Laparoscopic bilateral varicocelectomy: our technique with three 5-mm trocars

217 LAPAROSCOPIC

VARICOCELECTOMY:

LONG-TERM

218 LAPAROSCOPIC BILATERAL VARICOCELECTOMY: NIQUE WITH THREE S-MM TROCARS

RESULTS

OUR

TECH-

Melchior Andres, Hentschel Kristin, Manseck Andreas Urology, University

Bove Pierluigi, Micali Salvatore, Guido, Vespasiani Giuseppe

Hospital “C.G. Carus” Dresden, Dresden, Germany

INTRODUCTION & OBJECTIVES: Laparoscopic surgery for testicular varicoceles as first described in 1989 is now a well-established and effective treatment. However, long-term results of this treatment modality in large patient groups have not been reported. MATERIAL & METHODS: Between 1993 and 1999, 353 patients with varicocele of the testis were treated by laparoscopic transperitoneal resection and clip ligation of the testicular vessels. All cases were retrospectively reviewed. Mean patient age was 18 years, range 9-46,79% fell in the age range 11-23 years. For 26 patients this was a secondary procedure after failure of open surgery (5). percutaneous (17) or retrograde (4) sclerotherapy. Follow-up was done by the department’s outpatients clinics or obtained from private urologists. Follow-up was 20.2 months on average (range 3-96). RESULTS:

15 different surgeons did the surgical procedures,

average operating

time was 48.1 minutes (range 15-125). There were no conversions to open surgery or bleeding requiring substitution. Mean postoperative hospitalisation was 2.1 days. During follow-up 32 pts (8%) developed a secondary testicular hydrocele which was treated surgically in 13 (3.7%). 9 pts (2.5%) developed acute epididymitis during follow-up and 5 (I .4%) complained of temporary loss of sensation in the area supplied by the genito-femoral nerve. 2 patients (0.6%) developed

a recurrent

varicocele.

CONCLUSIONS: Laparoscopic, transperitoneal varicocelectomy is a safe and highly effective treatment option that has a lower recurrence rate than any other technique. The most frequent complication consists in the development of a secondary hydrocele.

Urology, University

Miano

Roberto,

Germani

Stefano, Virgili

of Tor Vergata, Rome, Italy

INTRODUCTION & OBJECTIVES: Bilateral varicocele is an association of clinical left varicocele and subclinical or ultrasound-diagnosed right varicocele. The laparoscopic technique offers the possibility of planning bilateral spermatic vein ligation in a safe and effective way. This report describes our technique with three 5-mm trocars. MATERIAL & METHODS: From November 1996 to April 2001, 15 patients underwent laparoscopic treatment of bilateral varicocele. Mean age of the patients was 24 years (range 14-32) and the indications for surgery were subfertility in 10115 patients (66.6%) and gravative scrotal pain in 5/15 (33.3%). In all patients a laparoscopic transperitoneal approach was used. Once the pneumoperitoneum is obtained, a first 5-mm optical trocar (Optiview; Ethicon Endosurgical, Inc.) is inserted in the ombelicus. It allows a dissection through the layers of the abdominal wall and an initial exploration of the operatory field. Two more 5.mm trocars are then inserted on the middle line, at 5 cm distance one each other, under direct vision of the first trocar. The spermatic veins are then individuated and ligated by 5 mm clips appliers. RESULTS: The operation was performed on a day surgery basis with an average operative time of 51.4 minutes (range 40.3-65 minutes). The optical trocar allows the surgeon a fast and safe access. No complications were observed during and after the procedures. CONCLUSIONS: Laparoscopic bilateral varicocelectomy is safe and effective, causing minimal discomfort and allow patients an early return to normal activity. With a 5 mm laparoscope, a xenon light source and a 3.CCD camera are necessary to optimalize intraoperative view.

220

219 LAPAROSCOPIC

RADICAL

CYSTECTOMY

ISTHMOTOMY

LAPAROSCOPIC PYELOPLASTY

Listooadzki

Slawomir,

Jarzemski

BY THE PATIENT

AND

DISMEMBERED

WITH HORSESHOE

KIDNEY

Piotr, Wronski Stanislaa

Urology, Jan Biziel Hospital, Bydgosaca,

Poland

INTRODUCTION & OBJECTIVES: Laparoscopy is used in our department since 1995. It is possible to use this method actually for each procedure. We decided to make a radical cystectomy using laparoscopic approach. MATERIAL & METHODS: In 2001 we performed 3 radical cystectomies: there was one woman, 68 years old and two men, 45 and 67 years old. The most difficult part of procedure was urinary diversion. For the first man we made Zeal conduit. making it extracorporeally through the small incision used there after for the stomy. By the second patient we made completely extracorporeally ileal neobladder. By the women we made ileal conduit completely intracorporeally. By two men operated on after cystoprostatectomy we took the specimen out through the small skin incision. By the women we took the specimen out through her vagina. For each case we used 5 trocars inserted into the abdomen like for prostatectomy. RESULTS: The operations lasted 8 and 9 hours for ileal conduit and I I hours for ileal neobladder. The blood loss was minimal and it did not require transfusion. The first part of procedure-cystectomy lasted by each case about three hours. We had one complication by the patient with ileal neobladder. It was perforation of the small bowel, which was not noticed during the operation. We had to operate on this patient on the 3’” day after procedure to suture the perforation. We took out the catheters from the ureters on the 81h day after procedures. The patients after ileal conduit were discharged from our department on the IO”’day. The patient with ileal neobladder was discharged home on the 171h day in good condition. All patients stay under our control without any complains. CONCLUSIONS: Laparoscopic radical cystectomy is feasible to perform. We can divide the procedure on two parts: the first and the easiest is cystectomy, the same by women and by men. The most difficult part of the operation is urinary diversion. The problem is how to do this and that it takes a lot of time. We conclude that probably the best way to solve this problem is to make bowel anastomosis and ureter- ileal anastomosis extracorporeally. Of course we need more experience for this not easy operation.

Listopadzki

Slawomir,

Jarzemski

Piotr. Wronski Stanislaw

Urology, Jan Biziel Hospital, Bydgoszcz,

Poland

INTRODUCTION

Laparoscopy

technique

& OBJECTIVES:

used successfully

by complicated MATERIAL

SLMETHODS:

approach.

optic. After preparing aorta.

We decided

For the procedure

confirmed

horseshoe

to treat this patient

using

we used 4 tracers and IO-mm O-grade

lower pole of left kidney we exposed isthmus lying on the

We put on it endo-GIA

dismembered

pyeloplasty

the procedure

we suspended

RESULTS:

invasive

A 15 year old boy was admitted to our department

left lumbar pain. Our investigations

and left side UPJ stricture.

laparoscopic

is a minimal

useful for children even

cases.

because of recurrent kidney

in urology. It is especially

and cut it. Then

we performed

left side

living in the ureter Double J catheter. On the end of left kidney.

The operation lasted 5 hours. The patient was mobile on the I“ day

after procedure.

The blood loss was minimal. We took out the Redon drain on

the 2”” day after the operation,

there was no leakage. On the 7”’ day we took out

the Double J catheter from the left ureter and the catheter from the bladder. On the gth day the patient complains. CONCLUSIONS: children

where

convalescence

was discharged

Laparoscopy the tissues

after procedure

scars. In our opinion horseshoe kidney.

is minimal are

very

soft

invasive technique, the preparation

without

especially is easy.

any

by The

is short, the pain is minimal because of minimal

laparoscopy

European

from our department

is a good

Urology

technique

Supplements

for operations

1 (2002)

on

No. 1, pp. 57