Transperitoneal laparoscopic radical nephrectomy is an effective procedure for large (more than 7 cm) renal masses.

PURPOSE: We aimed to evaluate our experience with the transperitoneal radical nephrectomy (TLRN) in patients with large (more than 7 cm) renal mass to determine if this procedure can be recommended as a reference standard for treating large renal masses. PATIENTS AND METHODS: Of 213 patients who underwent TLRN in both institutions we have reviewed medical files of 35 who had large than 7 cm renal masses. Operative time, blood loss, conversion rate, pathologic tumor type, and oncologic outcome were evaluated. RESULTS: The mean tumor size was 10.1 cm (range: 7 to 19 cm). Mean blood loss during surgery was 388 mL (range: 150 to 600 mL). In 2 patients with 16 cm renal masses the operation was converted to hand-assisted technique as planned upon the surgery after ligation and transsection of the vascular pedicel to facilitate kidney dissection from surrounding tissue. In 1 patient the operation was converted to the open technique. Twenty-two (62.8%) patients had renal cell carcinoma and the remaining 13(37.5%) patients had other types of the renal tumors. Mean hospital stay was 4.36 days (range: 3 to 7 d). Median follow-up after the surgery was 29 months (range: 8 to 60 mo). Three patients who underwent cytoreduction nephrectomy died whereas receiving immunotherapy 3, 8, and 11 months, respectively, after surgery. One patient developed a local tumor recurrence and 2 developed remote metastasizes. CONCLUSIONS: Our data show that TLRN is an effective procedure for the removal larger than 7 cm renal tumors. In those patients with exceptionally big tumors planned conversion to the hand-assisted technique after laparoscopic ligation of the renal vessels enabling easier renal dissection whereas preserving the advantages of minimally invasive procedure.

The use of laparoscopy in intersex patients.

The management of intersex patients is a challenge. Although in the majority of patients the diagnosis may be made on the basis of cytogenetic and biochemical tests, there is a selective group of patients with difficulties in the establishment of final diagnosis and gender assignment. Since laparoscopy has been used in the management of impalpable gonads in the normal male population, it may be an alternative method for the diagnosis and surgical management of intersex patients. Thus we have evaluated our experience with laparoscopy in intersex population. Over the last 10 years (1995-2005) more than 80 intersex patients underwent surgical correction at our department. Out of those, 14 patients with a median age of 3 years (range 2-18 years) underwent laparoscopic surgery. Laparoscopic gonadectomy with subsequent estrogen replacement was performed following gonadal biopsy in five patients with androgen insensitivity syndrome (AIS). In three patients with mixed gonadal dysgenesis (MGD) gonadal biopsy was performed. In two of those the initial diagnosis was changed to true hermaphroditism, and they underwent removal of ovotestis from one side and orchidopexy of the normal testis on the other. In one patient with MGD, timed gonadectomy following laparoscopic biopsy was performed due to malignant potential of the streak gonads. In two patients with persistent müllerian duct syndrome (PMDS), laparoscopic orchidopexy was performed following gonadal biopsy. Three patients with total gonadal dysgenesis (TGD) underwent laparoscopic gonadectomy and one with true hermaphroditism underwent laparoscopic biopsy followed by bilateral inguinal orchiectomy with preservation of the ovarian tissue. Our data show that the laparoscopic gonadal biopsy remains the only way to obtain morphologic gonadal structure and to establish a final diagnosis in doubtful cases. Magnification and easy access to the pelvic cavity allow removal of gonads or ductal structures with the advantages of minimally invasive procedure.