Laparoscopic removal of local renal cell carcinoma recurrence.

PURPOSE: To describe an entirely laparoscopic technique for excising a recurrence of local renal cell carcinoma (RCC). MATERIALS AND METHODS: The patient is placed in a full flank position. A 10-mm trocar is inserted using Hasson's technique with three additional ports in the upper abdomen. After lysis of adhesions, the psoas muscle, ureteral and gonadal vein remnants, inferior vena cava or aorta, and renal vessel stumps are dissected and isolated. The specimen, including the mass, the adrenal gland, and the ipsilateral pararenal and paracaval or para-aortic tissue within Gerota's fascia remnants, are excised en bloc and removed inside an Endocatch-II bag. RESULTS: To date we have used this technique for excising RCC recurrences in three patients. Pathologic examination showed clear cell type RCC Fuhrman grade 2 in the specimens of two patients and chromophobe type in one. No patient has had further recurrence after 50, 38 and 12 months of follow-up. CONCLUSIONS: An entirely laparoscopic surgical approach for excising local RCC recurrence has not, to our knowledge, been previously described. This method can be effectively applied while adhering to oncologic principles, with minimal blood loss and low morbidity.

Laparoscopic removal of local renal cell carcinoma recurrence

Purpose: To describe an entirely laparoscopic technique for excising a recurrence of local renal cell carcinoma (RCC). Materials and Methods: The patient is placed in a full flank position. A 10-mm trocar is inserted using Hasson's technique with three additional ports in the upper abdomen. After lysis of adhesions, the psoas muscle, ureteral and gonadal vein remnants, inferior vena cava or aorta, and renal vessel stumps are dissected and isolated. The specimen, including the mass, the adrenal gland, and the ipsilateral pararenal and paracaval or para-aortic tissue within Gerota's fascia remnants, are excised en bloc and removed inside an Endocatch-II bag. Results: To date we have used this technique for excising RCC recurrences in three patients. Pathologic examination showed clear cell type RCC Fuhrman grade 2 in the specimens of two patients and chromophobe type in one. No patient have had further recurrence after 50, 38 and 12 months of follow-up. Conclusions: An entirely laparoscopic surgical approach for excising local RCC recurrence has not, to our knowledge, been previously described. This method can be effectively applied while adhering to oncologic principles, with minimal blood loss and low morbidity.

Concomitant laparoscopic renal surgery and cholecystectomy: outcomes and technical considerations.

INTRODUCTION: We report our experience with simultaneous laparoscopic treatment of coexisting kidney and gallbladder pathologies, assess the feasibility of this technique, and highlight some technical considerations. METHODS: Our institutional database was searched for the records of simultaneous laparoscopic kidney surgery and laparoscopic cholecystectomy between 2002 and 2008. We retrieved data on patient demographics, preoperative work-up, surgical information, and postoperative outcome in terms of final pathology, complications, and hospital stay. RESULTS: A total of 19 patients had undergone laparoscopic renal surgery combined with cholecystectomy. Renal surgery consisted of a laparoscopic partial nephrectomy in 5 patients (26.3%), a laparoscopic radical nephrectomy in 12 (63.2%), and a simple nephrectomy in 2 (10.5%). Laparoscopic cholecystectomy was performed as a second surgery in all 19 patients. Two patients simultaneously underwent a third procedure: one was a bilateral salpingo-oophorectomy, and the other was a postoperative ventral hernia repair with mesh. The average renal surgery time was 144 minutes, and the average cholecystectomy time was 28.0 minutes. All procedures were successfully completed laparoscopically with no conversions. The mean hospital stay was 4.2 days (median 4, range 2-8). CONCLUSIONS: Combining laparoscopic renal surgery and laparoscopic cholecystectomy is a feasible, efficacious, and safe strategy that requires close collaboration between urologists and general surgeons. This approach offers the patient the benefits of minimally invasive surgery together with the obvious advantages of simultaneous treatment of coexisting pathologies.

Laparoscopic treatment of colovesical fistulas: technique and review of the literature.

Colovesical fistula is an uncommon complication of diverticulitis. We present our technique of a laparoscopic approach for treatment of vesicosigmoid fistulas and review the available published literature. We believe that a laparoscopic approach is a feasible and advantageous alternative for the treatment of colovesical fistulas, with low morbidity and short hospital stay.

Abdominal wall closure with a silastic patch after repair of congenital diaphragmatic hernia.

HYPOTHESIS: Newborns with congenital diaphragmatic hernia (CDH) have a high risk of mortality, ranging from 50% to 70%. Tensioned closure of the narrowed abdominal cavity is detrimental. PATIENTS AND METHODS: Twelve high-risk newborns underwent operation for CDH. To achieve tension-free closure of the abdominal wall, a Silastic patch was used. The Silastic patch was sutured intermittently to the edges of the abdominal wall fascia with absorbable sutures and left open to the air. The skin was not closed above the Silastic patch, which was lubricated with 1% gentamicin sulfate ointment. RESULTS: Eleven patients (91.6%) survived. No local or systemic septic complication occurred. The abdominal wall was gradually closed, and total closure was achieved within 4 to 6 weeks (mean, 4.9 weeks). CONCLUSION: Because of the high survival rate and the complication-free rapid healing of the abdominal wall, the technique can be used in any case of CHD in which tension-free closure of the abdominal wall cannot be achieved by other methods.