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1.
Ho Seok Chung Myung Soo Kim Ho Song Yu Eu Chang Hwang Sun‐Ouck Kim Kyung Jin Oh Seung Il Jung Taek Won Kang Kwangsung Park Dong Deuk Kwon 《International journal of urology》2018,25(5):414-419
Objectives
To evaluate the surgical feasibility of laparoscopic adrenalectomy using the lateral retroperitoneal approach for the treatment of large pheochromocytomas, and to identify the preoperative risk factors for intraoperative hypertension.Methods
We retrospectively reviewed 51 patients who underwent laparoscopic adrenalectomy using the lateral retroperitoneal approach for the treatment of pheochromocytomas. Patient characteristics and perioperative outcomes were analyzed and compared between the two study groups based on tumor size: group A (n = 27, ≤6 cm) and group B (n = 24, ?6 cm).Results
There was no significant difference in preoperative characteristics between the two groups except for tumor size (P = 0.001) and urinary metanephrine (P = 0.011). Group B patients required longer operating time (P = 0.008), had a greater estimated blood loss (P = 0.001) and hemoglobin change (P = 0.002). However, no significant differences were observed in perioperative complications and mortality. Multivariate analysis showed that symptomatic pheochromocytomas (P = 0.004) and tumor size (P = 0.007) were significant risk factors for intraoperative hypertension.Conclusions
Laparoscopic adrenalectomy using the lateral retroperitoneal approach for pheochromocytomas can be regarded as a treatment option, even for tumors measuring >6 cm. Symptomatic pheochromocytomas and large tumor size seem to represent risk factors for intraoperative hypertension.2.
Background Varicocele is a rare disorder in children that can lead to testicular atrophy and infertility; therefore, radical treatment
is frequently required. Whatever treatment is chosen, postoperative complications are fairly common (hydrocele, recurrence,
persistence, and testicular atrophy). Laparoscopic varicocelectomy (the laparoscopic Palomo procedure) is one of the surgical
options that has recently gained popularity. The aim of this study is to assess the safety and effectiveness of laparoscopic
Palomo varicocelectomy by describing a series of patients operated on during a 9 year period at the Royal Hospital for Sick
Children in Edinburgh.
Methods This is a retrospective unicentric study including patients operated on between June 1995 and June 2004. All patients preoperatively
underwent ultrasound scan of the testicles (color Doppler) and the abdomen. Indications for surgery included symptoms, high-grade
varicocele (grade II and III), and testicular atrophy. Pneumoperitoneum was created using carbon dioxide insufflation with
intraabdominal pressure up to 12 mmHg. Three 5 mm ports were inserted. The first port was inserted just below the umbilicus
(telescope) under direct vision, and the others were inserted at the left flank and in the suprapubic region. All the enlarged
spermatic and vas vessels were ligated or clipped. Outcomes and possible intraoperative, postoperative, or long-term complications
are described.
Results Forty-one patients were included in the study. Ninety percent of symptomatic patients improved significantly postoperatively,
and 62% of patients with preoperative testicular atrophy showed postoperative catch-up growth of the involved testis. Nevertheless,
hydrocele represents the most frequent postoperative complication in this series of patients. Approximately 15% of the patients
required some sort of further surgical intervention (12% because of postoperative hydrocele occurrence).
Conclusions The laparoscopic Palomo procedure is a safe and effective surgical option for the treatment of pediatric varicocele, although
it carries a fairly high risk of postoperative hydrocele. Postoperative hydrocele seems to be related to some sort of lymphatic
obstruction, therefore lymphatic sparing procedures that can be accomplished laparoscopically should be reconsidered. Nevertheless,
their feasibility and effectiveness need to be more carefully assessed. 相似文献
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Insang Hwang Seung-Il Jung Seong Hyeon Yu Eu Chang Hwang Ho Song Yu Sun-Ouck Kim Taek Won Kang Dong Deuk Kwon Kwangsung Park 《World journal of urology》2014,32(3):723-728
Purpose
To evaluate the surgical feasibility of retroperitoneal laparoscopic adrenalectomy for tumors exceeding 5 cm.Methods
A retrospective review was carried out on all adrenalectomies performed between 2002 and 2011. All surgical procedures were performed or supervised by one of two experienced laparoscopic surgeons. A total of 133 patients who underwent retroperitoneal laparoscopic adrenalectomy were divided according to tumor size: group I (n = 57) had tumors <5 cm and group II (n = 76) had tumors ≥5 cm. The operative outcomes included surgical time, change in hemoglobin level, estimated blood loss, necessity for blood transfusion, time to ambulation, hospitalization duration, postoperative complications according to the Clavien-Dindo classification, and the rate of conversion to open surgery.Results
The estimated blood loss (271.75 ± 232.98 mL vs. 367.24 ± 275.11 mL; p = 0.037), time to ambulation (1.60 ± 0.49 days vs. 1.89 ± 0.31 days; p = 0.001), and postoperative hospitalization (7.88 ± 3.08 days vs. 9.264 ± 3.10 days; p = 0.012) were significantly higher in group II. The operation time and hemoglobin level change were not statistically different between groups. Blood transfusions were performed in 3 patients from group I and 6 patients from group II (5.3 vs. 7.9 %; p = 0.449). No patients experienced conversion to open surgery.Conclusions
Retroperitoneal laparoscopic adrenalectomy can be used in patients with tumors larger than 5 cm. 相似文献5.
Background
It is not clear whether obesity has any negative impact on the results of laparoscopic antireflux surgery (LARS). In this prospective study we investigated the effect of body mass index (BMI) on the surgical outcome of LARS. 相似文献6.
Parnaby CN Chong PS Chisholm L Farrow J Connell JM O'Dwyer PJ 《Surgical endoscopy》2008,22(3):617-621
Background Laparoscopic adrenalectomy (LA) has been shown to reduce hospital stay and morbidity when compared to open adrenalectomy (OA).
It is uncertain if the laparoscopic resection of large (≥6 cm) potentially malignant adrenal tumours is appropriate due to
concern over incomplete resection and local recurrence. The aim of the present study was to compare the outcomes of LA for
tumours ≥6 cm with those < 6 cm.
Methods Details of all patients referred with adrenal tumours between January 1999 and January 2006 had been recorded prospectively
on a database. LA was performed using a lateral transabdominal approach. Contraindications to LA were local invasion requiring
en bloc resection of adjacent organs or the requirement of additional open procedures.
Results 103 patients were referred for adrenal resection. Three with metastatic adrenal carcinoma and two with severe cardiorespiratory
disease were deemed unsuitable for operation. One hundred and eleven adrenalectomies were performed: 101 LAs and 10 OAs. Thirty-nine
LA were for tumours ≥6 cm while nine OA were for tumours ≥6 cm. There were no significant differences between the median total
anaesthetic time, postoperative complications or postoperative stay for patients undergoing LA for tumours ≥6 cm versus tumours
<6 cm. Of the six conversions, five were performed for adrenal tumours ≥6 cm [local invasion (n = 3), adhesions (n = 1), primary renal carcinoma (n = 1)]. All tumours in the LA group were resected with clear margins and at a median follow up of 50 months (range 38–74 months).
There has been no evidence of local recurrence.
Conclusions In the absence of local invasion, the outcomes of laparoscopic adrenalectomy for patients with tumours ≥6 cm were comparable
to those with tumours <6 cm. This has helped confirm a policy of initial laparoscopic resection for all noninvasive adrenal
tumours can be applied safely. 相似文献
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Background: The elderly have prevalence rates and clinical features of gastroesophageal reflux disease (GERD) similar to those in younger
individuals, but the role of laparoscopic antireflux surgery (LARS) in the elderly has not been clearly established. The purpose
of this study was to determine if the results of LARS in the elderly are comparable with those in younger patients.
Methods: All patients undergoing LARS for GERD at the Washington University Medical Center were entered prospectively into a computerized
database. Between May 1992 and June 1998, 339 patients underwent LARS and were divided into two groups based on age: nonelderly
(ages, 18–64 years; n= 303) and elderly (age, ≥65 years; n = 36). Data were expressed as mean ± standard deviation (SD) and statistical analysis
was performed.
Results: Elderly patients had a higher American Society of Anesthesiology (ASA) score (2.3 ± 1.5) and a longer hospital stay (2.1
± 0.2 days) than the younger group (ASA, 1.9 ± 0.5; hospital stay, 1.6 ± 0.9 days; p < 0.001). Operation times averaged 154 ± 68 min in the elderly compared with 134 ± 49 min in the nonelderly (p= NS). Grade I complications occurred significantly more frequently in the elderly (13.9%) than in the nonelderly (2.6%),
but the incidence of grade II complications was similar between the groups (elderly 2.8% vs nonelderly 2.7%). There were no
grade III complications in either group, but there was one death in the nonelderly group. At follow-up ranging to 81 months
(median, 27 months), the two groups had similar low incidences of heartburn and dysphagia. Anatomic failures of LARS developed
in 19 nonelderly patients (6.2%) compared with 2 elderly patients (5.5%; p= NS).
Conclusions: As shown in this study, LARS is safe and effective in elderly patients with GERD. Age older than 65 years should not be a
contraindication to laparoscopic antireflux surgery in properly selected patients.
Received: 3 March 1999/Accepted: 2 April 1999 相似文献
8.
BACKGROUND: Laparoscopic adrenalectomy has become the gold standard for removing adrenal masses, but several authors still debate the role of laparoscopic adrenalectomy in pheochromocytoma. The purpose of this study was to evaluate the short- and long-term outcomes of laparoscopic versus open adrenalectomy for pheochromocytomas and to compare the feasibility and safety of laparoscopic adrenalectomy for neoplasms that are smaller than 6 cm versus those that are larger than 6 cm. METHODS: From January 1990 to December 2005, the same team in our department carried out 221 adrenalectomies in 211 patients. A total of 64 of these patients underwent 71 adrenalectomies for pheochromocytoma, 24 patients (37%) had open adrenalectomy, and 40 patients (63%) had laparoscopic adrenalectomy. Sex, age, side and size of lesion, operating time, duration of hospital stay, need for intensive care, intraoperative blood pressure variations, blood loss, postoperative analgesia, return to oral nutrition, and complications were compared among groups. RESULTS: An advantage of laparoscopic adrenalectomy over open adrenalectomy was observed in mean operating time, hospital stay, need for intensive care, intraoperative hypertension, intraoperative blood loss, postoperative analgesia, and return to oral nutrition (P 6 cm) in laparoscopic adrenalectomy showed that none of the variables differed significantly, except for intraoperative blood loss, which was greater for the larger neoplasms (P = .007). CONCLUSIONS: Laparoscopic adrenalectomy, when performed by experienced laparoscopic surgeons, is preferable to open adrenalectomy for the majority of pheochromocytomas, and as long as there is no evidence of invasion of surrounding structures, tumor size does not appear to have a profound effect on surgical outcome. 相似文献
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Objectives To evaluate technical feasibility and analyze outcome of laparoscopic adrenalectomy (LA) for large adrenal masses more than
5 cm.
Methods The data of 22 patients (8 men, 14 women), who underwent LA for adrenal masses >5 cm between January 1995 and July 2007 were
analyzed for this study.
Results Twenty-two patients with a mean age of 42.5 years underwent LA for large adrenal masses (>5 cm) between January 1995 and July
2007. Transperitoneal and retroperitoneal laparoscopic adrenalectomy (TPLA and RPLA) was performed in 15 and 7 patients, respectively.
The mean-operative time, blood loss, tumor size and hospital stay were 149.33 and 132.1 min, 132.33 and 94.28 ml, 7.85 and
5.85 cm and 3.5 and 3.28 days, respectively. Histopathological examination of the specimen confirmed adrenal carcinoma in
5, pheochromocytoma in 14, myelolipoma in 2 and adenoma in 1 patient. Two patients of pheochromocytoma had required open conversion,
one from each group (TPLA and RPLA). Three patients had postoperative complications (wound infection 1, pneumonitis with fever
1 and retroperitoneal collection 1).
Conclusions The size of an adrenal mass on preoperative imaging studies alone should not be the primary factor in determining whether
LA should be performed. LA for adrenocortical cancers could be performed safely and effectively in the selected group. Transperitoneal
approach is most suitable and recommended for large adrenal tumor and adrenal carcinoma to employ laparoscopy. One approach
(TP or RP) over the other also does not lead to the substantial benefits either to the patients or to the surgeon. 相似文献
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Porpiglia F Fiori C Tarabuzzi R Giraudo G Garrone C Morino M Fontana D Scarpa RM 《BJU international》2004,94(7):1026-1029
OBJECTIVE: To review our experience with laparoscopic adrenalectomy (LA), to evaluate the effectiveness and safety of this procedure in patients with adrenal malignancy. PATIENTS AND METHODS: The study included patients who underwent LA from 1995 to 2002, with histologically identified adrenocortical cancer (ACC) or metastasis. Indications for LA were adrenal masses with no radiological evidence of involvement of the surrounding structures, or solitary metastasis with well-controlled primary cancer. The variables evaluated were: size of the lesion, operative duration, estimated blood loss, intraoperative complications, local, port-site and intra-abdominal recurrence, distant metastasis, and survival time. RESULTS: Fourteen malignant adrenal lesions in 205 LAs (7%) were confirmed with histological diagnoses that showed a primary ACC in six and metastasis in another seven (in one there was bilateral metastasis). The mean (sd) size of the malignant lesions was 5.9 (2.8) cm. The 12 unilateral procedures required a mean operative duration of 164 (47) min; the bilateral procedure lasted 215 min. There was one conversion to open surgery caused by local infiltration, whereas there were no intraoperative complications. The mean follow-up was 30 months, during which three patients died, one from endoperitoneal and trocar port-site seeding. CONCLUSION: When the malignancy is confined to the adrenal gland, LA seems to be a feasible option if the principles of oncological surgery are respected. Nevertheless, further investigations are required to evaluate the appropriateness of this operation. 相似文献
13.
In this short review, the authors performed a database search and summarize current knowledge of the management of patients with pineal cysts (PCs) and investigate the role of surgical treatment. The scientific literature on the surgical treatment of PCs is sparse and encompasses only case series with little over 200 operated patients combined. All included papers reported favorable results after pineal cyst surgery with improvement of symptoms in most patients. Microsurgical resection of PCs, preferably using the supracerebellar-infratentorial approach, could be considered as a viable treatment option in symptomatic patients. Even patients with non-specific symptoms are reported to improve after surgery. However, evidence offered by this literature review is very limited and therefore our conclusions must be tempered by the restricted set of data. For ethical reasons, a randomized controlled trial is not an acceptable approach, and therefore patient registry could be a useful tool to identify a subset of symptomatic patients that might benefit from pineal cyst resection. 相似文献
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Brierly RD Hale PC Bishop NL 《Journal of the Royal College of Surgeons of Edinburgh》1999,44(6):374-377
AIM: To assess the safety and effectiveness of herniography in adult patients with suspected hernia. METHOD: The records of all patients undergoing herniography within one unit over a 1 year period were studied retrospectively. A follow-up postal questionnaire was sent out to all patients enquiring about outcome and any complications of herniography. RESULTS: From a total of 64 patients undergoing a herniogram, 36% were found to have a positive result and 64% a negative result. This study showed a sensitivity rate of 0.94 and a specificity rate of 0.95. There was a 5% major complication rate leading to hospital admission, and 42% of patients described minor complications occurring within 24 hours of herniography. CONCLUSION: Herniography is a useful diagnostic tool for identification of clinically occult hernias, with good rates of sensitivity and specificity. In most cases it is a safe investigation but it is not without a significant complication rate. 相似文献
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Masiakos PT Gerstle JT Cheang T Viero S Kim PC Wales P 《Journal of pediatric surgery》2004,39(5):754-758