipine and sinus tachycardia by bolus Esmolol. Catecholamines were dosed at different times during the intervention. As far as surgery was concerned, the adrenalectomies were performed 11 times using the transperitoneal route and twice using the retroperitoneal route. The adrenal vein was found and ligatured before manipulation of the adrenal gland. RESULTS: Average length of operation was 127 minutes (75 to 195). Average blood loss was 105 ml (0 to 1000). Catecholamines dosed throughout showed a variable increase in plasma rates during peritoneal insufflation and manipulation of the gland. They were responsible for 5 cases of hypertensive bouts and 2 cases of tachycardia which were treated with medication. No surgical conversions were necessary. Average length of hospital stay was 4.18 days (3 to 6); average size of adrenal tumours was 44 mm (30 to 72); average follow-up, 18.4 months. CONCLUSION: This study showed the feasibility of adrenalectomy for pheochromocytoma using laparoscopic surgery, subject to specific medical preparation to reduce the consequences of peroperative bouts of hypertension and sinus tachycardia during peritoneal insufflation and manipulation of the adrenal gland despite initial ligature of the main adrenal vein.