V26 LAPAROSCOPIC RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) FOR A LARGE RESIDUAL MASS POST C H E M O T H E R A P Y
L A P A R O S C O P I C ADRENALECTOMY: AN ESTABLISHED A P P R O A C H FOR MANAGEMENT OF ADRENAL P H E O C H R O M O C Y T O M A
Baumert H. 1, Khan F.2, Aho T.2, Shah N. 2, Turner W. 2
Shoma A,, Eraky I., E1 Kappany H.
~Hospital Saint Joseph, Department of Urology, Paris, France, 2Addenbrookes Hospital, Department of Urology, Cambridge, United Kingdom
Urology and Nephrology Center, Urology, Mansoura, Egypt
INTRODUCTION & OBJECTIVES: Laparoscopic RPLND for residual masses has been described previously. In general it has been attempted for small masses less than 4 to 5 cm in maximum dimension. This film demonstrates the feasibility of laparoscopic RPLND for a large residual mass (9x4 cm mass).
MATERIAL & METHODS: A 27-year-old man presented with a testicular tumour. After 4 cycles of BEP chemotherapy, prior to delayed orehidectomy, a post chemotherapy CT scan showed a large 9x4 cm residual para-aortic mass. The patient was placed supine with the legs in slight abduction with Trendelenberg tilt. The surgeon was positioned between the patients' legs and the assistant to the left. The different steps of the operation were: 1- Insertion of one 10 m m port with four 5 m m ports, 2- Mobilisation of the right colon and the root of the mesentery, exposing the retroperitoneal space, 3- A left para-aortic template was then dissected from the left renal pedicle to the left common iliac artey with preservation of the inferior mesenteric artery. 4- The interaorto-caval tissue was then removed from the right renal pedicle to the aortic bifurcation. 5- Dissection of the left spermatic vein which was removed, 6- Both lymph node masses were extracted in an endo-bag. RESULTS: The operative time was 6 hours and the blood loss 200 mls. The patient made an uncomplicated recovery and was discharged on postoperative day 5. The residual lymph node masses were 9x4 cm and 5x2 cm. Histopathology revealed the presence of fibrosis.
CONCLUSIONS: Large residual retroperitoneal masses post chemotherapy may be removed by laparoscopy. Such patients can benefit from all the advantages of minimally invasive surgery. However, laparoscopic expertise is necessary to perform such procedures.
INTRODUCTION & OBJECTIVES: Currently laparoscopic adrenalectomy is considered the standard management for adrenal masses of 5 cm or less in their largest diameter. Nevertheless, laparoscopic excision of pheochromocytoma represents a challenge. Repeated attaches of hypertension might be encountered during the procedure, which increase the risk of intraoperative morbidity. A video film is provided to show the technique of adrenalectomy for pheochromocytoma. The adrenal vein is early identified and clipped before any attempt at dissection of the adrenal gland.
M A T E R I A L & METHODS: A 25 years old female patient with right adrenal mass (4 cm in its largest diameter) was diagnosed as a pheochromocytoma. The patient was placed in a lumbar position. The procedure was performed through transp~ritoneal approach using 4 ports. The ascending colon and the duodenum were reflected medially. Inferior vena Cava was identified and dissected upward till identification of the adrenal vein that was clipped before dissection of the adrenal mass. Then the mass itself was dissected from the surrounding and extracted via the site of 12-mm port. RESULTS: Sixteen patients with adrenal pheochromocytoma were performed using the same technique. Conversion to open surgery was not required in any. Mean operative time was 98 minutes. Hospital stay ranged from 3-4 days. There were no reported major complications. CONCLUSIONS: Laparoscopic adrenalectomy is a good and viable option for management of adrenal pheochromocytoma.
V27
V28
ENDOUROLOGICAL TREATMENT OF U R E T E R A L AND B L A D D E R PATHOLOGY AFTER R E N A L T R A N S P L A N T
ROBOT ASSISTED D I S M E M B E R E D PYELOPLASTY: A N E W A P P R O A C H FOR MANAGEMENT OF PRIMARY URETEROPELVIC JUNCTION OBSTRUCTION WITH SECONDARY RENAL STONES
Burgos EJ. 1, Marcen R. z, Pascual j.2, Garcia Ortells D ) , Gomez Garcia I. 1, Gomez Dosantos V.I ~Ramon y Cajal Hospital. Alcala University, Urology, Madrid, Spain, 2Ramon y Cajal Hospital. Alcala University, Nephrology, Madrid, Spain INTRODUCTION & OBJECTIVES: The incidence of ureteral and bladder complications after renal transplant ranges from 5 to 8%. Obstruction due to m'eteral stenosis, calculi or tumour influences not only renal function, but also patient and graft survivals. MATERIAL & METHODS: One thousand renal transplants have been performed between 1978 and 2004. The insertion of a nephrostomy tube was the first approach in the case of graft hydronephrosis. An antegrade pyelogram usually permits to determine the cause of the obstruction. Endourological techniques: nephroscopy, antegrade or retrograde ureteroscopy, cistoscopy or transurethral resection were performed for resolution of these surgical complications. RESULTS: The video shows: Endoscopic resection of implantation pedicle of a bone lithiasis located at the level of the graft ureteroneocistostomy, balloon dilatation and endoureterotomy of ureteral stenosis, retrograde ureteroscopy for treatment of ureteral lithiasis, ureteral stenosis and ureteral adenocarcinoma. Antegrade ureteroscopy through a nephrostomy tract for resolution of ureteral stenosis or Iithiasis is also shown. Finally, the feasibility of self-expanding metallic stent implantation under endoscopic control is demonstrated. Endourological approach was successful in 82% of the cases.
CONCLUSIONS: Endourological techniques are essential for diagnosis and treatment of complications after renal transplant. European Urolosy S u p p l e m e n t s 4 (2005) No. 3, pp. 278
Shoma A ) , Hemal A. e, E1 Tabey N. 1 1Urology and Nephrology Center, Urology Department, Mansoura, Egypt, 2Vattikuti Urology Institute, Urology Department, Detroit, United States I N T R O D U C T I O N & OBJECTIVES: We describe the technique of laparoscopic dismembered Anderson-Hyens (A-H) pyeloplasty and pyelolithotomy that performed completely by robot and showed the outcome after 6 months. MATERIAL & METHODS: A 24-years old female patient presented with primary left ureteropelvic junction obstruction and secondary renal stones. Laparoscopic (A-H) pyeloplasty and pyelolithotomy were performed through transperitoneal approach. The different steps of the technique were done exclusively by the robotic assistance and included: 1> Mobilization and reflection of the colon medially; 2> Identification and release of the renal pelvis and upper ureters all around. 3> Pyelotomy was made in such a way that the same incision was used later for retrieval of the stones and pyeloplasty. 4> The renal stones were removed and the redundant pelvis was excised following the principle of (A-H) pyeloplasty; 5> The ureter was spatulated laterally; 6>Reconstruction of neoureteropelvic junction was performed with intracorporeal suturing .The patient was followed up at3&6 months postoperatively to assess the outcome. RESULTS: Operative time was 4 hours; hospital stay was 3 days. There was no reported morbidity. Radiological evaluation after 3&6 months showed significant improvement in renal morphology and function.
CONCLUSIONS: Robot could be effectively used to perform the entire procedure of laparoscopic dismembered pyeloplasty with extraction of the associated renal stones. The short term outcome is satisfactory.