[Post chemotherapy laparoscopic retroperitoneal lymph node dissection]. / Linfadenectomía retroperitoneal vía laparoscópica postquimioterapia.

OBJECTIVES: To describe the laparoscopic excision of a postchemotherapy retroperitoneal residual mass in a patient with mixed germ cell testicular tumor. METHODS/RESULTS: We report the operative technique of laparoscopic excision of a retroperitoneal mass in a 33 year old patient with mixed germ cell testicular tumor. The patient is placed in a lateral decubitus right lumbotomy position and trocars are introduced into the abdominal cavity. Once the retroperitoneum is approached, and after a Kocher manoeuvre of the duodenum, the interaortocaval mass is identified and excised. The operation is completed with lympadenectomy down to the common iliac artery bifurcation bilaterally. CONCLUSION: The laparoscopic approach is another option for the surgical treatment of residual masses after chemotherapy in testicular tumors. Nevertheless, previous laparoscopic experience is necessary due to its difficulty.

[Right transperitoneal laparoscopic nephroureterectomy]. / Nefroureterectomía derecha laparoscópica vía transperitoneal.

OBJECTIVES: To describe the surgical technique of the right laparoscopic nephroureterectomy. METHODS/RESULTS: With the patient in the lithotomy position we performed an endoscopic section of the ureteral meatus. Once the patient is placed in the lumbotomy position and trocars are placed, the retroperitoneal space is accessed. The gonadal vein, and the ureter medial to it, are identified. We proceed to dissect and clip it. Posteriorly, the Kocher maneuver on the duodenum is performed, identifying the inferior vena cava. We dissect the renal artery and vein placing Hemolock clips on both. Once the vascular control is achieved, we free the upper pole with the help of the Ligasure Atlas instrument. When the kidney is free we continue with the ureter down. CONCLUSIONS: Laparoscopic nephroureterectomy is a feasible technique for groups with experience in laparoscopic surgery.

Nefrourectomiía derecha laparoscópica vía transperitoneal / right transperitoneal laparoscopic nephroureterectomy

OBJETIVO: Describir la técnica quirúrgica para la realización de una nefroureterectomía por vía laparoscópica. MÉTODOS/RESULTADOS: Con el paciente en posición de litotomía se realiza desinserción endoscópica del meato ureteral. Una vez colocado el paciente en posición de lumbotomía e introducidos los trócares, se accede al espacio retroperitoneal. Se identifica la vena gonadal y más medial el uréter. Procedemos a su disección y clipado precoz. Posteriormente se realiza la maniobra de Kocher sobre el duodeno, identificándose la vena cava. Disecamos la vena y arteria renal colocando clips Hemolock® en ambas. Con el control vascular realizado, liberamos el polo superior de riñón, ayudándonos de la pinza Atlas de Ligasure®. Una vez liberado todo el riñón, realizamos la misma operación sobre el uréter hasta desinsertarlo completamente. CONCLUSIÓN: La nefroureterectomía por vía laparoscópica es una técnica realizable en grupos con experiencia en cirugía laparoscópica

OBJECTIVES: To describe the surgical technique of the right laparoscopic nephroureterectomy. METHODS/RESULTS: With the patient in the lithotomy position we performed an endoscopic section of the ureteral meatus. Once the patient is placed in the lumbotomy position and trocars are placed, the retroperitoneal space is accessed. The gonadal vein, and the ureter medial to it, are identified. We proceed to dissect and clip it. Posteriorly, the Kocher maneuver on the duodenum is performed, identifying the inferior vena cava. We dissect the renal artery and vein placing Hemolock clips on both. Once the vascular control is achieved, we free the upper pole with the help of the Ligasure Atlas instrument. When the kidney is free we continue with the ureter down. CONCLUSIONS: Laparoscopic nephroureterectomy is a feasible technique for groups with experience in laparoscopic surgery

Linfadenectomía retroperitoneal vía laparoscópica postquimioterapia / Post chemotherapy laparoscopic retroperitoneal lymph node dissection

OBJETIVO: Describir la realización de la exéresis de una masa residual retroperitoneal post-quimioterapia, de un tumor germinal mixto por vía laparoscópica. MÉTODO/RESULTADOS: Presentamos la descripción técnica, por vía laparoscópica, de la exéresis de una masa residual post-quimioterapia de un tumor germinal mixto, en un paciente de 33 años. Se coloca al paciente en posición de lumbotomía derecha y se introducen los trócares. Una vez que se accede al retroperitoneo y realizada la maniobra de Kocher sobre el duodeno identificamos la masa residual interaorto-cava, procediendose a su exéresis. Por último se completa la disección, realizándose una linfadenectomía hasta la bifurcación de las arterias ilíacas primitivas. CONCLUSIÓN: La vía laparoscópica es una alternativa más para el tratamiento quirúrgico de las masas residuales post-quimioterapia en los tumores de testículo. No obstante precisa de experiencia en técnicas laparoscópicas debido a su dificultad

OBJECTIVES: To describe the laparoscopic excision of a postchemotherapy retroperitoneal residual mass in a patient with mixed germ cell testicular tumor. METHODS/RESULTS: We report the operative technique of laparoscopic excision of a retroperitoneal mass in a 33 year old patient with mixed germ cell testicular tumor. The patient is placed in a lateral decubitus right lumbotomy position and trocars are introduced into the abdominal cavity. Once the retroperitoneum is approached, and after a Kocher manoeuvre of the duodenum, the interaortocaval mass is identified and excised. The operation is completed with lympadenectomy down to the common iliac artery bifurcation bilaterally. CONCLUSION: The laparoscopic approach is another option for the surgical treatment of residual masses after chemotherapy in testicular tumors. Nevertheless, previous laparoscopic experience is necessary due to its difficulty

[Laparoscopic pyelolithotomy]. / Pielolitotomía laparoscópica.

The application of laparoscopy as a surgical technique in Urology has enabled to expand the therapeutic options for various pathologies. The treatment of urinary lithiasis localized in the renal pelvis is one of them. We report a laparoscopic pyelolithotomy, describing the operation step-by-step, from patient positioning and trochar insertion to drainage tube insertion and closure. The objective of this article is to show the technique, presenting it as an alternative option.

Pielotitotomía laparoscópica / Laparoscopic pyelolithotomy

La aplicación de la laparoscopia como técnica quirúrgica en Urología ha permitido ampliar el abanico de opciones terapéuticas para diferentes patologías.Esto incluye también el tratamiento de la litiasis localizada en pelvis renal.Presentamos una Pielolitotomía laparoscópica como técnicaquirúrgica, describiendo paso a paso todo el procesodesde la colocación del paciente e introducción de trócares, hasta la colocación del drenaje y cierre.El objetivo del trabajo es mostrar la realización de dichatécnica y presentarla como alternativa a otras ya existentes

The application of laparoscopy as a ;;surgical technique in Urology has enabled to expand the therapeutic options for various pathologies. The ;;treatment of urinary lithiasis localized in the renal pelvis is one of them. ;;We report a laparoscopic pyelolithotomy, describing the operation step-by-step, from patient positioning and trochar insertion to drainage tube insertion and closure. ;;The objective of this article is to show the technique, presenting it as an alternative option

Prostatectomía radical laparoscópica transperitoneal / Transperitoneal laparoscopic radical prostatectomy

Las técnicas quirúrgicas laparoscópicas cada vez están más extendidas dentro de la práctica urológica y es preciso realizar un entrenamiento exhaustivopara llegar a un nivel óptimo de habilidad para realizarlas. Presentamos la técnica quirúrgica paso a paso de la prostatectomía radical laparoscópica transperitoneal

Laparoscopic surgical techniques are ;;reaching widespread diffusion in the urological ;;community but intensive training is necessary to achieve an optimal level of skill to perform them. We report the transperitoneal laparoscopic radical prostatectomy surgical technique step-by-step

[Renal carcinoma and ipsilateral pheochromocytoma]. / Carcinoma renal y feocromocitoma ipsilateral.

OBJECTIVES: To report one case of associated renal cancer and ipsilateral pheochromocytoma treated by laparoscopic surgery METHODS: We describe the case of a 67-year-old female presenting with left lumbar pain and recurrent urinary tract infections. Ultrasound and abdominal CT scan were performed revealing renal carcinoma and ipsilateral adrenal mass, which was confirmed by MRI. With the diagnosis of left renal carcinoma and possible adrenal metastasis, laparoscopic left nephrectomy and adrenalectomy were performed. RESULTS: Pathologic study of the specimen reported a chromophobic renal cell carcinoma and adrenal pheochromocytoma. CONCLUSIONS: The association of renal carcinoma and pheochromocytoma is unfrequent, as suggested by the limited available bibliography on the topic. The presence of an adrenal mass in a patient with history of primary tumor is frequently secondary to metastasic disease, although primary adrenal neoplasia should not be discarded.

Carcinoma renal y feocromocitoma ipsilateral / Renal carcinoma and ipsilateral pheochromocytoma

OBJETIVO: Comunicar un caso de uropatíaobstructiva que evolucionó a anulación funcional renalpor lesión pseudotumoral en uréter iliaco.METODOS: Varón de 66 años en estudio por HBP, presentaepisodio autolimitado de hematuria monosintomática.RESULTADOS: En estudio ecográfico se detecta ureteropielocaliectasiagrado II RD; U.I.V. demuestra anulaciónfuncional RD.Citología de orina compatible con carcinomade células transicionales de bajo grado. Se realizanefrostomía percutánea que confirma la pérdida funcionalirreversible. La pielografía descendente muestra defectode replección a nivel de uréter iliaco derecho. El pacientees intervenido quirúrgicamente practicándosele nefroureterectomíaradical con cistectomía perimeática, con buenaevolución postoperatoria. El dictamen histopatológico dela pieza es de pielonefritis crónica y lesión inflamatoriaparietal ureteral que oblitera la luz con infiltrado inflamatorio,erosión de urotelio y presencia de actinomices.CONCLUSIONES: La actinomicosis es una infección bacterianacrónica cuyo patógeno más común es A.israelii.Se encuentra como comensal en la cavidad oral y tubodigestivo y la. afectación clínica más frecuente es laregión cervicofacial (60% casos) La infección del tractourinario es excepcional y en la evolución del paciente alargo plazo no se ha constatado ningún otro foco

OBJECTIVES: To report one case of pseudotumoral lesion of the iliac ureter with obstructive uropathy leading to loss of function of the renal unit. METHODS: 66-year-old male being studied for BPH who presents with a self-limited monosymptomatic hematuria. RESULTS: Renal ultrasound detected grade II pyelocaliectasis of the right kidney. IVU showed absence of function of the right kidney. Urine cytology was consistent with low-grade transitional cell carcinoma. Percutaneous nephrostomy was performed confirming irreversible function loss. Antegrade pyelography showed a filling defect in the right iliac ureter. Radical nephroureterectomy with bladder cuff was carried out with good results. Pathology reported chronic pyelonephritis and parietal inflammatory lesion of the ureter obliterating the lumen with inflammatory infiltrates, urothelial erosion and presence of actinomyces. CONCLUSIONS: Actinomycosis is a chronic bacterial infection, with A. israeli being the most common pathogen. It is part of the normal flora of the oral cavity and GI tract, and cervical-facial region is the most frequent clinical involvement (60% of the cases). Urinary tract infection is exceptional. No other focus was found in the long-term follow-up

[Transperitoneal laparoscopic radical prostatectomy]. / Prostatectomía radical laparoscópica transperitoneal.

Summary.reaching widespread diffusion in the urological community but intensive training is necessary to achieve an optimal level of skill to perform them. We report the transperitoneal laparoscopic radical prostatectomy surgical technique step-by-step.