Case report: subcapsular hepatic hematoma: retraction injury during laparoscopic adrenalectomy.

We present a case of subcapsular hepatic hematoma resulting from retraction of the liver during laparoscopic adrenalectomy. We discuss the management and prevention of this rare and important complication.

Retroperitoneal lymph node dissection in the treatment of low-stage nonseminomatous germ cell tumors of the testicle: an update.

Nonseminomatous germ cell tumors (NSGCT) of the testicle are highly treatable and curable. The evolution of cancer control for this disease has shown an effective integration of medical and surgical approaches over the last 3 decades. Current emphasis in the therapy of NSGCT focuses on minimizing treatment-related morbidity while maintaining consistently high cure rates as previously seen. Retroperitoneal lymph node dissection (RPLND) in experienced hands is a critical component of the treatment armamentarium in this disease. RPLND is an accurate staging tool providing important information to determine the need for chemotherapy. When performed properly, RPLND eliminates the retroperitoneum as a site for relapse, which in turn provides emotional and psychological relief to the patient, and simplifies the follow-up protocol. RPLND alone can also provide high cure rates in patients with low clinical stage disease and high risk factors, such as lymphovascular invasion or predominance of embryonal histology in the primary tumor. Teratoma is chemoresistant and, when present in the primary tumor of patients with low stage, may be best treated with primary RPLND. Primary chemotherapy in the treatment of low stage NSGCT deserves continual investigation as long-term toxicities become more apparent. Observation is an option for the highly motivated patient but requires a rigorous follow-up schedule to avoid relapse. Laparoscopic RPLND is a viable staging tool; however, oncologic control of the retroperitoneum has not been reliably determined.

Retroperitoneal lymph node dissection in the treatment of low-stage nonseminomatous germ cell tumors of the testicle.

Nonseminomatous germ cell tumors of the testicle are highly treatable and curable. The evolution of cancer control for this disease has demonstrated an effective integration of medical and surgical approaches over the last 30 years. Current emphasis in the therapy of nonseminomatous germ cell tumors focuses on minimizing treatment-related morbidity while maintaining consistently high cure rates. Retroperitoneal lymph node dissection in experienced hands is a critical component of the treatment armamentarium in this disease. Retroperitoneal lymph node dissection is an accurate staging tool that provides important information in determining the need for chemotherapy. When performed properly, retroperitoneal lymph node dissection eliminates the retroperitoneum as a site for relapse, which in turn provides emotional and psychological relief to the patient and simplifies the follow-up protocol. Retroperitoneal lymph node dissection alone can also provide high cure rates in patients with clinical low-stage disease and high-risk factors such as lymphovascular invasion or predominance of embryonal histology in the primary tumor. Teratoma is known to be chemoresistant and, when present in the primary tumor of low-stage patients, may be best treated with primary retroperitoneal lymph node dissection. Primary chemotherapy in the treatment of low-stage nonseminomatous germ cell tumors deserves continual investigation as long-term toxicities become more apparent. Observation is an option for the highly motivated patient, but requires a rigorous follow-up schedule to avoid relapse. Laparoscopic retroperitoneal lymph node dissection is a viable staging tool, however, oncologic control of the retroperitoneum has not been reliably determined.