Laparoscopic adrenalectomy for large adrenal masses: a challenge or a routine?

AIM: The increased incidence of malignancy and the concern for higher rate of complications with laparoscopic resection of larger tumors typically limits laparoscopic adrenalectomy to small adrenal masses. We used our prospectively collected database to compare laparoscopic adrenalectomy outcomes between small and large adrenal tumors. METHODS: Operative details and outcomes were compared by adrenal mass size size: Group A≤4 cm and Group B>4 cm, for consecutive laparoscopic adrenalectomies performed between 2009 and 2013. RESULTS: Group A (N.=50) and Group B (N.=27) subjects had similar operative times (131 vs. 132 min, P=0.48). Group B subjects were older, had more adrenal malignancies, and had a higher blood loss with a slightly larger change in hemoglobin than Group A subjects; however, no subject required blood transfusion and complication rates were similar between groups (4% vs. 11%, P=0.34). One subject from each group required conversion to open adrenalectomy. CONCLUSION: Laparoscopic adrenalectomy can be performed safely for adrenal masses >4 cm and size is not a contraindication to the laparoscopic approach.

[Percutaneous nephrolithotomy (PCNL) in a 9-year-old patient with horseshoe kidney]. / Paziente di nove anni con rene a ferro di cavallo.

INTRODUCTION: The horseshoe kidney is the most frequent renal anomaly, with a prevalence of 0.25% and a male to female ratio of 3:1. Although the pathogenesis remains controversial, the consequences of the impaired urinary drainage are well known: up to two third of patients present with urinary stasis, infection and urolithiasis. Percutaneous nephrolithotomy (PCNL) is a successful procedure for urolithiasis in horseshoe kidneys. MATERIALS AND METHODS: A 9-year-old patient with a 4-cm stone associated with horseshoe kidney underwent Percutaneous nephrolithotomy (PCNL). During the procedure, a flexible uretheroscopy was performed in order to obtain a complete vision and an optimal management of the procedure. RESULTS: At the end of the procedure, the patient was stone-free. We reported no hemorrhagic complications, no pain and no infection. The patient was discharged after 48 hours. CONCLUSIONS: The procedure is safe and effective, as long as the surgeon pays attention to the recommendations below.