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Sample records for retroperitoneal laparoscopic ureterolithotomy

  1. RETROPERITONEAL LAPAROSCOPIC TREATMENT OF LARGE ...

    African Journals Online (AJOL)

    Conclusion Retroperitoneal laparoscopic ureterolithotomy is a good minimally invasive alternative line of treatment for ureteral stones in cases not amenable for ESWL or endoscopy. However, it takes a long learning curve. Moreover, a careful case selection and good working instruments are necessary for success.

  2. Laparoscopic transperitoneal ureterolithotomy for large ureteric stones

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    Ahmed Al-Sayyad

    2012-01-01

    Conclusion: Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain and short hospital stay, and should be considered as a treatment option for such stones.

  3. Ultrasonography-guided PNL in comparison with laparoscopic ureterolithotomy in the management of large proximal ureteral stone.

    Science.gov (United States)

    Karami, Hossein; Mazloomfard, Mohammad Mohsen; Lotfi, Behzad; Alizadeh, Asghar; Javanmard, Babak

    2013-01-01

    The aim of study was to evaluate the clinical outcomes of PNL in comparison with laparoscopic ureterolithotomy (LUL) in proximal ureteral stones larger than 1 cm. A total of 80 patients who were candidates for treatment of large ureteral stones in our urology center were enrolled in the study between September 2004 and September 2008. By using patient randomization, they were assigned into two forty-patient groups (PNL and LUL). After evaluating the patients with laboratory tests and IVP, PNL was performed under sonography guidance in the prone position or the patients were submitted to classic laparoscopic ureterolithotomy (LUL) transperitoneally. All patients underwent postoperative assessments including KUB and ultrasonography. A hundred-percent success was achieved in both groups. The mean age of the patients were 39.4 (16-63) and 35.2 (18-57) years old in PNL and LUL groups, respectively. The mean stone size in PNL group was 14.2 (10-25) mm and in LUL group was 13.5 (10-28) mm. The duration of the operations were 54.35 (50-82) minutes, and 82.15 (73-180) minutes (P PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dL and in LUL group was 0.4mg/dL (p = 0.001). No statistically significant differences in terms of blood transfusion, fever, ICU admission, and prolonged urinary leakage were detected in both groups. According to our study, percutaneous nephrolithotomy under ultrasonography guidance is comparable with the laparoscopic ureterolithotomy for the treatment of proximal ureteral stones larger than 1 cm.

  4. Ultrasonography-guided PNL in comparison with laparoscopic ureterolithotomy in the management of large proximal ureteral stone

    Directory of Open Access Journals (Sweden)

    Hossein Karami

    2013-01-01

    Full Text Available Purpose: The aim of study was to evaluate the clinical outcomes of PNL in comparison with laparoscopic ureterolithotomy (LUL in proximal ureteral stones larger than 1 cm. Materials and Methods: A total of 80 patients who were candidates for treatment of large ureteral stones in our urology center were enrolled in the study between September 2004 and September 2008. By using patient randomization, they were assigned into two forty-patient groups (PNL and LUL. After evaluating the patients with laboratory tests and IVP, PNL was performed under sonography guidance in the prone position or the patients were submitted to classic laparoscopic ureterolithotomy (LUL transperitoneally. All patients underwent postoperative assessments including KUB and ultrasonography. Results: A hundred-percent success was achieved in both groups. The mean age of the patients were 39.4 (16-63 and 35.2 (18-57 years old in PNL and LUL groups, respectively. The mean stone size in PNL group was 14.2 (10-25 mm and in LUL group was 13.5 (10-28 mm. The duration of the operations were 54.35 (50-82 minutes, and 82.15 (73-180 minutes (P < 0.0001; and the average hospital stay days were 2.6 (2-5 and 3.5 (3-8 days (p = 0.011 in groups PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dL and in LUL group was 0.4mg/dL (p = 0.001. No statistically significant differences in terms of blood transfusion, fever, ICU admission, and prolonged urinary leakage were detected in both groups. Conclusion: According to our study, percutaneous nephrolithotomy under ultrasonography guidance is comparable with the laparoscopic ureterolithotomy for the treatment of proximal ureteral stones larger than 1 cm.

  5. The Retrograde and Retroperitoneal Totally Laparoscopic Hysterectomy for Endometrial Cancer

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    Eugenio Volpi

    2012-01-01

    Full Text Available Introduction. We retrospectively report our experience with the utilization of an original procedure for total laparoscopic hysterectomy based on completely retrograde and retroperitoneal technique for surgical staging and treatment of the endometrial cancer. The surgical, financial, and oncological advantages are here discussed. Methods. The technique used here has been based on a combination of a retroperitoneal approach with a retrograde and lateral dissection of the bladder and retrograde culdotomy with variable resection of parametrium. No disposable instruments and no uterine manipulator were utilized. Results. Intraoperative and postoperative complications were observed in 10% of the cases overall. Operative time length and mean haemoglobin drop value results were 129 min and 125 mL, respectively. Most patients were dismissed on days 3–5 from the hospital. Seventy-eight percent of the patients were alive with no evidence of disease at mean followup of 49 months. Conclusions. Our original laparoscopic technique is based on a retroperitoneal approach in order to rapidly control main uterine vessels coagulation, constantly check the ureter, and eventually decide type and site of lymph nodes removal. This procedure has important cost saving implications and the avoidance of uterine manipulator is of matter in case such as these of uterine malignancy.

  6. LAPAROSCOPIC MANAGEMENT OF RETROPERITONEAL INJURIES IN PENETRATING ABDOMINAL INJURIES.

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    Mosai, F

    2017-09-01

    Laparoscopy in penetrating abdominal injuries is now accepted and practiced in many modern trauma centres. However its role in evaluating and managing retroperitoneal injuries is not yet well established. The aim of this study was to document our experience in using laparoscopy in a setting of penetrating abdominal injuries with suspected retroperitoneal injury in haemodynamically stable patients. A retrospective descriptive study of prospectively collected data from a trauma unit at Dr George Mukhari Academic Hospital (DGMAH) was done. All haemodynamically stable patients with penetrating abdominal injury who were offered laparoscopy from January 2012 to December 2015 were reviewed and those who met the inclusion criteria were analysed. A total of 284 patients with penetrating abdominal injuries were reviewed and 56 met the inclusion criteria and were analysed. The median age was 30.8 years (15-60 years) and males constituted 87.5% of the study population. The most common mechanism of injury was penetrating stab wounds (62.5%). Forty-five patients (80.3%) were managed laparoscopically, of these n=16 (28.5%) had retroperitoneal injuries that required surgical intervention. The most commonly injured organ was the colon (19.6%). The conversion rate was 19.6% with most common indication for conversion been active bleeding (14%). The complication rate was 7.14% (N=4) and were all Clavien-Dindo grade 3. There were no recorded missed injuries and no mortality. The positive outcomes documented in this study with no missed injuries and absence of mortality suggests that laparoscopy is a feasible option in managing stable patients with suspected retroperitoneal injuries.

  7. Surgical experience of laparoscopic retroperitoneal triple neurectomy for a patient with chronic neuropathic inguinodynia

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    Masato Narita

    2017-01-01

    Conclusions: Laparoscopic retroperitoneal triple neurectomy is useful for treating refractory neuropathic pain. The diagnosis of neuropathic pain via thorough preoperative assessment is vital for procedure success because the procedure would not be effective for other types of pain.

  8. Retroperitoneal laparoscopic dismembered pyeloplasty with a novel technique of JJ stenting in children.

    Science.gov (United States)

    Yu, Jianhua; Wu, Zhonghua; Xu, Youming; Li, Zhuo; Wang, Jiansong; Qi, Fan; Chen, Xiang

    2011-09-01

    • To report our experience with retroperitoneal laparoscopic dismembered pyeloplasty for pelvi-ureteric junction (PUJ) obstruction in children. • Between March 2007 and December 2009, 38 children with PUJ obstruction (mean age 8.3 years, range 3-14) underwent retroperitoneal laparoscopic dismembered pyeloplasty. • A ureteric catheter was inserted into the mid-ureter cystoscopically. During pyeloplasty, the proximal end of the ureteric catheter was extracorporeally sutured to the distal end of the JJ stent with silk. • The ureteric catheter was then pulled down and the stent was pulled antegrade into the ureter and bladder. • The approach was retroperitoneal in all patients except one who required open conversion. The overall mean operative time was 162 min (range 145-210 min) and this appeared to decrease with experience. Mean hospital stay was 4 days (range 3-7 days). • Mean follow-up was 20.2 months (range 6-32 months). Satisfactory drainage with decreased hydronephrosis was documented in all patients on ultrasonography and intravenous urography. • Our study shows that retroperitoneal laparoscopic dismembered pyeloplasty is a feasible and effective alternative to open pyeloplasty with a relatively minimal complication rate in children 3 years of age and older, but it should be undertaken by experienced laparoscopic surgeons. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  9. Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study.

    Science.gov (United States)

    Singal, Rikki; Dhar, Siddharth

    2018-01-01

    The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.

  10. Medial arcuate ligament: a new anatomic landmark facilitates the location of the renal artery in retroperitoneal laparoscopic renal surgery.

    Science.gov (United States)

    Cai, Wei; Li, Hong Zhao; Zhang, Xu; Song, Yong; Ma, Xin; Dong, Jun; Chen, Wenzheng; Chen, Guang-Fu; Xu, Yong; Lu, Jin Shan; Wang, Bao-Jun; Shi, Tao-Ping

    2013-01-01

    The purpose of this study was to introduce a new method for locating the renal artery during retroperitoneal laparoscopic renal surgery. The medial arcuate ligament (MAL) is a tendinous arch in the fascia under the diaphragm that arches across the psoas major muscle and is attached medially to the side of the first or the second lumbar vertebra. The renal artery arises at the level of the intervertebral disc between the L1 and L2 vertebrae. We evaluate the role of the MAL that serves as an anatomic landmark for locating the renal artery during retroperitoneal laparoscopic renal surgery. There is a reproducible consistent anatomic relationship between MAL and the renal artery in 210 cases of retroperitoneal laparoscopic renal surgery. Two main types of the MAL, the "narrow arch" and the "fascial band" types, can be observed. MAL can serve as an accurate and reproducible anatomic landmark for the identification of the renal artery during retroperitoneal laparoscopic renal surgery.

  11. Fast access and early ligation of the renal pedicle significantly facilitates retroperitoneal laparoscopic radical nephrectomy procedures: modified laparoscopic radical nephrectomy

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    Yang Qing

    2013-01-01

    Full Text Available Abstract Background The objective of this study was to develop a modified retroperitoneal laparoscopic nephrectomy and compare its results with the previous technique. Methods One hundred retroperitoneal laparoscopic nephrectomies were performed from February 2007 to October 2011. The previous technique was performed in 60 cases (Group 1. The modified technique (n = 40 included fast access to the renal pedicle according to several anatomic landmarks and early ligation of renal vessels (Group 2. The mean operation time, mean blood loss, duration of hospital stay conversion rate and complication rate were compared between the groups. Results No significant differences were detected regarding mean patient age, mean body mass index, and tumor size between the two groups (P >0.05. The mean operation time was 59.5 ± 20.0 and 39.5 ± 17.5 minutes, respectively, in Groups 1 and 2 (P P P >0.05. Conclusions Early ligature using fast access to the renal vessels during retroperitoneal laparoscopic radical nephrectomy contributed to less operation time and intraoperative blood loss compared with the previous technique. In addition, the modified technique permits the procedure to be performed following the principles of open radical nephrectomy.

  12. Laparoscopic management of retroperitoneal injuries from penetrating abdominal trauma in haemodynamically stable patients.

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    Koto, Modise Zacharia; Matsevych, Oleh Y; Mosai, Fusi; Balabyeki, Moses; Aldous, Colleen

    2018-02-27

    Laparoscopy is increasingly utilised in the trauma setting. However, its safety and reliability in evaluating and managing retroperitoneal injuries are not known. The aim of this study was to analyse our experience with laparoscopic management of retroperitoneal injuries due to penetrating abdominal trauma (PAT) and to investigate its feasibility, safety and accuracy in haemodynamically stable patients. Over a 4-year period, patients approached laparoscopically with retroperitoneal injuries were analysed. Mechanism, location and severity of injuries were recorded. Surgical procedures, conversion rate and reasons for conversion and outcomes were described. Of the 284 patients with PAT, 56 patients had involvement of retroperitoneum. Stab wounds accounted 62.5% of patients. The mean Injury Severity Score was 7.4 (4-20). Among retroperitoneal injuries, the colon (27%) was the most commonly involved hollow viscera followed by duodenum (5%). The kidney (5%) and the pancreas (4%) were the injured solid organs. The conversion rate was 19.6% and was mainly due to active bleeding (73%). Significantly more patients with gunshot wound were converted to laparotomy (38% vs. 9%). Therapeutic laparoscopy was performed in 36% of patients. There were no recorded missed injuries or mortality. Five (9%) patients developed the Clavien-Dindo Grade 3 complications, three were managed with reoperation, one with drainage/debridement and one with endovascular technique. Laparoscopic management of retroperitoneal injuries is safe and feasible in haemodynamically stable patients with PAT. However, a high conversion rate indicates difficulties in managing these injuries. The requirements are the dexterity in laparoscopy and readiness to convert in the event of bleeding.

  13. Mentored retroperitoneal laparoscopic renal surgery in children: a safe approach to learning.

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    Farhat, W; Khoury, A; Bagli, D; McLorie, G; El-Ghoneimi, A

    2003-10-01

    To review the feasibility of introducing advanced retroperitoneal renal laparoscopic surgery (RRLS) to a paediatric urology division, using the mentorship-training model. Although the scope of practice in paediatric urology is currently adapting endoscopic surgery into daily practice, most paediatric urologists in North America have had no formal training in laparoscopic surgery. The study included four paediatric urologists with 3-25 years of practice; none had had any formal laparoscopic training or ever undertaken advanced RRLS. An experienced laparoscopic surgeon (the mentor) assisted the learning surgeons over a year. The initial phases of learning incorporated detailed lectures, visualization through videotapes and 'hands-on' demonstration by the expert in the technique of the standardized steps for each type of surgery. Over 10 months, ablative and reconstructive RRLS was undertaken jointly by the surgeons and the mentor. After this training the surgeons operated independently. To prevent lengthy operations, conversion to open surgery was planned if there was no significant progression after 2 h of laparoscopic surgery. Over the 10 months of mentorship, 36 RRLS procedures were undertaken in 31 patients (28 ablative and eight reconstructive). In all cases the mentored surgeons accomplished both retroperitoneal access and the creation of a working space within the cavity. The group was able to initiate ablative RRLS but the mentor undertook all the reconstructive procedures. After the mentorship period, over 10 months, 12 ablative procedures were undertaken independently, and five other attempts at RRLS failed. Although the mentored approach can successfully and safely initiate advanced RRLS in a paediatric urology division, assessing the laparoscopic practice pattern after mentorship in the same group of trainees is warranted. Ablative RRLS is easier to learn for the experienced surgeon, but reconstructive procedures, e.g. pyeloplasty, require a high degree

  14. Comparative study on ureteroscopic lithotripsy and laparoscopic ureterolithotomy for treatment of unilateral upper ureteral stones Estudo comparativo entre litotripsia e ureterolitotomia laparoscópica no tratamento de cálculos unilaterais altos

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    You-qiang Fang

    2012-03-01

    Full Text Available PURPOSE: To compare the curative effects of ureteroscopic lithotripsy and laparoscopic ureterolithotomy for unilateral upper ureteral stones, and to explore optimal surgical indications and skills. METHODS: Fifty cases of unilateral upper ureteral stones were randomly divided into two groups: one group underwent ureteroscopic holmium laser lithotripsy under epidural or lumbar anesthesia (n=25, and another group underwent laparoscopic ureterolithotomy under general anesthesia (n=25. Double-J stent was routinely indwelled in both groups. Operating time, postoperative hospitalization time, stone clearance rate and perioperative complications were compared. RESULTS: Operation was successfully performed in all 50 cases, and no open surgery was converted in any case. In the ureteroscopy and laparoscopy groups, the mean operating time was 49.0±10.7 min and 41.8±8.0 min (t=2.68, P=0.00999, respectively, their hospitalization time was 2.8±1.3 days vs. 2.9±0.8 days (t =-0.40, P=0.69413, and stone clearance rate was 88.0% (22/25 vs. 100% (25/25. Stone moved to the renal pelvis in three cases in the ureteroscopy group, and residual stones were removed by extracorporeal shock-wave lithotripsy (ESWL. All patients were followed up for more than three months, and no serious complications such as ureterostenosis occurred. CONCLUSIONS: Laparoscopic ureterolithotomy has a higher stone clearance rate and shorter operation time compared with ureteroscopic lithotripsy. Laparoscopic ureterolithotomy is one safe and effective treatment on unilateral upper ureteral stones.OBJETIVO: Comparar os efeitos curativos da litotripsia ureteroscópica e a ureterolitotomia laparoscópica para cálculos unilaterais altos e pesquisar as indicações e resultados. MÉTODOS: Cinquenta casos de cálculos unilaterais altos foram distribuídos aleatoriamente em dois grupos: um grupo submetido a litotripsia ureteroscópica com laser holmium sob anestesia epidural ou lombar (n=25 e

  15. Retroperitoneal laparoscopic nephrectomy: the effect of the learning curve, and concentrating expertise, on operating times.

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    Skinner, Adrian; Maoate, Kiki; Beasley, Spencer

    2010-05-01

    Laparoscopic nephrectomy is an accepted alternative to open nephrectomy. We analyzed our first 80 procedures of laparoscopic nephrectomy to evaluate the effect of experience and configuration of service on operative times. A retrospective review of 80 consecutive children who underwent retroperitoneal laparoscopic nephrectomy or heminephrectomy during an 11-year period from 1997 at Christchurch Hospital (Christchurch, New Zealand) was conducted. Operative times, in relation to the experience of the surgeon for this procedure, were analyzed. Four surgeons, assisted by an annually rotating trainee registrar, performed the procedure in 26 girls and 54 boys (range, 8 months to 15 years). Operating times ranged from 38 to 225 minutes (mean, 104). The average operative time fell from 105 to 90 minutes. One surgeon performed 40% of the procedures and assisted with a further 55%. The operative times for all surgeons showed a tendency to reduce, but this was not marked. Most procedures were performed by two surgeons working together, although one surgeon was involved in the majority of cases. The lead surgeon is often assisted by a fellow consultant colleague. Operative times were influenced by experience, but not markedly so. The shorter operative times and minimal "learning curve," compared with other reported series, may, in part, be due to the involvement of two surgeons experienced in laparoscopy for the majority of cases.

  16. Perioperative Endocrine Therapy for Patients with Cushing's Syndrome Undergoing Retroperitoneal Laparoscopic Adrenalectomy

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    Xiaobo Cui

    2012-01-01

    Full Text Available Objectives. To investigate the efficacy and safety of perioperative endocrine therapy (PET for patients with Cushing’s syndrome (CS undergoing retroperitoneal laparoscopic adrenalectomy (RLA. Methods. The novel, simplified PET modality of 82 patients who underwent RLA procedures for CS were studied. Clinical manifestations were observed for all patients on days 1 and 5 postoperatively, and clinical data, such as blood pressure (BP, levels of serum cortisol, adrenocorticotropin (ACTH, blood glucose, and electrolytes, were acquired and analyzed. Results. Supraphysiological doses of glucocorticoid were administered during the perioperative period, and the dosage was reduced gradually. In all 82 cases, the RLAs were performed successfully without any perioperative complication, such as steroid withdrawal symptoms. The patient’s symptoms and signs were improved quickly and safely during the hospital days. The serum cortisol and potassium levels were rather stable on days 1 and 5 postoperatively, and most were within the normal range. The clinical manifestations, serum levels of cortisol, ACTH, and potassium in most patients restored to normal gradually after several months (mean, 6.7 ± 1.2 months, except for one patient undergoing bilateral adrenalectomy. Conclusions. This perioperative endocrine therapy for patients with Cushing’s syndrome (mainly for adrenocortical adenoma undergoing retro-laparoscopic adrenalectomy is both effective and safe.

  17. Peritoneal Dialysis and Retroperitoneal Laparoscopic Radical Nephrectomy: A Favorable Experience With a Patient Complicated by Renal Cell Carcinoma

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    Reika Imai

    2017-12-01

    Full Text Available Peritoneal dialysis (PD is an accepted modality for managing end-stage kidney disease. We herein report a 75-year-old female patient on chronic PD who was complicated by renal cell carcinoma. She was successfully treated with retroperitoneal laparoscopic radical nephrectomy followed by a prompt resumption of the procedure. Various surgeries disturbing the abdominal wall integrity often disrupt the regular PD schedule, and using minimally invasive approaches is therefore an attractive therapeutic option. Our experience emphasizes the feasibility and safety of a retroperitoneal approach–based laparoscopic technique based on several empirical examples. However, systemic studies on this topic are obviously lacking, so we strongly recommend the accumulation of more cases similar to our own. Several surgical concerns that need to be dealt with among PD patients are also discussed.

  18. Laparoscopic Transperitoneal Ureterolithotomy for Complex Lower Ureteral Stones:a Report of 13 Cases%经腹腔入路腹腔镜治疗复杂性输尿管下段结石13例报告

    Institute of Scientific and Technical Information of China (English)

    邵四海; 王荣江; 陈晓农; 王伟高; 钟欢; 陈煜

    2014-01-01

    Objective To study the technical points and application value of laparoscopic transperitoneal ureterolithotomy for complex lower ureteral stones. Methods Thirteen cases of complex lower ureteral stones were treated with laparoscopic transperitoneal ureterolithotomy.Firstly, the ureter was separated to find the calculi.And then the ureter was opened longitudinally and the stones were removed completely.A double J tube was inserted in the ureter and the incision was sewed by 2 -3 times of 4-0 absorbable suture.The urinary tube and the peritoneal drainage tube were retained. Results The operations of the 13 cases were successfully performed.No case was converted into open operation.The operation time was 70-180 min, with a mean of 103.9 min. The blood loss was 56.2 ml (30-210 ml).The period of drainage was 2.7 days (1-6 days).Postoperative hospitalization stay was 5.6 days (4-9 days).One patient suffered from urine leakage and was found retracted double J stents into ureter, and was cured at 6 days postoperation after the replacement of the stent under ureteroscopy.The follow-up period of 13 cases was 7 months ( 3 -12 months).Hydronephrosis became better or recovered, except 1 case was found renal atrophy. Conclusions Laparoscopic transperitoneal ureterolithotomy has advantages of minimally invasive, little postoperative discomfort, and high stone clearance rate.It should be adopted for the patients with complex lower ureteral stones instead of open surgery.%目的:探讨经腹腔入路行腹腔镜输尿管下段切开取石术治疗复杂性输尿管结石的技术要点和应用价值。方法2008年6月~2013年10月对13例复杂性输尿管下段结石行经腹腹腔镜输尿管下段切开取石术,术中切开腹膜,游离结石段输尿管,纵行切开输尿管壁取出结石,输尿管内留置双J管,4-0可吸收线缝合切口2~3针,保留尿管及腹腔引流管。结果13例手术均成功,无中转开放手术。手术时间70~180

  19. 后腹腔镜下输尿管中上段结石治疗临床经验总结(附145例报告)%Clinical Experience Review in the Retroperitoneal Laparoscopy Ureterolithotomy in Treating Upper-Middle Ureteric Calculus(Report of 145 Cases)

    Institute of Scientific and Technical Information of China (English)

    李永响; 乔梁; 刘鲁东; 于淼; 周阳

    2014-01-01

    目的:探讨腹腔镜下输尿管切开取石术的技术要点和临床效果。方法2003年6月~2013年10月,本研究完成腹腔镜下输尿管切开取石145例,左侧79例,右侧66例。输尿管上段结石93例,输尿管中段结石52例。术中应用观察镜直接分离法建立后腹腔,自创单支架管技术放置肾盂D-J管,5-0可吸收线缝合输尿管切口。结果手术均取得成功,无中转开放手术,手术时间为30~180min,平均67min,失血20~50ml,平均35ml,术后住院时间为3~7d,平均3.6d,随访2个月~10年,无输尿管狭窄、尿漏等并发症。结论腹腔镜输尿管切开取石术是治疗输尿管结石有效、可行的微创技术,是输尿管中上段结石手术治疗推荐术式。%Objective To evaluate the key techniques and clinical value of retroperitoneal laparoscopy ureterolithot omy in trea -ting upper ureteric calculus .Methods The clinical data of 145 ureteral calculus patients treated by retroperitoneal laparoscopy ureterolithoto -my in our hospital from june 2003 to October 2013 were analyzed retrospectively ,including 79 cases left,66 cases right,93 cases upper ureter-al calculi,52 cases middle ureteral calculi .The retroperitoneal space was isolated and established through opening the machine of pneumoper -itoneum in the observation of endoscopic ,and single stent technology was used in the Place of D-J stent,5-0 absorbable line suture the inci-sion of ureter.Results All operation were successful,no conversion to open procedure.The operation time was 30~180min(mean,87min). The intraoperative blood loss was 10~50ml(mean,32.5ml).The postoperative length of hospitalization was 3~7 days.During the follow-up period from two months to ten yeas ,ureteric stricture and urinary leakage hadn't been found .Conclusion Retroperitoneal laparoscopy uret-erolithotomy is feasible and safe with the advantages of minimal invasion ,in the upper ureteral calculi surgery

  20. Retroperitoneal Laparoscopic Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1 Renal Hilar Tumor: Comparison of Perioperative Characteristics and Short-Term Functional and Oncologic Outcomes.

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    Yang, Chuance; Wang, Zhenlong; Huang, Shanlong; Xue, Li; Fu, Delai; Chong, Tie

    2018-04-18

    To present our single-center experience with retroperitoneal laparoscopic partial nephrectomy (LPN) and retroperitoneal laparoscopic radical nephrectomy (LRN) for T1 renal hilar tumors and evaluate which one is better. A retrospective review of 63 patients with hilar tumors undergoing retroperitoneal LPN or LRN was performed. The perioperative characteristics, change in estimated glomerular filtration rate (eGFR) from baseline to month 3, and oncologic outcomes were summarized. In total, 25 patients underwent LPN, and 38 patients underwent LRN. The mean tumor size in the LPN and LRN groups was 4.5 and 4.9 cm, respectively. The mean operation time was longer in the LPN group than that in the LRN group (212.5 minutes versus 160.7 minutes, respectively; P  .05). In experienced hands, although retroperitoneal LRN can result in shorter operation times and shorter lengths of stay, retroperitoneal LPN can preserve renal function better than LRN. Retroperitoneal LPN should be the priority in selected patients with T1 renal hilar tumors, especially for patients with renal insufficiency.

  1. Laparoscopic and open postchemotherapy retroperitoneal lymph node dissection in patients with advanced testicular cancer – a single center analysis

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    Busch Jonas

    2012-05-01

    Full Text Available Abstract Background The open approach represents the gold standard for postchemotherapy retroperitoneal lymph node dissection (O-PCLND in patients with residual testicular cancer. We analyzed laparoscopic postchemotherapy retroperitoneal lymph node dissection (L-PCLND and O-PCLND at our institution. Methods Patients underwent either L-PCLND (n = 43 or O-PCLND (n = 24. Categorical and continuous variables were compared using the Fisher exact test and Mann–Whitney U test respectively. Overall survival was evaluated with the log-rank test. Results Primary histology was embryonal cell carcinomas (18 patients, pure seminoma (2 cases and mixed NSGCTs (47 patients. According to the IGCCCG patients were categorized into “good”, “intermediate” and “poor prognosis” disease in 55.2%, 14.9% and 20.8%, respectively. Median operative time for L-PCLND was 212 min and 232 min for O-PCLND (p = 0.256. Median postoperative duration of drainage and hospital stay was shorter after L-PCLND (0.0 vs. 3.5 days; p 500 ml was almost equally distributed (8.6% vs. 14.2%: p = 0.076. No significant differences were observed for injuries of major vessels and postoperative complications (p = 0.758; p = 0.370. Tumor recurrence occurred in 8.6% following L-PCLND and in 14.2% following O-PCLND with a mean disease-free survival of 76.6 and 89.2 months, respectively. Overall survival was 83.3 and 95.0 months for L-PCNLD and O-PCLND, respectively (p = 0.447. Conclusions L-PCLND represents a safe surgical option for well selected patients at an experienced center.

  2. Retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy: a matched-pair, bicenter analysis with cost comparison using time-driven activity-based costing.

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    Laviana, Aaron A; Tan, Hung-Jui; Hu, Jim C; Weizer, Alon Z; Chang, Sam S; Barocas, Daniel A

    2018-03-01

    To perform a bicenter, retrospective study of perioperative outcomes of retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy (RALPN) and assess costs using time-driven activity-based costing (TDABC). We identified 355 consecutive patients who underwent RALPN at University of California Los Angeles and the University of Michigan during 2009-2016. We matched according to RENAL nephrometry score, date, and institution for 78 retroperitoneal versus 78 transperitoneal RALPN. Unadjusted analyses were performed using McNemar's Chi-squared or paired t test, and adjusted analyses were performed using multivariable repeated measures regression analysis. From multivariable models, predicted probabilities were derived according to approach. Cost analysis was performed using TDABC. Patients treated with retroperitoneal versus transperitoneal RALPN were similar in age (P = 0.490), sex (P = 0.715), BMI (P = 0.273), and comorbidity (P = 0.393). Most tumors were posterior or lateral in both the retroperitoneal (92.3%) and transperitoneal (85.9%) groups. Retroperitoneal RALPN was associated with shorter operative times (167.0 versus 191.1 min, P = 0.001) and length of stay (LOS) (1.8 versus 2.7 days, P factoring in disposable equipment, operative time, LOS, and personnel. In two high-volume, tertiary centers, retroperitoneal RALPN is associated with reduced operative times and shortened LOS in posterior and lateral tumors, whereas sharing similar clinicopathologic outcomes, which may translate into lower healthcare costs. Further investigation into anterior tumors is needed.

  3. Application and analysis of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for patients with multiple renal tumor: initial experience.

    Science.gov (United States)

    Zhu, Jundong; Jiang, Fan; Li, Pu; Shao, Pengfei; Liang, Chao; Xu, Aiming; Miao, Chenkui; Qin, Chao; Wang, Zengjun; Yin, Changjun

    2017-09-11

    To explore the feasibility and safety of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for the patients with multiple renal tumor of who have solitary kidney or contralateral kidney insufficiency. Nine patients who have undergone retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping between October 2010 and January 2017 were retrospectively analyzed. Clinical materials and parameters during and after the operation were summarized. Nineteen tumors were resected in nine patients and the operations were all successful. The operation time ranged from 100 to 180 min (125 min); clamping time of segmental renal artery was 10 ~ 30 min (23 min); the amount of blood loss during the operation was 120 ~ 330 ml (190 ml); hospital stay after the operation is 3 ~ 6d (5d). There was no complication during the perioperative period, and the pathology diagnosis after the surgery showed that there were 13 renal clear cell carcinomas, two papillary carcinoma and four perivascular epithelioid cell tumors with negative margins from the 19 tumors. All patients were followed up for 3 ~ 60 months, and no local recurrence or metastasis was detected. At 3-month post-operation follow-up, the mean serum creatinine was 148.6 ± 28.1 μmol/L (p = 0.107), an increase of 3.0 μmol/L from preoperative baseline. For the patients with multiple renal tumors and solitary kidney or contralateral kidney insufficiency, retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping was feasible and safe, which minimized the warm ischemia injury to the kidney and preserved the renal function effectively.

  4. Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?

    Directory of Open Access Journals (Sweden)

    Achilles Ploumidis

    2013-01-01

    Full Text Available Spontaneous rapture with consequent retroperitoneal hemorrhage (Wunderlich’s syndrome is the complication mostly feared from large renal angiomyolipomas (RAMLs. In hemodynamic stable patients, minimal invasive therapies have superseded open surgery as the mainstay of treatment, with contemporary cases mostly treated by selective arterial embolization. Robotic-assisted laparoscopic partial nephrectomy (RALPN is an established minimal access treatment that has been used in the past for benign and malignant lesions of the kidney in the elective setting, but rarely in urgent situations as primary treatment. We present a case of a ruptured RAML in a young female treated effectively by RALPN.

  5. Robotic posterior retroperitoneal adrenalectomy.

    Science.gov (United States)

    Okoh, Alexis Kofi; Yigitbas, Hakan; Berber, Eren

    2015-09-01

    Since its initial description by Mercan et al. laparoscopic posterior retroperitoneal (PR) adrenalectomy has served as an alternaltive to the transabdominal (TL) approach for the treatment of adrenal pathologies. Robotic adrenal surgery has been reported to improve surgeon ergonomics and facilitate dissection. In patients with bilateral adrenal masses, PR adrenalectomy may be the approach of choice. We herein describe the technique, discuss its limitations and present a critical review of the current literature. © 2015 Wiley Periodicals, Inc.

  6. Impact of high- versus low-dose neuromuscular blocking agent administration on unplanned 30-day readmission rates in retroperitoneal laparoscopic surgery.

    Directory of Open Access Journals (Sweden)

    Martijn Boon

    Full Text Available Recent data shows that a neuromuscular block (NMB induced by administration of high doses of rocuronium improves surgical conditions in certain procedures. However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose versus low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 versus 37 ± 5 mg rocuronium, respectively. In the high-dose rocuronium group neuromuscular activity was consistently monitored; matched patients were unreliably monitored. All patients receiving high-dose rocuronium were reversed with sugammadex, while just 33% of matched patients were reversed with sugammadex and 20% with neostigmine; the remaining patients were not reversed. Unplanned 30-day readmission rate was significantly lower in the high-dose compared to the low-dose rocuronium cohort (3.8% vs. 12.7%; p = 0.03; odds ratio = 0.33, 95% C.I. 0.12-0.95. This small retrospective study demonstrates a lower incidence of unplanned readmissions within 30-days following laparoscopic retroperitoneal surgery with high-dose relaxant anesthesia and sugammadex reversal in comparison to low-dose relaxant anesthesia. Further prospective studies are needed in larger samples to corroborate our

  7. Impact of high- versus low-dose neuromuscular blocking agent administration on unplanned 30-day readmission rates in retroperitoneal laparoscopic surgery.

    Science.gov (United States)

    Boon, Martijn; Martini, Chris; Yang, H Keri; Sen, Shuvayu S; Bevers, Rob; Warlé, Michiel; Aarts, Leon; Niesters, Marieke; Dahan, Albert

    2018-01-01

    Recent data shows that a neuromuscular block (NMB) induced by administration of high doses of rocuronium improves surgical conditions in certain procedures. However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose versus low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 versus 37 ± 5 mg rocuronium, respectively. In the high-dose rocuronium group neuromuscular activity was consistently monitored; matched patients were unreliably monitored. All patients receiving high-dose rocuronium were reversed with sugammadex, while just 33% of matched patients were reversed with sugammadex and 20% with neostigmine; the remaining patients were not reversed. Unplanned 30-day readmission rate was significantly lower in the high-dose compared to the low-dose rocuronium cohort (3.8% vs. 12.7%; p = 0.03; odds ratio = 0.33, 95% C.I. 0.12-0.95). This small retrospective study demonstrates a lower incidence of unplanned readmissions within 30-days following laparoscopic retroperitoneal surgery with high-dose relaxant anesthesia and sugammadex reversal in comparison to low-dose relaxant anesthesia. Further prospective studies are needed in larger samples to corroborate our findings and

  8. 后腹腔镜肾实质切开取石术治疗肾结石%Analysis of retroperitoneal laparoscopic nephrolithotomy for renal calculi

    Institute of Scientific and Technical Information of China (English)

    钱庆鹏; 于广海; 杜浩

    2015-01-01

    目的:探讨后腹腔镜肾实质切开取石术的治疗效果及手术技巧。方法2012年1月~2014年1月实施后腹腔镜肾实质切开取石术12例。手术采用自制气囊制造后腹腔间隙。切开肾实质,取出结石。将斑马导丝自肾盂放入输尿管,再沿导丝放置D-J管。用可吸收线连续缝合肾实质切口。术后2~4d可下地活动,术后4~6d拔引流管,术后1个月拔除D-J管。结果12例手术均成功完成,无改开放者,术后无出血、漏尿等并发症。手术时间平均86min(70~125min),肾蒂阻断时间平均28min(21~35min),放置D-J管时间平均4.8min(3~8min),失血量平均90mL(50~150mL),术后住院时间平均9.6 d(7~14 d)。术后1周复查KUB示无1cm以上结石残留,D-J管位置正常。结论腹腔镜肾实质切开取石术取石彻底,手术时间短,可以作为经皮肾镜碎石术治疗肾结石的补充手段。缩短肾动脉阻断时间,选准肾切口,熟练的缝合技术及双J管置入技术能提高手术成功率及安全性。%Objective To evaluate the clinical efficacy of retroperitoneal laparoscopic nephrolithotomy and surgery techniques. Methods 12 cases of retroperitoneal laparoscopic nephrolithotomy were performed during January 2012 to January 2014. Retroperitoneal space was made by self-made balloon. Renal parenchyma was sliced open and the stone was removed. The Zebra Urological Guidewire was placed in ureter through pelvis, and the D-J stents were placed into ureter along the Zebra Urological Guidewire. The incision of renal parenchyma was sutured continuously using absorbable suture. The patients can get up and move around 2-4 days after operation. The drainage tube was removed 4-6 days after operation and the D-J stents was removed until a month after operation. Results All the 12 surgeries were completed successfully without hemorrhagic complications and urine leakage. The mean operation time was 86

  9. 后腹腔镜下肾窦内肾盂切开取石术%Retroperitoneal laparoscopic pyelolithotomy in the treatment of intrarenal pelvic calculi

    Institute of Scientific and Technical Information of China (English)

    林超; 时少显; 李海涛; 吕共生; 和学强; 陈家旺

    2008-01-01

    Objective To evaluate the clinical efficacy and safety of retroperitoneal laparoscopic pyelolithotomy in the treatment of intrarenal pelvic staghorn calculus or multiple renal calculi. Methods Fifteen patients(9 males and 6 females)with average age of 40 years old were treated. The diameters of the calculi were from 1.5 cm to 3.7 cm. Three trocars were used in this procedure as rou-tine. The renal sinus was exposed by separating the pelvis from outside to inside until reaching the in-fundibulum of the renal calyx. Then the renal calyx was cut open and the calculus was taken out. Double J stent was placed in the ureter and the incision of pelvis was closed by 3-0 absorbable suture. The drainage tube was pulled out 3-4 d post-operatively according to the drainage quantity. Double J stent was then pulled out 2 weeks after surgery. Results All the 15 procedures were successfully completed. The average operation time was 170 min and the average post-operative hospital stay was 7 d. During the 3-15 months' follow-up, 2 patients had calculus remnants with the size of 0. 2-0.5cm in diameter. Conclusions Retroperitoneal laparoscopic pyelolithotomy provides a minimally inva-sive treatment option in patients with intrarenal pelvic staghorn calculus or multiple renal calculi. It has the advantages of good exposure, little bleeding, small incision and fast recovery.%目的 探讨后腹腔镜下肾窦内肾盂切开取石治疗肾鹿角状及多发性结石的疗效. 方法肾多发及鹿角状结石患者15例.男9例,女6例.平均年龄40岁.结石直经1.5~3.7 cm.常规用3个穿刺器,建立气腹于腹膜后间隙,紧贴肾盂外膜向肾窦内分离,暴露出肾盏漏斗部,切开取石,输尿管内置入双J管,3-0可吸收线缝合肾盂切口.冲洗、放置引流管.术后3~4 d拔出引流管.2周左右拔出双J管. 结果 15例手术均获成功,平均手术时间170 rain.术后平均住院7 d.随访3~15个月,2例有0.2~0.5 cm结石残留. 结论 后腹腔

  10. Unusual Cause of Acute Abdomen—Ruptured Retroperitoneal Paraganglioma

    OpenAIRE

    Kwok-Kay Yau; Wing-Tai Siu; Michael Ka-Wah Li

    2008-01-01

    Ruptured retroperitoneal paraganglioma is a rare cause of acute abdomen. Its clinical presentation and laparoscopic features have seldom been reported in the literature. Herein, we report a case of ruptured retroperitoneal paraganglioma that presented as acute abdomen, and its subsequent management.

  11. Unusual Cause of Acute Abdomen—Ruptured Retroperitoneal Paraganglioma

    Directory of Open Access Journals (Sweden)

    Kwok-Kay Yau

    2008-01-01

    Full Text Available Ruptured retroperitoneal paraganglioma is a rare cause of acute abdomen. Its clinical presentation and laparoscopic features have seldom been reported in the literature. Herein, we report a case of ruptured retroperitoneal paraganglioma that presented as acute abdomen, and its subsequent management.

  12. Delayed hydronephrosis due to retroperitoneal hematoma after a seatbelt injury

    Science.gov (United States)

    Yumoto, Tetsuya; Kondo, Yoshitaka; Kumon, Kento; Masaoka, Yoshihisa; Hiraki, Takao; Yamada, Taihei; Naito, Hiromichi; Nakao, Atsunori

    2018-01-01

    Abstract Rationale: Hydronephrosis caused by retroperitoneal hematoma after a seatbelt injury is a unique clinical entity. Patient concerns: A 21-year-old man, who had been wearing a seatbelt, was brought to our hospital after a motor vehicle collision, complaining of abdominal pain. Computed tomography (CT) revealed retroperitoneal hematoma in the upper pelvic region. Since he was hemodynamically stable throughout admission, he was managed conservatively. Seventeen days after initial discharge, the patient revisited our emergency department due to right back pain. Diagnoses: CT scans indicated retroperitoneal hematoma growth resulting in hydronephrosis of the right kidney. Interventions: Laparoscopic drainage of the retroperitoneal hematoma was successfully performed. Outcomes: His symptoms resolved after the surgery. Follow-up CT scans three months later demonstrated complete resolution of the hydronephrosis and retroperitoneal hematoma. Lessons: Our case highlights a patient with delayed hydronephrosis because of retroperitoneal hematoma expansion after a seatbelt injury. PMID:29879068

  13. Idiopathic Retroperitoneal Hematoma

    African Journals Online (AJOL)

    6. Stewart BT, McLaughlin SJ, Thompson GA. Spontaneous retroperitoneal haemorrhage:a general surgeon's perspective. Aust N. Z J Surg 1998;68:371-3. Monib, et al.: Idiopathic retroperitoneal hematoma. How to cite this article: Monib S, Ritchie A, Thabet E. Idiopathic retroperitoneal hematoma. J Surg Tech Case Report ...

  14. Surgical anatomy of the retroperitoneal spaces, Part V: Surgical applications and complications.

    Science.gov (United States)

    Mirilas, Petros; Skandalakis, John E

    2010-04-01

    Knowledge of the surgical anatomy of the retroperitoneum is crucial for surgery of the retroperitoneal organs. Surgery is essential for treatment of retroperitoneal pathologies. The list of these diseases is extensive and comprises acute and chronic inflammatory processes (abscess, injury, hematoma, idiopathic fibrosis), metastatic neoplasms, and primary neoplasms from fibroadipose tissue, connective tissue, smooth and striated muscle, vascular tissue, somatic and sympathetic nervous tissue, extraadrenal chromaffin tissue, and lymphatic tissue. The retroperitoneum can be approached and explored by several routes, including the transperitoneal route and the extraperitoneal route. The retroperitoneal approach to the iliac fossa is used for ectopic renal transplantation. Safe and reliable primary retroperitoneal access can be performed for laparoscopic exploration. The anatomic complications of retroperitoneal surgery are the complications of the organs located in several compartments of the retroperitoneal space. Complications may arise from incisions to the somatic wall, somatic nerves, blood and lymphatic vessels, lymph nodes, visceral autonomous plexuses, and neighboring splanchna.

  15. Delayed hydronephrosis due to retroperitoneal hematoma after a seatbelt injury: A case report.

    Science.gov (United States)

    Yumoto, Tetsuya; Kondo, Yoshitaka; Kumon, Kento; Masaoka, Yoshihisa; Hiraki, Takao; Yamada, Taihei; Naito, Hiromichi; Nakao, Atsunori

    2018-06-01

    Hydronephrosis caused by retroperitoneal hematoma after a seatbelt injury is a unique clinical entity. A 21-year-old man, who had been wearing a seatbelt, was brought to our hospital after a motor vehicle collision, complaining of abdominal pain. Computed tomography (CT) revealed retroperitoneal hematoma in the upper pelvic region. Since he was hemodynamically stable throughout admission, he was managed conservatively. Seventeen days after initial discharge, the patient revisited our emergency department due to right back pain. CT scans indicated retroperitoneal hematoma growth resulting in hydronephrosis of the right kidney. Laparoscopic drainage of the retroperitoneal hematoma was successfully performed. His symptoms resolved after the surgery. Follow-up CT scans three months later demonstrated complete resolution of the hydronephrosis and retroperitoneal hematoma. Our case highlights a patient with delayed hydronephrosis because of retroperitoneal hematoma expansion after a seatbelt injury.

  16. Idiopathic Retroperitoneal Hematoma

    Directory of Open Access Journals (Sweden)

    Tomoyuki Abe

    2010-09-01

    Full Text Available A 34-year-old female presented with sudden onset of severe abdominal pain in a flank distribution. A large mass was palpable in the right upper quadrant on physical examination. Abdominal contrast-enhanced computed tomography showed a well-defined, right-sided, retroperitoneal cystic lesion located between the abdominal aorta and the inferior vena cava (IVC. The tumor size was 55 × 58 mm, and it compressed the gallbladder and the duodenum. Upper gastrointestinal radiography revealed a stricture of the second portion of the duodenum by the tumor. T2-weighted magnetic resonance imaging showed that the whole part was hyperintense with hypointense rims, but the inner was partially hypointense. Based on the radiological findings, the preoperative differential diagnosis included retroperitoneal teratoma, Schwannoma, abscess, and primary retroperitoneal tumor. On laparotomy, the tumor was located in the right retroperitoneal cavity. Kocher maneuver and medial visceral rotation, which consists of medial reflection of the upper part of right colon and duodenum by incising their lateral peritoneal attachments, were performed. Although a slight adhesion to the IVC was detected, the tumor was removed safely. Thin-section histopathology examination detected neither tumor tissues nor any tissues such as adrenal gland, ovarian tissue, or endometrial implants. The final pathological diagnosis was idiopathic retroperitoneal hematoma; the origin of the bleeding was unclear. The patient was discharged without any complication 5 days after the operation.

  17. Retroperitoneal and pelvic fibromatosis

    International Nuclear Information System (INIS)

    Lopez de Lacalle, J. M.; Garmendia, G.; Laso, C.; Galardi, A.

    1998-01-01

    We present a case of retroperitoneal and pelvic fibromatosis in a 17-year-old boy who came to the emergency room with sudden onset acute abdominal pain. The initial radiological examination (plain X-ray and ultrasound) disclosed only minimal right hydronephrosis. Subsequent computed tomography revealed the presence of a solid retroperitoneal and pelvic mass involving right ureter and secondary right hydronephrosis. We stress its presentation in the form of acute abdominal pain with initial radiological signs suggestive of a primarily urological disorder. (Author) 8 refs

  18. Schwannoma retroperitoneal maligno Malign retroperitoneal schwannoma

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    Rafael Pinilla González

    2009-12-01

    Full Text Available Los tumores del retroperitoneo son poco frecuentes y se clasifican según el tejido del que se originan. Se presenta el caso de una paciente con dolor en el hipocondrio derecho y tumor en esta zona, pérdida de peso y molestia dolorosa en la cara anterolateral del muslo derecho. En el examen físico se halló palidez cutáneo-mucosa y tumoración indolora en el hipocondrio y flanco derecho. El ultrasonido abdominal mostró una masa homogénea de 14,11 cm y la tomografía computarizada de abdomen permitió observar un tumor retroperitoneal derecho que rechazaba el riñón. El urograma excretor mostró rechazamiento anteromedial del riñón derecho. Se extirpó un tumor encapsulado con pocas adherencias peritumorales. Mediante estudio histológico se confirmó un tumor de células fusiformes con hipercromatismo y pleomorfismo nuclear, numerosas mitosis y áreas de necrosis y el diagnóstico de tumor maligno de la vaina de un nervio periférico.The retroperitoneal tumors are infrequent and are classified according to the original tissue. This is a case presentation of a patient presenting with pain in right hypochondrium and a tumor in this zone, weight loss and painful discomfort in the anterolateral face of right thigh. In physical examination we found cutaneous-mucous paleness and painless tumor in hypochondrium and right flank. Abdominal ultrasound (US showed a homogenous mass of 14,11 cm and abdominal computed tomography allows to see a right retroperitoneal tumor rejecting the kidney. Excretory urogram showed a anteromedial rejection of right kidney. An encapsulated tumor with a few peritumoral adherences was removed. By histological study it was possible to confirm a fusiform cells tumor with hyperchromatism and nuclear pleomorphism, numerous mitosis and areas of necrosis and in the diagnosis of malign tumor of the sheath of a peripheral nerve.

  19. Malign retroperitoneal schwannoma

    International Nuclear Information System (INIS)

    Pinilla Gonzalez, Rafael; Hadi Al-Bahlooli, Saeed; Lopez Lazo, Sarah; Quintana Diaz, Juan Carlos; Gonzales Rivera, Armando

    2009-01-01

    The retroperitoneal tumors are infrequent and are classified according to the original tissue. This is a case presentation of a patient presenting with pain in right hypochondrium and a tumor in this zone, weight loss and painful discomfort in the anterolateral face of right thigh. In physical examination we found cutaneousmucous paleness and painless tumor in hypochondrium and right flank. Abdominal ultrasound (US) showed a homogenous mass of 14,11 cm and abdominal computed tomography allows to see a right retroperitoneal tumor rejecting the kidney. Excretory urogram showed a anteromedial rejection of right kidney. An encapsulated tumor with a few peritumoral adherences was removed. By histological study it was possible to confirm a fusiform cells tumor with hyperchromatism and nuclear pleomorphism, numerous mitosis and areas of necrosis and in the diagnosis of malign tumor of the sheath of a peripheral nerve.(author)

  20. Gigantic retroperitoneal leiomyosarcoma - case report

    International Nuclear Information System (INIS)

    Snarska, J.; Hady, H. R.; Kaminski, F.; Szajda, S. D.; Werel, D.; Zimnoch, L.; Siemiatkowski, A.

    2007-01-01

    Retroperitoneal leiomyosarcomas are very rare malignant neoplasms. They are built up of smooth muscle cells. They can be found beyond the retroperitoneal space in the uterus, the stomach, the intestines, the blood vessel walls and the skin. This type of tumour grows slowly and gives no characteristic clinical symptoms. This results in late diagnosis, when they grow to a huge size. Retroperitoneal leiomyosarcomas are most frequently described in the literature in the fifth or sixth decade of life. There are no biochemical markers which could suggest the development of leiomyosarcoma. The basic diagnostic examination includes: ultrasound and computer tomography of the abdomen. The fundamental treatment of retroperitoneal leiomyosarcomas consists in aggressive surgical treatment - complete tumour resection. Large size of the tumour can make it difficult to perform radical surgery. In the case presented in this report, our team managed to remove a retroperitoneal leiomyosarcoma completely despite its huge mass and size (300 x 200 mm). Data from the literature indicate that a complete resection of the tumour is the most significant prognostic factor in the case of patients with retroperitoneal leiomyosarcoma. The efficacy of radiotherapy and chemotherapy has not been proved. The other unfavourable prognostic factor in the course of sarcomas is the age of the patient, below 50 years old. The patient presented in the report is a 31-year-old woman, which is associated with a worse prognosis. According to some authors, the size of the tumour is not significant for the fast recurrence of the disease, whereas others state that it is. The case was presented because of such a huge leiomyosarcoma being rarely found in the retroperitoneal space, the age of the patient and the asymptomatic course of the disease. (authors)

  1. Retroperitoneal duplication cyst with a fistulous tract to the vagina: a case report.

    Science.gov (United States)

    Filmar, Gilad A; Lotze, Peter M; Fisher, Hilaire W

    2012-01-01

    To describe a rare case of a retroperitoneal duplication cyst that fistulized to the vagina. Case description and discussion of a patient found to have an intestinal duplication cyst. A patient presented for a laparoscopic hysterectomy because of menorrhagia and a fibroid uterus. She also complained of recurrent urinary tract infections (UTIs) and a vaginal discharge. A retroperitoneal intestinal duplication cyst that fistulized to the vagina and caused her recurrent UTIs was identified. Surgical resection of the cyst resolved her complaint of recurrent UTIs. Retroperitoneal intestinal duplication cysts are rare congenital anomalies with vague clinical manifestations. The finding of a fistulous communication to the vagina originating from such a structure can be associated with recurrent UTIs.

  2. Retroperitoneal fibrosis: findings with MR

    International Nuclear Information System (INIS)

    Martinez Rodrigo, J.; Marti-Bonnati, L.; Diago, T.; Ferrer, M.D.; Aleixandre, A.; Morote, V.

    1993-01-01

    Retroperitoneal fibrosis (RF) is an uncommon disease characterized by the presence of a chronic inflammatory reaction, with the formation of fibrous tissue that replaces the normal retroperitoneal tissue, trapping vessels and/or ureters. We present a retrospective review of 3 cases of idiopathic RF studied by means of ultrasound, CT scan and MR imaging, and we assess the features of the MR image, as well as its capacity for characterizing the lesion. We compare the findings obtained with 3 imaging techniques, describing the utility of each one, and their advantages and disadvantages in the assessment of this pathology. In MR, idiopathic RF appears as a hypodense mass in SET1, SE-T2 and STIR sequences. (Author) 9 ref

  3. Misleading diagnosis of retroperitoneal actinomycosis

    Energy Technology Data Exchange (ETDEWEB)

    Berchtenbreiter, C.; Bruening, R.; Reiser, M. [Inst. of Diagnostic Radiology, University Hospital Grosshadern, Ludwig Maximilians University, Munich (Germany); Auernhammer, A. [Medical Clinic II, Univ. Hospital Grosshadern, Ludwig Maximilians University, Munich (Germany)

    1999-07-01

    A 34-year-old woman presented with a left-sided suprarenal space-occupying lesion on sonography. Culture of material obtained during sonographic-guided puncture of the retroperitoneal lesion yielded a mixed flora of Actinomyces and Peptostreptococcus. Initially, a misleading diagnosis of an adrenal pheochromocytoma was initiated by highly positive metaiodobenzylguanidine scintigraphy after chemical chemistry vanillylmandelic acid (VMA) test showed elevated values for adrenaline and its derivatives. Retroperitoneal actinomycosis with yet unproven spread into thoracic and cervical compartments is a particular unusual presentation of an infection with these organisms. Because it may mimic subacute infections or malignant masses in terms of clinical and laboratory findings, radiological diagnosis of this entity may be difficult. The diagnosis was based on results of culture and the response of the patient to long-term penicillin-derivate therapy after surgical drainage of the suprarenal abscess formation. (orig.)

  4. Giant Retroperitoneal Lipoma in an Infant

    African Journals Online (AJOL)

    2010-06-29

    Jun 29, 2010 ... We are reporting the case of a six-month-old child who presented with a giant retroperitoneal lipoma that was successfully managed by complete ... Retroperitoneal lipoma is an unusual entity that is most often found in adults between 40 and 60 years of age and rarely occurs in the first decade of life.

  5. Unusual Presentation Of Idiopathic Retroperitoneal Fibrosis: Case ...

    African Journals Online (AJOL)

    Idiopathic retroperitoneal fibrosis (IRF) is an uncommon entity described as progressive proliferation of connective tissues leading to a fibrous plaque-like lesions that encases the aorta and inferior vena cava inferior to the level of the renal arteries. Mass forming retroperitoneal fibrosis is rare. We present a rare case of a ...

  6. Retroperitoneal and rectus sheath hematomas.

    Science.gov (United States)

    Kasotakis, George

    2014-02-01

    The retroperitoneum is rich in vascular structures and can harbor large hematomas, traumatic or spontaneous. The management of retroperitoneal hematomas depends on the mechanism of injury and whether they are pulsatile/expanding. Rectus sheath hematomas are uncommon abdominal wall hematomas secondary to trauma to the epigastric arteries of the rectus muscle. The common risk factors include anticoagulation, strenuous exercise, coughing, coagulation disorders, and invasive procedures on/through the abdominal wall. The management is largely supportive, with the reversal of anticoagulation and transfusions; angioembolization may be necessary. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Retroperitoneal Schwannoma: A Rare Case

    Directory of Open Access Journals (Sweden)

    Murat Kalaycı

    2011-01-01

    Case Presentation. A 38-year-old woman was admitted to the emergency service with the complaints of progressive abdominal pain and nausea for the last 24 hours. Abdominal examination was compatible with acute abdomen. Acute appendicitis was diagnosed by CT. During CT evaluation, a round shaped soft-tissue mass at the retroperitoneal area inferior to the right kidney was detected, The mass was resected and histology revealed schwannoma. Conclusion. Rare tumoral lesions with benign course such as schwannoma can be detected incidentally.

  8. Laparoscopic donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Gupta Nitin

    2005-01-01

    Full Text Available Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN, by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient.

  9. Surgical outcomes of laparoscopic adrenalectomy for patients with Cushing's and subclinical Cushing's syndrome: a single center experience.

    Science.gov (United States)

    Miyazato, Minoru; Ishidoya, Shigeto; Satoh, Fumitoshi; Morimoto, Ryo; Kaiho, Yasuhiro; Yamada, Shigeyuki; Ito, Akihiro; Nakagawa, Haruo; Ito, Sadayoshi; Arai, Yoichi

    2011-12-01

    We retrospectively examined the outcome of patients who underwent laparoscopic adrenalectomy for Cushing's/subclinical Cushing's syndrome in our single institute. Between 1994 and 2008, a total of 114 patients (29 males and 85 females, median age 54 years) with adrenal Cushing's/subclinical Cushing's syndrome were studied. We compared the outcome of patients who underwent laparoscopic adrenalectomy between intraperitoneal and retroperitoneal approaches. Surgical complications were graded according to the Clavien grading system. We also examined the long-term results of subclinical Cushing's syndrome after laparoscopic adrenalectomy. Laparoscopic surgical outcome did not differ significantly between patients with Cushing's syndrome and those with subclinical Cushing's syndrome. Patients who underwent laparoscopic intraperitoneal adrenalectomy had longer operative time than those who received retroperitoneal adrenalectomy (188.2 min vs. 160.9 min). However, operative blood loss and surgical complications were similar between both approaches. There were no complications of Clavien grade III or higher in either intraperitoneal or retroperitoneal approach. We confirmed the improvement of hypertension and glucose tolerance in patients with subclinical Cushing's syndrome after laparoscopic adrenalectomy. Laparoscopic adrenalectomy for adrenal Cushing's/subclinical Cushing's syndrome is safe and feasible in either intraperitoneal or retroperitoneal approach. The use of the Clavien grading system for reporting complications in the laparoscopic adrenalectomy is encouraged for a valuable quality assessment.

  10. Dyspareunia in a Teenager Reveals a Rare Occurrence: Retroperitoneal Cervical Leiomyoma of the Left Pararectal Space.

    Science.gov (United States)

    Giannella, Luca; Mfuta, Kabala; Tuzio, Antonella; Cerami, Lillo Bruno

    2016-02-01

    Retroperitoneal uterine leiomyoma is a very rare occurrence and to discover it as a cause of female sexual dysfunction in a teen is unusual. An 18-year-old black woman reported deep dyspareunia, resulting in severe distress. Gynecological and instrumental examinations showed a pelvic mass of 7 cm in diameter. The preoperative diagnosis was uterine fibroid, but the exact location of the leiomyoma was uncertain. Laparoscopic examination showed a pedunculated retroperitoneal cervical leiomyoma in the left pararectal space. After surgical excision of the mass, normal sexual activity was restored. When a teen experiences pain with intercourse, pelvic masses should be part of differential diagnosis of dyspareunia. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  11. Laparoscopic Retroperitoneal Adrenalectomy: Clinical Experience with 120 Consecutive Cases

    Directory of Open Access Journals (Sweden)

    Allen W. Chiu

    2003-07-01

    Conclusion: LRA proved to be a safe and effective treatment for benign adrenal tumours, with few open conversions except for phaeochromocytomas. Finger-assisted dissection for space development was the major factor leading to shortened operation times.

  12. Complications of Laparoscopic Retroperitoneal Sutureless and Clampless Aortobifemoral Bypass

    Directory of Open Access Journals (Sweden)

    B. Segers

    Full Text Available : Introduction: This report describes our experience with early complications that occurred in two patients who underwent sutureless aortobifemoral bypass using the EndoVascular REtroperitoneoScopic Technique (EVREST. Report: Two patients who underwent EVREST for aortoiliac TASC D lesions experienced a dislocation of the proximal assembly. The first dislocation occurred four hours post-operatively and led to the death of the patient, and the second occurred during surgery and led to open conversion. Conclusion: As a result of these serious complications, we recommend the use of anchorage stitches while using an endograft connector in a sutureless aortobifemoral bypass. Keywords: Early complications, Sutureless, Clampless, Retroperitoneoscopy, Aortobifemoral bypass

  13. Lumbar artery pseudoaneurysm and arteriovenous fistula as a complication of laparoscopic splenectomy: treatment by transcatheter embolization

    International Nuclear Information System (INIS)

    Maleux, G.; Wilms, G.; Vermylen, J.

    2002-01-01

    Iatrogenic injury of a lumbar artery is very rare and mostly causes retroperitoneal hemorrhage. We report a case of a lumbar artery pseudoaneurysm and a concomitant arteriovenous fistula complicating laparoscopic splenectomy and provoking renal colic-like flank pain due to mass effect on the left ureter. Definitive treatment of both vascular lesions was obtained after percutaneous transcatheter embolization of several lumbar arteries. Control computed tomography scan 3 months after embolization showed almost complete resorption of the retroperitoneal hematoma. (orig.)

  14. Lumbar artery pseudoaneurysm and arteriovenous fistula as a complication of laparoscopic splenectomy: treatment by transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Maleux, G.; Wilms, G. [Department of Radiology, University Hospitals, Leuven (Belgium); Vermylen, J. [Department of Internal Medicine-Vascular Diseases, University Hospitals, Leuven (Belgium)

    2002-06-01

    Iatrogenic injury of a lumbar artery is very rare and mostly causes retroperitoneal hemorrhage. We report a case of a lumbar artery pseudoaneurysm and a concomitant arteriovenous fistula complicating laparoscopic splenectomy and provoking renal colic-like flank pain due to mass effect on the left ureter. Definitive treatment of both vascular lesions was obtained after percutaneous transcatheter embolization of several lumbar arteries. Control computed tomography scan 3 months after embolization showed almost complete resorption of the retroperitoneal hematoma. (orig.)

  15. Gigantic teratoma - retroperitoneal tumor: a case report

    International Nuclear Information System (INIS)

    Figueiredo, Rossana Lopes de; Nobrega, Rosangela Figueiredo; Toscano, Carlos Alberto Regis

    1996-01-01

    The authors report a case of primary retroperitoneal teratoma which has grown for seven years. the diagnosis was presumed through image diagnostic methods and it was confirmed after surgery and histopathology analysis. (author). 7 refs., 6 figs

  16. Retroperitoneal laparoscopy management for ureteral fibroepithelial polyps causing hydronephrosis in children: a report of five cases.

    Science.gov (United States)

    Dai, L N; Chen, C D; Lin, X K; Wang, Y B; Xia, L G; Liu, P; Chen, X M; Li, Z R

    2015-10-01

    Hydronephrosis is a common disease in children and may be caused by ureteral fibroepithelial polyps (UFP). Ureteral fibroepithelial polyps are rare in children and are difficult to precisely diagnose before surgery. Surgical treatment for symptomatic UFP is recommended. At the present institution, retroperitoneal laparoscopy has been used to treat five boys with UFP since 2006. To highlight the significance of UFP as an etiological factor of hydronephrosis in children and evaluate the applicative value of retroperitoneal laparoscopy in the treatment of children with UFP. Between 2006 and 2013 five boys underwent retroperitoneal laparoscopy at the present institution. They were identified with UFP by review of the clinical database. Detailed data were collected, including: radiographic studies, gross anatomical pathology, and pathology and radiology reports. All boys had been followed up at least every 6 months. All of the boys were aged between 7 and 16 years (mean 9.8 years). The main symptoms were flank pain (all five) and hematuria (three). Radiographic examination showed that all of the boys presented with incomplete ureteral obstruction and hydronephrosis. The ureteral fibroepithelial polyps were located near the left UPJ or the left proximal ureter. All of the boys had the UFP removed: three underwent retroperitoneal laparoscopic dismembered Anderson-Hynes pyeloplasty and polypectomy, and two had retroperitoneal laparoscopic ureteral anastomosis. These polyps were all on the left side and between 15 and 35 mm in length (mean 22 mm) (Figure). All of the boys recovered well and were discharged from hospital. The postoperative histological report confirmed that the specimens were UFP. Hydronephrosis was periodically assessed by ultrasonography (using the same method as pre-surgical ultrasonography) after surgery. Mean follow-up was 33 months (range 6-58 months) and no complications were found afterwards. Ureteral fibroepithelial polyps are rare but rather

  17. Atypical retroperitoneal extension of iliopsoas bursitis

    International Nuclear Information System (INIS)

    Coulier, B.; Cloots, V.

    2003-01-01

    We report two rare cases of iliopsoas bursitis extending into the retroperitoneal space. The first lesion contained much gas, mimicking a retroperitoneal abscess, and the second was responsible for atypical inguinal pain. The diagnosis was made by contrast-enhanced CT in both cases and arthrography in the first case. Iliopsoas bursitis in these two patients, it is hypothesized, extended into the retroperitoneum, at least in part, by way of intraneural or perineural structures. (orig.)

  18. Atypical retroperitoneal extension of iliopsoas bursitis

    Energy Technology Data Exchange (ETDEWEB)

    Coulier, B.; Cloots, V. [Department of Diagnostic Imaging, Cliniques St. Luc, Rue St Luc 8, 5004, Bouge, Namur (Belgium)

    2003-05-01

    We report two rare cases of iliopsoas bursitis extending into the retroperitoneal space. The first lesion contained much gas, mimicking a retroperitoneal abscess, and the second was responsible for atypical inguinal pain. The diagnosis was made by contrast-enhanced CT in both cases and arthrography in the first case. Iliopsoas bursitis in these two patients, it is hypothesized, extended into the retroperitoneum, at least in part, by way of intraneural or perineural structures. (orig.)

  19. Retroperitoneal Laparoscopic Ureteral Incision and Analysis of Two Kinds of Ureteral Stents Placement Method Contrast Stone Taken During the Operation%后腹腔镜输尿管上段切开取石术中两种放置输尿管支架方法的对比分析

    Institute of Scientific and Technical Information of China (English)

    高飞; 刘清学; 彭洪; 刘建洪; 李万华; 凌思果; 杨军

    2015-01-01

    目的 探讨后腹腔镜输尿管上段切开取石术中输尿管支架的放置方法. 方法 2006年7月至2014年5月共完成后腹腔镜输尿管上段切开取石术428例,术中均放置输尿管支架. 预先将输尿管支架分别向两端穿好导丝,经输尿管切口将其向远端插入至膀胱,拔出远端导丝,再向近端插入至肾盂,拔出近端导丝52例(方法一);将输尿管支架上端卷曲部分留下约1cm,其余部分剪掉,将具有可塑性钢丝从输尿管支架直行处侧孔插入至顶端,用操作钳辅助将全部输尿管支架置入输尿管内,包括卷曲部分,操作钳夹在输尿管支架与钢丝分叉处,倒退回抽钢丝,输尿管支架倒退进入输尿管-肾盂内,"倒退法"放置输尿管支架376例(方法二). 结果 所有患者输尿管支架放置均成功,输尿管均用4-0可吸收线间断缝合,其中方法一耗时7~12min,方法二耗时25S~3min. 所有患者拔出引流管时间、拔出导尿管时间、漏尿时间以及术后平均住院日差异无统计学意义(P>0. 05). 结论 "倒退法"放置输尿管支架操作简单易学、耗时明显减少,大大降低了该手术的难度,值得推广.%Objective To investigate the retroperitoneal laparoscopic ureteral incision method of placing Ureteral stents stone surgery. Methods In July 2006 to May 2014,after the completion of the 428 cases of laparoscopic incision in the upper u-reter stone extraction for intraoperative are placed D-J tube. In advance to D-J tube to wear good thread on both ends respectively, the ureter incision insert it to the distal to the bladder, pull out the remote thread,proximally insert again to the renal pelvis,pull out the proximal godet 52 cases( method a);Part D-J tube top crimping left about 1 cm,cut off,the rest will have plasticity steel wire from D-J tube straight side hole insert to the top,with operating forceps auxiliary all D-J tube placement within the ureter,in-cluding curly part

  20. Retroperitoneal lipo sarcoma: report of 6 cases

    International Nuclear Information System (INIS)

    Santamarina, Mario G.; Baltazar, Alberto D.; Stagno, Diego; Kristal, Marcos; Lopez, Jessica

    2003-01-01

    Objective: To determine CT and MRI imaging features in patients with a diagnosis of retroperitoneal lipo sarcoma. Material and Methods: Retrospective analysis of 6 cases, studied with CT and/or MRI in patients with retroperitoneal lipo sarcoma during the last 4 years at our institution. We analyzed symptoms, treatment and prognosis with special focus on the CT and MRI findings and their histological correlation. Results: the most frequent histological subtype in our group of patients was the pleomorphic lipo sarcoma (n=3). In the others cases, 2 were well differentiated and one was round-cell type. Retroperitoneal lipo sarcoma, especially the well differentiated, presented certain imaging patterns which allowed to suspect the subtype of tumor. Recurrences occurred in 50% (n=3). Mortality rate was 33.4% (n=2) (follow-up, 16 months). Conclusion: Both CT and MRI are methods which aid in the detection of this rare disorder, as well as in its diagnosis and follow-up. (author)

  1. CT diagnosis of retroperitoneal gigantic liposarcoma

    International Nuclear Information System (INIS)

    Fang Wei; Zheng Zhaohua; Liao Zuyuan; Hu Yinsong

    2009-01-01

    Objective: To analyze CT manifestation of retroperitoneal gigantic liposaxcoma and to improve the image understanding. Methods: Five cases of retroperitoneal gigantic liposarcoma confirmed by surgery and pathology in our hospital were collected. Plain and enhanced CT scan were performed. Results: Of five cases, one was substantive, two was pseudocyst and two was mixed tumor. Several patterns of enhancement such as strip, floccule, irregular patchy or nodular enhancement were revealed inside the lesions on enhanced CT scan. And strip-form of high density enhancement was a typical type. Conclusion: CT examination could determine the tumor's location, size and density, together with the relationship to adjacent organizations CT scan is an important method in diagnosing retroperitoneal gigantic liposarcoma. (authors)

  2. Endoscopic findings following retroperitoneal pancreas transplantation.

    Science.gov (United States)

    Pinchuk, Alexey V; Dmitriev, Ilya V; Shmarina, Nonna V; Teterin, Yury S; Balkarov, Aslan G; Storozhev, Roman V; Anisimov, Yuri A; Gasanov, Ali M

    2017-07-01

    An evaluation of the efficacy of endoscopic methods for the diagnosis and correction of surgical and immunological complications after retroperitoneal pancreas transplantation. From October 2011 to March 2015, 27 patients underwent simultaneous retroperitoneal pancreas-kidney transplantation (SPKT). Diagnostic oesophagogastroduodenoscopy (EGD) with protocol biopsy of the donor and recipient duodenal mucosa and endoscopic retrograde pancreatography (ERP) were performed to detect possible complications. Endoscopic stenting of the main pancreatic duct with plastic stents and three-stage endoscopic hemostasis were conducted to correct the identified complications. Endoscopic methods showed high efficiency in the timely diagnosis and adequate correction of complications after retroperitoneal pancreas transplantation. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Enhancement characteristics of retroperitoneal lymphomatous lymph nodes

    International Nuclear Information System (INIS)

    Hagtvedt, Trond; Smith, Hans-Joergen; Kolbenstvedt, Alf; Aaloekken, Trond Mogens; Graff, Bjoern Anton; Holte, Harald

    2013-01-01

    Background: Previous studies of CT enhancement of lymphomatous lymph nodes (LLN) of the neck and the mediastinum showed that the LLN had lower enhancement values than normal lymph nodes. Purpose: To elucidate the contrast medium enhancement curves of LLN in the retroperitoneum by comparing the curves of LLN with those of normal lymph nodes, to test whether differences between these curves could be of diagnostic value, and to compare the present enhancement curves of LLN of the retroperitoneum with the curves of LLN of the neck and the mediastinum from previous similar investigations. Material and Methods: Twenty-eight consecutive patients with LLN of the retroperitoneum (three with Hodgkin's lymphoma [HL]) and 21 control patients with sarcomas and thus presumably normal retroperitoneal nodes underwent dynamic CT examinations. The previous, similar investigation of lymph nodes of the neck comprised 28 patients with LLN and the investigation of mediastinal lymph nodes comprised 24 patients with LLN. Results: The enhancement curves of the retroperitoneal LLN had significantly lower attenuation than those of the retroperitoneal control nodes. A combination of peak contrast value and time to peak adjusted to total body weight yielded a diagnostic accuracy which at the best showed a sensitivity of 90.5% with a specificity of 82.6%. The LLN of the retroperitoneum had higher attenuation values than corresponding nodes of the mediastinum but no significant difference was found between LLN of the retroperitoneum and LLN of the neck in previous similar investigations. Conclusion: The comparison of enhancement curves of retroperitoneal LLN with retroperitoneal control nodes showed a marked similarity with and substantiates our previous findings in lymph nodes of the neck and of the mediastinum. The best diagnostic accuracy was achieved by combining the parameters peak contrast value and time to peak and adjusting these values to the body weight. Peak enhancement of the

  4. Mixed Capillary Venous Retroperitoneal Hemangioma

    Directory of Open Access Journals (Sweden)

    Mohit Godar

    2013-01-01

    Full Text Available We report a case of mixed capillary venous hemangioma of the retroperitoneum in a 61-year-old man. Abdominal ultrasonography showed a mass to be hypoechoic with increased flow in color Doppler imaging. Dynamic contrast-enhanced computed tomography revealed a centripetal filling-in of the mass, located anterior to the left psoas muscle at the level of sacroiliac joint. On the basis of imaging features, preoperative diagnosis of hemangioma was considered and the mass was excised by laparoscopic method. Immunohistochemical studies were strongly positive for CD31 and CD34, and negative for calretinin, EMA, WT1, HMB45, Ki67, synaptophysin, and lymphatic endothelial cell marker D2–40. Histologically, the neoplasm was diagnosed as mixed capillary venous hemangioma.

  5. Retroperitoneal abscess after transanal minimally invasive surgery: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Aaron Raney

    2017-10-01

    Full Text Available Abscesses are a rare complication of transanal minimally invasive surgery and transanal endoscopic micro surgery. Reported cases have been in the rectal and pre-sacral areas and have been managed with either antibiotics alone or in conjunction with laparotomy and diverting colostomy. We report a case of a large retroperitoneal abscess following a Transanal minimally invasive surgery full thickness rectal polyp excision. The patient was successfully managed conservatively with antibiotics and a percutaneous drain. Retroperitoneal infection should be included in a differential diagnosis following a Transanal minimally invasive surgery procedure as the presentation can be insidious and timely intervention is needed to prevent further morbidity. Resumo: Os abscessos são uma complicação rara da cirurgia de ressecção transanal minimamente invasiva (TAMIS e da micro cirurgia endoscópica transanal (TEMS. Os casos notificados foram nas áreas rectal e pré-sacral e foram administrados com antibióticos isoladamente ou em conjunto com laparotomia e desvio de colostomia. Relatamos um caso de grande abscesso retroperitoneal após uma excisão de pólipo retal de espessura total TAMIS. O paciente foi tratado com sucesso com a administração de antibióticos e drenagem percutânea. Para prevenir mais morbidade é necessária incluir a infecção retroperitoneal no diagnostico diferencial após um procedimento TAMIS onde a apresentação pode ser insidiosa e a intervenção atempada. Keywords: Colorectal surgery, Transanal minimally invasive surgery (TAMIS, Retroperitoneal abscess, Natural orifice transluminal endoscopic surgery (NOTES, Single-site laparoscopic surgery (SILS, Surgical oncology, Palavras-chave: Cirurgia colorretal, Cirurgia de ressecção transanal minimamente invasiva (TAMIS, Abscesso retroperitoneal, Cirurgia endoscópica transluminal de orifício natural (NOTES, Cirurgia laparoscópica de único local (SILS, Oncologia cirúrgica

  6. Gigantic teratoma - retroperitoneal tumor: a case report; Teratoma gigante - tumor retroperitoneal: relato de um caso

    Energy Technology Data Exchange (ETDEWEB)

    Figueiredo, Rossana Lopes de [Paraiba Univ., Campina Grande, PB (Brazil). Faculdade de Medicina; Franca Costa, Hamilton Belo de [Hospital Geral de Campina Grande, PB (Brazil); [Clinica Pronto-Socorro Infantil, Campina Grande, PB (Brazil); Nobrega, Rosangela Figueiredo [Clinica Inside, Campina Grande, PB (Brazil); Toscano, Carlos Alberto Regis [Hospital Pedro I, Campina Grande, PB (Brazil)

    1996-03-01

    The authors report a case of primary retroperitoneal teratoma which has grown for seven years. the diagnosis was presumed through image diagnostic methods and it was confirmed after surgery and histopathology analysis. (author). 7 refs., 6 figs.

  7. Radiological Findings of Primary Retroperitoneal Ewing Sarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Ulusan, S.; Koc, Z.; Tuba Canpolat, E.; Colakoglu, T. [Depts. of Radiology, Pathology, and General Surgery, Baskent Univ. Faculty of Medicine, Adana (Turkey)

    2007-09-15

    Ewing sarcomas are most commonly located in bone, while extra skeletal involvement of the retroperitoneum is extremely rare. We describe the radiologic and pathological findings in an adult patient with retroperitoneal extra skeletal Ewing sarcoma. Keywords: Color Doppler ultrasound; computed tomography; extra skeletal Ewing sarcoma; magnetic resonance imaging; ultrasound.

  8. Radiological Findings of Primary Retroperitoneal Ewing Sarcoma

    International Nuclear Information System (INIS)

    Ulusan, S.; Koc, Z.; Tuba Canpolat, E.; Colakoglu, T.

    2007-01-01

    Ewing sarcomas are most commonly located in bone, while extra skeletal involvement of the retroperitoneum is extremely rare. We describe the radiologic and pathological findings in an adult patient with retroperitoneal extra skeletal Ewing sarcoma. Keywords: Color Doppler ultrasound; computed tomography; extra skeletal Ewing sarcoma; magnetic resonance imaging; ultrasound

  9. Retroperitoneal extraadrenal paraganglioma report of two cases.

    Science.gov (United States)

    Becheanu, G; Laky, D

    1997-01-01

    Two cases with retroperitoneal tumours affecting young women who cannot undergo surgery were investigated by biopsy and needle sampling. One of these cases presented a mainly alveolar histologic pattern and was easily diagnosed by immunohistochemical means, as well as a chromaffin paraganglioma. We discussed different diagnoses and approaches in the literature.

  10. Spontaneous Retroperitoneal Hemorrhage from Adrenal Artery Aneurysm

    International Nuclear Information System (INIS)

    Gonzalez Valverde, F.M.; Balsalobre, M.; Torregrosa, N.; Molto, M.; Gomez Ramos, M.J.; Vazquez Rojas, J.L.

    2007-01-01

    Spontaneous adrenal hemorrhage is a very rare but serious disorder of the adrenal gland that can require emergent treatment. We report on a 42-year-old man who underwent selective angiography for diagnosis and treatment of retroperitoneal hemorrhage from small adrenal artery aneurysm. This case gives further details about the value of transluminal artery embolization in the management of visceral aneurysm rupture

  11. Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy : a shift to a new golden standard?

    NARCIS (Netherlands)

    Vrielink, O M; Wevers, K P; Kist, J W; Borel Rinkes, I H M; Hemmer, P. H. J.; Vriens, M. R.; de Vries, J; Kruijff, S.

    PURPOSE: There has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the "classic" laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size.

  12. Nonpalpable testicular pure seminoma with elevated serum alpha-fetoprotein presenting with retroperitoneal metastasis: a case report.

    Science.gov (United States)

    Iwatsuki, Shoichiro; Naiki, Taku; Kawai, Noriyasu; Etani, Toshiki; Iida, Keitaro; Ando, Ryosuke; Nagai, Takashi; Okada, Atsushi; Tozawa, Keiichi; Sugiyama, Yosuke; Yasui, Takahiro

    2016-05-05

    Patients with a primary pure seminoma in the testis who have elevated serum alpha-fetoprotein are rare and should be treated as patients with nonseminomatous germ cell tumors. However, nonpalpable testicular tumors in this condition have never been reported. We describe a case of nonpalpable pure testicular seminoma with elevated serum alpha-fetoprotein presenting retroperitoneal metastasis. A 29-year-old Asian man was referred to our hospital with right flank pain. Computed tomography showed a mass located between his aorta and inferior vena cava, but a testicular tumor was not detected. His serum levels of lactate dehydrogenase, alpha-fetoprotein, and DUPAN-2 were high. Although no tumor or nodule was palpable in his testis, ultrasonography revealed multiple low echoic lesions in his right testicular parenchyma. He was diagnosed with right testicular cancer with retroperitoneal lymph node metastasis and underwent right high orchiectomy. A pathological examination revealed pure seminoma and no nonseminomatous components were found in the specimen. Three courses of induction systemic chemotherapy (cisplatin, etoposide, and bleomycin) normalized his serum alpha-fetoprotein and DUPAN-2 levels. Three additional courses of chemotherapy (etoposide and bleomycin) were performed, and treatment was completed with laparoscopic retroperitoneal lymph node dissection. Pathology of the dissected specimen showed fibrous and necrotic tissue with no viable cells. He is alive without recurrence 54 months after orchiectomy. We report a case of pure testicular seminoma with elevated serum alpha-fetoprotein and DUPAN-2 presenting retroperitoneal metastasis. We recommend an ultrasound examination of bilateral testes when large retroperitoneal tumors are detected in young men, even if a mass is not palpable in the scrotum.

  13. Lymphoplasmacytic Sclerosing Pancreatitis and Retroperitoneal Fibrosis

    Directory of Open Access Journals (Sweden)

    Nigel K. F. Koo Ng

    2008-01-01

    Full Text Available Although cases of lymphoplasmacytic sclerosing pancreatitis (LSP associated with idiopathic retroperitoneal fibrosis have been reported, the association is rare. We describe a 74-year-old man who presented with obstructive jaundice and weight loss. Nineteen months earlier, he had been diagnosed with idiopathic retroperitoneal fibrosis and treated with bilateral ureteric stents. Initial investigations were suggestive of a diagnosis of LSP, however, a malignant cause could not be ruled out. He underwent an exploratory laparotomy and frozen sections confirmed the diagnosis of LSP. An internal biliary bypass was performed using a Roux loop of jejunum, and the patient made an uneventful recovery. This case illustrates the difficulty in distinguishing LSP from pancreatic carcinoma preoperatively.

  14. Delays in the management of retroperitoneal sarcomas

    DEFF Research Database (Denmark)

    Seinen, Jojanneke; Almquist, Martin; Styring, Emelie

    2010-01-01

    Retroperitoneal sarcomas are rare and treatment should optimally be centralized. Despite successful centralization with 90% of the patients referred prior to surgery, delays occur, which led us to assess lead times in a population-based series. Method. Patients diagnosed with retroperitoneal...... sarcoma in the southern Sweden health care region 2003-2009 were eligible for the study. Data on referrals and diagnostic investigations were collected from clinical files from primary health care, local hospitals, and from the sarcoma centre. Lead times were divided into patient delays and health care...... at the general practitioner, 36 days at local hospitals, and 55 days at the sarcoma centre. Conclusion. Centralization per se is not sufficient for optimized and efficient management. Our findings suggest that delays can be minimized by direct referral of patients from primary health care to sarcoma centers...

  15. Delays in the management of retroperitoneal sarcomas

    DEFF Research Database (Denmark)

    Seinen, Jojanneke; Almquist, Martin; Styring, Emelie

    2010-01-01

    Retroperitoneal sarcomas are rare and treatment should optimally be centralized. Despite successful centralization with 90% of the patients referred prior to surgery, delays occur, which led us to assess lead times in a population-based series. Method. Patients diagnosed with retroperitoneal...... sarcoma in the southern Sweden health care region 2003-2009 were eligible for the study. Data on referrals and diagnostic investigations were collected from clinical files from primary health care, local hospitals, and from the sarcoma centre. Lead times were divided into patient delays and health care...... delays caused by primary health care, local hospitals, or procedures at the sarcoma centre. Results. Complete data were available from 33 patients and demonstrated a median patient delay of 23¿days (0-17¿months) and median health care delay of 94¿days (1-40¿months) with delays of median 15¿days...

  16. [Retroperitoneal lymphadenectomy and disorders of ejaculation].

    Science.gov (United States)

    Deiana, G; Ranieri, A; Micheli, E; Peracchia, G; Canclini, L P; Sironi, D; Levorato, C A; Lembo, A

    1999-09-01

    Retrograde ejaculation is a frequent and permanent complication after bilateral retroperitoneal lymphadenectomy (RPLND). Seminal emission and ejaculation are primarily under sympathetic control. Several studies after RPLND in patients with nonseminomatous testis cancer proved the role of preservation of the efferent fibers originating from the lumbar sympathetic ganglia. Based on the results of anatomical studies, a modified unilateral operative technique and nerve-sparing approach permit to preserve normal anterograde ejaculation without reduction of long-term survival.

  17. Haemoperitoneurn Secondary to Rupture of Retroperitoneal Variceal

    Directory of Open Access Journals (Sweden)

    M. Molina-Perez

    1997-01-01

    Full Text Available A 45-year-old alcoholic male patient presented with hypovolemic shock and intense anemia (Hemoglobin 04.7 g/dl, and was operated on. A bleeding retroperitoneal varix located near the right colon was responsible for the clinical picture and was sutured. After operation the patient developed haemodynamic instability and pneumonia a situation which was reverted with intensive medical therapy. The patient is now doing well.

  18. Retroperitoneal fibromatosis presenting as a presacral mass

    International Nuclear Information System (INIS)

    Kim, Yong-Woo; Choi, Seok Jin; Jeon, Ung Bae; Choo, Kie Seok

    2014-01-01

    Aggressive fibromatosis arising from the retroperitoneum is extremely rare. It may occur in association with previous trauma, abdominal surgery, drugs, Gardner’s syndrome, or familial adenomatous polyposis. We report a case of retroperitoneal fibromatosis presenting as a presacral mass with an infiltrating nature, relatively intense enhancement on enhanced computed tomography scanning, and low-signal intensity on T2-weighted magnetic resonance imaging in a patient with no significant medical or surgical history

  19. The Value of Surgery for Retroperitoneal Sarcoma

    Directory of Open Access Journals (Sweden)

    Sepideh Gholami

    2009-01-01

    Full Text Available Introduction. Retroperitoneal sarcomas are uncommon large malignant tumors. Methods. Forty-one consecutive patients with localized retroperitoneal sarcoma were retrospectively studied. Results. Median age was 58 years (range 20–91 years. Median tumor size was 17.5 cm (range 4–41 cm. Only 2 tumors were <5 cm. Most were liposarcoma (44% and high-grade (59%. 59% were stage 3 and the rest was stage 1. Median followup was 10 months (range 1–106 months. Thirty-eight patients had an initial complete resection; 15 (37% developed recurrent sarcoma and 12 (80% had a second complete resection. Patients with an initial complete resection had a 5-year survival of 46%. For all patients, tumor grade affected overall survival (=.006. Complete surgical resection improved overall survival for high-grade tumors (=.03. Conclusions. Tumor grade/stage and complete surgical resection for high-grade tumors are important prognostic variables. Radiation therapy or chemotherapy had no significant impact on overall or recurrence-free survival. Complete surgical resection is the treatment of choice for patients with initial and locally recurrent retroperitoneal sarcoma.

  20. Ormond's disease or secondary retroperitoneal fibrosis? An overview of retroperitoneal fibrosis

    Energy Technology Data Exchange (ETDEWEB)

    Heckmann, M.; Uder, M.; Kuefner, M.A.; Heinrich, M.C. [Universitaetsklinikum Erlangen (Germany). Radiologisches Inst.

    2009-04-15

    Retroperitoneal fibrosis represents a rare inflammatory disease. About two thirds of all cases seem to be idiopathic (= Ormond's disease). The remaining one third is secondary and may be ascribed to infections, trauma, radiation therapy, malignant diseases, and the use of certain drugs. Up to 15 % of patients have additional fibrotic processes outside the retroperitoneum. The clinical symptoms of retroperitoneal fibrosis are non-specific. In sonography retroperitoneal fibrosis appears as a retroperitoneal hypoechoic mass which can involve the ureters and thus cause hydronephrosis. Intravenous urography and MR urography can demonstrate the typical triad of medial deviation and extrinsic compression of the ureters and hydronephrosis. CT and MRI are the modalities of choice for the diagnosis and follow-up of this disease. The lesion typically begins at the level of the fourth or fifth lumbar vertebra and appears as a plaque, encasing the aorta and the inferior vena cava and often enveloping and medially displacing the ureters. In unenhanced CT, retroperitoneal fibrosis appears as a mass that is isodense with muscle. When using MRI, the mass is hypointense in T1-weighted images and of variable intensity in T2-weighted images according to its stage: it may be hyperintense in early stages, while the tissue may have a low signal in late stages. After the administration of contrast media, enhancement is greatest in the early inflammatory phase and minimal in the late fibrotic phase. Dynamic gadolinium enhancement can be useful for assessing disease activity, monitoring response to treatment, and detecting relapse. To differentiate retroperitoneal masses, diffusion-weighted MRI may provide useful information. (orig.)

  1. Liposarcoma retroperitoneal gigante. Reporte de caso (Giant retroperitoneal liposarcoma. Case report

    Directory of Open Access Journals (Sweden)

    Eduardo Reyna-Villasmil

    2015-01-01

    Full Text Available Soft tissue sarcomas represent less than 1% of all human neoplasms. One-third of malignant tumors that arise in the retroperitoneum are sarcomas and liposarcoma is the most common retroperitoneal sarcoma and is known to grow to giant sizes, slow progress and few late symptoms. We report the case of a 40 year old woman with a giant retroperitoneal liposarcoma. A laparotomy was performed and a multilobulated tumor of 20 centimeters of diameter arising from retroperitoneum. The histological features were suggestive of pleomorphic liposarcoma weighing 8.5 Kilograms

  2. Does negative retroperitoneal CT in adolescents with paratesticular rhabdomyosarcoma preclude the need of retroperitoneal lymph node dissection?

    International Nuclear Information System (INIS)

    Damazio, Eulalio; Caran, Eliana; Ortiz, Valdemar; Macedo Junior, Antonio

    2011-01-01

    We report on a 16-year-old male with paratesticular rhabdomyosarcoma who underwent retroperitoneal lymph node dissection due to a stage I tumor (normal retroperitoneal computed tomography). The surgical finding was three enlarged nodes, positive for metastatic disease. Patient was referred to adjuvant chemotherapy. This case suggests that the Intergroup Rhabdomyosarcoma Study Group IV protocol is subject to questions regarding adolescents with paratesticular rhabdomyosarcoma, and that negative retroperitoneal CT does not preclude the need of lymph node dissection. (author)

  3. Laparoscopic herniorrhaphy.

    Science.gov (United States)

    Swanstrom, L L

    1996-06-01

    There is little doubt that laparoscopic herniorrhaphy has assumed a place in the pantheon of hernia repair. There is also little doubt that further work needs to be done to determine the exact role that laparoscopic hernia repair should play in the surgical armamentarium. Hernias have been surgically treated since the early Greeks. In contrast, laparoscopic hernia repair has a history of only 6 years. Even within that short time, laparoscopic hernia repair techniques have not remained unchanged. This is obviously a technique in evolution, as indicated by the abandonment of early repairs ("plug and mesh" and IPOM) and the gradual gain in pre-eminence of the TEP repair. During the same time frame, surgery itself has evolved into a discipline more concerned with cost-effectiveness, outcomes, and "consumer acceptance." Confluence of these two developments has led to a situation in which traditional concerns regarding surgical procedures (i.e., recurrence rates or complication rates) assume less of a role than cost-effectiveness, learnability, marketability, and medical-legal considerations. No surgeon, whether practicing in a academic setting or a private practice, is exempt from these pressures. Laparoscopic hernia repair therefore seems to fit into a very specialized niche. In our community, the majority of general surgeons are only too happy to not do laparoscopic hernia repairs. On the other hand, in our experience, certain indications do seem to cry out for a laparoscopic approach. At our own center we have found that laparoscopic repairs can indeed be effective, and even cost-effective, under specific circumstances. These include completing a minimal learning curve, utilizing the properitoneal approach, minimizing the use of reusable instruments, using dissecting balloons as a time-saving device, and very specific patient selection criteria. At present these include patients with bilateral inguinal hernias on clinical examination, patients with recurrent

  4. CT characteristics of primary retroperitoneal neoplasms in children

    International Nuclear Information System (INIS)

    Xu Yufeng; Wang Jichen; Peng Yun; Zeng Jinjin

    2010-01-01

    Primary retroperitoneal neoplasms are uncommon in children. Retroperitoneal neoplasms are either mesodermal, neurogenic, germ cell ectodermal or lymphatic in origin. In general, primary retroperitoneal neoplasms in children have different spectrum and prevalence compared to those in adults. Neuroblastoma, rhabdomyosarcoma, benign teratoma and lymphoma are the common retroperitoneal neoplasms. In this review, the clinical and CT futures of common retroperitoneal neoplasms in children are described. Coarse, amorphous, and mottled calcification are very common in neuroblastoma. Paraganglioma tends to show marked and early enhancement and may present with clinical symptoms associated with the excess catecholamine. Sarcomas are often very large and have heterogeneous appearance. Imaging cannot be reliably used to identify the type of retroperitoneal sarcomas due to overlapped radiographic features. In children, lipoblastoma is the most common lipomatous tumor in the retroperitoneum. The percentage of visible fat in tumor varies depending on the cellular composition of the lesion. The CT characteristics of teratoma are quite variable, which may be cystic, solid, on a combination of both. Typically teratoma appears as a large complex mass containing fluid, fat, fat-fluid level, and calcifications. Lymphoma is often homogeneous on both enhanced and unenhanced CT scans. Necrosis and calcification are rare on CT. In conclusion, making a final histological diagnosis of retroperitoneal tumor base on CT features is not often possible; however, CT can help to develop a differential diagnosis and determine the size and extent of the retroperitoneal neoplasms.

  5. Giant retroperitoneal lipoma in an infant | Mohammed | Journal of ...

    African Journals Online (AJOL)

    Retroperitoneal lipomas have remained the essentially rare tumors seen in clinical practice. The tumors are rarer in children, with very few reported cases in surgical literature worldwide. We are reporting the case of a six-month-old child who presented with a giant retroperitoneal lipoma that was successfully managed by ...

  6. Carbon Ion Radiotherapy for Unresectable Retroperitoneal Sarcomas

    International Nuclear Information System (INIS)

    Serizawa, Itsuko; Kagei, Kenji; Kamada, Tadashi; Imai, Reiko; Sugahara, Shinji; Okada, Tohru; Tsuji, Hiroshi; Ito, Hisao; Tsujii, Hirohiko

    2009-01-01

    Purpose: To evaluate the applicability of carbon ion radiotherapy (CIRT) for unresectable retroperitoneal sarcomas with regard to normal tissue morbidity and local tumor control. Methods and Materials: From May 1997 to February 2006, 24 patients (17 male and 7 female) with unresectable retroperitoneal sarcoma received CIRT. Age ranged from 16 to 77 years (median, 48.6 years). Of the patients, 16 had primary disease and 8 recurrent disease. Histologic diagnoses were as follows: malignant fibrous histiocytoma in 6, liposarcoma in 3, malignant peripheral nerve sheath tumor in 3, Ewing/primitive neuroectodermal tumor (PNET) in 2, and miscellaneous in 10 patients. The histologic grades were as follows: Grade 3 in 15, Grade 2-3 in 2, Grade 2 in 3, and unknown in 4. Clinical target volumes ranged between 57 cm 3 and 1,194 cm 3 (median 525 cm 3 ). The delivered carbon ion dose ranged from 52.8 to 73.6 GyE in 16 fixed fractions over 4 weeks. Results: The median follow-up was 36 months (range, 6-143 months). The overall survival rates at 2 and 5 years were 75% and 50%, respectively. The local control rates at 2 and 5 years were 77% and 69%. No complications of the gastrointestinal tract were encountered. No other toxicity greater than Grade 2 was observed. Conclusions: Use of CIRT is suggested to be effective and safe for retroperitoneal sarcomas. The results obtained with CIRT were a good overall survival rate and local control, notwithstanding the fact that most patients were not eligible for surgical resection and had high-grade sarcomas.

  7. Radiation therapy in retroperitoneal sarcoma management.

    Science.gov (United States)

    Haas, Rick L; Baldini, Elizabeth H; Chung, Peter W; van Coevorden, Frits; DeLaney, Thomas F

    2018-01-01

    Surgery is potentially curative for primary non-metastatic retroperitoneal soft tissue sarcomas (RPS), although patients remain at risk for local recurrence. To reduce this risk, the addition of radiotherapy to radical surgery may be considered. Nevertheless, level I evidence to support radiotherapy is currently lacking. The results from the EORTC-STBSG 62092-22092 studying this question are awaited. This manuscript addresses issues to consider when radiation-oncologists engage in a multidisciplinary treatment approach for RPS patients, including radiotherapy. © 2017 Wiley Periodicals, Inc.

  8. Retroperitoneal Cellular Angiofibroma: A Rare Gynecological Entity

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    Ana Brandão

    2017-12-01

    Full Text Available Cellular angiofibroma is a mesenchymal tumor, described in 1997, without gender preference, that usually appears at age 40. The vulvovaginal area is the most common site in women, mimicking vulvar benign tumors, like Bartholin gland cyst. However, there are a few described cases of a deep or extra-pelvic angiofibroma. Excision is the treatment of choice and the recurrence rate appears to be low. We present the case of a woman with a heterogeneous tumor in the right adnexial region. At the surgery, a retroperitoneal tumor was excised and the histopathological tissue analysis revealed a cellular angiofibroma.

  9. Recurrent thymoma in the retroperitoneal space: a rare case report

    Directory of Open Access Journals (Sweden)

    Jun Yang

    2015-06-01

    Full Text Available Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum and recurrences of thymoma generally are locally, and retroperitoneal recurrence is considered to be rare. A 46-year old Asian woman with invasive thymoma had undergone thymectomy 10 years ago. Computed tomography demonstrated a wellcircumscribed mass in the left retroperitoneal space. The patient had not any symptom including myasthenia gravis. Because on the anterior mediastinum area shows no sign of tumor recurrence and the mass adjacent to the vertebral body, neurogenic tumor was suspected. Surgical resection was performed using a retroperitoneal approach, which revealed the tumor adhering neighboring diaphragm. The tumor was histologically diagnosed to be type B1 thymoma according to the World Health Organization classification. The retroperitoneal mass was an unusual local recurrence after thymectomy. The patients whose had under invasive thymectomy should be evaluated carefully when finding retroperitoneal mass during follow-up.

  10. Diseases of the retroperitoneal space in the dog and cat

    International Nuclear Information System (INIS)

    Roush, J.K.; Bjorling, D.E.; Lord, P.

    1990-01-01

    The retroperitoneal space (RPS) is an anatomical area bounded dorsally by the sublumbar musculature and ventrally by the peritoneal surface of the abdomen. The RPS communicates with the pelvic space and mediastinum and is subject to primary diseases of the RPS connective tissue and to extension of disease from organs lying within or adjacent to it. Primary diseases include retroperitonitis, pneumoretroperitoneum, non-neoplastic retroperitoneal space-occupying lesions, and primary neoplasms of the RPS. Primary diseases of kidneys, ureters, adrenal glands or retroperitoneal lymph nodes may extend into the RPS, and the RPS may be the site of metastatic neoplastic disease. Clinical signs suggestive of retroperitoneal disease include lumbar pain, pyrexia, lethargy, and signs referable to organs within the RPS

  11. Laparoscopic Bullet Removal in a Penetrating Abdominal Gunshot

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    Christos Stefanou

    2016-01-01

    Full Text Available Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. Nowadays laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. We report a case of a lower anterior abdominal gunshot patient treated laparoscopically. A 32-year-old male presented to the Emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal wall. The patient had no symptoms or obvious bleeding and was vitally stable. On examination we identified 1 cm diameter entry wound at the left lower abdominal wall. The imaging studies showed the bullet in the peritoneal cavity but no injured intraperitoneal and retroperitoneal viscera. We decided to remove the bullet laparoscopically. Twenty-four hours after the intervention the patient was discharged. The decision for managing gunshot patients should be based on clinical and diagnostic findings. Anterior abdominal injuries in a stable patient without other health problems can be managed laparoscopically.

  12. Laparoscopic Removal of Streak Gonads in Turner Syndrome.

    Science.gov (United States)

    Mandelberger, Adrienne; Mathews, Shyama; Andikyan, Vaagn; Chuang, Linus

    To demonstrate the skills necessary for complete resection of bilateral streak gonads in Turner syndrome. Video case presentation with narration highlighting the key techniques used. The video was deemed exempt from formal review by our institutional review board. Turner syndrome is a form of gonadal dysgenesis that affects 1 in 2500 live births. Patients often have streak gonads and may present with primary amenorrhea or premature ovarian failure. Patients with a mosaic karyotype that includes a Y chromosome are at increased risk for gonadoblastoma and subsequent transformation into malignancy. Gonadectomy is recommended for these patients, typically at adolescence. Streak gonads can be difficult to identify, and tissue margins are often in close proximity to critical retroperitoneal structures. Resection can be technically challenging and requires a thorough understanding of retroperitoneal anatomy and precise dissection techniques to ensure complete removal. Laparoscopic approach to bilateral salpingo-oophorectomy of streak gonads. Retroperitoneal dissection and ureterolysis are performed, with the aid of the Ethicon Harmonic Ace, to ensure complete gonadectomy. Careful and complete resection of gonadal tissue in the hands of a skilled laparoscopic surgeon is key for effective cancer risk reduction surgery in Turner syndrome mosaics. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  13. Adrenal Hemangioma: A Case of Retroperitoneal Tumor

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    Genta Iwamoto

    2018-01-01

    Full Text Available Introduction. Adrenal hemangioma is a rare disease, with only some 60 cases reported previously. Due to the difficulty of the preoperative diagnosis of adrenal hemangioma, almost all of the cases were diagnosed by a histopathological analysis of surgical specimens. Case Presentation. A 52-year-old man was referred to our department for further examination of his left retroperitoneal tumor. He had received hemodialysis due to chronic renal failure resulting from membranous nephropathy. Computed tomography revealed a mass around his left hilum. Magnetic resonance imaging (MRI and positron-emission tomography (PET-CT were unable to confirm or deny malignancy, and tumor markers, including CEA and CA19-9, showed slight elevation. His tumor grew from 38 mm to 54 mm in diameter in 7 months of follow-up. We therefore planned retroperitoneal tumor resection with left nephrectomy. Histopathologically, hyperplastic small vessels with hemorrhaging and denaturation were seen. The endothelial cells showed no variants or division of the nucleus. Based on this diagnosis, no further therapy was performed. He has had no recurrence in the eight months since the surgery. Conclusion. We herein report a rare case of adrenal hemangioma.

  14. Retroperitoneal ganglioneuroma in a young bodybuilder

    International Nuclear Information System (INIS)

    Durczynski, A.; Szymanski, D.; Hogendorf, P.; Strzelczyk, J.; Sporny, S.

    2010-01-01

    Background: Anabolic steroid intake is common among bodybuilders, although it is associated with a number of adverse effects, including tumorgenesis. Case Report: We describe the case of 24-year-old male athletic bodybuilder (weight 110 kg, height 179, BMI 34 kg/m 2 ) admitted to our department with diffused, intermittent, abdominal pain of 4 months duration. The patient had a history of long-term abuse of large doses of anabolic steroids of unknown origin. Computed tomography scans revealed a large, 140 x 100 mm, well-demarcated tumor, located between the left kidney, pancreas and spleen, presumably originating from the left kidney or adrenal gland. The tumor was proven to be hormonally inactive. Retroperitoneal tumor excision was performed with surrounding organs left intact. A final histopathologic examination revealed a well-differentiated 16 cm ganglioneuroma. Despite the rarity of its occurrence, ganglioneuromas must be considered in the differential diagnosis of retroperitoneal tumors. Conclusions: This unique finding raises questions concerning potential development of ganglioneuroma secondary to steroid abuse among bodybuilders. Bodybuilders should be made aware of the serious medical risks of steroid abuse. (authors)

  15. Retroperitoneal Gastrointestinal Type Schwannoma Presenting as a Renal Mass

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    Susan J. Hall

    2015-11-01

    Full Text Available Retroperitoneal schwannomas are extremely rare, and unreported in Urology. Often thought to be malignant from imaging the diagnosis is often delayed until Histology. We report a case of retroperitoneal schwanoma thought to be a malignant renal mass. Seventy three year old lady presented with abdominal pain. Imaging showed a mass attached to the renal pelvis thus she underwent a radical nephrectomy. Histology reported retroperitoneal schwannoma. Malignant forms are rare however treatment for these is surgical excision. Awareness of the existence of these tumors may help in avoiding unnecessary radical surgeries by opting for biopsy preoperatively.

  16. A case of retroperitoneal fibrosis responding to steroid therapy

    Directory of Open Access Journals (Sweden)

    Ryuta Watanabe

    Full Text Available ABSTRACT A 69-year-old man presented at the hospital with complaints of prolonged stomach pain extending from the week prior. Enhanced computed tomography (CT revealed a low density area in the retroperitoneal space. A radiologist diagnosed the patient with retroperitoneal fibrosis. One week later, an enhanced CT revealed an exponential increase of the low density area and slight right hydronephrosis. Upon admission, prednisolone administration was initiated at a dose of 40mg/day. The size of the retroperitoneal soft tissue mass decreased gradually. Although the dose of prednisolone was tapered to 5mg, the patient is doing well without any sign of recurrence.

  17. Atypical presentations of retroperitoneal giant schwannomas

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    Sait Ozbir

    2011-06-01

    Full Text Available Schwannomas are usually benign rare tumors that originating from Schwann cells of peripheral nerve sheaths. Presentation is generally varied and changed in a non-specific range from abdominal mass, flank pain to incidental findings. Herein we report 2 cases of retroperitoneal giant schwannomas with different clinical presentations, of whom one presented with vague abdominal pain, palpable abdominal mass for 4 years, swelling and bilateral hydronephrosis that caused by giant abdominal mass; the other one presented with right flank pain, rectal hemorrhage and lower extremities edema. Two patients were treated by complete surgical excision of masses. The histological and immunohistochemical diagnosis was reported as benign schwannoma. Both of patients are doing well and had no recurrence in 9 years and 28 months follow-up, respectively.

  18. PARAVAGINAL AND RETROPERITONEAL HAEMATOMA POST PARTUM

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    Boštjan Lovšin

    2018-02-01

    Full Text Available Background. Postpartum haemorrhage from ruptured tissues can usually be diagnosed and managed properly. A problem exists with the occult haemorrhage without evident tissue trauma in which case a haematoma develops. Methods. After a normal delivery of the 41 years old secundipara after a previous caesarean in epidural analgesia a boy was born. Placenta was delivered spontaneously and perineal rupure sutured properly. About an hour after the delivery heavy pain was noted in the lower abdomen. Pelvic exam revealed a paravaginal haematoma and ultrasound scan coagulated and fresh blood behind the uterus. Rupture of the uterus was suspected and laparotomy revision performed. During the laparotomy there was no haemorrhage in the pelvic cavity, no uterine rupture but a large retroperitoneal haematoma extending to mesosigmoidal part of intestinum. Paravaginal heamatoma was evacuated vaginally and after half an hour the retroperitoneal haematoma diminished by 50 %. The patient received two blood transfusions. The blood loss was estimated as about 500 grams. The pulse and blood pressure were normal all the time. The laboratory values of haemoglobin was 96 g/l, haematocrit 0.30 before the operation and 93 g/l and 0.28 respectively 6 hours after. Beside anaemia the postoperative course was uneventful and the patient was dismissed from the hospital the 6th day postpartum. Conclusions. Although the laparotomy seems an excessive treatment it was the only way to exclude uterus rupture after a previous caesarean, heavy pain in the lower abdomen and blood behind the uterus noted on the ultrasound scan. In the non-urgent situation a CT scan could be performed to locate the blood accumulation and possibly exclude uterine rupture.

  19. Management and prevention of chylous leakage after laparoscopic lymphadenectomy.

    Science.gov (United States)

    Han, L-P; Zhang, H-M; Abha, H-D; Liu, T; Zhang, X-P

    2014-01-01

    To investigate the development and management of chylous leakage after laparoscopic retroperitoneal lymphadenectomy. From July 2006 to September 2013, 13 cases of chylous leakage after the laparoscopic lymphadenectomy (6 cases of renal cell carcinoma, 4 cases of gastric cancer, 2 cases of ovarian cancer, 1 case of endometrial cancer) were studied to analyze the occurrence, development and management of chylous leakage. In 3 cases (2 cases of renal cell carcinoma, 1 case of gastric cancer) massive amount of milky fluid drainage was be seen after the first two days post operation. Dietary intervention, TPN (total parenteral nutrition), somatostatin therapy, maintenance of continuous drainage helped to successfully manage the condition in about 1 month duration. In the remaining 10 cases, chylous leakage appeared after restoring normal diet. Managed with changes in diet and maintenance of unobstructed drainage, they were cured in about 2 weeks after treatment. There was significant reduction in drain output, ultrasonography did not reveal presence of free fluid collection in abdomen, and the patients were in good condition without signs and symptoms of infections. Chylous leakage is a rare complication of retroperitoneal lymph node dissection. Surgeons should be familiar with laparoscopic techniques, relevant anatomy and be aware of the fact that the effect of CO2 pressure and use of ultrasonic knife to occlude the lymphatic vessel can transiently block the leakage making the surgeon overlook them. Routine placement of indwelling drainage tube, immediate diagnosis, dietary modification, TPN, somatostatin and drainage are the modalities of conservative management.

  20. Giant Primary Retroperitoneal Teratoma in an Adult: A Case Report

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    Poonam Mathur

    2010-01-01

    Full Text Available Teratomas are bizarre neoplasms derived from embryonic tissues that are typically found only in the gonadal and sacrococcygeal regions of adults. Retroperitoneal teratomas are rare and present challenging management options. We report here the case of a histologically unusual retroperitoneal tumor detected on computed tomography during the workup of abdominal pain in a 32-year-old male. The evaluation and treatment of this condition and a review of the literature are included in this paper.

  1. Laparoscopic pyeloplasty.

    LENUS (Irish Health Repository)

    Cheema, I A

    2010-01-01

    We report our results and short term follow up of transperitoneal laparoscopic pyeloplasty for pelvi-ureteric junction (PUJ) obstruction. We have prospectively maintained a database to document our initial experience of 54 laparoscopic pyeloplasty. All procedures were carried out by one surgeon through a transperitoneal approach. The data extends from April 2005 to September 2008 and reports operative time, blood loss, complications, hospital stay, short term follow-up on symptomatic and radiological outcome. Fifty-four procedures were performed during the study period. Mean patient age was 29 years. Mean operating time was 133 minutes (range 65-300 minutes), and mean blood loss was 45 ml (range 20-300 ml). No intra operative complication occurred. Neither blood transfusion nor conversion to open surgery was required. Postoperative mean hospital stay was 3.4 days (range 3-14 days). There were 3 anastomotic leakages; 2 in the immediate postoperative period and 1 following removal of stent. They all required percutaneous drainage and prolonged stenting. Overall 47 (87%) patients have symptomatic relief and resolution of obstruction on renogram. Four (7%) patients developed recurrence. Three (5.5%) patients had symptomatic relief but have a persistent obstructive renogram. Laparoscopic pyeloplasty is an effective alternative treatment for symptomatic pelvi-ureteric junction obstruction. The results appear comparable to open pyeloplasty with decreased postoperative morbidity.

  2. Functional adrenal cortex preservation: A good reason for posterior retroperitoneal endoscopic approach.

    Science.gov (United States)

    Vidal, Óscar; Delgado-Oliver, Eduardo; Díaz Del Gobbo, Rafael; Hanzu, Felicia; Squarcia, Mattia; Martínez, Daniel; Fuster, David; Fondevila, Constantino

    2018-05-24

    Cortical-sparing adrenalectomy is a suitable treatment for hereditary and sporadic bilateral pheochromocytoma, in cases of low risk of malignancy, to reduce the possibility of adrenal insufficiency assuming the chance of local recurrence. The aim of the study is to analyze the functional results of partial adrenalectomy by retroperitoneal endoscopic approach in single-adrenal patients or patients requiring bilateral adrenalectomy. Prospective study between January 2015 and February 2016 including pheochromocytoma patients diagnosed with low risk of malignant mutations. All patients agreed to be included in the study. Experienced endocrine surgeons who have been trained in minimally invasive endocrine surgery performed the procedure using the same surgical technique. Demographic variables and clinical characteristics were collected, subsequently carrying out the descriptive analysis of the data. A total of 6 patients were registered, four associated with MEN type 2 syndrome and two in the context of VHL syndrome. Retroperitoneoscopic resection was performed without laparoscopic or open conversion and no postoperative complications; the average hospital stay was 2.5 days. Preservation of the functional cortex without corticosteroids was achieved in 5 (83%) of out 6 cases with a follow-up of 26.2 ± 6 months. Today, these 5 patients have a preserved adrenal function without hormone replacement. Cortical-sparing adrenalectomy by the retroperitoneal endoscopic approach, in expert hands, is safe and feasible for the treatment of hereditary and sporadic pheochromocytoma in a context of low malignancy, making it possible to avoid the need for corticoid replacement in most cases. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Retroperitoneal Fibrosis: A Retrospective Clinical Data Analysis of 30 Patients in a 10-year Period

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    Hai-Jiang Zhou

    2015-01-01

    Full Text Available Background: Retroperitoneal fibrosis (RPF is an uncommon disease that is characterized by development of fibrosclerotic tissues involving retroperitoneal structures. This study aimed to investigate the clinical features of 30 patients with RPF in a single center in Beijing in a 10-year period. Methods: We retrospectively analyzed clinical data on demographic characteristics, clinical manifestations, laboratory findings, radiological findings, modalities of treatments, outcomes and prognosis of 30 patients with RPF. Patients were treated in Beijing Chao-Yang Hospital between January 2003 and December 2013. Results: The mean age of patients with RPF was 56.7 ± 14.4 years. Twenty-three patients were men and seven patients were women. Acute phase reactants were elevated in most patients. Rheumatic factor was positive in 4/25 (16.0% patients, and antinuclear antibody was positive in 6/22 (27.3% patients. Elevation of IgG4 was observed in 9/22 (40.9% patients. The most common type was I + III (n = 13, followed by I + II + III (n = 12. Five patients undertook an 18 F-fluoro-deoxy-D-glucose positron emission tomography examination and increased uptake was detected in four patients. Eight patients received combination therapy with glucocorticoids and tamoxifen. Surgical intervention treatments included intraureteral double-J stent implantation (n = 26, percutaneous nephrostomy (n = 2, open ureterolysis and intraperitonealization of the ureters (n = 5 and laparoscopic ureterolysis and intraperitonealization of the ureters (n = 5. Three patients underwent hemodialysis because of renal failure. Conclusions: Clinical characteristics of RPF patients in our study are similar to those previously reported. Steroids and immunosuppressive therapy combined with ureterolysis could be a viable choice of treatment for RPF. More prospective, multi-center studies with a longer follow-up are warranted.

  4. Isolated Retroperitoneal Hydatid Cyst Invading Splenic Hilum

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    Safak Ozturk

    2014-01-01

    Full Text Available Introduction. Hydatid disease (HD is an infestation that is caused by the larval stage of Echinococcus granulosus. The liver is affected in approximately two-thirds of patients, the lungs in 25%, and other organs in a small proportion. Primary retroperitoneal hydatid cyst is extremely rare. The most common complaint is abdominal pain; however, the clinical features of HD may be generally dependent on the location of the cyst. Case Presentation. A 43-year-old female was admitted with the complaint of abdominal pain. Her physical examination was normal. Computed tomography (CT revealed a 17 × 11 cm cystic lesion, with a thick and smooth wall that is located among the left liver lobe, diaphragm, spleen, tail of the pancreas, and transverse colon and invading the splenic hilum. Total cystectomy and splenectomy were performed. Pathological examination was reported as cyst hydatid. Discussion. Cysts in the peritoneal cavity are mainly the result of the spontaneous or traumatic rupture of concomitant hepatic cysts or surgical inoculation of a hepatic cyst. Serological tests contribute to diagnosis. In symptomatic and large hydatid peritoneal cysts, surgical resection is the only curative treatment. Total cystectomy is the gold standard. Albendazole or praziquantel is indicated for inoperable and disseminated cases. Percutaneous aspiration, injection, and reaspiration (PAIR technique is another nonsurgical option.

  5. Laparoscopic Choledochoduodenostomy.

    Science.gov (United States)

    Cuendis-Velázquez, Adolfo; E Trejo-Ávila, Mario; Rosales-Castañeda, Enrique; Cárdenas-Lailson, Eduardo; E Rojano-Rodríguez, Martin; Romero-Loera, Sujey; A Sanjuan-Martínez, Carlos; Moreno-Portillo, Mucio

    Today's options for biliary bypass procedures, for difficult choledocholithiasis, range from open surgery to laparo-endoscopic hybrid procedures. The aim of this study was to analyze the outcomes of patients with difficult choledocholithiasis treated with laparoscopic choledochoduodenostomy. We performed a prospective observational study from March 2011 to June 2016. We included patients with difficult common bile duct stones (recurrent or unresolved by ERCP) in which a biliary bypass procedure was required. We performed a laparoscopic bile duct exploration with choledochoduodenostomy and intraoperative cholangioscopy. A total of 19 patients were included. We found female predominance (78.9%), advanced mean age (72.4±12 years) and multiple comorbidities. Most patients with previous episodes of choledocholitiasis or cholangitis, mode 1 (min-max: 1-7). Mean common bile duct diameter 24.9±7mm. Mean operative time 218.5±74min, estimated blood loss 150 (30-600)mL, resume of oral intake 3.2±1 days, postoperative length of stay 4.9±2 days. We found a median of 18 (12-32) months of follow-up. All patients with normalization of liver enzymes during follow-up. One patient presented with sump syndrome and one patient died due to nosocomial pneumonia. Laparoscopic choledochoduodenostomy with intraoperative cholangioscopy seems to be safe and effective treatment for patients with difficult common bile duct stones no resolved by endoscopic procedures. This procedure is a good option for patients with advanced age and multiple comorbidities. We offer all the advantages of minimally invasive surgery to these patients. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Guided fine needle aspiration cytology of retroperitoneal masses - Our experience

    Directory of Open Access Journals (Sweden)

    Mimi Gangopadhyay

    2011-01-01

    Full Text Available Background : Early pathological classification of retroperitoneal masses is important for pin-point diagnosis and timely management. Aims : This study was done to evaluate the usefulness and drawbacks of guided fine needle aspiration cytology (FNAC of retroperitoneal masses covering a period of two years with an intention to distinguish between neoplastic and non-neoplastic lesions and to correlate with histologic findings. Materials and Methods : FNAC was done under radiological guidance in all cases using long needle fitted with disposable syringe. Appropriate staining was done and cytology was correlated with histology which was taken as the gold standard for comparison. Results : Fifty-one patients who presented with retroperitoneal masses were studied. Forty-four lesions were malignant cytologically and 7 were inflammatory (tuberculous. According to radiological and cytologic findings, we classified our cases into four groups: renal tumors, retroperitoneal lymphadenopathy, germ cell tumors, soft tissue tumors. Except for cases of non-Hodgkin lymphoma (NHL and metastatic lesions, we had sensitivity and specificity of 100%. In NHL the sensitivity and specificity were both 50%. In cases of metastatic adenocarcinoma, the sensitivity and specificity were 84.6% and 81.8%, respectively. Conclusions : Ignoring the pitfalls, guided FNAC is still an inexpensive and reliable method of early diagnosis of retroperitoneal lesions.

  7. First case report of retroperitoneal metastasis of fascioliasis after surgery

    Science.gov (United States)

    Wang, Jun-Ke; Ma, Wen-Jie; Lu, Qiang; Zheng, Er-Liang; Yang, Qin; Hu, Hai-Jie; Liu, Fei; Li, Quan-Sheng; Li, Fu-Yu

    2017-01-01

    Abstract Rationale: Fascioliasis is a rare cause of liver abscesses, and its clinical course consists of hepatic phase and biliary phase. Patient concerns: We describe a 58-year-old female patient who presented with a 2-month history of intermittent fever and abdominal pain. An abdominal computed tomography (CT) revealed confluent low-density lesions in the liver. Complete surgical resection of these abscesses was performed, and postoperative pathological examination and serological tests confirmed a diagnosis of fascioliasis. However, 4 months after the surgery, follow-up CT revealed a lesion in the retroperitoneal area. Meanwhile, ultrasonography-guided percutaneous needle biopsy of the retroperitoneal lesion was performed, and a parasitic infection was suspected. Diagnoses: Retroperitoneal metastasis of hepatic phase fascioliasis. Interventions: The patient received parasitic resistance treatment with triclabendazole at a dose of 10 mg/kg/d for 2 consecutive days. Outcomes: After 2 courses of triclabendazole therapy, the retroperitoneal metastasis regressed to a minor lesion. Lessons: To the best of our knowledge, this is the first case report of retroperitoneal metastasis of fascioliasis, aimed at helping recognize the clinical features and treatment options of this rare disease. PMID:29390366

  8. First case report of retroperitoneal metastasis of fascioliasis after surgery.

    Science.gov (United States)

    Wang, Jun-Ke; Ma, Wen-Jie; Lu, Qiang; Zheng, Er-Liang; Yang, Qin; Hu, Hai-Jie; Liu, Fei; Li, Quan-Sheng; Li, Fu-Yu

    2017-12-01

    Fascioliasis is a rare cause of liver abscesses, and its clinical course consists of hepatic phase and biliary phase. We describe a 58-year-old female patient who presented with a 2-month history of intermittent fever and abdominal pain. An abdominal computed tomography (CT) revealed confluent low-density lesions in the liver. Complete surgical resection of these abscesses was performed, and postoperative pathological examination and serological tests confirmed a diagnosis of fascioliasis. However, 4 months after the surgery, follow-up CT revealed a lesion in the retroperitoneal area. Meanwhile, ultrasonography-guided percutaneous needle biopsy of the retroperitoneal lesion was performed, and a parasitic infection was suspected. Retroperitoneal metastasis of hepatic phase fascioliasis. The patient received parasitic resistance treatment with triclabendazole at a dose of 10 mg/kg/d for 2 consecutive days. After 2 courses of triclabendazole therapy, the retroperitoneal metastasis regressed to a minor lesion. To the best of our knowledge, this is the first case report of retroperitoneal metastasis of fascioliasis, aimed at helping recognize the clinical features and treatment options of this rare disease. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  9. Retroperitoneal fibrosis with pancreatic involvement – radiological appearance

    International Nuclear Information System (INIS)

    Zielonko, Joanna; Obołończyk, Łukasz

    2011-01-01

    Retroperitoneal fibrosis or Ormond’s disease is an uncommon process characterized by fibrous tissue proliferation in the retroperitoneum, usually involving the aorta, inferior vena cava and iliac vessels. Obstructive hydronephrosis is often observed due to ureteral entrapment. This report presents a case of the peripancreatic location of the disease. The role of CT and MRI in establishing diagnosis of retroperitoneal fibrosis in an atypical site is discussed. A 52-year-old woman with Hashimoto’s thyroiditis was admitted to hospital because of pain suggesting renal colic. The patient was subjected to ultrasound, CT, and MRI which did not confirm urolithiasis but revealed pancreatic infiltration. Partial pancreatectomy, left-sided adrenalectomy and splenectomy were performed. Retroperitoneal fibrosis was diagnosed in the histopathological examination. A few weeks after surgery, a complication such as pancreatitis developed. Repeat CT confirmed it and showed right hydronephrosis secondary to ureteral involvement by a mass adjacent to the common iliac artery (defined as a typical manifestation of retroperitoneal fibrosis). Nephrostomy and conservative treatment improved the clinical state of the patient. No progression of the process was observed in the follow-up examinations. Atypical retroperitoneal fibrosis remains a diagnostic challenge. Imaging techniques CT and MRI are useful tools for evaluating the extent of Ormond’s disease. An unusual distribution of the process (e.g. peripancreatic location reported in this study) requires histopathological assessment to establish the final diagnosis

  10. Laparoscopic Splenectomy

    International Nuclear Information System (INIS)

    Javed, I.; Malik, A. A.; Khan, A.; Shamim, R.; Allahnawaz, A.; Ayaaz, M.

    2014-01-01

    Patients undergoing laparoscopic splenectomy were observed for their postoperative recovery and development of complications. It was a retrospective analysis done at Services Hospital and National Hospital and Medical Center, Lahore, from January 2010 to December 2012. A total of 13 patients underwent laparoscopic splenectomy and were included in the study. Patients were followed for their postoperative recovery and development of any complications. The median age of patients was 19 years ranging from 13 to 69 years. Accessory spleens were removed in 3 patients. Mean operating time was 158 minutes. One operation had to be converted to open because of uncontrolled hemorrhage. Six patients experienced postoperative complications including unexplained hyperpyrexia (n=2), pleural effusion (n=4) and prolonged pain > 48 hours (n=1). No deaths or infections were seen. Seven out of 8 patients with idiopathic thrombocytopenic purpura developed a positive immediate response to the splenectomy, defined as a platelet count greater than 100 x 109/L after the surgery, which was maintained without medical therapy. Mean hospital stay was 5.5 days. Average time to return to activity was 15 days. All patients were followed for 6 months and no follow-up complications were noted. (author)

  11. A Retroperitoneal Isolated Enteric Duplication Cyst Mimicking a Teratoma: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Daichi Momosaka

    2016-01-01

    Full Text Available Enteric duplication cysts lacking anatomic association with the gastrointestinal tract are called isolated enteric duplication cysts (IEDCs. We present an atypical case of a retroperitoneal IEDC with a tortuous tubular complex shape that enfolded the surrounding retroperitoneal fat and mimicked a retroperitoneal teratoma. Multiplanar reconstruction images should be used to evaluate such a lesion correctly. A tortuous tubular complex shape could be a key finding to differentiate from other retroperitoneal cysts.

  12. Retroperitoneal fibrosis: the clinical and radiological manifestation

    International Nuclear Information System (INIS)

    Pan Weidong; Zhao Rongguo; Qin Mingwei; Xue Huadan; Liang Jixiang

    2005-01-01

    Objective: To analyze the clinical and radiological features of retroperitoneal fibrosis (RPF), and to deepen the understanding of this unusual disease and improve the diagnostic level at the early stage. Methods: Fourteen cases (10 males and 4 females, mean age 45.8 years) of pathologically diagnosed RPF from January 1990 to June 2004 were summarized. The clinical and radiological performance of the cases were analyzed. All patients received non-contrast CT scanning, 10 of them underwent enhanced CT scanning as well. 8 patients received MRI, 10 patients received IVP examination, and 11 received B-ultrasound. Results: (1) The very first symptoms usually included back pain, bellyache (10 cases), or urinary tract obstruction (3 cases), with increase of ESR, IgG, CRP value and abnormal renal function. (2) The result of radiological examination showed that 11 lesions of the 14 cases located at retroperitoneum. Ten cases were mass type and 4 cases were diffuse type. Non-contrast CT scanning revealed soft tissue mass at retroperitoneum with in homogenous or homogenous density. After contrast medium injection the lesions were enhanced with different extent. MRI results showed that the lesions presented low signal in T 1 WI, while in T 2 WI the signals had no obvious coherence but were different from one case to another. Conclusion: Radiological examination is one of the important methods for diagnosis of RPF. Based on the different characteristics of RPF in CT and MRI, together with the clinical findings, we will get valuable references for staging and follow-up of RPF. (authors)

  13. Renal fascial network in retroperitoneal extension of pathologic processes

    International Nuclear Information System (INIS)

    Raptopoulos, V.; Kleinman, P.K.; Marks, S.C. Jr.; Davidoff, A.

    1987-01-01

    The concept of the fascial network emerged after careful analysis of CT scans of 100 patients with a variety of retroperitoneal abnormalities, and after correlation of CT scans and anatomic dissections performed on eight unembalmed cadavers in which different-colored barium-mixed liquid latex was injected in various retroperitoneal compartments. Fat lobules are supported and connected with each other by surrounding thin layers of connective tissue. Thicker connective tissue lamellae (septa) connect and support organs and fascia. Thus, a fascial network infrastructure exists in which fat lobules act as mechanical barriers to the spread of pathologic processes, while these processes tend to take the course of least resistance by spreading along or dissecting within fascial and septal planes. The fascial network acts as a roadway, conduit, and barrier to spread in the retroperitoneum and fatty tissue in general. The insights afforded by the fascial network concept unwind the traditional views regarding the dynamics of retroperitoneal pathology

  14. Percutaneous Radiofrequency Ablation for Treatment of Recurrent Retroperitoneal Liposarcoma

    International Nuclear Information System (INIS)

    Keil, Sebastian; Bruners, Philipp; Brehmer, Bernhard; Mahnken, Andreas Horst

    2008-01-01

    Percutaneous CT-guided radiofrequency ablation (RFA) is becoming more and more established in the treatment of various neoplasms, including retroperitoneal tumors of the kidneys and the adrenal glands. We report the case of RFA in a patient suffering from the third relapse of a retroperitoneal liposarcoma in the left psoas muscle. After repeated surgical resection and supportive radiation therapy of a primary retroperitoneal liposarcoma and two surgically treated recurrences, including replacement of the ureter by a fraction of the ileum, there was no option for further surgery. Thus, we considered RFA as the most suitable treatment option. Monopolar RFA was performed in a single session with a 2-cm umbrella-shaped LeVeen probe. During a 27-month follow-up period the patient remained free of tumor.

  15. The retroperitoneal interfascial planes: current overview and future perspectives.

    Science.gov (United States)

    Ishikawa, Kazuo; Nakao, Shota; Nakamuro, Makoto; Huang, Tai-Ping; Nakano, Hiroshi

    2016-07-01

    Recently, the concept of interfascial planes has become the prevalent theory among radiologists for understanding the retroperitoneal anatomy, having replaced the classic tricompartmental theory. However, it is a little known fact that the concept remains incomplete and includes embryological errors, which have been revised on the basis of our microscopic study. We believe that the concept not only provides a much clearer understanding of the retroperitoneal anatomy, but it also allows further development for diagnosis and treatment of retroperitoneal injuries and diseases, should it become an accomplished theory. We explain the history and outline of the concept of interfascial planes, correct common misunderstandings about the concept, explain the unconsciously applied therapeutic procedures based on the concept, and present future perspectives of the concept using our published and unpublished data. This knowledge could be essential to acute care physicians and surgeons sometime soon.

  16. Retroperitoneal schwannoma: diagnostic imaging findings in 5 patients

    International Nuclear Information System (INIS)

    Baltazar, Alberto; Santamarina, Mario; Scalise, Gabriela; Ponce de Leon, Valeria; Bello, Lorena

    2003-01-01

    Purpose: To evaluate the different imaging findings (US, CT and MRI) in retroperitoneal schwannoma. Materials and methods: 5 patients (3 male and 2 females) with a diagnosis of retroperitoneal schwannoma were retrospectively evaluated. Ages ranged from 33 to 63 years (means 54 years). The images (US, CT and MR) were analyzed and correlated to histopathologic results. Results: The most frequent clinical finding was abdominal pain (60%). A presumptive diagnosis prior to surgery was suggested in 3/5 cases that had well-defined masses with a predominant cystic appearance. All patients underwent surgery with tumoral resection. Only 2 patients (40%) had recurrence within a three years period of follow-up. Conclusion: Retroperitoneal schwannoma is an infrequent tumor. In our series, no pathognomotic features were observed on US, CT or MRI. However, 3/5 tumors showed high signal intensity on T2-weighted images due to cystic areas. (author)

  17. A huge renal capsular leiomyoma mimicking retroperitoneal sarcoma

    Directory of Open Access Journals (Sweden)

    Lal Anupam

    2009-01-01

    Full Text Available A huge left renal capsular leiomyoma mimicking retroperitoneal sarcoma presented in a patient as an abdominal mass. Computed tomography displayed a large heterogeneous retro-peritoneal mass in the left side of the abdomen with inferior and medial displacement as well as loss of fat plane with the left kidney. Surgical exploration revealed a capsulated mass that was tightly adherent to the left kidney; therefore, total tumor resection with radical left nephrectomy was performed. Histopathology ultimately confirmed the benign nature of the mass. This is the largest leiomyoma reported in literature to the best of our knowledge.

  18. A retroperitoneal foregut duplication cyst: a case report

    International Nuclear Information System (INIS)

    Kim, Yong Woon; Lee, Jin Hee; Byun, Kyung Hwan; Kim, Byung Ki; Sohn, Kyung Sik; Kee, Se Kook; Jeon, Jin Min; Yun, Young Kook

    2006-01-01

    Retroperitoneal foregut duplication cyst is an extremely rare congenital malformation. Pathologically, this lesion contains both gastric mucosa and respiratory type mucosa; radiologically, it is often challenging to differentiate it from the other cystic neoplasms that present a similar appearance. We report on a case of retroperitoneal foregut duplication cyst that was lined by both gastric and pseudostratified ciliated columnar epithelium, and it was also accompanied by a pancreatic pseudocyst. Initially, it presented with peripancreatic and intrapancreatic cystic masses in an asymptomatic 30-year-old man, and this man has since undergone surgical resection

  19. Computerized tomography anatomy of the kidneys and retroperitoneal space

    International Nuclear Information System (INIS)

    Savchenko, A.P.; Mamaev, V.V.; Pkhakadze, Eh.G.

    1989-01-01

    The authors described the anatomy of the kidneys and retroperitoneal space in health on the basis of computerized tomography (CT) of 90 patients. Five typical levels in CT (ensuring all necessary data on roentgenomorphological trains of the kidneys and retroperitoneal space in the kidney area) were singled out. Some roentgenometric data on kidney cross-sections as well as the quantitative densitometric characterization of the parenchyma of the kidneys, renal sinus and adjacent tissues were presented. X-ray anatomy of the renal fiscia, pararenal space and perirenal fatty space of the kidney with different parts of the tetroperitoneal space was described

  20. Urological laparoscopic surgery: Our experience of first 100 cases in Dicle University

    Directory of Open Access Journals (Sweden)

    Ahmet Ali Sancaktutar

    2012-03-01

    Full Text Available Objectives: In this study the experience and results of first100 laparoscopic surgery is presented.Materials and methods: The laparoscopic surgical operationswere reviewed between July 2010 and October 2011,retrospectively.Results: During a year period we performed of 100 laparoscopicinterventions. The ratio of male to female and themean age was 57/43 and 48,65±8,94 years respectively.The kind of operation and total numbers were like this: simplenephrectomy 34, radical nephrektomy 22, renal cyst excision21, orchiectomy 7, ureterolitotomy 4, adrenalectomy 4,orchiopexy 3, pyeloplasti 2, nefroureterectomy+cystectomy1, nefroureterectomy+partial cystectomy 1 nefroureterectomy1 patient.Transperitoneal approach was used for 91 patients whileretroperitoneal approach was used to 9 patients. The operationwas completed by open surgical interventions foronly 6 of 100 patients. The reason for open proceduresduring laparoscopy was not reaching to renal pedicles forthree patients, adhesions to pararenal tissue and colonfor 2 patients and splenic artery injury for 1 patient. Threepatients needed blood transfusions. Except these patientsthere wasn’t any complications and mortalities. When performingright nephrectomy and adrenalectomy the fourthport was used to ecartate liver. Except these cases in alloperations 3 ports was used. The mean hospitalizationstay was 1,7(1-8 days. The operation times of mostlyperformed operations were like these minute (interval:simple nephrectomy 95 (70-135, radical nephrectomy 148(125-190, renal cyst excision 45 (20-80, orchiectomy 41(30-45, ureterolithotomy 104 (95-135, orchiopexy 85 (80-100, adrenalectomy 148 (110-180, pyeloplasty 170 (160-180 nefroureterectomy 150 minutes.Conclusions: The results, success and complication ratesof laparoscopic operations which are performed in our clinicswere found as similar to literature. The laparoscopicsurgery is alternative to open surgery that it can be usedsafely and effectively. J Clin

  1. Laparoscopic Spleen Removal (Splenectomy)

    Science.gov (United States)

    ... Affairs and Humanitarian Efforts Login Laparoscopic Spleen Removal (Splenectomy) Patient Information from SAGES Download PDF Find a ... are suspected. What are the Advantages of Laparoscopic Splenectomy? Individual results may vary depending on your overall ...

  2. Retroperitoneal ectopic pregnancy: a case report and review of the literature.

    Science.gov (United States)

    Yang, Man; Cidan, Lamu; Zhang, Dan

    2017-10-16

    Retroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy, with a total of less than 20 cases reported in the English literature. However, failure to recognize REP may result in severe consequences. We report a case of 32-year-old woman with REP. She had amenorrhea, left lower abdominal pain, but no vaginal bleeding. Her urine human chorionic gonadotropin (HCG) test was positive and blood HCG level was 1880 m-international units per milliliter (mIU/mL). Transvaginal ultrasound sonography showed a left adnexal mass. Laparoscopy found an enlarged uterus, normal right uterine tube and ovary, and normal left uterine tube. The left ovary was partly covered by a blood clot, but appeared normal after removing the clot. There was a 10-mm circular peritoneal defect located lateral to the left sacrocervical ligament, anterior to the left ovarian fossa, and next to the lower edge of the left broad ligament. The patient was diagnosed of having REP with the gestational tissues covered by the peritoneum. The REP was removed by laparoscopic surgery. Bleeding was stopped by bipolar coagulation and absorbable hemostatic cellulose. The patient recovered smoothly and was discharged on the next day after surgery. Her blood HCG returned to normal range 29 days after surgery. REP is very rare, but in any suspected case of ectopic pregnancy, caution must be paid to find signs of REP when the common sites of ectopic pregnancy do not have any positive findings.

  3. Castleman's disease imitating adrenal mass in the retroperitoneal area.

    Science.gov (United States)

    Koç, Gökhan; Turk, Hakan; Un, Sıtkı; Isoglu, Cemal Selcuk; Zorlu, Ferruh

    2015-01-01

    Castleman's disease (CD) is a non-clonal lymph node hyperplasia, mostly seen in the mediastinum. It has various clinical and pathological outcomes. There are different treatments because of its rare occurance and heterogenity. We present 2 cases which were referred to our clinic as retroperitoneal mass and diagnosed as CD after surgical resection.

  4. Robotic retroperitoneal partial nephrectomy: a step-by-step guide.

    Science.gov (United States)

    Ghani, Khurshid R; Porter, James; Menon, Mani; Rogers, Craig

    2014-08-01

    To describe a step-by-step guide for successful implementation of the retroperitoneal approach to robotic partial nephrectomy (RPN) PATIENTS AND METHODS: The patient is placed in the flank position and the table fully flexed to increase the space between the 12th rib and iliac crest. Access to the retroperitoneal space is obtained using a balloon-dilating device. Ports include a 12-mm camera port, two 8-mm robotic ports and a 12-mm assistant port placed in the anterior axillary line cephalad to the anterior superior iliac spine, and 7-8 cm caudal to the ipsilateral robotic port. Positioning and port placement strategies for successful technique include: (i) Docking robot directly over the patient's head parallel to the spine; (ii) incision for camera port ≈1.9 cm (1 fingerbreadth) above the iliac crest, lateral to the triangle of Petit; (iii) Seldinger technique insertion of kidney-shaped balloon dilator into retroperitoneal space; (iv) Maximising distance between all ports; (v) Ensuring camera arm is placed in the outer part of the 'sweet spot'. The retroperitoneal approach to RPN permits direct access to the renal hilum, no need for bowel mobilisation and excellent visualisation of posteriorly located tumours. © 2014 The Authors. BJU International © 2014 BJU International.

  5. Laparoscopic local excision and rectoanal anastomosis for rectal gastrointestinal stromal tumor: modified laparoscopic intersphincteric resection technique.

    Science.gov (United States)

    Akiyoshi, Takashi; Ueno, Masashi; Fukunaga, Yosuke; Nagayama, Satoshi; Fujimoto, Yoshiya; Konishi, Tsuyoshi; Kuroyanagi, Hiroya

    2014-07-01

    Rectal GI stromal tumor is uncommon. Local excision with free resection margins provides adequate treatment, but extended surgery such as abdominoperineal resection has been frequently performed because of technical difficulties in the confined pelvic space. We aimed to report the technical details of a new method of local excision for rectal GI stromal tumor: the modified laparoscopic intersphincteric resection technique. This study was a retrospective analysis. This study was performed at a single institute. We included 3 patients with rectal GI stromal tumor who underwent this procedure following neoadjuvant imatinib therapy. Medial-to-lateral retroperitoneal dissection was begun near the sacral promontory, and rectal dissection while preserving autonomic nerves was performed down to the pelvic floor into the anal canal without dividing the inferior mesenteric artery. Dissection between the tumor and prostate was meticulously performed under laparoscopic magnified view. Next, circumferential connection between the laparoscopic and transanal dissections was performed through a transanal approach, and the rectum was extracted through the anus. Circular full-thickness local excision of the rectum and handsewn straight rectoanal anastomosis was performed. The safety and feasibility of this procedure were the primary outcomes measured by this study. The median operative time was 180 minutes, and the median estimated blood loss was 115 mL. There were no conversions or intraoperative complications, and there was 1 postoperative intestinal obstruction that recovered with conservative therapy. All patients had negative resection margins (R0), including 1 pathological complete response. The study was limited by the small number of patients. This modified laparoscopic intersphincteric resection technique is a novel and safe method for local excision of rectal GI stromal tumors located very close to the anus (see Video, Supplemental Digital Content 1, http

  6. Mortality risk factor analysis in colonic perforation: would retroperitoneal contamination increase mortality in colonic perforation?

    Science.gov (United States)

    Yoo, Ri Na; Kye, Bong-Hyeon; Kim, Gun; Kim, Hyung Jin; Cho, Hyeon-Min

    2017-10-01

    Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.

  7. Retroperitoneal and lateral pelvic lymphadenectomy mapped by lymphoscintigraphy for rectal adenocarcinoma staging

    International Nuclear Information System (INIS)

    Quadros, C.A.; Araujo, I.; Lopes, A.

    2010-01-01

    The good prognosis of retroperitoneal and lateral pelvic lymphadenectomy has raised the question of whether total mesorectal excision is suitable for adequate staging of rectal adenocarcinoma patients. The aims of this study were to determine the accuracy of dye and probe detection of metastatic retroperitoneal and/or lateral pelvic nodes and to define the upstaging impact of retroperitoneal and lateral pelvic lymphadenectomy in rectal adenocarcinoma patients. Ninety-seven rectal adenocarcinoma patients were submitted to total mesorectal excision and retroperitoneal and lateral pelvic lymphadenectomy. Lymphoscintigraphy using technetium-99 m-phytate and patent blue was performed to detect blue and/or radioactive retroperitoneal and/or lateral pelvic nodes which were examined histopathologically and immunohistochemically with a step-sectioning technique. Mesorectal mean node count was 11.5 and retroperitoneal and/or lateral pelvic node was 11.7. Retroperitoneal and lateral pelvic lymphadenectomy identified metastases in 17.5%, upstaging 8.2%. Variables related to metastatic retroperitoneal and/or lateral pelvic nodes were the following: Stage III in total mesorectal excision specimens (P<0.04), pT3/pT4 tumors (P=0.047), high levels of carcinoembryonic antigen (P=0.014) and large tumors (P=0.03). Marker migration to retroperitoneal and/or lateral pelvic nodes occurred in 37.1%, upstaging 11.1%. The markers' accuracy in the detection of metastatic retroperitoneal and/or lateral pelvic nodes was 100%. Retroperitoneal and lateral pelvic lymphadenectomy detected an important rate of metastatic retroperitoneal and/or lateral pelvic nodes (RLPN), resulting in upstaging. When markers migrated, they were able to detect RLPN metastases. The use of markers should be improved in the identification of RLPN metastases for selective indication of retroperitoneal and lateral pelvic lymphadenectomy. (author)

  8. Primary retroperitoneal seminoma - embryology, histopathology and treatment particularities.

    Science.gov (United States)

    Gîngu, Constantin Virgil; Mihai, Mihaela; Baston, Cătălin; Crăsneanu, Mugurel Alexandru; Dick, Alexandru Vladimir; Olaru, Vlad; Sinescu, Ioanel

    2016-01-01

    Retroperitoneal seminoma is a very rare form of cancer, with embryological origin represented by primordial germ cells from the urogenital ridges left behind during the fetal development. Extragenital germ cell tumors can also occur in the mediastinum or the pineal gland. The aim of this paper is to outline the particularities and draw embryological, histopatological and treatment conclusions regarding extragonadal germ cell tumors. A 43-year-old patient without any additional pathology was admitted for anemia of unknown etiology. The clinical examination revealed through deep abdominal palpation a mass in the left flank, and normal testes. Thoraco-abdomino-pelvic computed tomography (CT) scan showed a large retroperitoneal tumor adjacent to the great vessels in the left lumbo-iliac region. The blood work revealed just a low hemoglobin and hematocrit. With the established diagnosis of retroperitoneal tumor, radical surgical removal was decided. During the surgery, we were required to dissect a large solid encapsulated tumor mass from the aorta and the common iliac artery, starting at the renal pedicle all the way to the left iliac bifurcation. The surgical access was obtained through a transperitoneal left subcostal incision prolonged pararectally. Histopathological and immunohistochemical studies revealed a seminoma of the usual type. After the histological findings, the patient's tumor markers were investigated (LDH - lactate dehydrogenase, βHCG - beta-human chorionic gonadotropin, αFP - alpha-fetoprotein), all values being within normal ranges. In addition, the left testicle was thoroughly reexamined, clinically, through ultrasound and magnetic resonance imaging (MRI) scans, and no abnormalities were observed. After the surgery, the patient followed three courses of chemotherapy (BEP - Bleomycin, Etoposide and Cisplatin). The CT scan done 24 months after surgery found no signs of local or distant tumor recurrence. The patient entered a follow-up schedule

  9. Hand-assisted laparoscopic splenectomy

    NARCIS (Netherlands)

    Bemelman, W. A.; de Wit, L. T.; Busch, O. R.; Gouma, D. J.

    2000-01-01

    Laparoscopic splenectomy is performed routinely in patients with small and moderately enlarged spleens at specialized centers. Large spleens are difficult to handle laparoscopically and hand-assisted laparoscopic splenectomy might facilitate the procedure through enhanced vascular control, easier

  10. Optimal management of primary retroperitoneal sarcoma: an update.

    Science.gov (United States)

    Miah, Aisha B; Hannay, Jonathan; Benson, Charlotte; Thway, Khin; Messiou, Christina; Hayes, Andrew J; Strauss, Dirk C

    2014-05-01

    Soft tissue sarcomas are a group of heterogeneous neoplasms with more than 50 histological subtypes exhibiting major differences in terms of pathogenesis, genetic alterations and clinical behavior. Sarcomas represent approximately 1% of malignancies with retroperitoneal sarcomas representing 10-15% of all soft tissue sarcomas. Surgery is currently the only modality which offers the chance of cure. Surgery for retroperitoneal sarcomas presents specific challenges due their location in a complex space surrounded by vital structures and visceral organs often prohibiting resection with wide margins. Furthermore, even after complete resection local recurrence is common and the leading cause of death. In this article the authors describe the initial investigations, prognostic factors and optimal surgical management. The evidence and current research as regards the role of multimodality treatment is reviewed and discussed.

  11. Left retroperitoneal hydatid cyst disease and the treatment approach

    Directory of Open Access Journals (Sweden)

    Alper Avcı

    2013-12-01

    Full Text Available Hydatid disease is one of the oldest diseases known to mankind. In 85-95% of the cases, the liver and/or the lung are involved and in only 5-15% the cyst occurs at the other sites. Echinococcal cysts are mostly found in the liver (60%-70% of cases, followed by the lungs (10%-25%, spleen, ovaries, kidneys, brain, bones and heart, but rarely elsewhere in the body. 1-3 Retroperitoneal location of hydatid cyst is encountered rarely and only occasional case reports have appeared since Lockhart and Sapinza first reported this entity in 1958. 4-6 Primary retroperitoneal hydatid cyst is extremely rare. Hydatid disease in extrahepatic locations usually remains asymptomatic unless the cyst grows and produces.

  12. Retroperitoneal Malignant Peripheral Nerve Sheath Tumour: A Rare Case Report.

    Science.gov (United States)

    Deger, Ayse Nur; Bayar, Mehmet Akif; Caydere, Muzaffer; Deger, Hakki; Tayfur, Mahir

    2015-09-01

    Malignant nerve sheath tumours (MPNST) are rare neoplasias and retroperitoneal cases are fairly rare and clinically difficult to be detected, but they are very agressive neoplasias. MPNST are frequently seen in head, neck and upper extremities. In patients with NF1; MPNST, a poor-prognostic lesion, may result from a malignant degeneration of a former plexiform neurofibroma. It is necessary to be aware of a potential malignancy in patients diagnosed with plexiform neurofibroma. We present a 21-year-old female with a diagnosis of MPNST. The patient was admited to the hospital because of a tumour in the subcutaneous region on her left buttock. The surgeon's clinical diagnosis was lipoma. After the pathological examination of biopsy specimen, the lesion was identified as "plexiform neurofibroma" and then the patient was diagnosed with Neurofibromatosis Type 1 (NF1). Simultaneously, another mass on the retroperitoneal region was identified as malignant peripheral nerve sheath tumour (MPNST).

  13. Primary retroperitoneal soft tissue sarcoma: Imaging appearances, pitfalls and diagnostic algorithm.

    Science.gov (United States)

    Messiou, C; Moskovic, E; Vanel, D; Morosi, C; Benchimol, R; Strauss, D; Miah, A; Douis, H; van Houdt, W; Bonvalot, S

    2017-07-01

    Although retroperitoneal sarcomas are rare tumours, they can be encountered by a wide variety of clinicians as they can be incidental findings on imaging or present with non specific symptoms and signs. Surgical resection can offer hope of cure and patient outcomes are improved when patients are managed in high-volume specialist centers. Failure to recognize retroperitoneal sarcomas on imaging can lead to inappropriate management in inexperienced centers. Therefore it is critical that a diagnosis of retroperitoneal sarcoma should be considered in the differential diagnosis of a retroperitoneal mass with prompt referral to a soft tissue sarcoma unit. In particular, the most common retroperitoneal sarcoma subtypes, liposarcoma and leiomyosarcoma, have characteristic imaging appearances which are discussed. This review therefore aims to set the context and guide clinicians through a diagnostic pathway for retroperitoneal masses in adults which arise extrinsic to the solid abdominal viscera. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Spontaneous resolution of apparent radiation associated retroperitoneal fibrosis.

    Science.gov (United States)

    Khezri, Azadeh; Berman, Howard L; Rosenstein, Elliot D; Kramer, Neil

    2011-12-01

    A 70-year-old man was diagnosed with retroperitoneal fibrosis (RPF) complicated by ureteral obstruction 4 months after finishing radiotherapy for prostate cancer. He was treated conservatively with ureteral stent placement. After 3 months, computed tomography scan of the abdomen revealed resolution of RPF without any medical or surgical interventions. Although an uncommon event, the possibility of spontaneous resolution of RPF, as demonstrated by this and previously reported cases, has led some to encourage conservative management.

  15. Retroperitoneal endodermal sinus tumor patient with palliative care needs

    Directory of Open Access Journals (Sweden)

    Surbhi Kashyap

    2016-01-01

    Full Text Available This article is a case reflection of a personal encounter on the palliative care treatment required after the removal of a complicated case of a primary extra-gonadal retro-peritoneal endodermal sinus tumor (yolk sac tumor. This reflection is from the perspective of a recently graduated MD student who spent one month with an Indian pain management and palliative care team at the Institute Rotary Cancer Hospital (IRCH, All India Institute of Medical Sciences (AIIMS, New Delhi

  16. Amyloidoma of Retroperitoneal Lymph Nodes: A Case Report

    International Nuclear Information System (INIS)

    Kim, Wee Kyoung; Song, Soon Young; Cho, On Koo; Koh, Byoung Hee; Kim, Yong Soo; Jung, Woo Kyoung; Kim, Min Yeong; Park, Moon Hyang

    2011-01-01

    Herein we report a case of retroperitoneal amyloidoma in a 56-year-old man and to describe its imaging findings and pathologic features. Abdomen computed tomography showed multiple nodular masses with amorphous calcifications in the retroperitoneum. On histologic review, these masses were composed of extensive nodular deposition of irregularly shaped amorphous eosinophilic material that was strongly positive on Congo red staining and apple green birefringence under polarizing microscopy, which is diagnostic for amyloidosis.

  17. Amyloidoma of Retroperitoneal Lymph Nodes: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Wee Kyoung; Song, Soon Young; Cho, On Koo; Koh, Byoung Hee [Dept. of Radiology, College of Medicine, Hanyang University, Seoul (Korea, Republic of); Kim, Yong Soo; Jung, Woo Kyoung; Kim, Min Yeong [Dept. of Radiology, College of Medicine, Hanyang University Guri Hospital, Guri (Korea, Republic of); Park, Moon Hyang [Dept. of Pathology, Hanyang University Hospital, College of Medicine, Seoul (Korea, Republic of)

    2011-05-15

    Herein we report a case of retroperitoneal amyloidoma in a 56-year-old man and to describe its imaging findings and pathologic features. Abdomen computed tomography showed multiple nodular masses with amorphous calcifications in the retroperitoneum. On histologic review, these masses were composed of extensive nodular deposition of irregularly shaped amorphous eosinophilic material that was strongly positive on Congo red staining and apple green birefringence under polarizing microscopy, which is diagnostic for amyloidosis.

  18. Pulmonary hyalinizing granuloma and retroperitoneal fibrosis in an adolescent

    International Nuclear Information System (INIS)

    Young, Adam S.; Binkovitz, Larry A.; Adler, Brent H.; Nicol, Kathleen K.; Rennebohm, Robert M.

    2007-01-01

    We describe a 15-year-old boy who developed pulmonary hyalinizing granuloma (PHG) and retroperitoneal fibrosis (RPF). His PHG and RPF were not associated with histoplasmosis or tuberculosis and appeared to represent idiopathic autoimmune phenomena. This is the first reported case of PHG in a pediatric patient and the fourth reported co-occurrence of PHG and RPF. The use of F-18 fluorodeoxyglucose positron emission tomography in the diagnostic and follow-up evaluation of PHG is reported. (orig.)

  19. Pulmonary hyalinizing granuloma and retroperitoneal fibrosis in an adolescent

    Energy Technology Data Exchange (ETDEWEB)

    Young, Adam S.; Binkovitz, Larry A.; Adler, Brent H. [Columbus Children' s Hospital, Children' s Radiological Institute, Columbus, OH (United States); Nicol, Kathleen K. [Columbus Children' s Hospital, Department of Pathology, Columbus, OH (United States); Rennebohm, Robert M. [Columbus Children' s Hospital, Department of Rheumatology, Columbus, OH (United States)

    2007-01-15

    We describe a 15-year-old boy who developed pulmonary hyalinizing granuloma (PHG) and retroperitoneal fibrosis (RPF). His PHG and RPF were not associated with histoplasmosis or tuberculosis and appeared to represent idiopathic autoimmune phenomena. This is the first reported case of PHG in a pediatric patient and the fourth reported co-occurrence of PHG and RPF. The use of F-18 fluorodeoxyglucose positron emission tomography in the diagnostic and follow-up evaluation of PHG is reported. (orig.)

  20. Laparoscopic splenectomy: Current concepts

    Science.gov (United States)

    Misiakos, Evangelos P; Bagias, George; Liakakos, Theodore; Machairas, Anastasios

    2017-01-01

    Since early 1990’s, when it was inaugurally introduced, laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. However some contraindications still apply. The evolution of the technology has allowed though, cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased experience of surgeons allows operative times comparable to those of an open splenectomy. In this review we discuss the indications and the contraindications of laparoscopic splenectomy. Moreover we analyze the standard and modified surgical approaches, and we evaluate the short-term and long-term outcomes. PMID:28979707

  1. Two Case Reports and Actual Treatment Approachs of Retroperitoneal Fibrosis

    Directory of Open Access Journals (Sweden)

    Eymen Gazel

    2013-06-01

    Full Text Available Retroperitoneal fibrosis (RPF is a rare disease of unclear etiology, which is characterized by a chronic non specific inflammation of the retroperitoneum. This inflammation of the retroperitoneum may entrap and obstruct retroperitoneal structures, particularly the ureters. Patients with RPF show non specific clinical symptoms, including poorly localized back pain, general malaise, weight loss, anemia, features of renal failure and occasionally, mild fever. The early symptoms are non specific and an accurate diagnosis is often achieved only subsequent to urological obstruction or the occurrence of renal failure. Although a number of scientific journals devoted to RPF are present in the litera¬ture, there is no accepted diagnostic or therapeutic strategy for this disease. However, there are several therapeutic strate¬gies which have been proven to be effective. Hereby, we reported two cases of retroperitoneal fibrosis which had similar symptoms and findings but different responses to medical treatment .We aimed to discuss challanges of RPF%u2019s diagnosis and the treatment protocol.

  2. Retroperitoneal unicentric Castleman's disease (giant lymph node hyperplasia: case report

    Directory of Open Access Journals (Sweden)

    Jaques Waisberg

    Full Text Available CONTEXT AND OBJECTIVE: Castleman's disease, or giant lymph node hyperplasia, is a rare disorder of the lymphoid tissue that causes lymph node enlargement. It is considered benign in its localized form, but aggressive in the multicentric type. The definitive diagnosis is based on postoperative pathological findings. The aim here was to describe a case of retroperitoneal unicentric Castleman's disease in the retroperitoneum. CASE REPORT: A 61-year old white male with weight loss and listlessness presented with moderate arterial hypertension and leukopenia. Abdominal tomography revealed a 5 x 4 x 5 cm oval mass of low attenuation, with inner calcification and intense enhancement on intravenous contrast, located in the retroperitoneal region, between the left kidney and the aorta, at the renal hilus. Exploratory laparotomy revealed a non-pulsatile solid oval mass situated in the retroperitoneum, adjacent to the left renal hilus. The retroperitoneal lesion was removed in its entirety. Examination of frozen samples revealed benign lymph node tissue and histopathological examination of the surgical sample revealed hyaline-vascular giant lymph node hyperplasia (Castleman's disease. The patient was discharged on the 12th day without significant events. Two months after the operation, the patient was readmitted with severe cardiac insufficiency, acute renal failure and bronchopneumonia, which progressed to acute respiratory insufficiency, sepsis and death.

  3. Extended retroperitoneal necrotizing fasciitis with genital involvement, resembling fournier gangrene.

    Science.gov (United States)

    Sugimoto, Motokazu; Matsuura, Kenji; Takayama, Hiroshi; Kayo, Munefumi; Ie, Tomotsugu

    2010-10-01

    Necrotizing fasciitis is a serious infection that originates in the subcutaneous tissues. Although many reports have been published about necrotizing infections of other anatomical sites, retroperitoneal necrotizing soft tissue infection is a rare entity that has been described in only a few case reports. The etiology and clinical course of retroperitoneal necrotizing fasciitis can be variable and it is often difficult to identify the etiology of the infective process. We report a 58-year-old man with rapidly progressive, gas-producing, necrotizing inflammation in the retroperitoneum, complicated with genital involvement resembling Fournier gangrene. The patient was managed successfully by aggressive drainage, debridement, and sequential laparotomies to track and control the extensive necrosis of the retroperitoneum and perineum, in addition to systemic care to control sepsis. After his general condition stabilized, early rectosigmoid adenocarcinoma was identified and resected curatively. He remained well at follow up, six months after discharge. In retrospect, the trigger of the disease process was unclear. Although it was believed possibly to be due to the colon lesion, adenocarcinoma of the rectosigmoid colon was identified and the patient was managed successfully. Similar to necrotizing infections at other anatomical sites, early diagnosis and timely surgical intervention and systemic antimicrobial therapy are mandatory for treating patients with retroperitoneal necrotizing fasciitis.

  4. Dedifferentiated retroperitoneal liposarcoma presenting as right inguinal hernia: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Myung; Lee, Su Lim; Ku, Young Mi [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of); Choi, Moon Hyung [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2016-01-15

    Retroperitoneal liposarcomas usually present as painless, slow-growing abdominal masses. When masses grow large enough to compress surrounding structures, symptoms may occur. Retroperitoneal liposarcoma clinically manifesting as inguinal hernia is a very rare entity; only 11 cases have been reported. Herein, we present radiographic features of a 37-year-old male with a painless palpable mass in the right groin that was identified as dedifferentiated retroperitoneal liposarcoma herniated through the right inguinal canal.

  5. Ergonomics in laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Supe Avinash

    2010-01-01

    Full Text Available Laparoscopic surgery provides patients with less painful surgery but is more demanding for the surgeon. The increased technological complexity and sometimes poorly adapted equipment have led to increased complaints of surgeon fatigue and discomfort during laparoscopic surgery. Ergonomic integration and suitable laparoscopic operating room environment are essential to improve efficiency, safety, and comfort for the operating team. Understanding ergonomics can not only make life of surgeon comfortable in the operating room but also reduce physical strains on surgeon.

  6. Comparison of open and laparoscopic pyeloplasty in ureteropelvic junction obstruction surgery: report of 49 cases.

    Science.gov (United States)

    Umari, Paolo; Lissiani, Andrea; Trombetta, Carlo; Belgrano, Emanuele

    2011-12-01

    This study aimed to evaluate laparoscopic dismembered pyeloplasty compared with open surgery and to determine whether the morbidity and outcome rates are different in each of these techniques. We report our 10-year experience with open and laparoscopic pyeloplasty at one istitution. From February 1999 to October 2010, 49 patients with ureteropelvic junction obstruction were assigned into two groups. 25 patients underwent open surgical pyeloplasty (period 1999-2010) and 24 underwent laparoscopic pyeloplasty (period 2004-2010). 25 patients undergoing open pyeloplasty had a retroperitoneal flank approach. Of the 24 laparoscopic cases 18 had a transperitoneal retrocolic access, 1 had a transperitoneal transmesocolic access and 5 had a retroperitoneal access. In all 49 cases an Anderson-Hynes dismembered pyeloplasty was used. We retrospectively compared the operative time, hospital stay, perioperative complications and follow-up of the two groups. Clinical symptoms were assessed before and after surgery, subjectively. Patients dermographic data were similar between the two groups with mean age of 42 years (range 6-78) and with a male/female ratio of 1:1.45. A crossing vessel could be identified in 37.5% (9/24) with laparoscopy vs. 32% (8/25) in open surgery. Compared with open procedures, laparoscopic procedures were associated with a longer mean operating time (274 vs 143 min), a shorter mean hospital stay (9.9 vs 15.8 day) and the perioperative complication rates were 16.7% for laparoscopic pyeloplasties and 20% for open pyeloplasties. The success rates were 90.5% for laparoscopy and 90.9% for open surgery. Average follow-up was 40.9 month for the laparoscopic group and 72.3 month for the open group. Failed procedures showed no improvement in loin pain or obstruction. The efficacy (in term of success rate and perioperative complications) of laparoscopic pyeloplasty is comparable to that of open pyeloplasty, with shorter mean hospital stay and better cosmetic results

  7. Retroperitoneal Angiomatoid Fibrous Histiocytoma Presenting as a Recurrent Spontaneous Retroperitoneal Hemorrhage in a 9-Year-Old Boy.

    Science.gov (United States)

    Slack, Jonathan C; Sanchez-Glanville, Carlos; Steele, MacGregor; Wong, Andrew L; Bründler, Marie-Anne

    2018-05-01

    Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor that typically presents in children and young adults. Occurrence outside of the extremities and the head and neck region is exceedingly rare. We report the case of a 9-year-old boy who presented with recurrent retroperitoneal hemorrhage initially thought to be a manifestation of an underlying bleeding disorder. After comprehensive diagnostic work-up, including multiple negative biopsies, the patient underwent surgical resection of an extensively hemorrhagic intramuscular mass and to date remains well. Pathologic examination confirmed AFH with EWSR1 gene rearrangement. This first documented report of an AFH in a retroperitoneal location in a child highlights the diagnostic difficulties and clinical challenges of AFH arising in an atypical location.

  8. Transperitoneal versus retroperitoneal approach for open abdominal aortic aneurysm repair in the targeted vascular National Surgical Quality Improvement Program

    NARCIS (Netherlands)

    Buck, Dominique B.; Ultee, Klaas H J; Zettervall, Sara L.; Soden, Pete A.; Darling, Jeremy; Wyers, Mark; van Herwaarden, Joost A.; Schermerhorn, Marc L.

    Objective: We sought to compare current practices in patient selection and 30-day outcomes for transperitoneal and retroperitoneal abdominal aortic aneurysm (AAA) repairs. Methods: All patients undergoing elective transperitoneal or retroperitoneal surgical repair for AAA between January 2011 and

  9. Feasibility of retroperitoneal pelvic lymph node exploration in cervix-carcinoma treated by radio-surgery association or a definitive radiotherapy

    International Nuclear Information System (INIS)

    Bolla, M.; Sarrazin, R.; Berland, E.; Schmidt, M.H.; Rolachon, I.; Salvat, J.

    1995-01-01

    From June 1980 to May 1993, 52 patients with a mean age of 49, underwent a retroperitoneal pelvic lymph node laparoscopy procedure for cervix carcinoma classified as stage IA (14), IB (12), IIA (6), IIB (14), IIIB(3), IVA (3). Two techniques were used: a retroperitoneoscopy in 16 cases and a panoramic retroperitoneal pelviscopy (PRPP) in 36 cases. The aim was to define, with a better accuracy, the pelvic lymph node status, to adapt the target volume, and to estimate the morbidity.More nodes were biopsied with PRPP than with retroperitoneoscopy (p<0.05). There was a disagreement between the conventional radiologic assessment and the histological results in 28.6%. Specificity is 100%. Intra-operative and post-surgical morbidity was equivalent in the two procedures. One grade 3 urinary late morbidity (3%) was observed among the 33 patients who underwent a pelvic external irradiation. There was no morbidity of the gastro-intestinal tract. Discussion deals with the support offered by the two laparoscopic procedures to define the pelvic lymph node status, to choose the planning target volume, and to precise the lymph node boost. (authors) 24 refs., 3 tabs

  10. Kidney fibroxanthoma (malignant fibrous xanthoma): a rare tumor and an unusual cause of retroperitoneal hemorrhage.

    Science.gov (United States)

    Witz, M; Bernheim, J; Dinbar, A; Griffel, B

    1984-06-01

    A case of kidney fibroxanthoma (malignant fibrous xanthoma, malignant variant of xanthogranuloma), a rare malignant neoplasm of kidney, is described. In addition to the typical histologic features of retroperitoneal xanthogranuloma, this tumor showed obvious pleomorphism and mitotic activity of the histiocytes. We present this case in view of the rarity of this neoplasm and the unusual presentation as massive retroperitoneal hemorrhage.

  11. A GIANT RETROPERITONEAL LIPOMA PRESENTING AS A SCIATIC HERNIA: MRI FINDINGS.

    Science.gov (United States)

    Duran, S; Cavusoglu, M; Elverici, E; Unal, T D

    2015-01-01

    Sciatic hernia is a rare condition and its clinical diagnosis is uneasy. Herniation of pelvic organs as well as of retroperitoneal neoplasm has been reported in the literature. Sciatica occurs as a result of compression of the sciatic nerve by the herniated sac. We present a case of retroperitoneal lipoma in a patient who had lower leg complaint and describe the imaging findings.

  12. A rare case of Riedel's thyroiditis, 6 years after retroperitoneal fibrosis: two diseases with one pathogenesis?

    NARCIS (Netherlands)

    de Boer, W. A.; van Coevorden, F.; Wiersinga, W. M.

    1992-01-01

    We describe a 70-yr-old female patient in whom both a retroperitoneal fibrosis and 6 years later a Riedel's thyroiditis were diagnosed. Both diseases belong to the group of fibrotic diseases called "multifocal fibrosis". Retroperitoneal fibrosis is now known to be an auto-allergic reaction to lipid

  13. Retroperitoneal Haematoma in a Patient with Dengue Haemorrhagic Fever: A Rare Case Report.

    Science.gov (United States)

    Singh, Jasminder; Singh, Harpreet; Sukhija, Gagandeep; Jagota, Ruchi; Bala, Saroj

    2016-11-01

    Dengue Haemorrhagic Fever (DHF) has diverse manifestations ranging from asymptomatic petechial skin haemorrhages to life threatening cerebral, pulmonary, gastrointestinal and genitourinary haemorrhages. However, the association of spontaneous retroperitoneal haematomas with DHF is not well documented in literature. We report a rare case of spontaneous retroperitoneal haematoma complicating DHF.

  14. Computer assisted pyeloplasty in children the retroperitoneal approach

    DEFF Research Database (Denmark)

    Olsen, L H; Jorgensen, T M

    2004-01-01

    PURPOSE: We describe the first series of computer assisted retroperitoneoscopic pyeloplasty in children using the Da Vinci Surgical System (Intuitive Surgical, Inc., Mountainview, California) with regard to setup, method, operation time, complications and preliminary outcome. The small space...... with the Da Vinci Surgical System. With the patient in a lateral semiprone position the retroperitoneal space was developed by blunt and balloon dissection. Three ports were placed for the computer assisted system and 1 for assistance. Pyeloplasty was performed with the mounted system placed behind...

  15. Laparoscopic and robotic adrenal surgery: transperitoneal approach.

    Science.gov (United States)

    Okoh, Alexis K; Berber, Eren

    2015-10-01

    Recent advances in technology and the need to decrease surgical morbidity have led a rapid progress in laparoscopic adrenalectomy (LA) over the past decade. Robotics is attractive to the surgeon owing to the 3-dimensional image quality, articulating instruments, and stable surgical platform. The safety and efficacy of robotic adrenalectomy (RA) have been demonstrated by several reports. In addition, RA has been shown to provide similar outcomes compared to LA. Development of adrenal surgery has involved the description of several surgical approaches including the anterior transperitoneal, lateral transperitoneal (LT) and posterior retroperitoneal (PR). Among these, the most frequently preferred technique is LT adrenalectomy, primarily due to the surgeon's familiarity of the operative field, wider working space and visibility. The LT technique is suitable for the resection of larger, unilateral tumors and in scenarios where conversion to an open transperitoneal approach is warranted, it offers a lesser burden. Also, the larger view of the entire abdominal cavity and excellent exposure of both adrenal glands and surrounding structures provided by the LT technique render it safe and feasible in pediatric and pregnant individuals.

  16. Laparoscopic total pancreatectomy

    Science.gov (United States)

    Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing

    2017-01-01

    Abstract Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien–Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450–540 minutes), the mean estimated blood loss was 266 mL (range 100–400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8–24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy. PMID:28099344

  17. Retroperitoneal Castleman's disease: US, CT and MRI findings

    International Nuclear Information System (INIS)

    Bonini, Claudio; Boretti, Juan J.; Villavicencio, Roberto; Oxilia, Hector; Costamagna, Cecilia; Ferrer, Jaime; Secchi, Mario

    2003-01-01

    Purpose: To describe de imaging features of this unusual localization of Castleman's disease. Materials and methods: Two patients (man: 62 years old, woman: 27 years old) with epigastric abdominal pain were studied. The physical examination was negative in the woman while in the other case a peri umbilical tumor was observed. The laboratory and the tumor markers were negative. Both patients had a history of appendectomy. US, TC and MRI were performed. After surgery the pathological examination included stain techniques with hematoxylin-eosin, Masson's techniques and PAS. Results: Retroperitoneal Castleman's disease in peri pancreatic localization (extremely rare). The US showed slight hypoechoic homogeneous lesions with clear rims. CT without contrast revealed isodense lesions and one of them presented a small calcification, the e.v. contrast CT showed a clear homogeneous reinforcement. MRI demonstrated hypointense lesions on T1, hyperintense on T2, and after the administration of gadolinium these lesions showed a marked reinforcement on the arterial phase, which persisted on the late venous phase. The differential diagnosis with pancreatic tumoral pathology was difficult. The pathological examination revealed a lymphoid angio follicular hyperplasia of hyaline vascular type. Conclusion: Retroperitoneal Castlelman's disease is a rare entity. The different imaging methods did not provide an accurate diagnosis of this entity since there are no pathognomonic features. The pathological examination was required to define the diagnosis in both reported cases. (author)

  18. Unstable patients with retroperitoneal vascular trauma: an endovascular approach.

    Science.gov (United States)

    Boufi, Mourad; Bordon, Sébastien; Dona, Bianca; Hartung, Olivier; Sarran, Anthony; Nadeau, Sébastien; Maurin, Charlotte; Alimi, Yves S

    2011-04-01

    In hemodynamically unstable patients, the management of retroperitoneal vascular trauma is both difficult and challenging. Endovascular techniques have become an alternative to surgery in several trauma centers. Between 2004 and 2006, 16 patients (nine men, mean age: 46 years, range: 19-79 years) with retroperitoneal vascular trauma and hemodynamic instability were treated using an endovascular approach. The mean injury severity score was 30.7 ± 13.1. Mean systolic blood pressure and the shock index were 74 mm Hg and 1.9, respectively. Vasopressor drugs were required in 68.7% of cases (n = 11). Injuries were attributable to road traffic accidents (n = 15) and falls (n = 1). The hemorrhage sites included the internal iliac artery or its branches (n = 12) with bilateral injury in one case, renal artery (n = 2), abdominal aorta (n = 1), and lumbar artery (n = 1). In all, 14 coil embolizations and three stent-grafts were implanted. The technical success rate was 75%, as early re-embolization was necessary in one case and three patients died during the perioperative period. Six patients died during the period of hospitalization (37.5%). No surgical conversion or major morbidity was reported. In comparison with particulates, coil ± stent-graft may provide similar efficacy with regard to survival, and thus may be a valuable solution when particulate embolization is not available or feasible. Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  19. Chronic expanding hematoma in the retroperitoneal space: a case report

    Science.gov (United States)

    2013-01-01

    Background Chronic expanding hematoma is a rare condition that develops after surgery, trauma, or injury. It can also develop at any location in the body in the absence of trauma. Clinical findings and various diagnostic imaging modalities can aid in the differential diagnosis of this condition. In general, hematomas are naturally reabsorbed and rarely cause serious problems. However, hematomas that develop slowly without a history of trauma, surgery, or bleeding disorders could be difficult to differentiate from soft tissue neoplasms. In the present case, we describe a patient, without any history or physical evidence of trauma, who exhibited a large chronic expanding hematoma in the retroperitoneal space that resulted in hydronephrosis because of the pressure exerted on the left ureter. Case presentation A 69-year-old man presented to our hospital with a swollen lesion in the left flank. A mass, 19 cm in diameter, was detected in the retroperitoneal space by computed tomography. We suspected the presence of a chronic expanding hematoma, soft tissue tumor, or left renal artery aneurysm. Surgical treatment was performed. However, postoperative histopathological examination indicated that the mass was a nonmalignant chronic expanding hematoma. No recurrence was observed during a 2-year follow-up period. Conclusion In patients without a history of trauma who present slowly growing masses, the differential diagnosis should include chronic expanding hematoma in addition to cysts and soft tissue tumors. Moreover, the use of magnetic resonance imaging and computed tomography is essential to differentiate between chronic expanding hematoma and soft tissue tumors. PMID:24237992

  20. Gallbladder removal - laparoscopic

    Science.gov (United States)

    ... Gallbladder anatomy Laparoscopic surgery - series References Jackson PG, Evans SRT. Biliary system. In: Townsend CM Jr, Beauchamp ... A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among ...

  1. Management of metastatic retroperitoneal sarcoma: a consensus approach from the Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG).

    Science.gov (United States)

    2018-04-01

    Retroperitoneal sarcoma (RPS) is a rare disease accounting for 0.1%-0.2% of all malignancies. Management of RPS is complex and requires multidisciplinary, tailored treatment strategies at all stages, but especially in the context of metastatic or multifocal recurrent disease. Due to the rarity and heterogeneity of this family of diseases, the literature to guide management is limited. The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaboration of sarcoma experts from all disciplines convened in an effort to overcome these limitations. The TARPSWG has compiled the available evidence surrounding metastatic and multifocally recurrent RPS along with expert opinion in an iterative process to generate a consensus document regarding the complex management of this disease. The objective of this document is to guide sarcoma specialists from all disciplines in the diagnosis and treatment of multifocal recurrent or metastatic RPS. All aspects of patient assessment, diagnostic processes, local and systemic treatments, and palliation are reviewed in this document, and consensus recommendations provided accordingly. Recommendations were guided by available evidence, in conjunction with expert opinion where evidence was lacking. This consensus document combines the available literature regarding the management of multifocally recurrent or metastastic RPS with the practical expertise of high-volume sarcoma centers from multiple countries. It is designed as a tool for decision making in the complex multidisciplinary management of this condition and is expected to standardize management across centers, thereby ensuring that patients receive the highest quality care.

  2. The clinical implications of variants of vena cava inferior and aorta on retroperitoneal surgery

    Directory of Open Access Journals (Sweden)

    S. V. Mukhtarulina

    2014-12-01

    Full Text Available Objective: to study variants of retroperitoneal vascular structure and its clinical implications on retroperitoneal surgery in patients with cervical cancer IA–IIB stage.Materials and methods. 101 patients who underwent paraaortic and bilateral pelvic lymphadenectomy were included in this study. 10 patients of the first group with anomalies of inferior vena cava, renal arteries and veins, common iliac vein and ovarian vessels were compared with 91 patients of the second group without anomalies.Results. Variants of major retroperitoneal vascular structure were present in 10 (9.9 % patients. Supernumerary renal arteries and veins observed in 5 (4.9 % patients; retroaortic left renal vein type I and II – in 3 (3.0 % patients. Double vena cava inferior detected in 1 (1.0 % patient. Patients with variants of retroperitoneal vascular structures hadn’t vessel injury. There was no difference in intraoperative hemorrhage, transfusion red blood cell, rate of intraoperative hemoglobin and removed paraaortic lymph nodes between the groups. Risk factors for intraoperative bleeding in patients with cervical cancer, depending on the presence or absence of anomalies of retroperitoneal vessels had no significant difference.Conclusion. Despite the fact that the variants of retroperitoneal vascular structures are rare (9.9 %, the success of retroperitoneal surgery is associated with the knowledge of vascular variations which decrease serious, life-threatening complications.

  3. Laparoscopic pancreatic cystogastrostomy.

    Science.gov (United States)

    Obermeyer, Robert J; Fisher, William E; Salameh, Jihad R; Jeyapalan, Manjula; Sweeney, John F; Brunicardi, F Charles

    2003-08-01

    The purpose of the review was to evaluate the feasibility and outcome of laparoscopic pancreatic cystogastrostomy for operative drainage of symptomatic pancreatic pseudocysts. A retrospective review of all patients who underwent laparoscopic pancreatic cystogastrostomy between June 1997 and July 2001 was performed. Data regarding etiology of pancreatitis, size of pseudocyst, operative time, complications, and pseudocyst recurrence were collected and reported as median values with ranges. Laparoscopic pancreatic cystogastrostomy was attempted in 6 patients. Pseudocyst etiology included gallstone pancreatitis (3), alcohol-induced pancreatitis (2), and post-ERCP pancreatitis (1). The cystogastrostomy was successfully performed laparoscopically in 5 of 6 patients. However, the procedure was converted to open after creation of the cystgastrostomy in 1 of these patients. There were no complications in the cases completed laparoscopically and no deaths in the entire group. No pseudocyst recurrences were observed with a median followup of 44 months (range 4-59 months). Laparoscopic pancreatic cystgastrostomy is a feasible surgical treatment of pancreatic pseudocysts with a resultant low pseudocyst recurrence rate, length of stay, and low morbidity and mortality.

  4. Laparoscopic female sterilization.

    Science.gov (United States)

    Filshie, G M

    1989-09-01

    An overview of laparoscopic sterilization techniques from a historical and practical viewpoint includes instrumentation, operative techniques, mechanical occlusive devices, anesthesia, failure rates, morbidity and mortality. Laparoscope was first reported in 1893, but was developed simultaneously in France, Great Britain, Canada and the US in the 1960s. There are smaller laparoscopes for double-puncture procedures, and larger, single-puncture laparoscopes. To use a ring or clip, a much larger operating channel, up to 8 mm is needed. Insufflating gas may be CO2, which does not support combustion, but is more uncomfortable, NO2, which is also an anesthetic, and room air often used in developing countries. Unipolar electrocautery is now rarely used, in fact most third party payers do not allow it. Bipolar cautery, thermal coagulation and laser photocoagulation are safer methods. Falope rings, Hulka-Clemens, Filshie, Bleier, Weck and Tupla clips are described and illustrated. General anesthesia, usually a short acting agent with a muscle relaxant, causes 33% of the mortality of laparoscope, often due to cardiac arrest and arrhythmias, preventable with atropine. Local anesthesia is safer and cheaper and often used in developing countries. Failure rates of the various laparoscopic tubal sterilization methods are reviewed: most result from fistula formation. Mortality and morbidity can be caused by bowel damage, injury or infection, pre- existing pelvic infection, hemorrhage, gas embolism (avoidable by the saline drip test), and other rare events.

  5. [Sacrocolpopexy - pro laparoscopic].

    Science.gov (United States)

    Hatzinger, M; Sohn, M

    2012-05-01

    Innovative techniques have a really magical attraction for physicians as well as for patients. The number of robotic-assisted procedures worldwide has almost tripled from 80,000 procedures in the year 2007 to 205,000 procedures in 2010. In the same time the total number of Da Vinci surgery systems sold climbed from 800 to 1,400. Advantages, such as three-dimensional visualization, a tremor-filter, an excellent instrument handling with 6 degrees of freedom and better ergonomics, together with aggressive marketing led to a veritable flood of new Da Vinci acquisitions in the whole world. Many just took the opportunity to introduce a new instrument to save a long learning curve and start immediately in the surgical master class.If Da Vinci sacrocolpopexy is compared with the conventional laparoscopic approach, robotic-assisted sacrocolpopexy shows a significantly longer duration of the procedure, a higher need for postoperative analgesics, much higher costs and an identical functional outcome without any advantage over the conventional laparoscopic approach. Although the use of robotic-assisted systems shows a significantly lower learning curve for laparoscopic beginners, it only shows minimal advantages for the experienced laparoscopic surgeon. Therefore it remains uncertain whether robotic-assisted surgery shows a significant advantage compared to the conventional laparoscopic surgery, especially with small reconstructive laparoscopic procedures such as sacrocolpopexy.

  6. Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy: a shift to a new golden standard?

    Science.gov (United States)

    Vrielink, O M; Wevers, K P; Kist, J W; Borel Rinkes, I H M; Hemmer, P H J; Vriens, M R; de Vries, J; Kruijff, S

    2017-08-01

    There has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the "classic" laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size. A retrospective analysis was performed on 204 laparoscopic transabdominal (UMC Groningen) and 57 retroperitoneal (UMC Utrecht) adrenalectomies between 1998 and 2013. We applied a univariate and multivariate regression analysis. Mann-Whitney and chi-squared tests were used to compare outcome variables between both approaches. Both mean operation time and median blood loss were significantly lower in the PRA group with 102.1 (SD 33.5) vs. 173.3 (SD 59.1) minutes (p < 0.001) and 0 (0-200) vs. 50 (0-1000) milliliters (p < 0.001), respectively. The shorter operation time in PRA was independent of tumor size. Complication rates were higher in the LTA (19.1%) compared to PRA (8.8%). There was no significant difference in recovery time between both approaches. Application of the PRA decreases operation time, blood loss, and complication rates compared to LTA. This might encourage institutions that use the LTA to start using PRA in patients with adrenal tumors, independent of tumor size.

  7. Preoperative radiation therapy and iododeoxyuridine for large retroperitoneal sarcomas

    International Nuclear Information System (INIS)

    Robertson, John M.; Sondak, Vernon K.; Weiss, Sharon A.; Sussman, Jeffrey J.; Chang, Alfred E.; Lawrence, Theodore S.

    1995-01-01

    Purpose: Local failure is frequent after conventional therapy for patients with retroperitoneal sarcomas. A Phase I/II multimodality approach was used, combining iododeoxyuridine (IdUrd) and radiation therapy, followed by attempted surgical resection, with the goal of improving local control. Methods and Materials: Patients with retroperitoneal sarcomas were treated with three to five consecutive cycles of treatment. Each 14-day cycle consisted of a continuous intravenous infusion of IdUrd on days 1-5, twice a day radiation therapy (1.25 Gy/fraction) on days 8-12, and a break on day 13 and 14. Surgical resection was attempted after three or five cycles. Patients resected after three cycles received an additional two cycles of treatment with radiation directed to the tumor bed. IdUrd dose was escalated in Phase I fashion (1000 mg/m 2 /day, 1333 mg/m 2 /day, and 1600 mg/m 2 /day). The median potential follow-up was 31 months. Results: Sixteen patients (13 with high grade tumors) were treated. The median maximum tumor size was 17 cm. Resection margins were negative in four patients, microscopically positive in four patients, and grossly positive in three patients. Five patients were not resected. The only grade 4 acute toxicity observed was vomiting which occurred in three patients receiving upper abdominal radiation. Postsurgical and long-term complications were rare. Median survival overall and for resected patients were 18 and 32 months, respectively. Local control was observed in three out of four patients with negative margins (9, 40+, and 51+ months), two out of four patients with microscopically positive margins (4 and 22 months), and one out of three patients with grossly positive margins (46+ months). The overall freedom from local progression was 45% at 24 months. Conclusion: Retroperitoneal sarcomas can be resected after preoperative radiation therapy and IdUrd, with encouraging local control in patients resected with negative or microscopically positive

  8. Retroperitoneal "triton" tumor. Report of a case and review of literature

    Directory of Open Access Journals (Sweden)

    Palacios Acosta José Martín

    2014-07-01

    Full Text Available The triton tumor was described in 1932 by Masson, as a peripheral nerve sheath malignancy with rabdomioblástica differentiation. The retroperitoneal location is extremely rare, only nine cases have been reported in children. The clinical picture depends on the size of the tumor and the organs involved, their retroperitoneal location is usually asymptomatic. The mainstay of treatment is the surgical excision of the tumor. We report the case of a child with retroperitoneal location of the tumor. A complete resection of it was performed. The patient had an uneventful postoperative course. He is currently under control. There is no evidence of relapse.

  9. Intra-operative haemodynamic volatility in a patient undergoing retroperitoneal cyst excision

    Directory of Open Access Journals (Sweden)

    Thrivikrama Padur Tantry

    2012-01-01

    Full Text Available Excision of a suspected retroperitoneal, duodenal duplication cyst was performed in a pre-operatively normotensive patient under combined epidural and general anaesthesia. Intraoperatively, the cystic tumour was discovered to be a retroperitoneal mass, free from duodenal or adrenal origin. Development of severe arrhythmias, ST segment changes and hypertensive spikes during cyst handling and dissection suggested the possibility of a catecholamine-secreting tumour. These were managed effectively with pharmacological agents. Subsequently, histopathology of the specimen revealed a paraganglioma. Vasoactive tumour has to be suspected in every patient undergoing anaesthesia for retroperitoneal cystic lesion.

  10. Presentation of idiopathic retroperitoneal fibrosis at a young age: A rare case report.

    Science.gov (United States)

    Minocha, Priyanka; Setia, Ankur

    2016-11-01

    Abdominal pain is a very common symptom in all age groups but retroperitoneal fibrosis is a rare differential diagnosis suspected in young patients presenting with nonspecific abdominal pain and symptoms of obstructive uropathy. Presented here is a case of a 16-year-old boy who presented with symptoms of persistent abdominal pain and a previous history of swelling in the left leg. A computed tomography (CT) scan suggested retroperitoneal fibrosis and an exploratory laparotomy and histopathological examination were performed for definitive diagnosis. This case report is intended to promote awareness of retroperitoneal fibrosis in young patients among health care providers.

  11. Encountering the Accessory Polar Renal Artery during Laparoscopic Para-Aortic Lymphadenectomy.

    Science.gov (United States)

    Lee, Won Moo; Choi, Joong Sub; Bae, Jaeman; Jung, Un Suk; Eom, Jeong Min

    2018-01-01

    A 60-year-old Korean woman underwent laparoscopic bilateral salpingo-oophorectomy and was confirmed to have high-grade serous carcinoma of both ovaries with a huge omental cake, extensive agglutinated intra-abdominal metastatic masses, extensive serosa invasion of the intestines, and mesenterial deposits. She underwent 3 cycles of neoadjuvant chemotherapy followed by laparoscopic interval debulking surgery, including hysterectomy, pelvic and para-aortic lymphadenectomy, appendectomy, partial peritonectomy, and omentectomy. We encountered the right accessory polar renal artery (APRA) during the surgery and carefully preserved the right APRA from the abdominal aorta to the right kidney (Fig. 1). Postoperative computed tomography angiography showed an intact right APRA and normal-appearing kidney (Fig. 2). The patient had adjuvant chemotherapy and is alive without disease recurrence. Because APRA is a functional end artery, it is important to preserve it during surgery to prevent ischemic damage and renal failure [1]. It is very important for the gynecologic-oncologist to have knowledge of the retroperitoneal vascular anatomy, experience in laparoscopic surgery, and an accurate surgical technique to avoid vascular injury during laparoscopic para-aortic lymphadenectomy. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

  12. Laparoscopic adrenalectomy for malignant disease – Technical feasibility and oncological results

    Directory of Open Access Journals (Sweden)

    Marcos Tobias Machado

    2007-03-01

    Full Text Available Objective: Laparoscopic resection is the gold standard for treatmentof benign adrenal lesions. Laparoscopic resection of malignant lesions,however, is controversial, and there are only limited series publishedin the literature. The aim of this study is to describe technical aspectsand oncological results of laparoscopic adrenalectomy for malignantdisease. Methods: Eight patients (five men and three womenunderwent laparoscopic adrenalectomy for primary or metastaticadrenal malignancy. The procedures were performed transperitoneallyin two cases and retroperitoneally in 6 cases. Results: The meanincision size was 5 cm (4-9 cm, the mean duration of surgery was135 minutes and the mean blood loss was 250 ml. There was onecase of postoperative pneumonia, which progressed favorably.Histopathological diagnosis was metastasis in four cases and primaryadrenal neoplasm in four cases. There were two cases of systemicrecurrence in patients with metastatic adrenal cancer which originatedfrom breast-cancer in one case and lung cancer in another case. Localrecurrence or implantations on the trocar sites were not observed.All patients with primary adrenal neoplasms and 50% of those withmetastatic lesions of the adrenal were alive at the end of the follow-upperiod. Conclusion: Treatment of adrenal malignant disease can besafely performed through videolaparoscopy in patients with primaryadenocarcinoma or adrenal gland metastasis. The prognosis dependson resectability and biological aggressiveness of the disease.

  13. Retroperitoneal extra-adrenal paraganglioma: a rare but important diagnosis.

    LENUS (Irish Health Repository)

    Ahmad, S

    2012-01-31

    BACKGROUND: Extra-adrenal paragangliomas of the retroperitonium are infrequently diagnosed. Their malignant behaviour cannot be predicted on initial clinical and histological assessment. These tumours have higher propensity for subsequent metastasis compared with pargangliomas at other sites. AIM: We aim to describe a case report of an incidental finding of left retroperitoneal paraganglioma in a young man who presented with right flank pain. We also aim to emphasize the importance of diagnosis and the malignant potential of these tumours. METHOD: Patient\\'s clinical notes, operative findings, imaging studies and laboratory investigations including histology results were reviewed. A literature search was done to look into the incidence, presentation, follow-up plan and treatment options for these tumours. CONCLUSION: Surgical resection is the only available curative option for extra-adrenal paragangliomas. Metastasis is observed years after surgery, hence long-term follow-up is required.

  14. Giant kidney worm (Dioctophyma renale) infection mimicking retroperitoneal neoplasm.

    Science.gov (United States)

    Sun, T; Turnbull, A; Lieberman, P H; Sternberg, S S

    1986-07-01

    A 50-year-old Chinese man was found by ultrasound and computed tomography to have a retroperitoneal mass in the right upper quadrant of the abdomen. At operation, a hemorrhagic cyst was detected at the upper pole of the right kidney adjacent to the adrenal gland. Microscopic examination revealed that the cyst wall was composed of granulomatous tissue loaded with eggs and cross-sections of parasites, identified as Dioctophyma renale. The eggs were characterized by a birefringent striated double wall. The presence of cross sections of adult worms of D. renale in human tissue has not been previously described. Another unique feature of this case was that the right kidney was intact, as examined grossly at laparotomy and by intravenous pyelography. Eggs were not detected in the urine.

  15. Extraosseous Multiple Myeloma with Retroperitoneal Manifestation: A Case Report

    International Nuclear Information System (INIS)

    Berdugo, Juan Oswaldo; Nieto, Sonia Janeth; Garzon, Julian Gonzalo

    2008-01-01

    This paper presents a case of a 57 years old man (patient of Hospital Militar Central of Bogota, Colombia) with weight loss and a mass in the right clavicle. Plain film radiography shows a lytic lesion in the sternum side of the clavicle. biopsy reports a plasmacytomas, radiotherapy was performed. Three years later lesions of similar characteristics within ribs and a focal lesion in left testicle were detected. The diagnosis was multiple myeloma, Chemotherapy and orquidectomy were performed. One year after, patient complained of diffuse abdominal pain and loss weight, contrast abdominal CT was performed. Computed tomography showed a left heterogeneous mass with irregular contours that involved the retroperitoneal space occupying its three compartments. Biopsy was performed and reported pleomorphicplasmocytic proliferation with nuclear enlargement and hyperchromic nuclei consistent with multiple myeloma with abdominal involvement.

  16. Retroperitoneal Paraganglioma – a rare cause of arterial hypertension

    Directory of Open Access Journals (Sweden)

    Isabel Silva

    2017-03-01

    Full Text Available Paragangliomas are rare neuroendocrine tumours, most commonly found in adults. These differ from pheochromocytomas in that their location is extra-adrenal, and they are responsible for about 1% of arterial hypertension aetiologies. We report the case of a 30-year-old female whose past medical history was unremarkable. However, her arterial hypertension led to further examination in search of secondary aetiologies, in which a retroperitoneal mass and an increase in levels of catecholamines were detected; findings that led to the final diagnosis of paraganglioma. A multidisciplinary team, whose approach was to use pharmacological alpha-adrenergic blocking agents and a surgical resection of the lesion, treated the patient. The patient is clinically well but will continue to be monitored as an outpatient, and genetic testing is being encouraged.

  17. Percutaneous embolisation of retroperitoneal bleeding from pelvic fractures

    International Nuclear Information System (INIS)

    Grabenwoeger, F.; Dock, W.; Ittner, G.; Vienna Univ.

    1989-01-01

    Pelvic fractures may lead to severe retroperitoneal bleeding. Percutaneous catheter embolisation has become an increasingly important therapeutic alternative to surgical intervention. Most studies dealing with this problem have been small and we have attempted to evaluate the method on the basis of our own experience and a review of the literature. The success rate of percutaneous embolisation appears to be about 94%. The use of blood transfusion dropped from an average of 25.7 units before embolisation to an average of 6.5 units after embolisation. In spite of this, mortality in these patients remains high at 43.3% because of the serious additional injuries. The advantages and disadvantages of various embolising materials are discussed and various techniques of percutaneous embolisation are described. (orig.) [de

  18. Differentiating retroperitoneal liposarcoma tumors with optical coherence tomography

    Science.gov (United States)

    Lev, Dina; Baranov, Stepan A.; Carbajal, Esteban F.; Young, Eric D.; Pollock, Raphael E.; Larin, Kirill V.

    2011-03-01

    Liposarcoma (LS) is a rare and heterogeneous group of malignant mesenchymal neoplasms exhibiting characteristics of adipocytic differentiation. Currently, radical surgical resection represents the most effective and widely used therapy for patients with abdominal/retroperitoneal LS, but the presence of contiguous essential organs, such as the kidney, pancreas, spleen, adrenal glands, esophagus or colon, as well as often reoccurrence of LS in A/RP calls for the enhancement of surgical techniques to minimize resection and avoid LS reoccurrences. Difficulty in detecting the margins of neoplasms due to their affinity to healthy fat tissue accounts for the high reoccurrence of LS within A/RP. Nowadays, the microscopic detection of margins is possible only by use of biopsy, and the minimization of surgical resection of healthy tissues is challenging. In this presentation we'll demonstrate the initial OCT results for the imaging and distinction of LS and normal human fat tissues and clear detection of tumor boundaries.

  19. Transformação carcinomatosa de endometriose retroperitoneal

    Directory of Open Access Journals (Sweden)

    João Augusto dos Santos Martines

    2012-08-01

    Full Text Available Os autores apresentam o caso de uma paciente de 45 anos de idade, portadora de dor abdominal crônica, sendo evidenciada massa retroperitoneal cuja biopsia por agulha revelou tratar-se de endometriose. Submetida a ooforectomia bilateral. A paciente evoluiu, durante 4 anos, sem controle do quadro álgico, com perda de peso e aumento das dimensões da massa tumoral. A exérese cirúrgica total da massa tumoral não foi possível devido às aderências às estruturas vasculares. O pós-operatóriofoi complicado com quadro séptico evoluindo a óbito. O resultado anatomopatológico fornecido pela autópsia foi de adenocarcinoma de padrão endometrióide.

  20. Current surgical treatment option, utilizing robot-assisted laparoscopic surgery in obese women with endometrial cancer: Farghalys technique

    International Nuclear Information System (INIS)

    Farghaly, S.A.

    2013-01-01

    Background: Endometrial cancer is the most prevalent cancer of the female genital tract in North America. Minimally invasive laparoscopic-assisted surgery and panniculectomy in obese women with endometrial cancer are associated with an improved lymph node count, and lower rate of incisional complications than laparotomy. Methods: Technique for robot-assisted laparoscopic surgery for obese women with endometrial cancer is detailed. Results: Robot-assisted laparoscopic surgical staging, pelvic and para-aortic lymphadenectomy and panniculectomy allow us to avoid the use of postoperative pelvic radiation which is recommended in women with histopathology high-risk findings: deep myometrial invasion or high grade histology. The procedure has the advantage of three-dimensional vision, ergonomic, intuitive control, and wristed instrument that approximate the motion of the human hand. Conclusion: Robot-assisted laparoscopic surgical staging, and panniculectomy in these patients are a safe, and effective alternative to laparoscopic, and laparotomy surgery. It is an ideal tool for performing the complex oncologic procedures encountered in endometrial cancer staging that requires delicate retroperitoneal, pelvic and para-aortic lymph node dissection, while maintaining the principles of oncologic surgery but in a minimally invasive fashion.

  1. Diffuse interstitial pulmonary infiltrate associated with retroperitoneal mass: report of two cases

    International Nuclear Information System (INIS)

    Teixeira, A.A.; Ramos, M.V.; Natal, M.R.C.

    1990-01-01

    The authors describe two cases of diffuse pulmonary interstitial infiltrate associated with retroperitoneal mass. Both patients were females and presented spontaneous pneumothorax. One of them had a typical hystological presentation of lymphangiomyomatosis and in the other on the retroperitoneal mass was classified as an angiomyolipoma. Angiomyomatosis are often associated with tuberous sclerosis and lymphangiomyomatosis. A review of the literature and the differential diagnosis are presented. (author)

  2. IVC filter limb penetration of the caval wall during retroperitoneal surgery/lymph node dissection.

    LENUS (Irish Health Repository)

    Goh, Gerard S

    2012-12-01

    Optional inferior vena cava (IVC) filters are being increasingly used for protection against pulmonary embolism in patients with deep vein thrombosis where anticoagulation is contraindicated. We describe two cases during retroperitoneal surgery where the IVC filters were found to have perforated the cava wall and were subsequently removed intra-operatively. Cava wall penetration by filter limbs poses a significant danger during retroperitoneal lymph node dissection and filters should be removed preoperatively.

  3. Primary retroperitoneal teratoma and crossed fused renal ectopia with turner's syndrome -a case report-

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yun Jung; Hong, Ki Ung [St. Francisco General Hospital, New York (United States)

    1988-02-15

    In 1938, Turner described a clinical entity in phenotype females characterized by sexual infantilism, congenital webbed neck and cubitus valgus. After then, the occurrence of renal anomalies in patients with Turner's syndrome has been recognized. Associated crossed fused renal ectopia is very rare. Primary retroperitoneal teratoma is also rare and usually during childhood. The authors report a case of primary retroperitoneal teratoma and crossed fused renal ectopia with Turner's syndrome (mosaic type). The clinical, pathological and radiographical findings are reviewed.

  4. Primary retroperitoneal teratoma and crossed fused renal ectopia with turner's syndrome -a case report-

    International Nuclear Information System (INIS)

    Kim, Yun Jung; Hong, Ki Ung

    1988-01-01

    In 1938, Turner described a clinical entity in phenotype females characterized by sexual infantilism, congenital webbed neck and cubitus valgus. After then, the occurrence of renal anomalies in patients with Turner's syndrome has been recognized. Associated crossed fused renal ectopia is very rare. Primary retroperitoneal teratoma is also rare and usually during childhood. The authors report a case of primary retroperitoneal teratoma and crossed fused renal ectopia with Turner's syndrome (mosaic type). The clinical, pathological and radiographical findings are reviewed

  5. A Case of Advanced Unicentric Retroperitoneal Castleman's Disease, Associated With Psoriasis

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Mohagheghi

    2017-05-01

    Full Text Available We present here a 32-year-old male with advanced lately diagnosed, right sided retroperitoneal mass, which had been already treated due to progressive muco-cutaneous lesions clinically consistent with psoriasis, during recent four years. The advanced retroperitoneal mass resected surgically and reported as hyaline-vascular castleman disease with a dense focus of coarse calcification, on histopathology. Association of psoriasis and castlman disease is discussed in this case report. 

  6. Extra-Gastrointestinal Stromal Tumor of Retroperitoneal Origin: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seung Joon; Kim, Hyung Sik; Park, Yul Ri; Choi, Hye Young [Dept. of Radiology, Gachon Medical Center, Gachon University of Medicine and Science, Incheon (Korea, Republic of)

    2012-03-15

    Extragastrointestinal stromal tumors (EGIST) are relatively rare, and cases originating in the retroperitoneum even rarer. We report a 60-year-old woman who presented with an EGIST originating in the retroperitoneum. Computed tomography results demonstrated a soft tissue mass on the right side of the retroperitoneum. The tumor abutted the duodenum, head of the pancreas, and right kidney. The mass was surgically proven to be a retroperitoneal tumor and histopathologically proven to be a retroperitoneal EGIST.

  7. Retroperitoneal disorders associated with IgG4-related autoimmune pancreatitis

    OpenAIRE

    Hara, Noboru; Kawaguchi, Makoto; Takeda, Keisuke; Zen, Yoh

    2014-01-01

    IgG4-related autoimmune pancreatitis is frequently accompanied by relevant lesions in the genitourinary tract and retroperitoneal organs, which cause various clinical problems, ranging from non-specific back pain or bladder outlet obstruction to renal failure. The diagnosis of IgG4-related retroperitoneal fibrosis requires a multidisciplinary approach, including serological tests, histological examination, imaging analysis, and susceptibility to steroid therapy. Radiological examinations are ...

  8. A rare case of a retroperitoneal enterogenous cyst with in-situ adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Woodland James G

    2007-10-01

    Full Text Available Abstract Background Retroperitoneal enterogenous cysts are uncommon and adenocarcinoma within such cysts is a rare complication. Case presentation We present the third described case of a retroperitoneal enterogenous cyst with adenocarcinomatous changes and only the second reported case whereby the cyst was not arising from any anatomical structure. Conclusion This case demonstrates the difficulties in making a diagnosis as well as the importance of a multi-disciplinary approach, and raises further questions regarding post-operative treatment with chemotherapy.

  9. Laparoscopic upper pole heminephroureterectomy in children: Seven-year experience

    Directory of Open Access Journals (Sweden)

    Antonio Marte

    2015-01-01

    Full Text Available Background: Minimally invasive surgery is the current approach to perform heminephroureterectomy (HN in children. This can be obtained through a transperitoneal (TP or a retroperitoneal approach. Here, we report our experience using a TP approach. Materials and Methods: From 2005 to 2014, 22 TP laparoscopic upper poles HN were performed at our institution. There were nine girls and 13 boys aged between 20 months and 6 years (mean age 3.9. Eight patients were diagnosed prenatally, 17 patients presented with urinary tract infection (UTI and three with vomiting and failure to thrive. The indication for HN was reflux nephropathy and UTI in non-functioning upper pole in 19 patients and cystic dysplasia in 1 patient. The surgical technique involved the following steps: Cystoscopic recognition; positioning of 3-4 trocar (right HN; identification of the kidney (detachment of the colon; isolation and low ligation of the dilated ureter; decrossing from renal vessels; section of the parenchyma by LigaSure; haemostasis with clips and LigaSure; drain. Results: The mean operative time was 154 min (range: 81-220 min. All patients were discharged from the 2 nd to 4 th day. Neither major complication nor conversion was recorded. 1 patient presented leakage of urine for 7 days from the drainage which resolved spontaneously. At ultrasound follow-up, 5 patients showed a secondary perirenal cyst, 2-5 cm diameter that resolved spontaneously. Conclusion: The results indicate that laparoscopic upper pole heminephrectomy is the treatment of choice in cases of non-functioning dilated lower segments of duplicated kidneys. The use of laparoscopic approach offers a good working space, a good visual control of the vessels and allows a very low isolation of the ureteral stump which counterbalance the peritoneal violation.

  10. "Knotless" laparoscopic extraperitoneal adenomectomy.

    Science.gov (United States)

    Garcia-Segui, A; Verges, A; Galán-Llopis, J A; Garcia-Tello, A; Ramón de Fata, F; Angulo, J C

    2015-03-01

    Laparoscopic adenomectomy is a feasible and effective surgical procedure. We have progressively simplified the procedure using barbed sutures and a technique we call "knotless" laparoscopic adenomectomy. We present a prospective, multicenter, descriptive study that reflects the efficacy and safety of this technique in an actual, reproducible clinical practice situation. A total of 26 patients with benign prostatic hyperplasia of considerable size (>80cc) underwent "knotless" laparoscopic adenomectomy. This is an extraperitoneal laparoscopic technique with 4 trocars based on the controlled and hemostatic enucleation of the adenoma using ultrasonic scalpels, precise urethral sectioning under direct vision assisted by a urethral plug, trigonization using barbed suture covering the posterior wall of the fascia, capsulorrhaphy with barbed suture and extraction of the morcellated adenoma through the umbilical incision. The median patient age was 69 (54-83)years, the mean prostate volume was 127 (89-245)cc, the mean operative time was 136 (90-315)min, the mean estimated bleeding volume was 200 (120-500)cc and the hospital stay was 3 (2-6)days. All patients experienced improved function in terms of uroflowmetry and International Prostate Symptom Score and quality of life questionnaires. There were complications in 6 patients, 5 of which were minor. "Knotless" laparoscopic adenomectomy is a procedure with low complexity that combines the advantages of open surgery (lasting functional results and complete extraction of the adenoma) with laparoscopic procedures (reduced bleeding and need for transfusions, shorter hospital stays and reduced morbidity and complications related to the abdominal wall). The use of ultrasonic scalpels and barbed sutures simplifies the procedure and enables a safe and hemostatic technique. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Does negative retroperitoneal CT in adolescents with paratesticular rhabdomyosarcoma preclude the need of retroperitoneal lymph node dissection?; A tomografia de retroperitoneo normal em adolescentes com rabdomiossarcoma paratesticular afasta necessidade de linfadenectomia?

    Energy Technology Data Exchange (ETDEWEB)

    Damazio, Eulalio [Hospital Lucano, Teresina (PI) (Brazil); Caran, Eliana [Instituto de Oncologia Pediatrica, Universidade Federal de Sao Paulo - UNIFESP, Sao Paulo, SP (Brazil); Ortiz, Valdemar; Macedo Junior, Antonio, E-mail: macedo.dcir@epm.br [Departamento de Urologia, Universidade Federal de Sao Paulo - UNIFESP, Sao Paulo, SP (Brazil)

    2011-07-01

    We report on a 16-year-old male with paratesticular rhabdomyosarcoma who underwent retroperitoneal lymph node dissection due to a stage I tumor (normal retroperitoneal computed tomography). The surgical finding was three enlarged nodes, positive for metastatic disease. Patient was referred to adjuvant chemotherapy. This case suggests that the Intergroup Rhabdomyosarcoma Study Group IV protocol is subject to questions regarding adolescents with paratesticular rhabdomyosarcoma, and that negative retroperitoneal CT does not preclude the need of lymph node dissection. (author)

  12. Laparoscopic adrenal cortex

    International Nuclear Information System (INIS)

    Peyrolou, A.; Salom, A.; Harguindeguy; Taroco, L.; Ardao, G.; Broli, F. . E mail: andresssss@adinet.com.uy

    2005-01-01

    The paper presents the case of a female patient who carried an aldosterone-secreting tumor of adrenal cortex.In the analysis of diagnosis and para clinical examinations there is particular reference to the laparoscopic surgery mode of treatment.Diagnosis should be established on the basis of clinical and laboratory tests (hypopotassemia and hyperaldosteronism).Tumor topography was confirmed through CT scan, MRI and Scintiscan in left adrenal cortex.Resection was consequently made through laparoscopic surgery.The patients evolution was excellent from the surgical viewpoint,with I levels of blood pressure, potassium and aldosterone returned to normal

  13. Laparoscopic Removal of Gossypiboma

    Directory of Open Access Journals (Sweden)

    Zeki Özsoy

    2015-01-01

    Full Text Available Gossypiboma is defined as a mass caused by foreign body reaction developed around the retained surgical item in the operative area. When diagnosed, it should be removed in symptomatic patients. Minimal invasive surgery should be planned for the removal of the retained item. The number of cases treated by laparoscopic approach is rare in the literature. We present a case of forty-year-old woman referred to emergency room with acute abdomen diagnosed as gossypiboma and treated successfully with laparoscopic surgery.

  14. LAPAROSCOPIC ADENOMECTOMY (PRELIMINARY RESULTS

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    A. Yu. Seroukhov

    2016-01-01

    Full Text Available Bladder outlet obstruction due to benign prostatic hyperplasia (BPH remains one of the most common problems of men in the advanced age group. Open prostatectomy for patients with large BPH is still the standard treatment recommended by the European Association of Urology and is performed quiet often. Disadvantages of this method of treatment are significant surgical trauma and high rate of perioperative complications . Laparoscopic modification of simple prostatectomy presents a worthy minimal invasive alternative to open surgical treatment of BPH. From November 2014 to December 2015, laparoscopic adenomectomy was performed for 16 patients. 7 (43.5% patients had transperitoneal (TP and 9 (56.25% patients had extraperitoneal (EP laparoscopic simple prostatectomy. None of the cases required conversion . All patients were discharged in satisfactory condition with complete restoration of free micturation. Laparoscopic prostatectomy as a method of surgical treatment for BPH can be easily reproducible. It can be adopted as a routine urological practice for large-sized BPH with the aim of minimizing operative trauma and achieving short hospital stay.

  15. Laparoscopic hemi-splenectomy

    NARCIS (Netherlands)

    de Pastena, Matteo; Nijkamp, Maarten W.; van Gulik, Thomas G.; Busch, Olivier R.; Hermanides, H. S.; Besselink, Marc G.

    2018-01-01

    Laparoscopic splenectomy is now established as a safe and feasible procedure. However, it remains associated with some short- and long-term postoperative complications, especially infectious complications. To our knowledge, this is the first report (with video) focusing on the safety and feasibility

  16. The Optimal Approach for Laparoscopic Adrenalectomy through Mono Port regarding Left or Right Sides: A Comparative Study

    Directory of Open Access Journals (Sweden)

    Wooseok Byon

    2014-01-01

    Full Text Available Introduction. Several studies have shown the feasibility and safety of both transperitoneal and posterior retroperitoneal approaches for single incision laparoscopic adrenalectomy, but none have compared the outcomes according to the left- or right-sided location of the adrenal glands. Materials and Methods. From 2009 to 2013, 89 patients who received LAMP (laparoscopic adrenalectomy through mono port were analyzed. The surgical outcomes attained using the transperitoneal approach (TPA and posterior retroperitoneal approach (PRA were analyzed and compared. Results and Discussion. On the right side, no significant differences were found between the LAMP-TPA and LAMP-PRA groups in terms of patient characteristics and clinicopathological data. However, outcomes differed in which LAMP-PRA group had a statistically significant shorter mean operative time (84.13 ± 41.47 min versus 116.84 ± 33.17 min; P=0.038, time of first oral intake (1.00 ± 0.00 days versus 1.21 ± 0.42 days; P=0.042, and length of hospitalization (2.17 ± 0.389 days versus 3.68 ± 1.38 days; P≤0.001, whereas in left-sided adrenalectomies LAMP-TPA had a statistically significant shorter mean operative time (83.85 ± 27.72 min versus 110.95 ± 29.31 min; P=0.002. Conclusions. We report that LAMP-PRA is more appropriate for right-sided laparoscopic adrenalectomies due to anatomical characteristics and better surgical outcomes. For left-sided laparoscopic adrenalectomies, however, we propose LAMP-TPA as a more suitable method.

  17. Outcomes in a series of 103 retroperitoneal sarcomas.

    Science.gov (United States)

    Pierie, J-P E N; Betensky, R A; Choudry, U; Willett, C G; Souba, W W; Ott, M J

    2006-12-01

    To report the effect on outcome of selection in patients receiving intra-operative electron beam radiation (IOERT) and external beam radiation therapy (EBRT). One hundred and three patients treated for primary RS were studied. Median follow-up was 27 months. Clinical presentation, tumor characteristics, and treatment methods were analyzed to determine impact on survival and recurrence and if selection was occurring. Mean age was 55+/-17 years. Mean tumor size was 15+/-6cm and 88 were high-grade. Complete gross tumor resection (CR) occurred in 62 patients and improved survival vs. both debulking (p=0.0005) and biopsy (p<0.0001). The 5- and 10-year survival rates were 62% and 52% for those with CR vs. 29% and 20% after incomplete resection. Among the 62 CR patients, there was selection to receive additional EBRT+/-IOERT in patients with high-grade tumors (p=0.005) and/or microscopically positive margins (p=0.011). In these high-risk patients there was a trend for IOERT to further augment survival vs. EBRT alone and to increase the time to both local and distant recurrences (p=0.036). Complete gross resection is the primary form of curative treatment for retroperitoneal sarcomas. Selection led to patients with high-risk tumors receiving additional radiation therapy. There appears to be a beneficial effect of IOERT plus EBRT in these high-risk patients after complete tumor resection.

  18. A case of retroperitoneal carcinoid tumor which was radioeffective

    International Nuclear Information System (INIS)

    Nishimura, Kazuo; Ogawa, Osamu; Yoshimura, Naoki; Nakagawa, Takashi; Takahashi, Rei; Sasaki, Miharu.

    1984-01-01

    A 51-year-old man was referred to our hospital on May, 24, 1978, with complaints of lower abdominal pain, lower abdominal mass, constipation and pollakisuria. Physical examination revealed a lower abdominal tumor which was smooth, elastic soft and of childs' head size. IVP and urethrography revealed left nonvisualizing kidney, right hydronephrosis and deformity of bladder. CT scan revealed a large intrapelvic mass. Under the diagnosis of retroperitoneal tumor, operation was done on June, 29, 1978. Adhesive changes between the tumor, sacrococcyx and left internal iliac artery was so severe that the tumor could not be resected, and only biopsy-specimen was taken. Pathohistological diagnosis of the tumor was carcinoid tumor. He received postoperative radiation therapy with total dosis of 5000 rad in 5 weeks, and complete remission was obtained. Now, more than 5 years have passed after operation, no recurrence was detected. Carcinoid tumors are rare and generally are not radioeffective, but some cases without carcinoid syndrome, including our case, are radioeffective. So radiation therapy should be the second choice of treatment for carcinoid tumor. (author)

  19. [Clinical spectrum of patients with spontaneous retroperitoneal hematomas].

    Science.gov (United States)

    Sánchez-González, Amada; Riancho-Zarrabeitia, Leyre; Salmón-González, Zaida; Riancho, José Antonio; Valero, Carmen

    2015-10-05

    Spontaneous retroperitoneal hematoma (SRH) is a potentially fatal clinical entity requiring immediate recognition and intervention. The clinical records of 18-year-old and older patients admitted to the University Hospital Marqués de Valdecilla from 2003 to 2013 were reviewed. "Spontaneous" was defined as unrelated to trauma, invasive procedures or bleeding due to aortic aneurysm rupture. Thirty-four patients with SRH (44% were on anticoagulant drugs). One-third of cases had chronic renal insufficiency. Abdominal pain was the most common symptom both in anticoagulated and non-anticoagulated patients (80% in anticoagulated and 89% in non-anticoagulated patients). About one half of the patients developed shock. A CT scan was the most commonly performed diagnostic test, followed by abdominal ultrasound. Most cases were managed conservatively (80%). More than half of the patients (66%) restarted anticoagulation therapy after the acute event with a mean delay of 19 days (range 2-90 days). None of them suffered a new bleeding episode. Restarting the anticoagulation treatment after hematoma resolution seems to be a safe practice. There is an increasing frequency of SRH in non-anticoagulated patients. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  20. Massive retroperitoneal haemorrhage after extracorporeal shock wave lithotripsy (ESWL).

    Science.gov (United States)

    Inoue, Hiromasa; Kamphausen, Thomas; Bajanowski, Thomas; Trübner, Kurt

    2011-01-01

    A 76-year-old male suffering from nephrolithiasis developed a shock syndrome 5 days after extracorporal shock wave lithotripsy (ESWL). CT scan of the abdomen showed massive haemorrhage around the right kidney. Although nephrectomy was performed immediately, the haemorrhage could not be controlled. Numerous units of erythrocytes were transfused, but the patient died. The autopsy revealed massive retroperitoneal haemorrhage around the right kidney. The kidney showed a subcapsular haematoma and a rupture of the capsule. The right renal artery was dissected. The inferior vena cava was lacerated. Accordingly, a hemorrhagic shock as the cause of death was determined, which might mainly have resulted from the laceration of the inferior vena cava due to ESWL. ESWL seems to be a relatively non-invasive modality, but one of its severe complications is perirenal hematoma. The injuries of the blood vessels might have been caused by excessive shock waves. Subsequently, anticoagulation therapy had been resumed 3 days after EWSL, which might have triggered the haemorrhage. Physicians should note that a haemorrhage after an ESWL can occur and they should pay attention to the postoperative management in aged individuals especially when they are under anticoagulation therapy.

  1. Type IV Ehlers-Danlos Syndrome: A Surgical Emergency? A Case of Massive Retroperitoneal Hemorrhage

    Science.gov (United States)

    Chun, Stephen G; Pedro, Patrick; Yu, Mihae; Takanishi, Danny M

    2011-01-01

    Retroperitoneal hemorrhagic bleeding is a known manifestation of Type-IV Ehlers-Danlos Syndrome that is caused by loss-of-function mutations of the pro-alpha-1 chains of type III pro-collagen (COL3A1) resulting in vascular fragility. A number of previous reports describe futile surgical intervention for retroperitoneal bleeding in Type-IV Ehlers-Danlos Syndrome with high post-operative mortality, although the rarity of retroperitoneal bleeding associated with Type-IV Ehlers-Danlos Syndrome precludes an evidence-based approach to clinical management. We report a 23-year-old male with history of Type-IV Ehlers-Danlos Syndrome who presented with severe abdominal pain and tachycardia following an episode of vomiting. Further work-up of his abdominal pain revealed massive retroperitoneal bleeding by CT-scan of the abdomen. Given numerous cases of catastrophic injury caused by surgical intervention in Type-IV Ehlers-Danlos Syndrome, the patient was treated non-operatively, and the patient made a full recovery. This case suggests that even in cases of large retroperitoneal hemorrhages associated with Ehlers-Danlos Syndrome, it may not truly represent a surgical emergency. PMID:21966332

  2. A rare life-threatening disease: unilateral kidney compressed by huge chronic spontaneous retroperitoneal hemorrhage

    Directory of Open Access Journals (Sweden)

    Lu HY

    2018-03-01

    Full Text Available Hao-Yuan Lu,1,* Wei Wei,2,* Qi-Wei Chen,1,* Qing-Gui Meng,1 Gao-Hua Hu,1 Xian-Lin Yi,1,3 Xian-Zhong Bai1 1Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021, China; 2Department of Radiology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021,China; 3Hubei Engineering Laboratory for Synthetic Microbiology, Wuhan Institute of Biotechnology, Wuhan 430075, China *These authors contributed equally to this work Objectives: To study an uncommon life-threatening disease, spontaneous retroperitoneal and perirenal hemorrhage. Case descriptions: A 69-year-old male presented with pain in the left waist and back of 1 month duration. The renal abscess was suspected by magnetic resonance imaging before operation. The perirenal hematoma was cleaned by operation. In another case, the patient had a functional solitary left kidney compressed by a huge retroperitoneal mass and uropenia appeared. Results: The first patient died of adult respiratory distress syndrome after surgery. The second patient died of cardiac insufficiency and pulmonary embolism on the second day after evacuation of retroperitoneal hematoma. Conclusion: Conservative surgery, such as selective arterial embolization, is a reasonable approach in patients with chronic spontaneous retroperitoneal and perirenal space hemorrhage and with poor general condition. We strongly recommend drainage or interventional therapy, but not a major surgery, in patients with poor condition. Keywords: kidney, spontaneous, retroperitoneal, hemorrhage, surgery

  3. Virtual reality in laparoscopic surgery.

    Science.gov (United States)

    Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg

    2004-01-01

    Although the many advantages of laparoscopic surgery have made it an established technique, training in laparoscopic surgery posed problems not encountered in conventional surgical training. Virtual reality simulators open up new perspectives for training in laparoscopic surgery. Under realistic conditions in real time, trainees can tailor their sessions with the VR simulator to suit their needs and goals, and can repeat exercises as often as they wish. VR simulators reduce the number of experimental animals needed for training purposes and are suited to the pursuit of research in laparoscopic surgery.

  4. Single access laparoscopic nephrectomy

    Directory of Open Access Journals (Sweden)

    Jay D Raman

    2008-01-01

    Full Text Available Laparoscopic nephrectomy has assumed a central role in the management of benign and malignant kidney diseases. While laparoscopy is less morbid than open surgery, it still requires several incisions each at least 1-2 cm in length. Each incision carries morbidity risks of bleeding, hernia and/or internal organ damage, and incrementally decreases cosmesis. An alternative to conventional laparoscopy is single access or keyhole surgery, which utilizes magnetic anchoring and guidance system (MAGS technology or articulating laparoscopic instruments. These technical innovations obviate the need to externally space trocars for triangulation, thus allowing for the creation of a small, solitary portal of entry into the abdomen. Laboratory and early clinical series demonstrate feasibility as well as safe and successful completion of keyhole nephrectomy. Future work is necessary to improve existing instrumentation, increase clinical experience, assess benefits of this surgical approach, and explore other potential applications for this technique.

  5. Hernia inguinal laparoscopic surgery

    International Nuclear Information System (INIS)

    Morelli Brum, R. . E mail: raulmorelli@hotmail.com

    2005-01-01

    The purpose of this paper is to enhance treatment of inguinal hernia through a bibliographic study of its main complications and the analysis of a retrospective series of laparoscopic restorations performed by the author in the same private medical care center. From December 1994 through July 2003, ninety-nine patients were operated in 108 procedures.The technique employed was trans-abdominal peritoneal (TAPP)Follow-up covered over 2 years in 80% of patients with a relapse of 2.8%. Main morbidity was neuralgia due to a nerve being trapped, which fact required re-intervention.There was no mortality.The conclusion arrived at is that it is and excellent technique which requires a long learning curve and its main indication would be relapse of conventional surgery, bilateralism, coexistence with another laparoscopic abdominal pathology and doubts concerning contra lateral hernia

  6. Effect of early adrenal vein ligation on blood pressure and catecholeamine fluctuation during laparoscopic adrenalectomy for pheochromocytoma.

    Science.gov (United States)

    Wu, Guojun; Zhang, Bo; Yu, Chuigong; Gao, Lei; Gao, Yang; Huang, Yi; Yu, Lei; Zhang, Geng; Yang, Lijun; Yuan, Jianlin

    2013-09-01

    To define whether previous control of the adrenal vein is a crucial procedure in laparoscopic adrenalectomy for pheochromocytoma. From January 2000 to December 2010, 114 patients with pheochromocytoma who underwent laparoscopic adrenalectomy through transperitoneal or retroperitoneal approach were included. The patients were divided into 2 groups randomly (group 1: dissection after ligation; group 2: dissection before ligation). Blood samples for the measurement of catecholamines levels using high performance liquid chromatography were taken at the following time points: t1, before anesthesia; t2, during manipulation-extraction of pheochromocytoma; t3, after removal of pheochromocytoma. The blood pressure fluctuation was recorded. Laparoscopic adrenalectomy was successfully performed on 113 patients with 1 elective open conversion because of dense peritumor adhesions. The operating time ranged from 80 to 150 minutes (mean 108, 102 in group 1, 110 in group 2). Mean blood loss ranged from 20 to 500 mL (mean 120 mL, 110 in group 1, 125 in group 2). The concentrations of plasma catecholamines between the 2 groups had no statistical differences. The blood pressure fluctuation incidence between the 2 groups had no marked difference. But the incidence increased with high functionary grade, and the difference was significant (P = .043). This study demonstrated that previous control of the adrenal vein was not a determinate factor in dealing with dangerous hypertension during laparoscopic adrenalectomies. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Leiomyosarcoma, embrionary rhabdomyosarcoma and malignant peripheral nerve sheath tumor: report of three cases of atypical retroperitoneal sarcomas

    International Nuclear Information System (INIS)

    Catalan, Julian; Justino Junior, Reinaldo Ottero; Tjioe Tjia Min; Lima, Ana Carolina Mori; Fonte, Alexandre Calabria da; Goncalves, Carlos Marcelo

    2005-01-01

    We report three cases of atypical retroperitoneal sarcomas: leiomyosarcoma, embrionary rhabdomyosarcoma and malignant peripheral nerve sheath tumor (previously known as neuro sarcoma and neuro fibrosarcoma). These lesions, which are characterized by large and heterogeneous retroperitoneal masses, are uncommon and usually diagnosed late. Intravenous contrast enhanced computerized tomography is a useful method for the evaluation of these tumors and their relationship with adjacent structures. (author)

  8. Laparoscopic specimen retrieval bags.

    Science.gov (United States)

    Smorgick, Noam

    2014-10-01

    Specimen retrieval bags have long been used in laparoscopic gynecologic surgery for contained removal of adnexal cysts and masses. More recently, the concerns regarding spread of malignant cells during mechanical morcellation of myoma have led to an additional use of specimen retrieval bags for contained "in-bag" morcellation. This review will discuss the indications for use retrieval bags in gynecologic endoscopy, and describe the different specimen bags available to date.

  9. Peritonitis: laparoscopic approach

    Directory of Open Access Journals (Sweden)

    Agresta Ferdinando

    2006-03-01

    Full Text Available Abstract Background Laparoscopy has became as the preferred surgical approach to a number of different diseases because it allows a correct diagnosis and treatment at the same time. In abdominal emergencies, both components of treatment – exploration to identify the causative pathology and performance of an appropriate operation – can often be accomplished via laparoscopy. There is still a debate of peritonitis as a contraindication to this kind of approach. Aim of the present work is to illustrate retrospectively the results of a case-control experience of laparoscopic vs. open surgery for abdominal peritonitis emergencies carried out at our institution. Methods From January 1992 and January 2002 a total of 935 patients (mean age 42.3 ± 17.2 years underwent emergent and/or urgent surgery. Among them, 602 (64.3% were operated on laparoscopically (of whom 112 -18.7% – with peritonitis, according to the presence of a surgical team trained in laparoscopy. Patients with a history of malignancy, more than two previous major abdominal surgeries or massive bowel distension were not treated Laparoscopically. Peritonitis was not considered contraindication to Laparoscopy. Results The conversion rate was 23.2% in patients with peritonitis and was mainly due to the presence of dense intra-abdominal adhesions. Major complications ranged as high as 5.3% with a postoperative mortality of 1.7%. A definitive diagnosis was accomplished in 85.7% (96 pat. of cases, and 90.6% (87 of these patients were treated successfully by Laparoscopy. Conclusion Even if limited by its retrospective feature, the present experience let us to consider the Laparoscopic approach to abdominal peritonitis emergencies a safe and effective as conventional surgery, with a higher diagnostic yield and allows for lesser trauma and a more rapid postoperative recovery. Such features make Laparoscopy a challenging alternative to open surgery in the management algorithm for abdominal

  10. Laparoscopic liver resection assisted by the laparoscopic Habib Sealer.

    Science.gov (United States)

    Jiao, Long R; Ayav, Ahmet; Navarra, Giuseppe; Sommerville, Craig; Pai, Madhava; Damrah, Osama; Khorsandi, Shrin; Habib, Nagy A

    2008-11-01

    Radiofrequency has been used as a tool for liver resection since 2002. A new laparoscopic device is reported in this article that assists liver resection laparoscopically. From October 2006 to the present, patients suitable for liver resection were assessed carefully for laparoscopic resection with the laparoscopic Habib Sealer (LHS). Detailed data of patients resected laparoscopically with this device were collected prospectively and analyzed. In all, 28 patients underwent attempted laparoscopic liver resection. Four cases had to be converted to an open approach because of extensive adhesions from previous colonic operations. Twenty-four patients completed the procedure comprising tumorectomy (n = 7), multiple tumoretcomies (n = 5), segmentectomy (n = 3), and bisegmentectomies (n = 9). Vascular clamping of portal triads was not used. The mean resection time was 60 +/- 23 min (mean +/- SD), and blood loss was 48 +/- 54 mL. None of the patients received any transfusion of blood or blood products perioperatively or postoperatively. Postoperatively, 1 patient developed severe exacerbation of asthma that required steroid therapy, and 1 other patient had a transient episode of liver failure that required supportive care. The mean duration of hospital stay was 5.6 +/- 2 days (mean +/- SD). At a short-term follow up, no recurrence was detected in patients with liver cancer. Laparoscopic liver resection can be performed safely with this new laparoscopic liver resection device with a significantly low risk of intraoperative bleeding or postoperative complications.

  11. Surgical anatomy of the retroperitoneal spaces--part I: embryogenesis and anatomy.

    Science.gov (United States)

    Mirilas, Petros; Skandalakis, John E

    2009-11-01

    Embryologically, the retroperitoneal (extraperitoneal) connective tissue includes three strata, which respectively form the internal fascia lining of the body wall, the renal fascia, and the covering of the gastrointestinal viscera. All organs, vessels, and nerves, that lie on the posterior abdominal wall, along with their tissues and surrounding connective and fascial planes, are collectively referred to as the retroperitoneum. The retroperitoneal space is the area of the posterior abdominal wall that is located between the parietal peritoneum and the fascia. Within the greater retroperitoneal space, there are also several small spaces, or subcompartments. Loose connective tissue and fat surround the anatomic entities, and, to a variable degree, occupy the subcompartments. The multilaminar thoracolumbar (lumbodorsal) fascia begins at the occipital area and terminates at the sacrum.

  12. Acute gaseous peritonitis after rupture of a retroperitoneal rectal diverticulum in a dog.

    Science.gov (United States)

    Saulnier-Troff, F G; De Busscher, V; Hamaide, A

    2008-07-01

    An 11-year-old, entire male coton de tulear was presented on emergency with acute and severe depression, acute abdominal pain and vomiting of 24 hours duration. Historical complaints included right perineal swelling, dyschezia and tenesmus of 18 months duration. Abdominal ultrasonography and radiography suggested a pneumoperitoneum and positive-contrast colonography showed leakage of contrast medium into the caudal abdomen and the presence of a large retroperitoneal pouch. Exploratory laparotomy allowed the visualisation of faecal leakage from the retroperitoneal space into the peritoneal cavity. Using a perineal approach, a large necrotised rectal diverticulum filled with faeces was found over the retroperitoneal structures. A standard herniorrhaphy was then performed. The dog recovered uneventfully and dyschezia did not recur at the nine month follow-up. Rectal diverticulum rupture associated with peritonitis has not been described in the veterinary literature, to the authors' knowledge, and should be considered as a rare differential diagnosis in dogs being presented with gaseous peritonitis.

  13. Chryseobacterium meningosepticum Sepsis Complicated with Retroperitoneal Hematoma and Pleural Effusion in a Diabetic Patient

    Directory of Open Access Journals (Sweden)

    Shou-Wu Lee

    2008-09-01

    Full Text Available Intra-abdominal infection due to Chryseobacterium meningosepticum is rare, and bacteremia complicated with pleural effusion and retroperitoneal hematoma caused by C. meningosepticum has not been reported previously. A 57-year-old diabetic man presented with bacteremia with retroperitoneal abscess and pleural effusion caused by C. meningosepticum on the 12th day of hospitalization. His clinical condition improved after antimicrobial therapy with levofloxacin and rifampin, debridement of the retroperitoneal hematoma and left-side chest tube insertion. Antibiotics were administered for 1 month, and he was later transferred to a local respiratory care ward under afebrile condition. C. meningosepticum should be included in the list of suspected nosocomial infections, especially in patients with immunocompromised status. Administration of appropriate antibiotics, such as quinolone, minocycline, trimethoprim-sulfamethoxazole or rifampin, and treatment of local infection improve the clinical outcome of patients with C. meningosepticum infection.

  14. Laparoscopic radical trachelectomy.

    Science.gov (United States)

    Rendón, Gabriel J; Ramirez, Pedro T; Frumovitz, Michael; Schmeler, Kathleen M; Pareja, Rene

    2012-01-01

    The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported. We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old female with stage IB1 adenocarcinoma of the cervix who desired future fertility. She underwent a laparoscopic radical trachelectomy and bilateral pelvic lymph node dissection. The operative time was 340 min, and the estimated blood loss was 100mL. There were no intraoperative or postoperative complications. The final pathology showed no evidence of residual disease, and all pelvic lymph nodes were negative. At 20 mo of follow-up, the patient is having regular menses but has not yet attempted to become pregnant. There is no evidence of recurrence. Laparoscopic radical trachelectomy with pelvic lymphadenectomy in a young woman who desires future fertility may also be an alternative technique in the treatment of early cervical cancer in developing countries.

  15. Preliminary embryological study of the radiological concept of retroperitoneal interfascial planes: what are the interfascial planes?

    Science.gov (United States)

    Ishikawa, Kazuo; Nakao, Shota; Murakami, Gen; Rodríguez-Vázquez, Jose Francisco; Matsuoka, Tetsuya; Nakamuro, Makoto; Shimazu, Takeshi

    2014-12-01

    Recently, the radiological concept of retroperitoneal interfascial planes has been widely accepted to explain the extension of retroperitoneal pathologies. This study aimed to explore embryologically based corroborative evidence, which remains to be elucidated, for this concept. Using serial or semi-serial transverse sections from 29 human fetuses at the 5th-25th week of fetal age, we microscopically observed the development of the retroperitoneal fasciae and other structures in the retroperitoneal connective tissue. A hypothesis for the formation of the interfascial planes was generated from the developmental study and analysis of retroperitoneal fasciae in computed tomography images from 224 patients. Whereas the loose connective tissue was uniformly distributed in the retroperitoneum by the 9th week, the primitive renal and transversalis fasciae appeared at the 10th-12th week, as previous research has noted. By the 23rd week, the renal fascia, transversalis fascia, and primitive adipose tissue of the flank pad emerged. In addition, the primitive lateroconal fascia, which runs parallel to and close to the posterior renal fascia, emerged between the renal fascia and the adipose tissue of the flank pad. Conversely, pre-existing loose connective tissue was sandwiched between the opposing fasciae and was compressed and narrowed by the developing organs and fatty tissues. Through this developmental study, we provided the hypothesis that the compressed loose connective tissue and both opposed fasciae compose the interfascial planes. Analysis of the thickened retroperitoneal fasciae in computed tomography images supported this hypothesis. Further developmental or histological studies are required to verify our hypothesis.

  16. Prolonged lymphatic leak after retroperitoneal lymph node dissection: a case report

    Directory of Open Access Journals (Sweden)

    Browne Katherine M

    2009-08-01

    Full Text Available Abstract Introduction Persistent lymphatic drainage following retroperitoneal lymph node dissection for testicular tumor is an uncommon complication. Case presentation We describe a 21-year old man of Caucasian origin who had metastatic non-seminomatous germ cell tumor of the testis, and underwent retroperitoneal lymph node dissection, nephrectomy and partial inferior vena cava excision for a residual mass. The patient subsequently developed persistent lymphatic drainage causing foot drop that eventually responded to conservative medical and surgical measures. Conclusion This postoperative condition usually responds well to conservative measures but has the potential for serious morbidity if it is not managed appropriately.

  17. Retroperitoneal fibrosis: A rare cause of both ureteral and small bowel obstruction

    Institute of Scientific and Technical Information of China (English)

    Faisal Aziz; Srinivasulu Conjeevaram; Than Phan

    2006-01-01

    Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of the cecum. Upon exploring the abdomen, the classical glistening white, unyielding retroperitoneal fibrosis was encountered. A right hemicolectomy was performed.Subsequently, the patient presented with bilateral ureteral obstruction, and later on with small bowel obstruction. Ureteral obstruction was treated with stents,and small bowel obstruction was treated with bypass.To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstruction has been reported in the literature.

  18. Endoscopic techniques for diagnosis and correction of complications after retroperitoneal pancreas transplantation

    Directory of Open Access Journals (Sweden)

    A. V. Pinchuk

    2016-01-01

    Full Text Available Relevance. Timely diagnosis and treatment of postoperative complications after pancreas transplantation is an actual problem of modern clinical transplantation. Purpose. The assessment of the endoscopy potential for the diagnosis and correction of postoperative complications after pancreas transplantation. Materials and methods. Since October 2011, simultaneous retroperitoneal pancreas-kidney transplantation has been performed in 27 patients. In 8 cases, the use of endoscopic techniques allowed a timely identification and treatment of the complications occurred. Conclusions. Endoscopic techniques proved to be highly efficient in the diagnosis and treatment of surgical complications and immunological impairments after retroperitoneal pancreas transplantation. 

  19. Sex differences in laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Thesbjerg, Simon E; Harboe, Kirstine Moll; Bardram, Linda

    2010-01-01

    Conversion from laparoscopic to open cholecystectomy may not be desirable due to the increased complication rate and prolonged convalescence. In Denmark, nationwide data show that 7.7% of the laparoscopic cholecystectomies are converted to open surgery. This article aims to document the relations...

  20. Laparoscopic reversal of Hartmann's procedure

    DEFF Research Database (Denmark)

    Svenningsen, Peter Olsen; Bulut, Orhan; Jess, Per

    2010-01-01

    of Hartmann's procedure as safely as in open surgery and with a faster recovery, shorter hospital stay and less blood loss despite a longer knife time. It therefore seems reasonable to offer patients a laparoscopic procedure at departments which are skilled in laparoscopic surgery and use it for standard...

  1. Virtual reality and laparoscopic surgery.

    Science.gov (United States)

    Coleman, J; Nduka, C C; Darzi, A

    1994-12-01

    The nature of laparoscopic surgery makes it likely to benefit from current and future developments in virtual reality and telepresence technology. High-definition screens, three-dimensional sensory feedback and remote dextrous manipulation will be the next major developments in laparoscopic surgery. Simulators may be used in surgical training and in the evaluation of surgical capability.

  2. Extramucosal pancreaticojejunostomy at laparoscopic pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Servet Karagul

    2018-01-01

    Full Text Available While the 'best pancreatic anastomosis technique' debate is going during Whipple procedure, the laparoscopic pancreaticoduodenectomy lately began to appear more and more often in the medical literature. All the popular anastomosis techniques used in open pancreas surgery are being experienced in laparoscopic pancreaticoduodenectomy. However, when they were adapted to laparoscopy, their implementation was not technically easy, and assistance of robotic surgery was sometimes required at the pancreatic anastomosis stage of the procedure. Feasibility and simplicity of a new technique have a vital role in its adaptation to laparoscopic surgery. We frequently use the extra-mucosal single row handsewn anastomosis method in open and laparoscopic surgery of the stomach, small and large bowel and we found it easy and reliable. Here, we defined the adaptation of this technique to the laparoscopic pancreas anastomosis. The outcomes were not inferior to the other previously described techniques and it has the advantage of simplicity.

  3. Intestinal duplication and retroperitoneal teratoma in child hoof: a case report; Duplicacao intestinal e teratoma retroperitoneal na infancia: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Atzingen, Augusto Castelli Von; Bazzano, Felix Carlos Ocariz; Tiburzio, Nicolas Biagione; Grande, Rogerio Mendes; Juntolli Netto, Joao Diniz [Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG (Brazil). Hospital das Clinicas Samuel Libanio (HCSL)]. E-mail: augvonatzingen@bol.com.br; augvonatzingen@hotmail.com

    2007-07-01

    The authors present a case of intestinal duplication and retroperitoneal teratoma in a 7-year-old patient with evident mass and abdominal pain to explain; that it was submitted to study conventional X-ray, ultrasonography, computed tomography and subsequent exploiting laparotomia. The anatomopathological study verified intestinal duplication and ripe teratoma. In the existent medical literature it was not found any similar case. (author)

  4. Laparoscopic Puestow: lateral pancreaticojejunostomy.

    Science.gov (United States)

    Biteman, Benjamin R; Harr, Jeffrey N; Brody, Fred

    2016-12-01

    Chronic pancreatitis is a painful inflammatory disease that leads to progressive and irreversible destruction of pancreatic parenchyma [1]. A lateral pancreaticojejunostomy, also known as the Puestow procedure, is performed for symptomatic chronic pancreatitis associated with a dilated pancreatic duct secondary to calcifications or strictures [4]. An open approach is used traditionally due to the complexity of the case, and there have only been a handful of laparoscopic case reports [2]. This video depicts a laparoscopic lateral pancreaticojejunostomy for chronic pancreatitis. A 45-year-old gentleman with a 20-year history of chronic alcohol abuse presented with diffuse abdominal pain. His pain was worse postprandially and associated with loose stools. A computed tomography scan revealed multiple calcified deposits within the body and tail of the pancreas, and a dilated pancreatic duct measuring 1.4 cm with a proximal obstructing calcified stone. A 5-port foregut technique was used, and a 15-cm pancreatic ductotomy was performed with an ultrasonic scalpel. Calcified stones were cleared from the duct, and a roux-en-y pancreaticojejunostomy was performed using a hand-sewn technique. The patient had a relatively uncomplicated hospital course with return of bowel function on postoperative day 4. His patient-controlled analgesic device was discontinued on post operative day 3. He was ambulating, tolerating a regular diet and discharged home on postoperative day 5. At 12- and 26-month follow-up, he remains off narcotics, but still requires 1-2 tabs of pancreatic enzyme replacement per meal. Most importantly, he has not had any alcohol for over 2 years. The two primary goals in treating chronic pancreatitis include long-term pain relief and improvements in quality of life [3]. For patients with chronic pancreatitis and a dilated pancreatic duct, a laparoscopic lateral pancreaticojejunostomy may be an effective approach to decrease pain and improve quality of life.

  5. Laparoscopic Heller's cardiomyotomy.

    LENUS (Irish Health Repository)

    Doodnath, R

    2012-02-01

    Achalasia is a rare motility disorder which causes failure of relaxation of the lower oesophageal sphincter (LES) and is thought to affect 0.31\\/100,000 children per year in Ireland. The classic presentation is difficulty swallowing and vomiting undigested food, and children can often present with chest pain. In some instances, these symptoms can lead to considerable weight loss. In this report, we present 2 cases of patients with achalasia who have also been the first 2 cases of laparoscopic Heller\\'s cardiomyotomy performed in children in the Republic of Ireland.

  6. Laparoscopic and robotic nephroureterectomy

    DEFF Research Database (Denmark)

    Azawi, Nessn H; Berg, Kasper Drimer; Thamsborg, Andreas Key Milan

    2017-01-01

    nephroureterectomy between January 2008 and December 2014 was conducted. Outcome measures were OS and CSM. RESULTS: In total, 298 patients underwent robot-assisted or laparoscopic radical nephroureterectomy with a final histological diagnosis of UTUC. LND was performed in 46 (15.4%). One hundred and seventy...... in the selection of patients undergoing LND. CONCLUSIONS: Five-year OS and CSM are comparable between patients with N1 and N0 MID. This evidence may support the use of the LND procedure in patients with muscle-invasive UTUC....

  7. Castleman’s disease imitating adrenal mass in the retroperitoneal area

    Science.gov (United States)

    Koç, Gökhan; Turk, Hakan; Un, Sıtkı; Isoglu, Cemal Selcuk; Zorlu, Ferruh

    2015-01-01

    Castleman’s disease (CD) is a non-clonal lymph node hyperplasia, mostly seen in the mediastinum. It has various clinical and pathological outcomes. There are different treatments because of its rare occurance and heterogenity. We present 2 cases which were referred to our clinic as retroperitoneal mass and diagnosed as CD after surgical resection. PMID:25624969

  8. Retroperitoneal hematoma following rofecoxib and enoxaparin coadministration in a patient with atrial fibrillation

    International Nuclear Information System (INIS)

    Khan, Fahmi Y.; Hassan, Ibrahim F.; Allity, Mustafa H.; Khan, Saifatullah M.

    2005-01-01

    There are very few published reports implicating enoxaparin as a factor in retroperitoneal hematoma. We report a patient who developed a retroperitoneal hematoma after using enoxaparin for paroxysmal atrial fibrillation. A 72 year old man was admitted with a history of low back pain, radiating beyond the back to the buttocks. His medical history was positive for bilateral knee osteoarthritis. On his physical examination his vital signs were: temperature 36.8, blood pressure 100/70 mm Hg, pulse 72/min, respiratory rate 16/min. X-ray of both the knees showed bilateral osteoarthritic changes. Computerized tomography scan of the spine showed lumbar spinal stenosis and he was referred to a Neurosurgeon, who finds the patient not fit surgical intervention. ECG showed atrial fibrillation. He was given enoxaparin one mg/kg every 12 hour and digoxin. Abdominal computed tomography revealed a right retroperitoneal hematoma and no aortic aneurysm was noted and enoxaparin and rofecoxib were discontinued. His general condition improved. The factors that increase the risk of bleeding in patients receiving enoxaparin are use of high doses of enxaparin, advanced stage, renal impairment, and the concomitant use of drugs affecting hemostasis. Retroperotoneal hematoma should be considered in the different diagnosis in patients receiving enoxaparin and experiencing unexplained decreases in hemoglobin and hematocrit. In the order of precedence of radiologic diagnostic procedures for fast diagnosis of a retroperitoneal hematoma, abdominal CT-scan is the preferred method

  9. CT finding of right retroperitoneal space : analysis of extension of right perirenal hematoma

    International Nuclear Information System (INIS)

    Seo, Kwang Won; Kim, Kyung Rak; Lee, Hyeok; Kim, Young Hwa; Cho, Won Soo; Kim, Il Young

    1997-01-01

    To understand the structure and character of the right retroperitoneal space by analysis of the extension of retroperitoneal hematoma in patients with traumatic right renal injuries. We retrospectively reviewed CT scans of 13 patients with right retroperitoneal hematomas caused by right renal injury. At te renal level, we analyzed the relation of a hematoma contacting psoas muscle with other retroperitoneal compartmental hematomas. At the suprarenal level, a perirenal hematoma and a hematoma contacting the diaphragm were analyzed according to their relation with intrahepatic IVC and pericaval hematoma. Below renal hilar level, all hematomas contacting psoas muscle, observed in eight cases, were connected with retrorenal extension of anterior pararenal hematoma. At the suprarenal level, intrahepatic pericaval hematomas were not, in all 13 cases, connected with a hematoma contacting the diaphragm, but with a perirenal hematoma. At the upper suprarenal level, the only pericaval hematomas containing a medial component of perirenal hematoma extended superiorly to the upper one third of the tenth thoracic vertebral body. The anterior renal fascia envelops perirenal space except in its medial aspect. In the upper suprarenal region, the anterior and posterior planes of the anterior renal fascia unite to fuse with diaphragmatic fascia, but along the medial aspect they fuse with intrahepatic pericaval connective tissue and posteromedial diaphragm, respectively

  10. IgG4-related retroperitoneal fibrosis: a newly characterized disease.

    Science.gov (United States)

    Lian, Linjuan; Wang, Cong; Tian, Jian-Li

    2016-11-01

    Retroperitoneal fibrosis (RPF) is a rare disease characterized by chronic, nonspecific inflammatory and sclerotic or fibrotic tissue in the periaortic or periiliac retroperitoneum that encases adjacent structures. There will be a series of clinical manifestations once the proliferated fibrous tissues encase the abdominal aorta, iliac arteries and urinary duct. RPF is generally divided into two types: idiopathic retroperitoneal fibrosis (IRPF) without identified pathogenesis, making up about two-thirds of cases, and secondary retroperitoneal fibrosis. Recent studies on Immunoglobulin G4-related disease (IgG4-RD) reveal that abundant infiltration of IgG4 positive plasma cells is found in biopsies on the mass of RPF of some IRPF patients, which is identified as one spectrum of IgG4-RD and is named IgG4-related RPF. IgG4-related RPF is often misdiagnosed as retroperitoneal visceral malignancy and is treated with surgery. In addition, because of its good response to glucocorticoid, early detection and treatment is important. We review the definition, epidemiology, clinical features, diagnostic criteria, treatment and prognosis of IgG4-related RPF in this article to raise awareness of this newly characterized disease. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  11. Laparoscopic resection for diverticular disease.

    Science.gov (United States)

    Bruce, C J; Coller, J A; Murray, J J; Schoetz, D J; Roberts, P L; Rusin, L C

    1996-10-01

    The role of laparoscopic surgery in treatment of patients with diverticulitis is unclear. A retrospective comparison of laparoscopic with conventional surgery for patients with chronic diverticulitis was performed to assess morbidity, recovery from surgery, and cost. Records of patients undergoing elective resection for uncomplicated diverticulitis from 1992 to 1994 at a single institution were reviewed. Laparoscopic resection involved complete intracorporeal dissection, bowel division, and anastomosis with extracorporeal placement of an anvil. Sigmoid and left colon resections were performed laparoscopically in 25 patients and by open technique in 17 patients by two independent operating teams. No significant differences existed in age, gender, weight, comorbidities, or operations performed. In the laparoscopic group, three operations were converted to open laparotomy (12 percent) because of unclear anatomy. Major complications occurred in two patients who underwent laparoscopic resection, both requiring laparotomy, and in one patient in the conventional surgery group who underwent computed tomographic-guided drainage of an abscess. Patients who underwent laparoscopic resection tolerated a regular diet sooner than patients who underwent conventional surgery (3.2 +/- 0.9 vs. 5.7 +/- 1.1 days; P < 0.001) and were discharged from the hospital earlier (4.2 +/- 1.1 vs. 6.8 +/- 1.1 days; P < 0.001). Overall costs were higher in the laparoscopic group than the open surgery group ($10,230 +/- 49.1 vs. $7,068 +/- 37.1; P < 0.001) because of a significantly longer total operating room time (397 +/- 9.1 vs. 115 +/- 5.1 min; P < 0.001). Follow-up studies with a mean of one year revealed two port site infections in the laparoscopic group and one wound infection in the open group. Of patients undergoing conventional resection, one patient experienced a postoperative bowel obstruction that was managed nonoperatively, and, in one patient, an incarcerated incisional hernia

  12. Laparoscopic ureteral reimplantation with Boari flap for the management of long- segment ureteral defect: A case series with review of the literature.

    Science.gov (United States)

    Bansal, Ankur; Sinha, Rahul Janak; Jhanwar, Ankur; Prakash, Gaurav; Purkait, Bimalesh; Singh, Vishwajeet

    2017-09-01

    The incidence of ureteral stricture is showing a rising trend due to increased use of laparoscopic and upper urinary tract endoscopic procedures. Boari flap is the preferred method of repairing long- segment ureteral defects of 8-12 cm. The procedure has undergone change from classical open (transperitoneal and retroperitoneal) method to laparoscopic surgery and recently robotic surgery. Laparoscopic approach is cosmetically appealing, less morbid and with shorter hospital stay. In this case series, we report our experience of performing laparoscopic ureteral reimplantation with Boari flap in 3 patients. This prospective study was conducted between January 2011 December 2014. The patients with a long- segment ureteral defect who had undergone laparoscopic Boari flap reconstruction were included in the study. Outcome of laparoscopic ureteral reimplantation with Boari flap for the manangement of long segment ureteral defect was evaluated. The procedure was performed on 3 patients, and male to female ratio was 1:2. One patient had bilateral and other two patient had left ureteral stricture. The mean length of ureteral stricture was 8.6 cm (range 8.2-9.2 cm). The mean operative time was 206 min (190 to 220 min). The average estimated blood loss was 100 mL (range 90-110 mL) and mean hospital stay was 6 days (range 5 to 7 days). The mean follow up was 19 months (range 17-22 months). None of the patients experienced any complication related to the procedure in perioperative period. Laparoscopic ureteral reimplantation with Boari flap is safe, feasible and has excellent long term results. However, the procedure is technically challenging, requires extensive experience of intracorporeal suturing.

  13. Laparoscopic vs open gastrectomy. A retrospective review.

    Science.gov (United States)

    Reyes, C D; Weber, K J; Gagner, M; Divino, C M

    2001-09-01

    The totally laparoscopic approach to partial gastrectomy had not been compared previously with results of the open technique. This study compares the results of a series of laparoscopic cases with matched open cases. A retrospective case-matched study was performed in 36 patients (18 laparoscopic surgeries, 18 open surgeries). Each laparoscopic case was matched for patient age and indication for surgery. The intraoperative and postoperative details of the two groups were compared. Laparoscopic surgery resulted in less blood loss, although operative time was increased. Nasogastric tubes were less likely to be used after laparoscopic surgery, and patients in the laparoscopic group had an earlier return to normal bowel function than those in the open group. Length of hospital stay was 2 days shorter in the laparoscopic group. The totally laparoscopic approach to partial gastrectomy is an excellent alternative to the more traditional open approach. It results in a more rapid return of intestinal function and a shorter hospital stay.

  14. [Laparoscopic therapy of choledocholithiasis].

    Science.gov (United States)

    Rechner, J; Beller, S; Zerz, A; Szinicz, G

    1996-01-01

    The introduction of laparoscopic cholecystectomy has led to controversial discussions about the proceeding in case of coincident common bile duct stones. In our unit choledocholithiasis has been treated laparoscopically since November 1991. Basic requirement has been a routine intraoperative cholangiography. 67 patients with common bile duct stones were treated until January 1995. All patients underwent a follow up and the results were compared to other concepts. In 40 cases common bile duct stones were eliminated via cystic duct and in 27 cases by choledochotomy. The choledochus was drained routinely for postoperative x-ray control. In 9 cases we found residual concrements: 7 patients required postoperative endoscopic papillotomy and in 2 cases the calculi where eliminated with a dormia basket introduced via drainage tube. In one case surgical management was changed to laparotomy. Postoperative complications occurred in 8 cases. One patient suffering from bacterial peritonitis underwent laparotomy on the 9th postoperative day; one with bleeding from the cystic artery was treated by relaparoscopy. One patient developed a liver abscess and two patients a bilioma requiring ultrasound guided drainage. A superficial wound infection in one patient and a biliary leakage after removal of the drainage in two patients healed spontaneously. Due to an intact papilla with less stress to the patient, as well as a complication rate comparable with other published therapeutic concepts, this strategy can be recommended as a valuable alternative procedure.

  15. Contrast-enhanced 18F-fluorodeoxyglucose positron emission tomography/computed tomography in immunoglobulin G4-related retroperitoneal fibrosis

    International Nuclear Information System (INIS)

    Sharma, Punit; Chatterjee, Piyali

    2015-01-01

    Immunoglobulin G4 (IgG4)-related disease encompasses a wide variety of immune disorders previously thought be distinct. IgG4-related retroperitoneal fibrosis is one such entity. Metabolic imaging with 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) can be useful in the management of IgG4-related retroperitoneal fibrosis. We here discuss the case of 63-year-old male with IgG4-related retroperitoneal fibrosis and the role, 18 F-FDG PET/CT played in his management

  16. Mini-laparoscopic versus laparoscopic approach to appendectomy

    Directory of Open Access Journals (Sweden)

    Kercher Kent W

    2001-10-01

    Full Text Available Abstract Background The purpose of this clinical study is to evaluate the feasibility of using 2-mm laparoscopic instruments to perform an appendectomy in patients with clinically suspected acute appendicitis and compare the outcome of this mini-laparoscopic or "needlescopic" approach to the conventional laparoscopic appendectomy. Methods Two groups of patients undergoing appendectomy over 24 months were studied. In the first group, needlescopic appendectomy was performed in 15 patients by surgeons specializing in advanced laparoscopy. These patients were compared with the second or control group that included 21 consecutive patients who underwent laparoscopic appendectomy. We compared the patients' demographic data, operative findings, complications, postoperative pain medicine requirements, length of hospital stay, and recovery variables. Differences were considered statistically significant at a p-value Results Patient demographics, history of previous abdominal surgery, and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. No postoperative morbidity or mortality occurred in either group. The needlescopic group had a significantly shorter mean operative time (p = 0.02, reduced postoperative narcotics requirements (p = 0.05, shorter hospital stay (p = 0.04, and quicker return to work (p = 0.03 when compared with the laparoscopic group. Conclusions We conclude that the needlescopic technique is a safe and effective approach to appendectomy. When performed by experienced laparoscopic surgeons, the needlescopic technique results in significantly shorter postoperative convalescence and a prompt recovery.

  17. [Laparoscopic surgery for perforated peptic ulcer].

    Science.gov (United States)

    Yasuda, Kazuhiro; Kitano, Seigo

    2004-03-01

    Laparoscopic surgery has become the treatment of choice for the management of perforated peptic ulcer. The advantages of laparoscopic repair for perforated peptic ulcer include less pain, a short hospital stay, and an early return to normal activity. Although the operation time of laparoscopic surgery is significantly longer than that of open surgery, laparoscopic technique is safe, feasible, and with morbidity and mortality comparable to that of the conventional open technique. To benefit from the advantages offered by minimally invasive laparoscopic technique, further study will need to determine whether laparoscopic surgery is safe in patients with generalized peritonitis or sepsis.

  18. Laparoscopic treatment of perforated appendicitis

    Science.gov (United States)

    Lin, Heng-Fu; Lai, Hong-Shiee; Lai, I-Rue

    2014-01-01

    The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis. PMID:25339821

  19. [Laparoscopic cholecystectomy in transplant patients].

    Science.gov (United States)

    Coelho, Júlio Cezar Uili; Contieri, Fabiana L C; de Freitas, Alexandre Coutinho Teixeira; da Silva, Fernanda Cristina; Kozak, Vanessa Nascimento; da Silva Junior, Alzemir Santos

    2010-02-01

    This study reviews our experience with laparoscopic cholecystectomy in the treatment of cholelithiasis in transplant patients. Demographic data, medications used, and operative and postoperative data of all transplant recipients who were subjected to laparoscopic cholecystectomy for cholelithiasis at our hospital were obtained. A total of 15 transplant patients (13 renal transplantation and 2 bone marrow transplantation) underwent laparoscopic cholecystectomy. All patients were admitted to the hospital on the day of the operation. The immunosuppressive regimen was not modified during hospitalization. Clinical presentation of cholelithiasis was biliary colicky (n=12), acute cholecystitis (n=2), and jaundice (n=1). The operation was uneventful in all patients. Postoperative complications were nausea and vomiting in 2 patients, prolonged tracheal intubation in 1, wound infection in 1 and large superficial hematoma in 1 patient. Laparoscopic cholecystectomy is associated to a low morbidity and mortality and good postoperative outcome in transplant patients with uncomplicated cholecystitis.

  20. Laparoscopic Repair of Inguinal Hernias

    OpenAIRE

    Carter, Jonathan; Duh, Quan-Yang

    2011-01-01

    For patients with recurrent inguinal hernia, or bilateral inguinal hernia, or for women, laparoscopic repair offers significant advantages over open techniques with regard to recurrence risk, pain, and recovery. For unilateral first-time hernias, either laparoscopic or open repair with mesh can offer excellent results. The major drawback of laparoscopy is that the technique requires a significant number of cases to master. For surgeons in group practice, it makes sense to have one surgeon in ...

  1. Lack of retroperitoneal lymphadenopathy predicts survival of patients with metastatic renal cell carcinoma.

    Science.gov (United States)

    Vasselli, J R; Yang, J C; Linehan, W M; White, D E; Rosenberg, S A; Walther, M M

    2001-07-01

    Patients with metastatic renal cell carcinoma have a reported 5-year survival of 0% to 20%. The ability to predict which patients would benefit from nephrectomy and interleukin-2 (IL-2) therapy before any treatment is initiated would be useful for maximizing the advantage of therapy and improving the quality of life. A retrospective analysis of the x-rays and charts of patients treated at the National Institutes of Health Surgery Branch between 1985 and 1996, who presented with metastatic renal cancer beyond the locoregional area and the primary tumor in place, was performed. Preoperative computerized tomography or magnetic resonance imaging, or radiological reports if no scans were available, were used to obtain an estimate of the volume of retroperitoneal lymphadenopathy. Operative notes were used to evaluate whether all lymphadenopathy was resected or disease left in situ, or if any extrarenal resection, including venacavotomy, was performed. Mean survival rate was calculated from the time of nephrectomy to the time of death or last clinical followup. If patients received IL-2 therapy, the response to treatment was recorded. Mean survival and response rate for IL-2 were compared among patients in 3 separate analyses. Patients without preoperatively detected lymphadenopathy were compared with those with at least 1 cm.3 retroperitoneal lymphadenopathy. Also, the patients who had detectable lymphadenopathy were divided into subgroups consisting of all resected, incompletely resected, unresectable and unknown if all disease was resected. Each subgroup was compared with patients without detectable preoperative lymphadenopathy. Patients with less than were compared to those with greater than 50 cm.3 retroperitoneal lymphadenopathy. Patients undergoing extrarenal resection at nephrectomy (complex surgery) due to direct invasion of the tumor into another intra-abdominal organ were compared with those undergoing radical nephrectomy alone, regardless of lymph node status

  2. Laparoscopic herniorrhaphy in children

    Directory of Open Access Journals (Sweden)

    Mirko Bertozzi

    2015-11-01

    Full Text Available The authors report their experience in laparoscopic repair of inguinal hernias in children. From May 2010 to November 2013, 122 patients with inguinal hernia underwent laparoscopic herniorrhaphy (92 males and 30 females. Telescope used was 5 mm, while trocars for the operative instruments were 3 or 2 mm. After introducing the camera at the umbilical level and trocars in triangulation, a 4-0 nonabsorbable monofilament suture was inserted directly through the abdominal wall. The internal inguinal ring was then closed by N or double N suture. All operations were performed in one-day surgery setting. In the case of association of inguinal and umbilical hernia an original technique was performed for positioning and fixing the umbilical trocar and for the primary closure of the abdominal wall defect. The postoperative follow-up consisted of outpatient visits at 1 week and 1, 3, and 6 months. The mean age of patients was 38.5 months. Of all patients, 26 were also suffering from umbilical hernia (19 males and 7 females. A total of 160 herniorrhaphies were performed; 84 were unilateral (66 inguinal hernia, 18 inguinal hernia associated with umbilical hernia, 38 bilateral (30 inguinal hernia, 8 inguinal hernia associated with umbilical hernia. Nine of 122 patients (6 males and 3 females were operated in emergency for incarcerated hernia. A pre-operative diagnosis of unilateral inguinal hernia was performed in 106 cases. Of these patients, laparoscopy revealed a controlateral open internal inguinal ring in 22 cases (20.7%. The mean operative time was 29.9±15.9 min for the monolateral herniorrhaphies, while in case of bilateral repair the mean operative time was 41.5±10.4 min. The mean operative time for the repair of unilateral inguinal hernia associated with umbilical hernia was 30.1±7.4 while for the correction of bilateral inguinal hernia associated with umbilical hernia 39.5±10.6 min. There were 3 recurrences (1.8%: 2 cases in unilateral repair and

  3. Laparoscopic resection of hilar cholangiocarcinoma.

    Science.gov (United States)

    Lee, Woohyung; Han, Ho-Seong; Yoon, Yoo-Seok; Cho, Jai Young; Choi, YoungRok; Shin, Hong Kyung; Jang, Jae Yool; Choi, Hanlim

    2015-10-01

    Laparoscopic resection of hilar cholangiocarcinoma is technically challenging because it involves complicated laparoscopic procedures that include laparoscopic hepatoduodenal lymphadenectomy, hemihepatectomy with caudate lobectomy, and hepaticojejunostomy. There are currently very few reports describing this type of surgery. Between August 2014 and December 2014, 5 patients underwent total laparoscopic or laparoscopic-assisted surgery for hilar cholangiocarcinoma. Two patients with type I or II hilar cholangiocarcinoma underwent radical hilar resection. Three patients with type IIIa or IIIb cholangiocarcinoma underwent extended hemihepatectomy together with caudate lobectomy. The median (range) age, operation time, blood loss, and length of hospital stay were 63 years (43-76 years), 610 minutes (410-665 minutes), 650 mL (450-1,300 mL), and 12 days (9-21 days), respectively. Four patients had a negative margin, but 1 patient was diagnosed with high-grade dysplasia on the proximal resection margin. The median tumor size was 3.0 cm. One patient experienced postoperative biliary leakage, which resolved spontaneously. Laparoscopic resection is a feasible surgical approach in selected patients with hilar cholangiocarcinoma.

  4. Laparoscopic adrenalectomy: Single centre experience.

    LENUS (Irish Health Repository)

    O'Farrell, N J

    2012-02-01

    BACKGROUND: Laparoscopic adrenalectomy is an attractive alternative to the traditional open approach in the surgical excision of an adrenal gland. It has replaced open adrenalectomy in our institution and we review our experience to date. METHODS: All cases of laparoscopic adrenalectomies in our hospital over eight years (from 2001 to May 2009) were retrospectively reviewed. Patient demographics, diagnosis, length of hospital stay, histology and all operative and post-operative details were evaluated. RESULTS: Fifty-five laparoscopic adrenalectomies (LA) were performed on 51 patients over eight years. The mean age was 48 years (Range 16-86 years) with the male: female ratio 1:2. Twenty-three cases had a right adrenalectomy, 24 had a left adrenalectomy and the remaining four patients had bilateral adrenalectomies. 91% were successfully completed laparoscopically with five converted to an open approach. Adenomas (functional and non functional) were the leading indication for LA, followed by phaeochromocytomas. Other indications for LA included Cushing\\'s disease, adrenal malignancies and rarer pathologies. There was one mortality from necrotising pancreatitis following a left adrenalectomy for severe Cushing\\'s disease, with subsequent death 10 days later. CONCLUSION: Laparoscopic adrenalectomy is effective for the treatment of adrenal tumours, fulfilling the criteria for the ideal minimally invasive procedure. It has replaced the traditional open approach in our centre and is a safe and effective alternative. However, in the case of severe Cushing\\'s disease, laparoscopic adrenalectomy has the potential for significant adverse outcomes and mortality.

  5. Minimally Invasive Surgery (MIS) in Children and Adolescents with Pheochromocytomas and Retroperitoneal Paragangliomas: Experiences in 42 Patients.

    Science.gov (United States)

    Walz, Martin K; Iova, Laura D; Deimel, Judith; Neumann, Hartmut P H; Bausch, Birke; Zschiedrich, Stefan; Groeben, Harald; Alesina, Pier F

    2018-04-01

    Pheochromocytomas (PH) and paragangliomas (PGL) are rare tumours in children accounting for about 1% of the paediatric hypertension. While minimally invasive surgical techniques are well established in adult patients with PH, the experience in children is extremely limited. To the best of our knowledge, we herewith present the largest series of young patients operated on chromaffin tumours by minimally invasive access. In the setting of a prospective study (1/2001-12/2016), 42 consecutive children and adolescents (33 m, 9 f) were operated on. Thirty-seven patients (88%) suffered from inherited diseases. Twenty-six patients had PH, 11 presented retroperitoneal PGL, and five patients suffered from both. Altogether, 70 tumours (mean size 2.7 cm) were removed (45 PH, 25 PGL). All operations were performed by a minimally invasive access (retroperitoneoscopic, laparoscopic, extraperitoneal). Partial adrenalectomy was the preferred procedure for PH (31 out of 39 patients). Twenty patients received α-receptor blockade preoperatively. One patient died after induction of anaesthesia due to cardiac arrest. All other complications were minor. Conversion to open surgery was necessary in two cases with PGL. Median operating time for unilateral PH was 55 min, in bilateral cases 125, 143 min in PGs, and 180 min in combined cases. Median blood loss was 20 ml (range 0-1000). Blood transfusion was necessary in two cases. Intraoperative, systolic peak pressure was 170 ± 39 mmHg with α-receptor blockade and 191 ± 33 mmHg without α-receptor blockade (p = 0.41). The median post-operative hospital stay was 3 days. After a mean follow-up of 8.5 years, two patients presented ipsilateral recurrence (after partial adrenalectomy). All patients with bilateral PH (n = 13) are steroid independent post-operatively. PH and PGL in children and adolescents should preferably be removed by minimally invasive surgery. Partial adrenalectomy provides long-term steroid independence

  6. Clinical significance of peritoneal and retroperitoneal edema in patients with de-compensated cirrhosis as demonstrated by CT scan

    International Nuclear Information System (INIS)

    Xue Yanshan; Wang Jun; Wang Xinwen

    2002-01-01

    Objective: To investigate the clinical significance of peritoneal and retroperitoneal edema in patients with de-compensated cirrhosis (DCC). Methods: Forty-four patients, were identified with DCC on the basis of clinic and laboratory examinations, except the cases with mesenteric, omental and retroperitoneal edema caused by inflammatory and malignant diseases. The diagnosis of edema depended upon hyper-density in peritoneal and retroperitoneal. The degree of edema was divided into minor, middle, and sever types based on the extent of edema. Ascites, varices, serum albumin (ALB) levels, and hyaluronic acid (HA) levels were also documented. Correlations between the laboratory and CT findings were analyzed. Results: The severity of peritoneal edema was correlated with decreasing serum ALB (r s = 0.7088, P s = 0.5294, P s = 0.5440, P s = 0.1335, P > 0.05). Conclusion: CT findings of the edema in peritoneal and retroperitoneal may indicate the severity of the liver cirrhosis

  7. Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: Long-term results of a prospective trial.

    LENUS (Irish Health Repository)

    Smith, Myles J F

    2014-01-07

    Late failure is a challenging problem following resection of retroperitoneal sarcoma (RPS). We investigated the effects of preoperative XRT plus dose escalation with early postoperative brachytherapy (BT) on long-term survival and recurrence in RPS.

  8. Predicting retroperitoneal histology in postchemotherapy testicular germ cell cancer : A model update and multicentre validation with more than 1000 patients

    NARCIS (Netherlands)

    Vergouwe, Yvonne; Steyerberg, Ewout W.; Foster, Richard S.; Sleijfer, Dirk T.; Fossa, Sophie D.; Gerl, Arthur; de Wit, Ronald; Roberts, J. Trevor; Habbema, J. Dik F.

    Objectives: Surgical resection of postchemotherapy retroperitoneal lymph nodes is often performed in patients with advanced nonseminomatous testicular germ cell cancer. We previously developed a model to predict the probability that the lymph nodes contain only necrotic or fibrotic (benign) tissue

  9. Laparoscopic diagnosis of endometriosis.

    Science.gov (United States)

    Wood, Carl; Kuhn, Raphael; Tsaltas, Jim

    2002-08-01

    To consider and explain the possibility of difficulties in diagnosis of endometriosis at previous laparoscopy Retrospective patient record review. The Endometriosis Care Centre of Australia and the private practices of authors. Two hundred and fifteen patients with clinical evidence of endometriosis examined laparoscopically between March 1999 and May 2001. Confirmation of endometriosis by histological biopsy. Endometriosis was confirmed in 168 of the 215 women. Of these women 38 had a previous negative laparoscopy within 12 months of the current laparoscopy. It is possible that in some of the patients, who previously had a negative laparoscopy, endometriosis was not recognised. Possible reasons for difficulty in diagnosis have been identified and techniques to improve diagnosis suggested. This retrospective study was performed to consider and explain the possibility of difficulties in diagnosis of endometriosis at previous laparoscopy.

  10. Sleep after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Rosenberg-Adamsen, S; Skarbye, M; Wildschiødtz, G

    1996-01-01

    .01). SWS was absent in four of the patients after operation, whereas in six patients it was within the normal range (5-20% of the night). The proportion of rapid eye movement (REM) sleep was not significantly changed after operation. There were no changes in arterial oxygen saturation on the postoperative...... compared with the preoperative night. Comparison of our results with previous studies on SWS and REM sleep disturbances after open laparotomy, suggests that the magnitude of surgery or administration of opioids, or both, may be important factors in the development of postoperative sleep disturbances.......The sleep pattern and oxygenation of 10 patients undergoing laparoscopic cholecystectomy were studied on the night before operation and the first night after operation. Operations were performed during general anaesthesia and postoperative analgesia was achieved without the administration...

  11. Laparoscopic ovariectomy in rabbits

    Directory of Open Access Journals (Sweden)

    M. S. Al-Badrany

    2009-01-01

    Full Text Available A comparative evaluation of three different techniques of laparoscopic ovariectomy was carried out in 33 healthy female in rabbits, which included resection and removal of ovary after clip application, electrocautery of the ovary, then resection, and pulling ovary outside abdomen, ligation by silk, then ovary was removed. The ovaries and associated structures were better visualized by laparoscopy and all three techniques were carried out perfectly. All rabbits after operation were healthy and they were monitored for one month after operation. However, 3 of them died after operation, two of them died due to bleeding and the other of them died due to unknown causes. General anesthesia by using ketamine-xylazine i.m., was suitable for this technique, and the anesthesia provided good analgesia and good muscle relaxation. CO2 was used to establish pneumoperitoneum. In conclusion, resection and removal of the ovaries after clip application technique was found superior to the other two techniques.

  12. Laparoscopic Cystogastrostomy in the Management of Pancreatic ...

    African Journals Online (AJOL)

    laparoscopic cystogastrostomy as a method of managing ... A 61 year old male patient presented to the emergency ... He was reviewed as an outpatient two weeks later. He was in ... Combined. Laparoscopic Cholecystectomy and Drainage.

  13. Laparoscopic cholecystectomy in pregnancy. A case report.

    Science.gov (United States)

    Williams, J K; Rosemurgy, A S; Albrink, M H; Parsons, M T; Stock, S

    1995-03-01

    Laparoscopic cholecystectomy was performed on a pregnant woman at 18 weeks of gestation without complications. Considering the risk/benefit ratio, laparoscopic cholecystectomy in pregnant women is preferable to conventional cholecystectomy.

  14. Deep Neuromuscular Blockade Improves Laparoscopic Surgical Conditions

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Herring, W Joseph; Blobner, Manfred

    2017-01-01

    INTRODUCTION: Sustained deep neuromuscular blockade (NMB) during laparoscopic surgery may facilitate optimal surgical conditions. This exploratory study assessed whether deep NMB improves surgical conditions and, in doing so, allows use of lower insufflation pressures during laparoscopic cholecys...

  15. Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report

    Directory of Open Access Journals (Sweden)

    Daliakopoulos Stavros I

    2008-05-01

    Full Text Available Abstract Introduction Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present as a rare life-threatening event characterized by sudden onset of bleeding into the retroperitoneal space, occurring in association with bleeding disorders, intratumoral bleeding, or ruptures of any retroperitoneal organ or aneurysm. The spontaneous form is the most infrequent retroperitoneal hemorrhage, causing significant morbidity and representing a diagnostic challenge. Case presentation We report the case of a patient with coronary artery disease who presented with transient ischemic attack, in whom anticoagulant therapy with heparin precipitated a massive spontaneous atraumatic retroperitoneal hemorrhage (with international normalized ratio 2.4, which was treated conservatively. Conclusion Delay in diagnosis is potentially fatal and high clinical suspicion remains crucial. Finally, it is a matter of controversy whether retroperitoneal hematomas should be surgically evacuated or conservatively treated and the final decision should be made after taking into consideration patient's general condition and the possibility of permanent femoral or sciatic neuropathy due to compression syndrome.

  16. Usefulness of simulation with multi-slice CT for laparoscopic nephrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Akiyama, Yuji; Ishifuro, Minoru; Ookubo, Masaomi [Hiroshima Univ. (Japan). Hospital] (and others)

    2002-12-01

    In recent years, laparoscopic surgery has attracted attention as a minimally invasive type of surgery because of the small surgical wounds and early recovery it provides. We carry out this technique on the basis of volume data that we make use of in multi-slice CT imaging technology in laparoscopic nephrectomy by the retroperitoneal approach, and we have created CT virtual laparoscopy by virtual endoscopic display as an intra-operative navigator with an image analysis system. We provide information on detailed vascular anatomy to form intra-operative images that act as similar support images. With the provision of this volume data, we consider virtual endoscopic display the most suitable method for surgery. When we perform virtual laparoscopy, we simulate the insertion point and angle, the order of vascular structures and their locations, the number of arteries and veins, and their bifurcation points and ligation points in conjunction with the surgeon prior to operation. As the branch patterns of the renal artery are varied, perioperative confusion and surgical mishaps can be avoided through the information that is provided beforehand. Thus surgery is more accurate and proceeds more smoothly, because the surgeon has accurate anatomical information. In addition, the time required for surgery is decreased, reducing risk and the possibility of complications. (author)

  17. Usefulness of simulation with multi-slice CT for laparoscopic nephrectomy

    International Nuclear Information System (INIS)

    Akiyama, Yuji; Ishifuro, Minoru; Ookubo, Masaomi

    2002-01-01

    In recent years, laparoscopic surgery has attracted attention as a minimally invasive type of surgery because of the small surgical wounds and early recovery it provides. We carry out this technique on the basis of volume data that we make use of in multi-slice CT imaging technology in laparoscopic nephrectomy by the retroperitoneal approach, and we have created CT virtual laparoscopy by virtual endoscopic display as an intra-operative navigator with an image analysis system. We provide information on detailed vascular anatomy to form intra-operative images that act as similar support images. With the provision of this volume data, we consider virtual endoscopic display the most suitable method for surgery. When we perform virtual laparoscopy, we simulate the insertion point and angle, the order of vascular structures and their locations, the number of arteries and veins, and their bifurcation points and ligation points in conjunction with the surgeon prior to operation. As the branch patterns of the renal artery are varied, perioperative confusion and surgical mishaps can be avoided through the information that is provided beforehand. Thus surgery is more accurate and proceeds more smoothly, because the surgeon has accurate anatomical information. In addition, the time required for surgery is decreased, reducing risk and the possibility of complications. (author)

  18. Conventional laparoscopic adrenalectomy versus laparoscopic adrenalectomy through mono port.

    Science.gov (United States)

    Kwak, Ha Na; Kim, Jun Ho; Yun, Ji-Sup; Son, Byung Ho; Chung, Woong Youn; Park, Yong Lai; Park, Chan Heun

    2011-12-01

    A standard procedure for single-port laparoscopic adrenal surgery has not been established. We retrospectively investigated intraoperative and postoperative outcomes after laparoscopic adrenalectomy through mono port (LAMP) and conventional laparoscopic adrenalectomy to assess the feasibility of LAMP. Between March 2008 and December 2009, 22 patients underwent adrenalectomy at the Department of Surgery, Kangbuk Samsung Hospital. Twelve patients underwent conventional laparoscopic adrenalectomy and 10 patients underwent LAMP. The same surgeon performed all the surgeries. The 2 procedures were compared in terms of tumor size, operating time, time to resumption of a soft diet, length of hospital day, and postoperative complications. The 2 groups were similar in terms of tumor size (30.08 vs. 32.50 mm, P=0.796), mean operating time (112.9 vs. 127 min, P=0.316), time to resumption of a soft diet (1.25 vs. 1.30 d, P=0.805), and length of hospital day (4.08 vs. 4.50 d, P=0.447). Despite 1 patient in the LAMP group experiencing ipsilateral pleural effusion as a postoperative complication, this parameter was similar for the 2 groups (P=0.195). Perioperative mortality, blood transfusion, and conversion to open surgery did not occur. Perioperative outcomes for LAMP were similar to those for conventional laparoscopic adrenalectomy. LAMP appears to be a feasible option for adrenalectomy.

  19. Thromboelastographic changes during laparoscopic fundoplication.

    Science.gov (United States)

    Zostautiene, Indre; Zvinienė, Kristina; Trepenaitis, Darius; Gerbutavičius, Rolandas; Mickevičius, Antanas; Gerbutavičienė, Rima; Kiudelis, Mindaugas

    2017-01-01

    Thromboelastography (TEG) is a technique that measures coagulation processes and surveys the properties of a viscoelastic blood clot, from its formation to lysis. To determine the possible hypercoagulability state and the effect of antithrombotic prophylaxis on thromboelastogram results and development of venous thrombosis during laparoscopic fundoplication. The study was performed on 106 patients who were randomized into two groups. The first group received low-molecular-weight heparin (LMWH) 12 h before the operation, and 6 and 30 h after it. The second group received LMWH only 1 h before the laparoscopic fundoplication. The TEG profile was collected before LMWH injection, 1 h after the introduction of the laparoscope and 15 min after the surgery was completed. There was no significant difference in thromboelastography R-time between the groups before low-molecular-weight heparin injection. In group I preoperative R-values significantly decreased 1 h after the introduction of the laparoscope, after the end of surgery and on the third postoperative day. K-time values decreased significantly on the third postoperative day compared with the results before low-molecular-weight heparin injection, and after the operation. In group II, preoperative R-values significantly decreased 1 h after the introduction of the laparoscope, and after surgery. K-time values did not change significantly during or after the laparoscopic operation. Our study results demonstrated that the hypercoagulation state (according to the TEG results) was observed during and after laparoscopic fundoplication in patients when LMWH was administered 12 h before the operation together with intraoperative intermittent pneumatic compression. The optimal anticoagulation was obtained when LMWH was administered 1 h before fundoplication.

  20. A cutting biopsy needle for the histological diagnosis of abdominal and retroperitoneal masses

    International Nuclear Information System (INIS)

    Hauenstein, K.H.; Wimmer, B.; Freudenberg, N.; Freiburg Univ.

    1985-01-01

    A new cutting biopsy needle has been used to obtain histologically useful material while causing the minimum of trauma. It permits biopsies of organs, but its small external diameter of 0.8 or 0.95 mm makes it possible to carry out transperitoneal puncture of the stomach, colon or liver and of the retroperitoneal space, using a ventral approach. Tissue samples were obtained in 96% of 63 patients. The risk of complications is no higher than for conventional needles used for cytology. The accuracy with which the material can be obtained is therefore the most important problem. The position of the area to be biopsied should determine whether the biopsy is to be aided by sonography or CT. Biopsies of organs can be appropriately carried out under ultrasound control, but processes in the pelvis and in retroperitoneal-paravertebral and extra-peritoneal positions are best biopsied under CT control. (orig.) [de

  1. Rare aggressive behavior of MDM2-amplified retroperitoneal dedifferentiated liposarcoma, with brain, lung and subcutaneous metastases

    Directory of Open Access Journals (Sweden)

    Imen Ben Salha

    2016-10-01

    Full Text Available Dedifferentiated liposarcoma (DDL is a histologically pleomorphic sarcoma, traditionally defined as well-differentiated liposarcoma with abrupt transition to high grade, nonlipogenic sarcoma. It can occur as part of recurrent well-differentiated liposarcoma, or may arise de novo. DDL most frequently occurs within the retroperitoneum, and while it is prone to local recurrence, it usually has a lower rate of metastasis than other pleomorphic sarcomas. We describe a case of retroperitoneal dedifferentiated liposarcoma in a 63-year-old male, who showed MDM2 amplification with fluorescence in situ hybridization, which displayed unusually aggressive behavior, with brain, lung and subcutaneous soft tissue metastases. As previous reports of metastatic liposarcoma have largely grouped DDL in with other (genetically and clinically distinct liposarcoma subtypes, we highlight and discuss the rare occurrence of brain metastasis in MDM2-amplified retroperitoneal liposarcoma.

  2. Acute retroperitoneal bleeding due to inferior mesenteric artery aneurysm: Case report

    Directory of Open Access Journals (Sweden)

    Ferrón JA

    2010-06-01

    Full Text Available Abstract Background Visceral artery aneurysms (VAA, although uncommon, are increasingly being detected. We describe a case of spontaneous retroperitoneal hemorrhage from a ruptured IMA aneurysm associated with stenosis of the superior mesenteric artery (SMA and celiac trunk, successfully treated with surgery. Methods A 65-year-old man presented with abdominal pain and hypovolemic shock. Abdominal CT scan showed an aneurysm of the inferior mesenteric artery with retroperitoneal hematoma. In addition, an obstructive disease of the superior mesenteric artery and celiac axis was observed. Results Upon emergency laparotomy a ruptured inferior mesenteric artery aneurysm was detected. The aneurysm was excised and the artery reconstructed by end-to-end anastomosis. Conclusions This report discusses the etiology, presentation, diagnosis and case management of inferior mesenteric artery aneurysms.

  3. Massive retroperitoneal ganglioneuroma presenting with small bowel obstruction 18 years following initial diagnosis.

    LENUS (Irish Health Repository)

    Cronin, E M P

    2012-02-03

    BACKGROUND: Ganglioneuroma is a rare tumour of neural crest origin, which arises from maturation of a neuroblastoma. While previously considered to be non-functioning, they are now known to be frequently endocrinologically active. AIMS AND METHODS: We report a case of a massive retroperitoneal ganglioneuroma presenting with small bowel obstruction in an adult, 18 years after initial diagnosis. Urinary dopamine levels were elevated, but other catecholamines were within normal limits. This is the first report in the English-language literature of a retroperitoneal ganglioneuroma presenting with or causing intestinal obstruction. We also review the metabolic, radiological, and histological features of these tumours. Relevant publications were identified from a Medline search using the MeSH headings \\'ganglioneuroma\\

  4. [Laparoscopic colorectal surgery - SILS, robots, and NOTES.

    NARCIS (Netherlands)

    D'Hoore, André; Wolthuis, Albert M.; Mizrahi, Hagar; Parker, Mike; Bemelman, Willem A.; Wara, Pål

    2011-01-01

    Single incision laparoscopic surgery resection of colon is feasible, but so far evidence of benefit compared to standard laparoscopic technique is lacking. In addition to robot-controlled camera, there is only one robot system on the market capable of performing laparoscopic surgery. The da Vinci

  5. Laparoscopic Elective Colonic Operation and Concomitant ...

    African Journals Online (AJOL)

    extracorporeal bowel resection and anastomosis after laparoscopic anterior resection. Another possibility that could be used in this case would be a laparoscopic transabdominal preperitoneal repair (TAPP) associated with laparoscopic anterior resection. Anyway, the presented case shows that a full preoperative surgical ...

  6. Three ports versus four ports laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Shah, S.F.; Waqar, S.; Chaudry, M.A.; Hameed, S.

    2017-01-01

    To compare three ports laparoscopic cholecystectomy and four ports laparoscopic cholecystectomy in terms of complications, time taken to complete the procedure, hospital stay and cost effectiveness in local perspective. Methodology: This randomized control trial included 60 patients who underwent elective laparoscopic cholecystectomy at Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2013 to June 2013. These patients were randomized on computer generated table of random numbers into group A and Group B. In Group A patients four ports were passed to perform laparoscopic cholecystectomy and in Group B patients three ports were passed to perform the procedure. Results: The mean age in both groups was 44 years (range 18-72). Three ports laparoscopic cholecystectomy (43 min) took less time to complete than four ports laparoscopic cholecystectomy (51 min). Patients in three ports laparoscopic cholecystectomy experienced less pain as compared to four ports group. The total additional analgesia requirement in 24 hours calculated in milligrams was less in three port laparoscopic cholecystectomy group as compared four port laparoscopic cholecystectomy group. The mean hospital stay in three port laparoscopic cholecystectomy group is 25 hours while the mean hospital stay in the four port laparoscopic cholecystectomy group is 28 hours. Conclusion: Three ports laparoscopic cholecystectomy is safe and effective procedure and it did not compromise the patient safety. (author)

  7. Intestinal duplication and retroperitoneal teratoma in child hoof: a case report

    International Nuclear Information System (INIS)

    Atzingen, Augusto Castelli Von; Bazzano, Felix Carlos Ocariz; Tiburzio, Nicolas Biagione; Grande, Rogerio Mendes; Juntolli Netto, Joao Diniz

    2007-01-01

    The authors present a case of intestinal duplication and retroperitoneal teratoma in a 7-year-old patient with evident mass and abdominal pain to explain; that it was submitted to study conventional X-ray, ultrasonography, computed tomography and subsequent exploiting laparotomia. The anatomopathological study verified intestinal duplication and ripe teratoma. In the existent medical literature it was not found any similar case. (author)

  8. Intraduodenal sarcoma recurrence of retroperitoneal origin: an unusual cause for a duodenal obstruction

    Directory of Open Access Journals (Sweden)

    Bao Jean J

    2012-04-01

    Full Text Available Abstract Soft tissue sarcomas are uncommon tumors, and intraduodenal soft tissue sarcoma manifestation is even more rare. Only three cases of intraduodenal sarcomas have been reported in the literature thus far. Here, we report a case of an intraduodenal recurrence of a retroperitoneal sarcoma causing bowel obstruction. This unusual recurrence pattern likely relates to the patient’s previous resection and radiation treatment, and highlights the benefits, limitations and follow-up strategies after multimodality treatment.

  9. Retroperitoneal myxoid liposarcoma of the renal capsule causing Budd-Chiari syndrome

    International Nuclear Information System (INIS)

    Gruetzner, G.; Fuerst, G.; Kuhn, F.P.; Kliche, K.O.

    1991-01-01

    A retroperitoneal myxoid liposarcoma of the renal capsule must be differentiated from renal cell carcinomas, angiomyolipomas, fibrogenous lipomas, fibrolipomas and mixed tumours containing fat tissue. Myxoid liposarcomas can lead to intracavale tumourthromboses, which is often the case with renal cell carcinomas and revealed clinical with Budd-Chiari syndrome. Computed tomography and magnetic resonance imaging give additional information in the diagnosis of intracaval tumourthromboses and show the exact expansion of the topographic-anatomical structure. (orig.) [de

  10. Historical perspectives and future directions in the surgical management of retroperitoneal sarcoma.

    Science.gov (United States)

    Tseng, William W; Seo, Hyun Jae; Pollock, Raphael E; Gronchi, Alessandro

    2018-01-01

    Retroperitoneal sarcomas (RPS) have fascinated and intrigued physicians both past and present. Operative mortality rates were historically very high and complete resection was not possible for the majority of patients until only the last 2 decades. More recently, changes to the surgical approach and clinical decision-making in RPS have improved patient outcomes. With select integration of nonsurgical therapies, continued RPS-specific research, and ongoing collaborative efforts among major referral centers, the future appears promising. © 2017 Wiley Periodicals, Inc.

  11. Retroperitoneal abscess shortly after chemotherapy for lung cancer: A case report

    OpenAIRE

    OHARA, GEN; KONDO, TADASHI; KAGOHASHI, KATSUNORI; WATANABE, HIROKO; KAWAGUCHI, MIO; KURISHIMA, KOICHI; SATOH, HIROAKI; HIZAWA, NOBUYUKI

    2013-01-01

    To the best of our knowledge, the formation of a retroperitoneal abscess due to acute appendicitis shortly after administration of chemotherapy for lung cancer has not been previously reported. This is the case report of a 59-year-old male who was admitted to the Mito Medical Center (Mito, Japan) and diagnosed with lung adenocarcinoma with pleuritis carcinomatosis. Although no distant metastasis was identified, combination chemotherapy with cisplatin and pemetrexed was administered. Nine days...

  12. Retroperitoneal Mass Masquerading as Failure to Thrive in a 91-year-old Woman.

    Science.gov (United States)

    Ologun, Gabriel O; Yarze, Noel; Bertsch, David; Mwesige, Joseph

    2017-11-08

    Failure to thrive (FTT) is a state of overall decline. Patients often present with weight loss, poor appetite, malnutrition, and decreased physical functioning. The etiology is multifactorial including chronic diseases, functional impairments, and acute illnesses. Evaluation for reversible causes is paramount, and treatment is aimed at maintaining or improving functional status. We present a case of a 91-year-old woman with a retroperitoneal mass that was found on workup for failure to thrive.

  13. Compined preoperative diagnosis of stomach cancer involvement of the abdominal and retroperitoneal organs and tissues

    International Nuclear Information System (INIS)

    Fisher, M.E.; Gabuniya, R.I.; Kolesnikova, E.K.; Bal'ter, S.A.; Ostrovtsev, I.V.; Dolgushin, B.I.; Mazurov, S.T.; Mironova, G.T.

    1987-01-01

    An analysis of 136 cases of stomach cancer led to the determination of the role and place of gammatopography, echography, computerized X-ray tomography, angiography and laparoscopy in specified preoperative diagnosis of extraorganic spreading of primary tumors. The informative value and shortcomings of certain methods were shown. A high accuracy of the entire set of diagnostic procedures (94.8%) in the preoperative definition of stomach cancer involvement of the abdominal and retroperitoneal organs and tissues was emphasized

  14. Giant retroperitoneal lipoma: a case report Lipoma gigante do retroperitônio: relato de caso

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Real Martinez

    2003-12-01

    Full Text Available BACKGROUND: Retroperitoneal lipoma is an extremely rare neoplasm. AIMS: The authors report a case of giant retroperitoneal lipoma in a 32-year-old white female, with a history of pain and an abdominal mass over a 2-year period. Total abdominal ultrasonography and barium enema showed a large mass located in the retroperitoneal space behind the ascending colon. Laparotomy showed a large encapsulated tumor measuring 20 x 13 x 10 cm and weighing 3.400 g. The histological study revealed a benign neoplasm of fatty cells. CONCLUSION: The patient remains well 17 years after surgery, without recurrentce of the disease.RACIONAL: O lipoma é a neoplasia mesenquimal mais freqüente, raramente localizada no retroperitônio. Na maioria das vezes, o diagnóstico diferencial pré-operatório com os lipossarcomas de baixo grau de malignidade é difícil de ser estabelecido. OBJETIVO: Apresentar um caso de lipoma gigante retroperitoneal em mulher de 32 anos que há 2 anos apresentava história de dor e tumor abdominal palpável. A ultra-sonografia abdominal e o enema opaco mostraram grande massa localizada no retroperitônio, que deslocava o ceco e o cólon ascendente. A laparotomia mostrou tumor encapsulado com 20 x 13 x 10 cm e 3.400 g de peso. O estudo histopatológico mostrou presença de lipoma retroperitonial. A paciente encontra-se bem, sem recidiva da doença, 17 anos após a cirurgia.

  15. Completely Isolated Retroperitoneal Enteric Duplication Cyst with Adenocarcinoma Transformation Managed with Robotic Radical Nephrectomy

    OpenAIRE

    Faraj, Kassem; Edwards, Luke; Gupta, Alia; Seifman, Brian

    2017-01-01

    Abstract Background: Enteric duplication cysts are congenital malformations that typically affect children in infancy, but can also affect adults. Rarely, these cysts can be complicated by malignancy. We present the first case of retroperitoneal duplication cyst that was complicated by malignancy transformation and managed by robot-assisted excision. Case presentation: A 64-year-old female with a history of a left-sided renal cyst presented with a 4-month history of abdominal pain and fatigue...

  16. Primary Cyst adenocarcinoma: exceptional etiology of a retroperitoneal cystic tumor.First National Communication

    International Nuclear Information System (INIS)

    Gonzalez, D.; Ruso, L.; Ettlin, A.

    2010-01-01

    This work is about the clinical case of a 29 year old patient who consulted for right lank pain, where a tumor was identified. Ultrasound confirmed the existence of a cystic process, and complete surgical abscission/exeresis was performed next to an area in the in the abdominal wall. Anatomopathological report confirmed a primary retroperitoneal cistoadenocarcinoma. No adjuvant treatment was applied, evolution was good 11 months after surgery, no evidence of the disease

  17. Pharmacokinetics of cephem antibiotics in exudate of pelvic retroperitoneal space after radical hysterectomy and pelvic lymphadenectomy.

    Science.gov (United States)

    Ito, K; Hayasaki, M; Tamaya, T

    1990-01-01

    Many cephalosporin antibiotics have recently been invented and attempts have been made to use them clinically. The choice of which of these drugs should be used has been difficult in gynecology. The efficacies of these drugs depend on their antibacterial spectra, potencies, and concentrations in tissues. This study was designed to investigate the pharmacokinetics of various cephem antibiotics in the exudate of the retroperitoneal space that is formed after radical hysterectomy and pelvic lymphadenectomy. These cephem antibiotics were cefoxitin, cefotiam, cefotetan, cefpiramide, cefminox, cefotaxime, ceftizoxime, cefoperazone, cefmenoxime, cefbuperazone, ceftazidime, cefpimizole, flomoxef, and cefuzonam. The maximum concentrations after administration of a 1-g dose in the exudate of the pelvic retroperitoneal space were 37.9 micrograms/ml with cefminox, 30.3 micrograms/ml with cefpimizole, 21.6 micrograms/ml with flomoxef, 21.5 micrograms/ml with ceftazidime, and 17.6 micrograms/ml with cefbuperazone, which were relatively high. When selecting antibiotics for prophylactic use against infections in the retroperitoneal space after radical hysterectomy and pelvic lymphadenectomy, on the basis of drug transfer, flomoxef, cefminox, cefbuperazone, ceftazidime, and cefpimizole were considered to be the drugs of first choice at a dose of 1 g. PMID:2393276

  18. MR-guided biopsies of lesions in the retroperitoneal space: technique and results

    International Nuclear Information System (INIS)

    Zangos, S.; Eichler, K.; Wetter, A.; Lehnert, T.; Hammerstingl, R.; Diebold, T.; Reichel, P.; Herzog, C.; Mack, M.G.; Vogl, T.J.; Hansmann, M.-L.

    2006-01-01

    The purpose of this study was to evaluate the safety and precision of MRI-guided biopsies of retroperitoneal space-occupying tumors in an open low-field system. In 30 patients with indistinct retroperitoneal tumors [paraaortic lesion (n=20), kidney (n=2), suprarenal gland (n=3) and pancreas (n=5)] MR-guided biopsies were performed using a low-field system (0.2 T, Magnetom Concerto, Siemens, Germany). For the monitoring of the biopsies T1-weighted FLASH sequences (TR/TE=160/5 ms; 90 ) were used in all patients and modified FLASH sequences (TR/TE=160/13 ms; 90 ) in ten patients. After positioning of the needle in the tumors 114 biopsy specimens were acquired in coaxial technique with 16-gauge cutting needles (Somatex, Germany). The biopsies were successfully performed in all patients without vascular or organ injuries. The visualization of the aortic blood flow with MRI facilitated the biopsy procedures of paraaortic lesions. The size of the lesions ranged from 1.6 to 7.5 cm. The median distance of the biopsy access path was 10.4 cm. Adequate specimens were obtained in 28 cases (93.3%) resulting in a correct histological classification of 27 lesions (90%). In conclusion, MR-guided biopsies of retroperitoneal lesions using an open low-field system can be performed safely and accurately and is an alternative to CT-guided biopsies. (orig.)

  19. Primary Retroperitoneal Mucinous Cystadenocarcinoma: 5th Male Case in the Literature

    Directory of Open Access Journals (Sweden)

    F. Tugba Kos

    2015-11-01

    Full Text Available Retroperitoneal primary mucinous tumor is an extremely rare malignancy. To date, only 52 cases of primary retroperitoneal mucinous cystadenocarcinoma (PRMC have been reported in the literature, with the majority being women. Our patient is the 5th known male case. A 57-year-old male patient presented with a two year history of an undefined abdominal pain.Computed tomography demonstrated a 12 x 9.5 cm cystic mass lesion extending superiorly from right iliac fossa, while localizing below the abdominal wall and close to the psoas muscle. According to the laparotomy, iliopsoas muscle was infiltrated by the mass in the retroperitoneal region. Pathological diagnosis was mucinous cystadenocarcinoma . The asymptomatic patient was followed up without applying an adjuvant chemotherapy, since the clinical course of the tumor is known to be slow and postoperative therapy is not recognized as a standardized treatment. The clinical course of PRMC is generally indolent, however, it may manifest an aggressive course, as well. It has no definitive and clear pathogenesis. The treatment is contentious, as well. Diagnosis and treatment require surgical excision but data on adjuvant chemotherapy is limited.

  20. Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma

    Science.gov (United States)

    Tan, Marcus C.B.; Brennan, Murray F.; Kuk, Deborah; Agaram, Narasimhan P.; Antonescu, Cristina; Qin, Li-Xuan; Moraco, Nicole; Crago, Aimee M.; Singer, Samuel

    2015-01-01

    Objective To determine the prognostic significance of histologic type/subtype in a large series of patients with primary resected retroperitoneal sarcoma. Summary Background Data The histologic diversity and rarity of retroperitoneal sarcoma has hampered the ability to predict patient outcome. Methods From a single-institution, prospective database, 675 patients treated surgically for primary, non-metastatic retroperitoneal sarcoma during 1982–2010 were identified and histologic type/subtype was reviewed. Clinicopathologic variables were analyzed for association with disease-specific death (DSD), local recurrence (LR), and distant recurrence (DR). Results Median follow-up for survivors was 7.5 years. The predominant histologies were well-differentiated liposarcoma, dedifferentiated liposarcoma, and leiomyosarcoma. Five-year cumulative incidence of DSD was 31%, and factors independently associated with DSD were R2 resection, resection of ≥3 contiguous organs, and histologic type. Five-year cumulative incidence for LR was 39% and for DR was 24%. R1 resection, age, tumor size, and histologic type were independently associated with LR; size, resection of ≥3 organs, and histologic type were independently associated with DR. Liposarcoma and leiomyosarcoma were associated with late recurrence and DSD (as long as 15 years from diagnosis). For solitary fibrous tumor, local recurrence was uncommon (sarcoma. Histology predicts the pattern and incidence of LR and DR and will aid in more accurate patient counseling and selection of patients for adjuvant therapy trials. PMID:25915910

  1. Retroperitoneal disorders associated with IgG4-related autoimmune pancreatitis

    Science.gov (United States)

    Hara, Noboru; Kawaguchi, Makoto; Takeda, Keisuke; Zen, Yoh

    2014-01-01

    IgG4-related autoimmune pancreatitis is frequently accompanied by relevant lesions in the genitourinary tract and retroperitoneal organs, which cause various clinical problems, ranging from non-specific back pain or bladder outlet obstruction to renal failure. The diagnosis of IgG4-related retroperitoneal fibrosis requires a multidisciplinary approach, including serological tests, histological examination, imaging analysis, and susceptibility to steroid therapy. Radiological examinations are helpful to diagnose this condition, but surgical resection is occasionally unavoidable to exclude malignancy, particularly for patients with isolated retroperitoneal involvement. Steroid therapy is the treatment of choice for this condition, the same as for other manifestations of IgG4-related disease. For patients with severe ureteral obstruction, additional ureteral stenting needs to be considered prior to steroid therapy to preserve the renal function. Some papers have suggested that IgG4-related disease can affect male reproductive organs including the prostate and testis. IgG4-related prostatitis usually causes lower urinary tract symptoms, such as dysuria and pollakisuria. Patients sometimes state that corticosteroids given for IgG4-related disease at other sites relieve their lower urinary tract symptoms, which leads us to suspect prostatic involvement in this condition. Because of the limited number of publications available, further studies are warranted to better characterize IgG4-related disease in male reproductive organs. PMID:25469023

  2. Prospective assessment of MRI for imaging retroperitoneal metastases from testicular germ cell tumours

    Energy Technology Data Exchange (ETDEWEB)

    Sohaib, S.A. [Department of Radiology, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey (United Kingdom)], E-mail: aslam.sohaib@rmh.nhs.uk; Koh, D.M. [Department of Radiology, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey (United Kingdom); Barbachano, Y. [Department of Computing and Statistics, Royal Marsden Hospital, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey (United Kingdom); Parikh, J.; Husband, J.E.S. [Department of Radiology, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey (United Kingdom); Dearnaley, D.P.; Horwich, A.; Huddart, R. [Department of Academic Urology Unit, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey (United Kingdom)

    2009-04-15

    Aim: To determine the sensitivity of magnetic resonance imaging (MRI) in the detection of retroperitoneal lymph nodes in patients with testicular germ cell tumours (TGCT). Methods and materials: A prospective study of 52 patients (mean age 34 years, range 18-54 years) was performed. Imaging of the retroperitoneum was performed using multidetector computed tomography (CT) and 1.5 T MRI systems. The CT and MRI images were read independently by three observers. The number, size, and site of enlarged nodes ({>=}10 mm maximum short axis diameter) were recorded. Retroperitoneal nodal detection on MRI was compared to CT. Results: Twenty-two (42%) of the 52 patients had no retroperitoneal disease; in remaining 30 patients 51 enlarged nodes were identified. On a per patient basis readers 1, 2, and 3 identified nodal disease in 28 of 29, 29 of 30, and 24 of 30 patients, respectively, using MRI compared to CT. Thus for experienced radiologists (readers 1 and 2) MRI is comparable to CT for nodal detection (i.e., this study excludes MRI being inferior to CT with 80% power and 5% type 1 error). Conclusion: MRI offers an alternative method for staging the retroperitoneum in young patients being followed for TGCT and has the major advantage of avoiding exposure to ionizing radiation.

  3. Laparoscopic intestinal derotation: original technique.

    Science.gov (United States)

    Valle, Mario; Federici, Orietta; Tarantino, Enrico; Corona, Francesco; Garofalo, Alfredo

    2009-06-01

    The intestinal derotation technique, introduced by Cattel and Valdoni 40 years ago, is carried out using a laparoscopic procedure, which is described here for the first time. The method is effective in the treatment of malign lesions of the III and IV duodenum and during laparoscopic subtotal colectomy with anastomosis between the ascending colon and the rectum. Ultimately, the procedure allows for the verticalization of the duodenal C and the anterior positioning of the mesenteric vessels, facilitating biopsy and resection of the III and IV duodenal portions and allowing anastomosis of the ascending rectum, avoiding both subtotal colectomy and the risk of torsion of the right colic loop. Although the procedure calls for extensive experience with advanced video-laparoscopic surgery, it is both feasible and repeatable. In our experience we have observed no mortality or morbidity.

  4. Laparoscopic surgery in colorectal cancer

    International Nuclear Information System (INIS)

    Bressler Hernandez, Norlan; Martinez Perez, Elliot; Fernandez Rodriguez, Leopoldo; Torres Core, Ramiro

    2011-01-01

    In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as oncologically equivalent to conventional open surgery. The advantages of laparoscopic surgery have translated into smaller incisions and shorter recovery. Since the advent of laparoscopy, surgeons have been fueled to develop less invasive operative methods as feasible alternatives to traditional procedures. As techniques evolved and technology advanced, laparoscopy became more widely accepted and is now more commonly used in many institutions. Recently, a trend toward less invasive surgery, driven by patient and surgeon alike, has been a major objective for many institutions because of the ability of laparoscopic surgery to reduce postoperative pain, achieve a quicker recovery time, and improve cosmetic outcomes. Although still evolving, traditional laparoscopy has served as a foundation for even further refinements in the minimally invasive approach and as a result, more advanced equipment and newer techniques have arisen

  5. Dysphagia after laparoscopic Nissen fundoplication

    DEFF Research Database (Denmark)

    Funch-Jensen, Peter; Jacobsen, Bo

    2007-01-01

    OBJECTIVE: To investigate the frequency and severity of dysphagia during the first 8 weeks after laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. So far, there have been no studies reporting data on day-to-day occurrence of dysphagia after laparoscopic fundoplication...... in a consecutive series of patients. This may explain why the frequency of dysphagia varies greatly in the literature (4-100%). MATERIAL AND METHODS: Forty consecutive patients, undergoing elective laparoscopic Nissen fundoplication, completed a standard dysphagia registration diary each day during the first 8...... weeks after surgery. Patients who preoperatively had suffered from dysphagia were excluded. Thus, none of the patients had dysphagia in the 2-month period before surgery. Ten patients undergoing elective cholecystectomy served as controls. Data were quantified, and a score value of 4 or more...

  6. Single Incision Laparoscopic Splenectomy: Our First Experiences

    Directory of Open Access Journals (Sweden)

    Umut Barbaros

    2011-06-01

    Full Text Available Objective: Most laparoscopic surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes by using less and smaller trocars. Single incision laparoscopic splenectomy is a new laparoscopic procedure. Herein we would like to present our experiences.Material and Methods: Between January 2009 and June 2009, data of the 7 patients who underwent single incision laparoscopic splenectomy were evaluated retrospectively.Results: There were 7 patients (5 females and 2 males with a mean age of 29.9 years. The most common splenectomy indication was idiopathic thrombocytopenic purpura. Single incision laparoscopic splenectomy was performed successfully in 6 patients. In one patient the operation was converted to an open procedure.Conclusion: With surgeons experienced in minimally invasive surgery, single incision laparoscopic splenectomy could be performed successfully. However, in order to demonstrate the differneces between standard laparoscopic splenectomy and SILS splenetomy, prospective randomized comparative studies are required.

  7. Laparoscopic Partial Hepatectomy: Animal Experiments

    Directory of Open Access Journals (Sweden)

    Haruhiro Inoue

    1995-01-01

    Full Text Available As a first step in firmly establishing laparoscopic hepatectomy, we introduce a porcine model of laparoscopic partial hepatectomy. This procedure has been successfully performed under the normal-pressure or low-pressure pneumoperitoneum condition supported by the full-thickness abdominal wall lifting technique. An ultrasonic dissector combined with electrocautery, newly developed by Olympus Optical Corporation (Japan was effectively utilized in facilitating safe and smooth incisions into the liver parenchyma. Although indications for this procedure seem to be limited only to peripheral lesions and not to central lesions, clinical application of this method may be useful for some patients in the near future.

  8. Laparoscopic ultrasound and gastric cancer

    Science.gov (United States)

    Dixon, T. Michael; Vu, Huan

    2001-05-01

    The management of gastrointestinal malignancies continues to evolve with the latest available therapeutic and diagnostic modalities. There are currently two driving forces in the management of these cancers: the benefits of minimally invasive surgery so thoroughly demonstrated by laparoscopic surgery, and the shift toward neoadjuvant chemotherapy for upper gastrointestinal cancers. In order to match the appropriate treatment to the disease, accurate staging is imperative. No technological advances have combined these two needs as much as laparascopic ultrasound to evaluate the liver and peritoneal cavity. We present a concise review of the latest application of laparoscopic ultrasound in management of gastrointestinal malignancy.

  9. Surgical packages for laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Bhattacharya K

    2005-01-01

    Full Text Available ′Packages′ are in fashion today for most surgical procedures in various corporate hospitals and this has included laparoscopic procedures too. A package system enables the hospitals to get cost settlements done more easily. Also, it is more convenient for the patients who are aware upfront of the charges. The principal disadvantages seems to be for the surgeon, who may face displeasure of the patient, hospital or insurance agencies apart from forfeiting his personal charges if (a he is a novice in laparoscopic surgery and takes extra time to complete a procedure, (b unforeseen problems occur during surgery, or (c new pathologies are discovered on exploration.

  10. Laparoscopic partial nephrectomy for endophytic hilar tumors: feasibility and outcomes.

    Science.gov (United States)

    Di Pierro, G B; Tartaglia, N; Aresu, L; Polara, A; Cielo, A; Cristini, C; Grande, P; Gentile, V; Grosso, G

    2014-06-01

    To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients. This is a single centre retrospective study. From May 2009 to September 2011, 208 LPNs were performed at our institution. Overall 11 (5.2%) elective LPNs were for hilar tumors not visible on kidney surface. Hilar tumor was defined as a mass located in the renal hilum and in contact with a major renal vessel on preoperative imaging. Procedures were carried out by a single experienced surgeon (G.G.) via retroperitoneal approach by clamping the only main renal artery. Mean (range) age of patients was 45.3 years (38.2-64.1), tumor size 1.6 cm (1.2-2.0), warm ischemia time 24 min (19-32), operative time 140 min (110-200) and estimated blood loss 270 ml (100-750). Two collecting system injuries were observed and repaired intraoperatively. No conversion to open surgery was required. Final pathological examination revealed 10 renal cell carcinomas and 1 oncocytoma. A negative surgical margin was obtained in 10/11 (91%) patients. Renal function and serum hemoglobin were nearly unaltered pre and post-surgery. No tumor recurrence was observed at mean (range) follow-up of 34 months (15-43). In experienced hands, LPN represents a feasible, safe and effective treatment for selected patients diagnosed with endophytic hilar masses. A larger number of patients and longer follow-up are required to draw definitive conclusions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Image-guided fine needle cytology with aspiration versus non-aspiration in retroperitoneal masses: is aspiration necessary?

    Science.gov (United States)

    Misra, Rajiv Kumar; Mitra, Shaila; Jain, Rishav Kumar; Vahikar, Shilpa; Bundela, Archana; Misra, Purak

    2015-03-01

    Although using fine needle cytology with aspiration (FNC-A) for establishing diagnoses in the retroperitoneal region has shown promise, there is scant literature supporting a role of non-aspiration cytology (FNC-NA) for this region. We assessed the accuracy and reliability of FNC-A and FNC-NA as tools for preoperative diagnosis of retroperitoneal masses and compared the results of both techniques with each other and with histopathology. Fifty-seven patients with retroperitoneal masses were subjected to FNC-A and FNC-NA. Smears were stained with May-Grunwald Giemsa and hematoxylin and eosin stain. An individual slide was objectively analysed using a point scoring system to enable comparison between FNC-A and FNC-NA. By FNC-A, 91.7% accuracy was obtained in cases of retroperitoneal lymph node lesions followed by renal masses (83.3%). The diagnostic accuracy of other sites by FNC-A varied from 75.0%-81.9%. By FNC-NA, 93.4% diagnostically accurate results were obtained in the kidney, followed by 75.0% in adrenal masses. The diagnostic accuracy of other sites by FNC-NA varied from 66.7%-72.8%. Although both techniques have their own advantages and disadvantages, FNC-NA may be a more efficient adjuvant method of sampling in retroperitoneal lesions.

  12. Laparoscopic management of large ovarian cysts: more than cosmetic considerations.

    Science.gov (United States)

    Ma, K K; Tsui, P Z Y; Wong, W C; Kun, K Y; Lo, L S F; Ng, T K

    2004-04-01

    Laparoscopic management of three cases, each with a large ovarian cyst, is reported. Appropriate preoperative assessment, patient counselling, and good laparoscopic skills are the cornerstones of successful laparoscopic management in such patients.

  13. Laparoscopic radical cystectomy: key points

    Directory of Open Access Journals (Sweden)

    D. V. Perlin

    2018-01-01

    Full Text Available Background. Radical cystectomy remains the golden standard for treatment of muscle invasive bladder cancer. Objective: to duplicate with highest accuracy the open radical cystectomy procedure, which we successfully utilized earlier in our clinic, in the of laparoscopic conditions in order to preserve the advantages of minimally invasive procedures and retain the reliability of the tried and tested open surgery.Materials and methods. In the report were included 35 patients (27 men and 8 women with bladder cancer, who underwent laparoscopic radical cystectomy in Volgograd Regional Center of Urology and Nephrology between April 2013 and March 2016. Only the patients who had been submitted to full intracorporal ileal conduits were included.Results. The mean operative time was 378 minutes, the mean blood loss was 285 millilitres, the mean length of hospital stay was 12.4 days, only 20 % of patients required the narcotic anesthetics. The postoperative complication rate was 11.4 %. However, the majority of the patients were successfully treated with minimally invasive procedures. Generally, our results were similar to other reported studies.Conclusion. Laparoscopic radical cystectomy is a safe and efficient modality of treatment of bladder cancer. However, it needs more procedures and longer observation period to establish laparoscopic radical cystectomy as an alternative to open radical cystectomy.

  14. Laparoscopically assisted vaginal radical trachelectomy

    International Nuclear Information System (INIS)

    Bielik, T.; Karovic, M.; Trska, R.

    2013-01-01

    Purpose: Radical trachelectomy is a fertility-sparing procedure with the aim to provide adequate oncological safety to patients with cervical cancer while preserving their fertility. The purpose of this study was to retrospectively evaluate, in a series of 3 patients, the feasibility, morbidity, and safety of laparoscopically assisted vaginal radical trachelectomy for early cervical cancer. Patients and Methods: Three non consecutive patients with FIGO stage IA1 and IB1 cervical cancer was evaluated in a period of years 2008 - 2011. The patients underwent a laparoscopic pelvic lymphadenectomy and radical parametrectomy class II procedure according to the Piver classification. The section of vaginal cuff, trachelectomy, permanent cerclage and isthmo-vaginal anastomosis ware realised by vaginal approach. Results: The median operative time, the median blood loss and the mean number of resected pelvic nodes was comparable with published data. Major intraoperative complications did not occur and no patient required a blood transfusion. The median follow-up time was 33 (38-59) months. One vaginal recurrence occurred in 7 months after primary surgery. The patient was underwent a radicalisation procedure and adjuvant oncologic therapy and now is free of disease. Conclusions: Laparoscopically assisted vaginal radical trachelectomy (LAVRT)may be an alternative in fertility-preserving surgery for early cervical cancer. The procedure offers patients potential benefits of minimally invasive surgery with adequate oncological safety, but it should be reserved for oncologic surgeons trained in advanced laparoscopic procedures. (author)

  15. Laparoscopic repair of epiphrenic diverticulum.

    Science.gov (United States)

    Zaninotto, Giovanni; Parise, Paolo; Salvador, Renato; Costantini, Mario; Zanatta, Lisa; Rella, Antonio; Ancona, Ermanno

    2012-01-01

    Epiphrenic diverticula (ED) are a rare clinical entity characterized by out-pouchings of the esophageal mucosa originating in the distal third of the esophagus, close to the diaphragm. The proportion of diverticula reported symptomatic enough to warrant surgery is extremely variable, ranging from 0% to 40%. The natural history of ED is still almost unknown and the most intriguing question concerns whether or not they all need surgical treatment. From 1993 to 2010 35 patients underwent surgery at our institution. Eleven patients were treated via a thoracotomic approach alone and were excluded from present study. The remaining 24 patients formed our study population. Seventeen patients (48.6%) underwent surgery via a purely laparoscopic approach, and received a diverticulectomy + myotomy + antireflux procedure. Seven patients (23%), with ED positioned well above inferior pulmonary vein, were treated via a combined laparoscopic-thoracotomic approach: they all underwent diverticulectomy + myotomy + an antireflux procedure. Mortality was nil. The overall morbidity rate was 25%. A suture leakage occurred in 4 patients (16.6%) and they were all conservatively treated. Patients' symptom scores decreased from a median of 15 to 0 (P = 0.0005). Laparoscopic surgery for ED is effective, but given the not negligible incidence of complications such suture-line leakage, should be considered only in symptomatic patients or in event of huge diverticula. A tailored combined laparoscopic-thoracotomic approach may be useful in case of ED located high in mediastinum or with large neck. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Laparoscopic management of Bouveret syndrome.

    Science.gov (United States)

    Newton, Richard Charles; Loizides, Sofronis; Penney, Nicholas; Singh, Krishna Kumar

    2015-04-22

    Bouveret syndrome is a proximal form of gallstone ileus where a large gallstone lodges in the pylorus or proximal duodenum, having passed through a bilioenteric fistula that has formed secondary to previous cholecystitis. We describe the laparoscopic extraction of a giant 'Bouveret' gallstone from the duodenum of an elderly man with morbid obesity. 2015 BMJ Publishing Group Ltd.

  17. Laparoscopic transureteroureterostomy: a novel approach.

    Science.gov (United States)

    Piaggio, Lisandro A; González, Ricardo

    2007-06-01

    We describe the feasibility and short-term results of laparoscopic transureteroureterostomy in children. We performed transperitoneal laparoscopic transureteroureterostomy with a 4-trocar technique in 3 children with a mean age of 63 months (range 18 to 105). Diagnoses were unilateral ureteral obstruction after cross-trigonal reimplantation for vesicoureteral reflux (1 patient), unilateral refluxing megaureter (1) and ureteral injury after bladder diverticulectomy (1). Cystoscopy, retrograde pyelogram and stent placement in the recipient ureter were performed at the beginning of each case. The anastomoses were carried out with running 6-zero reabsorbable sutures at the level of the pelvic bream. An abdominal drain and Foley catheter were left indwelling for 1 to 3 days. All cases were performed successfully. Postoperative course was uneventful except for a transient urinary leak, and patients were discharged home on postoperative day 2 to 4. At a mean followup of 6 months all patients were clinically well, with normal kidney function and blood pressure, and no significant hydronephrosis. Based on our initial experience, laparoscopic transureteroureterostomy is safe and effective, and is associated with little blood loss, minimal analgesia requirements, fast recovery and excellent cosmetic results. We believe that in selected cases in which transureteroureterostomy is the chosen technique a laparoscopic approach is advantageous.

  18. Errors and complications in laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Liviu Drăghici

    2017-05-01

    Full Text Available Background. In laparoscopic surgery errors are unavoidable and require proper acknowledgment to reduce the risk of intraoperative and accurately assess the appropriate therapeutic approach. Fortunately, their frequency is low and cannot overshadow the benefits of laparoscopic surgery. Materials and Methods. We made an epidemiological investigation in General Surgery Department of Emergency Clinical Hospital "St. John" Bucharest, analyzing 20 years of experience in laparoscopic surgery, during 1994-2014. We wanted to identify evolution trends in complications of laparoscopic surgery, analyzing the dynamic of errors occurred in all patients with laparoscopic procedures. Results. We recorded 26847 laparoscopic interventions with a total of 427 intra-or postoperative complications that required 160 conversions and 267 reinterventions to resolve inconsistencies. The average frequency of occurrence of complications was 15.9‰ (15.9 of 1,000 cases. In the period under review it was a good momentum of laparoscopic procedures in our department. Number of minimally invasive interventions increased almost 10 times, from 266 cases operated laparoscopically in 1995 to 2638 cases in 2008. Annual growth of the number of laparoscopic procedures has surpassed the number of complications. Conclusions. Laborious work of laparoscopic surgery and a specialized centre with well-trained team of surgeons provide premises for a good performance even in the assimilation of new and difficult procedures.

  19. Hidatidosis retroperitoneal secundaria a quiste hidatídico de localización hepática Retroperitoneal hydatidosis secondary to hepatic hydatid cyst

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    Katherina A Vizcaychipi

    2012-12-01

    Full Text Available La hidatidosis es una enfermedad de distribución mundial, producida por un platelminto parásito del género Echinococcus. El caso que se presenta corresponde a una paciente con una tumoración fluctuante en el espacio retroperitoneal lumbar, secundaria a un quiste hepático. El diagnóstico inicial de certeza fue dado por el hallazgo de ganchos rostelares de protoescólices en el líquido aspirado de un absceso. Este trabajo describe el cuadro clínico, el diagnóstico y el tratamiento médico-quirúrgico de esta paciente. Se analiza cómo la elaboración de un diagnóstico certero requiere de un análisis adecuado de los antecedentes epidemiológicos, las manifestaciones clínicas, los estudios de imágenes y las pruebas de laboratorio, ya que el conjunto de estos datos confirman el caso.Hydatid disease in a worldwide zoonosis. It is caused by a parasitic platyhelminth of the genus Echinococcus. We present a patient with a fluctuating lumbar tumor in the retroperitoneal space, secondary to a hepatic cyst. The initial diagnosis was made by identification of rostellar hooks from protoscoleces in the fluid aspirated from the abscess. We herein describe the clinical manifestations, diagnosis and medical and surgical treatment of this unusual case and conclude that the development of an accurate diagnosis required a proper analysis of the patient's epidemiological history, clinical manifestations, imaging studies and laboratory tests. A multidisciplinary approach and differential diagnosis is paramount to be able to establish a cause of the disease to deliver appropriate treatment.

  20. Laparoscopic repair for vesicouterine fistulae

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    Rafael A. Maioli

    2015-10-01

    Full Text Available ABSTRACT Objective: The purpose of this video is to present the laparoscopic repair of a VUF in a 42-year-old woman, with gross hematuria, in the immediate postoperative phase following a cesarean delivery. The obstetric team implemented conservative management, including Foley catheter insertion, for 2 weeks. She subsequently developed intermittent hematuria and cystitis. The urology team was consulted 15 days after cesarean delivery. Cystoscopy indicated an ulcerated lesion in the bladder dome of approximately 1.0cm in size. Hysterosalpingography and a pelvic computed tomography scan indicated a fistula. Materials and Methods: Laparoscopic repair was performed 30 days after the cesarean delivery. The patient was placed in the lithotomy position while also in an extreme Trendelenburg position. Pneumoperitoneum was established using a Veress needle in the midline infra-umbilical region, and a primary 11-mm port was inserted. Another 11-mm port was inserted exactly between the left superior iliac spine and the umbilicus. Two other 5-mm ports were established under laparoscopic guidance in the iliac fossa on both sides. The omental adhesions in the pelvis were carefully released and the peritoneum between the bladder and uterus was incised via cautery. Limited cystotomy was performed, and the specific sites of the fistula and the ureteral meatus were identified; thereafter, the posterior bladder wall was adequately mobilized away from the uterus. The uterine rent was then closed using single 3/0Vicryl sutures and two-layer watertight closure of the urinary bladder was achieved by using 3/0Vicryl sutures. An omental flap was mobilized and inserted between the uterus and the urinary bladder, and was fixed using two 3/0Vicryl sutures, followed by tube drain insertion. Results: The operative time was 140 min, whereas the blood loss was 100ml. The patient was discharged 3 days after surgery, and the catheter was removed 12 days after surgery

  1. Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation-volvulus

    OpenAIRE

    Rivier, Pablo; Furneaux, Rob; Viguier, Eric

    2011-01-01

    This prospective study describes a simple method of combining laparoscopic ovariectomy and laparoscopic-assisted prophylactic gastropexy and determines the duration of surgery, complications, and long-term outcome including prevention of gastric dilatation-volvulus (GDV). Laparoscopic ovariectomy and laparoscopic-assisted gastropexy were performed on 26 sexually intact female dogs susceptible to GDV. The mean surgery time was 60.8 ± 12.4 min. No GDV episode was seen during the study period (m...

  2. Localized bilateral perirenal fibrosis, a rare cause of idiopathic retroperitoneal fibrosis

    Directory of Open Access Journals (Sweden)

    Maja Kveder

    2014-08-01

    Full Text Available Background: Idiopathic retroperitoneal fibrosis is an infrequent process of unknown aetiology characterised by fibrous tissue proliferation in the retroperitoneum. Even less frequent is a localized form of this disease by a proliferation of fibrous tissue around single or both kidneys.Case report: We describe a case of 46-year old man in whom medical management was started for accidentally discovered arterial hypertension, which turned out to be difficult to control.   During diagnostic work-up of hypertension, an abdominal ultrasound was obtained a year later demonstrating slight bilateral caliectasis without obvious visible cause for it. Laboratory exams have shown significantly impaired renal function, normocytic anaemia, slightly higher sedimentation rate, increased CRP and normal urinalysis. Nephrologist has decided for hospitalisation during which magnetic resonance imaging was performed  showing a few mm wide tissue coats surrounding both kidneys with fluid lying between the coat and kidney capsule. A biopsy of perirenal mass has confirmed a dense cellular lesion consisted of interweaved fascicles of spindle-shaped cells. After exclusion of tumours and other causes, a diagnosis of retroperitoneal fibrosis was confirmed. Clinical picture and laboratory data corresponded to idiopathic form of this disease. A treatment with tamoxifen was started after patient refused treatment with methylprednisolone. During tamoxifen monotherapy, there was gradual significant improvement of general symptoms, notable decline in inflammation markers, improvement of anaemia, normalisation of kidney function, and normalisation of blood pressure. Conclusion: Retroperitoneal fibrosis is still an obscure and multifaceted disease. A proper selection of diagnostic methods is the key to correct and fast diagnosis as well as good grounding for proper treatment.

  3. Clinical Value of CT-Guided Needle Biopsy for Retroperitoneal Lesions

    International Nuclear Information System (INIS)

    Tomozawa, Yuki; Inaba, Yoshitaka; Yamaura, Hidekazu; Sato, Yozo; Kato, Mina; Kanamoto, Takaaki; Sakane, Makoto

    2011-01-01

    The purpose of this study was to investigate retrospectively the clinical procedural performance of CT-guided needle biopsy for retroperitoneal lesions. CT-guided needle biopsy was performed in 74 consecutive patients (M:F = 44:30; mean age, 59.7 years) with retroperitoneal lesions between April 1998 and June 2009. The target lesion ranged from 1.5 to 12.5 cm in size. The biopsy access path ranged from 3.5 to 11.5 cm in depth. A biopsy specimen was obtained using an 18-gauge core needle under a CT or CT-fluoroscopy guidance and with the patient under local anesthesia. The histopathological diagnoses from the biopsies were obtained. The diagnostic confirmation of the subtype of lymphoma was evaluated. Satisfactory biopsy samples were obtained in 73 (99%) of 74 patients and a pathological diagnosis was made in 70 (95%) of 74 patients. Sixty three lesions were malignant (45 lymphomas, nine primary tumors, nine lymph node metastases) and seven were benign. The subtype of lymphoma was specified in 43 (96%) of 45 patients who were diagnosed with lymphoma. Analysis of the value of CT-guided biopsy in this series indicated 63 true positives, zero false positive, six true negatives and five false negatives. This test had a sensitivity of 93%, a specificity of 100% and an accuracy of 93%. No major complications were seen and minor complications were noted in seven patients (five with local hematomas, two with transient pain at the puncture site). CT-guided needle biopsy for retroperitoneal lesions is highly practical and useful, and particularly for determining the subtypes in patients with lymphoma.

  4. A case report and a literature review of primary retroperitoneal mucinous cystadenoma: the importance of imaging in diagnosis and management.

    Science.gov (United States)

    Pesapane, Filippo; Renterghem, Sofie Van; Patella, Francesca; Visschere, Pieter De; Villeirs, Geert

    2018-01-29

    Primary retroperitoneal mucinous cystadenoma (PRMC) is an extremely rare tumor: its histogenesis and its biological behavior remain speculative. Since most retroperitoneal tumors are malignant, a preoperative diagnosis of benignity is essential and it can be reached through imaging examinations, allowing a conservative management approach. We describe the case of a 52-year-old woman with abdominal pain and a palpable mass. Computed tomography of the abdomen revealed a retroperitoneal cystic mass, which was resected successfully through laparoscopy and diagnosed as PRMC. Although there are no pathognomonic, clinical or radiological findings for PRMC, it should be included in the list of differential diagnoses and its imaging criteria of benignity should always be sought, with the aim to exclude malignant tumors.

  5. Clinical observation on the therapeutic efficacy of CyberKnife for primary or metastatic retroperitoneal tumors

    International Nuclear Information System (INIS)

    Zhuang Hongqing; Yuan Zhiyong; Wang Ping

    2012-01-01

    Objective: To evaluate the early response rate and radiation toxicity of CyberKnife in the treatment of primary or metastatic retroperitoneal tumors. Methods: Twenty-eight patients with retroperitoneal tumors were treated with CyberKnife. The total doses were 2000-6000 cGy (median 4500 cGy) and biological effective doses were 3750-10080 cGy (median 7680 cGy) in 2-10 fractions (median 5). Of all patients, 3 received three dimensional conformal radiotherapy (3DCRT) or intensity modulated radiotherapy (IMRT) boost, 1 was treated as second-course radiotherapy, and others were treated with CyberKnife only. The survival rates were calculated by Kaplan-Meier method and compared with Logrank test. Results: The complete response, stable disease and progression disease rates were 43% (12/28), 6% (10/28), 18% (5/28), 4%, (1/28), respectively. The overall response rate was 96%. The number of patients who were followed up more than 1, 2, 3 years were 17, 9, 7, respectively. The 1-, 2- and 3-year local control rates were 92%, 86%, and 86%, respectively. The 1-, 2- and 3-year overall survival rates were 60%, 49% and 49%, respectively. The difference between local progression-free survival and overall survival was not significant (median 9.5 and 12.0 months, χ 2 =0.17, P=0.680), Moreover, if the patients did not have metastasis elsewhere and local treatment was effective, there was no significant difference between local progression-free survival and progression free survival (median 17 and 11 months, χ 2 =0.13, P=0.720), Acute radiation-induced side effects (≥ 2 grade) such as fatigue, anorexia, nausea, vomiting and epigastric discomfort occurred in 9, 9, 7, 7 and 2 patients, respectively. Intestinal stenosis of 1 grade occurred in 1 patients. Conclusions: Radiotherapy for retroperitoneal tumors with CyberKnife has provided a high response rate with minimal side effects. It is a safe and effective local treatment method for retroperitoneal tumors. (authors)

  6. Retroperitoneal migration of a self-inflicted ballpoint pen via the urethra

    Directory of Open Access Journals (Sweden)

    Jose Cury

    2006-04-01

    Full Text Available Numerous accounts documenting the introduction of foreign bodies into the urinary bladder have been reported. These foreign bodies are typically self-inserted via urethral but migration from adjacent organs by an ulcerative process and penetrating injuries are also reported. However, "contrary" migration of a self-inflicted vesical foreign body to the retroperitoneum was not previously reported in literature. We report here a case of a ballpoint pen self-inserted via urethral by a female patient, which was identified in retroperitoneal position years later.

  7. Idiopathic retroperitoneal fibrosis involving a unilateral renal sinus: A case report and literature review

    International Nuclear Information System (INIS)

    Lee, Seul Bi; Yoon, Jung Hee; Kim, Seung Ho; Lee, Ye Daum; Kim, Suk Jung; Lim, Yun Jung; Jung, Hyun Kyung; Lee, Jin Soo

    2016-01-01

    Idiopathic retroperitoneal fibrosis (RPF) is a rare disease entity and its etiology is uncertain. We report two similar cases which showed an uncommon presentation of idiopathic RPF. A 66-year-old woman and an 80-year-old man presented with incidental findings of left renal pelvic mass-like lesions. Computed tomography revealed a soft tissue density mass replacing the left renal pelvis, which was suspicious for renal pelvic cancer, and the diagnosis of idiopathic RPF was surgically confirmed. To the best of our knowledge, a few cases of idiopathic RPF presenting with features of a localized unilateral renal pelvic mass mimicking renal pelvic cancer have been reported

  8. Idiopathic retroperitoneal fibrosis associated with Hashimoto's thyroiditis in a patient with a single functioning kidney

    Directory of Open Access Journals (Sweden)

    Byung Sun Kim

    2013-12-01

    Full Text Available Retroperitoneal fibrosis (RPF is a rare disease characterized by the presence of fibroinflammatory tissue around the abdominal aorta and ureteral entrapment in most cases. Idiopathic RPF is frequently reported in association with autoimmune diseases; however, there have been few reports of idiopathic RPF associated with Hashimoto's thyroiditis. Here, we report a case of idiopathic RPF with Hashimoto's thyroiditis in a patient with a single functioning kidney, which was successfully treated by corticosteroid therapy and transient intraureteral stent insertion with a double-J catheter.

  9. Adenocarcinomas arising from primary retroperitoneal mature teratomas: CT and MR imaging

    International Nuclear Information System (INIS)

    Wang, Li-Jen; Wong, Yon-Cheong; Chu, Sheng-Hsien; Ng, Kwai-Fong

    2002-01-01

    An adenocarcinoma arising from mature teratoma is one form of teratoma with malignant transformation. It is extremely rare but highly malignant. The authors report two patients with adenocarcinomas arising from primary retroperitoneal teratomas. The CT and MRI findings of the tumors are presented with emphasis on imaging features implying the presence of malignant transformation and differing from those of pure benign mature teratoma. Correct diagnosis of the presence of malignant transformation from a benign mature teratoma can be made as early as possible by awareness of the imaging features. (orig.)

  10. Idiopathic retroperitoneal fibrosis involving a unilateral renal sinus: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seul Bi; Yoon, Jung Hee; Kim, Seung Ho; Lee, Ye Daum; Kim, Suk Jung; Lim, Yun Jung; Jung, Hyun Kyung; Lee, Jin Soo [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2016-06-15

    Idiopathic retroperitoneal fibrosis (RPF) is a rare disease entity and its etiology is uncertain. We report two similar cases which showed an uncommon presentation of idiopathic RPF. A 66-year-old woman and an 80-year-old man presented with incidental findings of left renal pelvic mass-like lesions. Computed tomography revealed a soft tissue density mass replacing the left renal pelvis, which was suspicious for renal pelvic cancer, and the diagnosis of idiopathic RPF was surgically confirmed. To the best of our knowledge, a few cases of idiopathic RPF presenting with features of a localized unilateral renal pelvic mass mimicking renal pelvic cancer have been reported.

  11. Lymphatic endothelial cell line (CH3) from a recurrent retroperitoneal lymphangioma.

    Science.gov (United States)

    Way, D; Hendrix, M; Witte, M; Witte, C; Nagle, R; Davis, J

    1987-09-01

    An endothelial cell line derived from a massive recurrent chyle-containing retroperitoneal lymphangioma was isolated in monolayer culture. Scanning and transmission electron microscopy and immunohistochemistry confirmed a close resemblance to blood vascular endothelium with typical cobblestone morphology, positive immunofluorescence staining for endothelial marker Factor VIII-associated antigen and fibronectin, and prominent Weibel-Palade bodies. The endothelial cells also exhibited other ultrastructural features characteristic of lymphatic endothelium, including sparse microvillous surface projections, overlapping intercellular junctions, and abundant intermediate filaments. This endothelial cell line represents a new source of proliferating lymphatic endothelium for future study, including structural and functional comparison to blood vascular endothelium.

  12. The role of CT in pelvic fracture. CT finding of retro-peritoneal hematoma and indication of transcatheter arterial embolization

    International Nuclear Information System (INIS)

    Igarashi, Tsuneo; Hoshikawa, Yoshikazu; Saeki, Mitsuaki; Nakajima, Yasuo

    1998-01-01

    Although retro-peritoneal hematoma accompanying a pelvic fracture has been treated by arterial ligation formerly, it is associated with a high mortality rate and a transcatheter arterial embolization has now become the first choice of treatment. Meanwhile, the usefulness of computed tomography (CT) in traumatized patient has been reported frequently. Our hospital also employs CT positively as an examination following plain radiography in the cases with pelvic fracture. However, while indication of angiography is seen in several reports, the amount of retro-peritoneal hematoma as an index has not been reported. In the present study, we examined 112 patients given CT at the time of examination at the emergency center of our hospital between April 1, 1988, and June 30, 1997, and classified the amount of retro-peritoneal hematoma on CT into 5 groups to discuss indication of angiography. In the cases with moderate or massive amount of retro-peritoneal hematomas, cases with shock state exceeded 60% and the amount of hematoma was considered to reflect the circulation profile to a certain extent. As the amount of retro-peritoneal hematoma increased, the number of cases given embolization also increased; embolization was performed in 29 cases (61.7%) among those which had moderate or massive amount of hematoma. From the above findings, it was predicted that the amount of retro-peritoneal hematoma could be one of the deciding factors for indication of angiography. However, as there are cases falling into a shock state due to gradual increase of hematoma or associated with injuries in other organs, careful observation is needed for the cases judged out of indication. (author)

  13. Errors and complications in laparoscopic surgery

    OpenAIRE

    Liviu Drăghici; Mircea Lițescu; Rubin Munteanu; Constantin Pătru; Carmen L. Gorgan; Radu Mirică; Isabela Drăghici

    2017-01-01

    Background. In laparoscopic surgery errors are unavoidable and require proper acknowledgment to reduce the risk of intraoperative and accurately assess the appropriate therapeutic approach. Fortunately, their frequency is low and cannot overshadow the benefits of laparoscopic surgery. Materials and Methods. We made an epidemiological investigation in General Surgery Department of Emergency Clinical Hospital "St. John" Bucharest, analyzing 20 years of experience in laparoscopic surgery, during...

  14. Laparoscopic colectomy for transverse colon carcinoma.

    Science.gov (United States)

    Zmora, O; Bar-Dayan, A; Khaikin, M; Lebeydev, A; Shabtai, M; Ayalon, A; Rosin, D

    2010-03-01

    Laparoscopic resection of transverse colon carcinoma is technically demanding and was excluded from most of the large trials of laparoscopic colectomy. The aim of this study was to assess the safety, feasibility, and outcome of laparoscopic resection of carcinoma of the transverse colon. A retrospective review was performed to identify patients who underwent laparoscopic resection of transverse colon carcinoma. These patients were compared to patients who had laparoscopic resection for right and sigmoid colon carcinoma. In addition, they were compared to a historical series of patients who underwent open resection for transverse colon cancer. A total of 22 patients underwent laparoscopic resection for transverse colon carcinoma. Sixty-eight patients operated for right colon cancer and 64 operated for sigmoid colon cancer served as comparison groups. Twenty-four patients were identified for the historical open group. Intraoperative complications occurred in 4.5% of patients with transverse colon cancer compared to 5.9% (P = 1.0) and 7.8% (P = 1.0) of patients with right and sigmoid colon cancer, respectively. The early postoperative complication rate was 45, 50 (P = 1.0), and 37.5% (P = 0.22) in the three groups, respectively. Conversion was required in 1 (5%) patient in the laparoscopic transverse colon group. The conversion rate and late complications were not significantly different in the three groups. There was no significant difference in the number of lymph nodes harvested in the laparoscopic and open groups. Operative time was significantly longer in the laparoscopic transverse colectomy group when compared to all other groups (P = 0.001, 0.008, and transverse colectomy, respectively). The results of laparoscopic colon resection for transverse colon carcinoma are comparable to the results of laparoscopic resection of right or sigmoid colon cancer and open resection of transverse colon carcinoma. These results suggest that laparoscopic resection of transverse

  15. A Rare Case of Retroperitoneal Follicular Dendritic Cell Sarcoma Identified by 99mTc-HYNIC-TOC SPECT/CT.

    Science.gov (United States)

    Li, Yi; Xu, Xiaoping; Xu, Junyan; Huang, Dan

    2018-05-31

    Follicular dendritic cell sarcoma is a very rare neoplasm, which is not lymphoma, but originates from a type of immune cells called follicular dendritic cells. We presented a 37-year-old woman who has suffered from obstructive jaundice, weight loss and right upper abdominal pain for 2 months. The contrast CT revealed masses located in the region of pancreatic head and lots of enlarged retroperitoneal lymph nodes, both of which were enhanced on the artery phase of CT images. Meanwhile, Tc-HYNIC-TOC SPECT/CT revealed high activity in the corresponding lesions. After biopsy, the masses were pathologically confirmed as retroperitoneal follicular dendritic cell sarcoma.

  16. Retroperitoneal cystic lymphangioma with change of internal morphology on follow-up ultrasound and CT: a case report

    International Nuclear Information System (INIS)

    Shin, G. H; Lim, J. W.; Lee, D. H.; Ko, Y. T.; Kim, B. H.; Yang, M. H.

    1995-01-01

    We report a case of retroperitoneal cystic lymphangioma in an 65-year-old male. Two years prior to this admission, a mass was incidentally detected by ultrasound during hospitalization for the treatment of lung cancer. Ultrasound study showed a multiloculated cystic mass with debris and CT revealed a fat-fluid level within the mass. On two years follow-up, the mass has changed into a unicameral mass without internal echogenicity on US and homogeneous water-density mass on CT. The mass was removed by surgery and confirmed as retroperitoneal cystic lymphangioma

  17. Retroperitoneal cystic lymphangioma with change of internal morphology on follow-up ultrasound and CT: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, G. H; Lim, J. W.; Lee, D. H.; Ko, Y. T.; Kim, B. H.; Yang, M. H. [College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    1995-08-15

    We report a case of retroperitoneal cystic lymphangioma in an 65-year-old male. Two years prior to this admission, a mass was incidentally detected by ultrasound during hospitalization for the treatment of lung cancer. Ultrasound study showed a multiloculated cystic mass with debris and CT revealed a fat-fluid level within the mass. On two years follow-up, the mass has changed into a unicameral mass without internal echogenicity on US and homogeneous water-density mass on CT. The mass was removed by surgery and confirmed as retroperitoneal cystic lymphangioma.

  18. Retroperitoneal aortic hemorrhage caused by penetration of an endovascular stent-graft anchoring barb.

    Science.gov (United States)

    Twine, Christopher P; Winterbottom, Andrew; Shaida, Nadeem; Boyle, Jonathan R

    2013-08-01

    To report a rare case of acute intraoperative retroperitoneal hemorrhage secondary to aortic penetration by the suprarenal anchoring barb on a stent-graft. A 75-year-old patient on dual antiplatelet therapy for coronary stents and low-molecular-weight heparin for atrial thrombus underwent elective endovascular repair of a 6.7-cm infrarenal abdominal aortic aneurysm. A device with suprarenal fixation and metal anchoring barbs was implanted, and a molding balloon was used that at no time covered the proximal bare metal stents or barbs. In recovery, the patient became tachycardic and hypotensive. After resuscitation, imaging identified an anterior barb penetrating the aortic wall, causing the acute retroperitoneal hemorrhage. A decision to treat conservatively rather than resort to open surgery was difficult but ultimately influenced by the patients' high risk for open surgery. The patient was treated by aggressive reversal of heparin and platelet transfusion, and the bleed settled spontaneously. Major surgery and subsequent morbidity may be avoided by medical management of what would appear to be a surgical problem.

  19. C. T. criteria of the differential diagnosis in primary retroperitoneal masses

    Energy Technology Data Exchange (ETDEWEB)

    Pistolesi, G.F.; Procacci, C.; Caudana, R.; Bergamo Andreis, I.A.; Manera, V.; Recla, M.; Grasso, G.; Florio, C.

    1984-05-01

    This personal series of 44 primary retroperitoneal masses (P.R.P.M.) studied by C.T. is analyzed. The reliability of C.T. in the identification (44/44), characterization (43/44) and origin evaluation (41/44) of P.R.P.M. has been absolutely satisfactory. In particular, those criteria of C.T. diagnosis which may be utilized in the evaluation of the origin of upper abdominal masses are thoroughly described. The evaluation of the involvement (non invasive; invasive) of adjacent viscera has been achieved in 22/38 P.R.P.M. verified at operation. The evaluation of tumour resectability has been less reliable due to the high incidence of under-diagnosis (60% in our personal experience). C.T. may be used in addition as an aid to different diagnostic techniques (percutaneous guided needle biopsy) or to therapy (drainage of retroperitoneal abscesses). C.T. is absolutely necessary in the follow-up of P.R.P.M. after surgery, radiotherapy or chemotherapy.

  20. C.T. criteria of the differential diagnosis in primary retroperitoneal masses

    International Nuclear Information System (INIS)

    Pistolesi, G.F.; Procacci, C.; Caudana, R.; Bergamo Andreis, I.A.; Manera, V.; Recla, M.; Grasso, G.; Florio, C.

    1984-01-01

    This personal series of 44 primary retroperitoneal masses (P.R.P.M.) studied by C.T. is analyzed. The reliability of C.T. in the identification (44/44), characterization (43/44) and origin evaluation (41/44) of P.R.P.M. has been absolutely satisfactory. In particular, those criteria of C.T. diagnosis which may be utilized in the evaluation of the origin of upper abdominal masses are thoroughly described. The evaluation of the involvement (non invasive; invasive) of adjacent viscera has been achieved in 22/38 P.R.P.M. verified at operation. The evaluation of tumour resectability has been less reliable due to the high incidence of under-diagnosis (60% in our personal experience). C.T. may be used in addition as an aid to different diagnostic techniques (percutaneous guided needle biopsy) or to therapy (drainage of retroperitoneal abscesses). C.T. is absolutely necessary in the follow-up of P.R.P.M. after surgery, radiotherapy or chemotherapy. (orig.)

  1. Retroperitoneal abscess shortly after chemotherapy for lung cancer: A case report.

    Science.gov (United States)

    Ohara, Gen; Kondo, Tadashi; Kagohashi, Katsunori; Watanabe, Hiroko; Kawaguchi, Mio; Kurishima, Koichi; Satoh, Hiroaki; Hizawa, Nobuyuki

    2014-03-01

    To the best of our knowledge, the formation of a retroperitoneal abscess due to acute appendicitis shortly after administration of chemotherapy for lung cancer has not been previously reported. This is the case report of a 59-year-old male who was admitted to the Mito Medical Center (Mito, Japan) and diagnosed with lung adenocarcinoma with pleuritis carcinomatosis. Although no distant metastasis was identified, combination chemotherapy with cisplatin and pemetrexed was administered. Nine days after initiating chemotherapy, the patient developed right lower quadrant abdominal pain and high fever. Computed tomography (CT) of the abdomen and pelvis revealed the collection of gas and fluid in the retroperitoneum adjacent to the cecum. The abscess was locally drained; however, the infection continued to spread, with subsequent development of a scrotal abscess. Consequently, appendectomy was performed. The patient recovered well and the lung adenocarcinoma was treated with additional courses of chemotherapy following the remission of the local inflammation. Retroperitoneal abscess due to acute appendicitis is an unusual finding; however, this rare complication should be considered during or shortly after chemotherapy in patients with lung cancer.

  2. Retroperitoneal approach for robot-assisted partial nephrectomy: technique and early outcomes

    Directory of Open Access Journals (Sweden)

    A. Porreca

    Full Text Available ABSTRACT Objectives The aim of our study is to present early outcomes of our series of retroperitoneal-RAPN (Robot Assisted Partial Nephrectomy. Materials and methods From September 2010 until December 2015, we performed 81 RAPN procedures (44 at left kidney and 37 at right. Average size was 3cm (1-9. Average PADUA score 7.1 (5-10. Average surgical time (overall and only robot time, ischemia time, blood loss, pathological stage, complications and hospital stay have been recorded. Results All of the cases were completed successfully without any operative complication or surgical conversion. Average surgical time was 177 minutes (75-340. Operative time was 145 minutes (80-300, overall blood loss was 142cc (60-310cc. In 30 cases the pedicle was late clamped with an average ischemia time of 4 minutes (2-7. None of the patient had positive surgical margins at definitive histology (49pT1a, 12pT1b, 3pT2a, 2pT3a. Hospital stay was 3 days (2-7. Conclusions The retroperitoneal robotic partial nephrectomy approach is safe and allows treatment of even quite complex tumors. It also combines the already well known advantages guaranteed by the da Vinci® robotic surgical system, with the advantages of the retroperitoneoscopic approach.

  3. Characterization and management of patients with retroperitoneal sarcoma, Hospital San Juan de Dios 2007-2012

    International Nuclear Information System (INIS)

    Batista Rodriguez, Gabriela

    2013-01-01

    Patients diagnosed with retroperitoneal sarcoma at the Hospital San Juan de Dios were characterized during the years 2007 to 2012. The population framework was taken from the hospital's Pathology service database. A total of 15 patients older than 12 years with a diagnosis of sarcoma or malignant fibrous histiocytoma and that the site of origin of the biopsy was the retroperitoneum were selected. The data of the selected patients were collected through a data collection form. The variables included were: age, sex, origin, dates of importance (income, discharge, surgery, complication), presence and type of complications, pathological staging, type of surgery, comorbidities, presence and date of recurrence, treatment with chemotherapy and radiotherapy, death and causes of death. A descriptive analysis with the calculation of frequency measurements (absolute and relative) was carried out to describe the occurrence of the event. The analysis of proportional risks was performed considering the relationship between death and time, the possible relationship with the service of approach, clinical stage and resection status was also assessed. Information on diagnosis, evaluation, staging and management of retroperitoneal sarcomas is cited in the theoretical framework [es

  4. A rare case of retroperitoneal malignant triton tumor invading renal vein and small intestine

    Directory of Open Access Journals (Sweden)

    Mijović Žaklina

    2013-01-01

    Full Text Available Introduction. Malignant Triton tumor is a very rare malignant peripheral nerve sheath tumor with rhabdomyosarcomatous differentiation. Most of those tumors occur in patients with von Recklinghausen’s disease or as a late complication of irradiation and commonly seen in the head, neck, extremities and trunk. Case report. We reported retroperitoneal malignant Triton tumor in a 57-year-old female patient. Skin lesions were not present, and there was no family history of neurofibromatosis or previous irradiation. The presented case is one of a few recorded in the specialized literature that occurs in the retroperitoneal space in sporadic form. In this case, tumor consisted of a multilobular mass was in close relation with the abdominal aorta and inferior vena cava and involved the renal vein with gross invasion of the small intestine. The patient underwent total resection of the tumor and left nefrectomy was performed. The small intestine 10 cm in length was also resected and end-to-end anastomosis was conducted. The postoperative course was uneventful and the patient was discharged from the hospital ten days after the surgery. Conclusion. Diagnostically, it is crucial to recognize this uncommon histological variant because malignant Triton tumor has a worse prognosis than classic malignant peripheral nerve sheath tumor does. The use of the immunohistochemistry is essential in making the correct diagnosis. Only appropriate pathological evaluation supported by immunostaining with S-100 protein and desmin confirmed the diagnosis. Aggressive surgical management treatment improves the prognosis of such cases with adjuvant radiotherapy.

  5. Immunoglobulin G4-Related Retroperitoneal Fibrosis Treated with Hochuekkito, a Kampo Medicine, following Steroid Treatment

    Directory of Open Access Journals (Sweden)

    Minoru Fukuchi

    2014-05-01

    Full Text Available We report a case of immunoglobulin G4 (IgG4-related retroperitoneal fibrosis (RF with complete remission and no relapses after therapy with steroids and Hochuekkito, a Kampo (i.e. traditional Japanese herbal medicine. A 62-year-old Japanese man was admitted to our hospital for treatment of a retroperitoneal mass detected by computed tomography. The mass had a maximum diameter of 11.0 cm; it involved the left ureter and was associated with left hydronephrosis. After inserting a ureteral stent, we performed a biopsy by laparotomy. Histopathology revealed IgG4-related RF. The lesion disappeared after 7 months of steroid therapy. We subsequently used Hochuekkito as an alternative maintenance treatment because of steroid-related complications. The patient has not relapsed in the 3 years since starting the medication. To the best of our knowledge, this is the first case of IgG4-related RF treated with Hochuekkito as a maintenance treatment.

  6. Lateral retroperitoneal transpsoas interbody fusion in a patient with achondroplastic dwarfism.

    Science.gov (United States)

    Staub, Blake N; Holman, Paul J

    2015-02-01

    The authors present the first reported use of the lateral retroperitoneal transpsoas approach for interbody arthrodesis in a patient with achondroplastic dwarfism. The inherent anatomical abnormalities of the spine present in achondroplastic dwarfism predispose these patients to an increased incidence of spinal deformity as well as neurogenic claudication and potential radicular symptoms. The risks associated with prolonged general anesthesia and intolerance of significant blood loss in these patients makes them ideal candidates for minimally invasive spinal surgery. The patient in this case was a 51-year-old man with achondroplastic dwarfism who had a history of progressive claudication and radicular pain despite previous extensive lumbar laminectomies. The lateral retroperitoneal transpsoas approach was used for placement of interbody cages at L1/2, L2/3, L3/4, and L4/5, followed by posterior decompression and pedicle screw instrumentation. The patient tolerated the procedure well with no complications. Postoperatively his claudicatory and radicular symptoms resolved and a CT scan revealed solid arthrodesis with no periimplant lucencies.

  7. EUS-FNA for the Diagnosis of Retroperitoneal Primitive Neuroectodermal Tumor

    Directory of Open Access Journals (Sweden)

    Aijaz A. Sofi

    2011-01-01

    Full Text Available Primitive neuroectodermal tumor (PNET is a rare “small round blue cell tumor” that is diagnosed by open biopsy or percutaneous biopsy of the lesion under radiologic guidance. In this case report, we present a novel approach to the diagnosis of a retroperitoneal PNET by endoscopic ultrasound- (EUS- guided fine needle aspiration (FNA. A 35-year-old man presented with the history of left-sided flank pain and swelling of 3-weeks duration. Computerized tomography (CT scan of his abdomen revealed a 12.8 × 13 × 12.5 cm cystic and solid mass arising from the retroperitoneum and displacing the third and fourth portions of the duodenum. He underwent EUS which revealed a well-circumscribed heterogeneous mass abutting the inferior portion of the stomach. EUS-FNA of the mass revealed malignant cells consistent with primitive neuroectodermal tumor (PNET/Ewing's sarcoma. EUS-guided FNA is an appropriate technique for diagnosing retroperitoneal PNET/Ewing's sarcoma.

  8. [Ultrasound dissection in laparoscopic cholecystectomy].

    Science.gov (United States)

    Horstmann, R; Kern, M; Joosten, U; Hohlbach, G

    1993-01-01

    An ultrasound dissector especially developed for laparoscopic surgery was used during laparoscopic cholecystectomy on 34 patients. The ultrasound power, the volume of suction and irrigation could be determined individually at the generator and activated during the operation with a foot pedal. With the dissector it was possible to fragmentate, emulgate and aspirate simultaneously fat tissue as well as infected edematous structures. The cystic artery and cystic duct, small vessels, lymphatic and connective tissue were not damaged. Therefore this system seems to be excellent for the preparation of Calot's trigonum and blunt dissection of the gallbladder out of its bed, particularly in fatty, acute or chronic infected tissue. No complications were observed within the peri- and postoperative period.

  9. Clinical privileges for laparoscopic surgery.

    Science.gov (United States)

    Albrink, M H; Rosemurgy, A S

    1993-06-01

    Laparoscopic cholecystectomy has undergone an explosive growth. Its benefits to patients--shortened recovery time and less pain--became immediately obvious. The procedure's development and adaptation have largely been devised and implemented by ingenious and creative private practitioners, not the typical mode of introduction. Most or many new procedures in the past evolved from academic institutions after laboratory and then clinical trials. With rapid development and acceptance has come an additional new burden among medical practitioners: credentialing and granting clinical privileges.

  10. Laparoscopic pancreatectomy: Indications and outcomes

    Science.gov (United States)

    Liang, Shuyin; Hameed, Usmaan; Jayaraman, Shiva

    2014-01-01

    The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and short-term oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons’ experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve. PMID:25339811

  11. Laparoscopic surgery for morbid obesity.

    Science.gov (United States)

    Hallerbäck, B; Glise, H; Johansson, B; Johnson, E

    1998-01-01

    Morbid obesity, defined as a body mass index (BMI), i.e. weight (kg)/height (m2) over 36 for males and 38 for females, is a common condition and a threat for health, life and individual well being. Hitherto, surgery is the only effective treatment for weight reduction. Surgical methods can be malabsorptive, reducing the patients ability to absorb nutrients, or restrictive, reducing the capacity of food intake. Exclusively malabsorptive methods have been abandoned due to severe side effects. Restrictive methods, gastroplasties, reduces the compliance capacity of the stomach. Two types are performed laparoscopically, the vertical banded gastroplasty and the adjustable gastric banding. The proximal gastric by pass is also performed laparoscopically and is a combination of a restrictive proximal gastroplasty and a malabsorptive Roux-en-Y gastro-jejunal anastomosis. With laparoscopic adjustable gastric banding mean BMI was reduced from 41 kg/m2 to 33 kg/m2 (n = 43) after one year. Two years after surgery mean BMI was 30 kg/m2 (n = 16). The different operative techniques are further discussed in this paper.

  12. Laparoscopic adhesiolysis: consensus conference guidelines.

    Science.gov (United States)

    Vettoretto, N; Carrara, A; Corradi, A; De Vivo, G; Lazzaro, L; Ricciardelli, L; Agresta, F; Amodio, C; Bergamini, C; Borzellino, G; Catani, M; Cavaliere, D; Cirocchi, R; Gemini, S; Mirabella, A; Palasciano, N; Piazza, D; Piccoli, M; Rigamonti, M; Scatizzi, M; Tamborrino, E; Zago, M

    2012-05-01

    Laparoscopic adhesiolysis has been demonstrated to be technically feasible in small bowel obstruction and carries advantages in terms of post-surgical course. The increasing dissemination of laparoscopic surgery in the emergency setting and the lack of concrete evidence in the literature have called for a consensus conference to draw recommendations for clinical practice. A literature search was used to outline the evidence, and a consensus conference was held between experts in the field. A survey of international experts added expertise to the debate. A public jury of surgeons discussed and validated the statements, and the entire process was reviewed by three external experts. Recommendations concern the diagnostic evaluation, the timing of the operation, the selection of patients, the induction of the pneumoperitoneum, the removal of the cause of obstructions, the criteria for conversion, the use of adhesion-preventing agents, the need for high-technology dissection instruments and behaviour in the case of misdiagnosed hernia or the need for bowel resection. Evidence of this kind of surgery is scanty because of the absence of randomized controlled trials. Nevertheless laparoscopic skills in emergency are widespread. The recommendations given with the consensus process might be a useful tool in the hands of surgeons. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

  13. Parasitic leiomyoma after laparoscopic myomectomy

    Directory of Open Access Journals (Sweden)

    Srithean Lertvikool

    2015-08-01

    Full Text Available A 31-year-old nulligravid underwent laparoscopic myomectomy and the masses were removed by an electric morcellator. Five years later, this patient suffered from acute pelvic pain and received an operation. During laparoscopic surgery, an 8-cm right-sided multiloculated ovarian cyst with chocolate-like content was seen. After adhesiolysis, two parasitic myomas (each ∼2 cm in diameter were found attached to the right ovarian cyst and the other two parasitic myomas (each ∼1 cm in diameter were found at the right infundibulopelvic ligament and omentum respectively. These tumors were successfully removed by laparoscopic procedure. Histopathological examination confirmed that all masses were leiomyomas and the right ovarian cyst was confirmed to be endometriosis. The formation of parasitic myomas was assumed that myomatous fragments during morcellation at the time of myomectomy may have been left behind unintentionally. Thus, morcellator should be used carefully. With that being said, all of the myomatous fragment should be removed after morcellation.

  14. Retroperitoneal relapse of non-seminomatous testicular cancer: computed tomography findings before retroperitoneal lymphadenectomy; Retroperitoneale Rezidive nicht-seminomatoeser Hodentumoren: Computertomographische Befunde vor retroperitonealer Lymphadenektomie

    Energy Technology Data Exchange (ETDEWEB)

    Hosten, N.; Stroszczynski, C.; Lemke, M.; Felix, R. [Strahlenklinik und Poliklinik, Charite Campus Virchow, Humboldt Univ. zu Berlin (Germany); Rick, O. [Abt. Innere Medizin mit Schwerpunkt Haematologie/Onkologie, Charite Campus Virchow, Humboldt Univ. zu Berlin (Germany)

    1999-01-01

    Purpose: In relapsing testicular cancer, additional chemotherapy is followed by abdominal CT. If residual lesions are found, retroperitoneal lymphadenectomy is considered. We studied retrospectively whether morphological criteria can help in selected cases in deciding about lymphadenectomy by distinguishing between vital tumor, scarring and mature teratoma. Methods: In 26 patients who had been treated by salvage chemotherapy and retroperitoneal lymphadenectomy for non-seminomatous testicular cancer between 1990 and 1997, abdominal computed tomography and histology were correlated. Results: Histological examination found scarring in 10 patients, vital tumor in 6, mature teratoma in 4, and simultaneous teratoma and vital tumor in 6. A single CT criterion for distinguishing between these histologies was not identified. In two patients with large masses which were partly cystic and partly solid vital tumor and teratoma were verified. Scarrings may be expected in cystic lesions at the level of the renal hilus which are lined by a thin and smooth wall. Size did not matter. Conclusion: Accurate differentiation between vital tumor and necrosis was not possible. Before lymphadenectomy CT, however, localised lesions. (orig.) [Deutsch] Ziel: Bei Patienten mit rezidivierten Hodentumoren wird nach erneuter Chemotherapie die abdominelle CT durchgefuehrt. Wenn verbliebene Raumforderungen nachgewiesen werden, wird eine retroperitoneale Lymphadenektomie in Betracht gezogen. Untersucht wurde, ob der Bildbefund Hinweise auf das Vorliegen von vitalem Tumor, Nekrose bzw. Narbe oder reifem Teratom geben kann, die in Einzelfaellen zur Indikationsstellung herangezogen werden koennten. Methoden: Bei 26 Patienten, die wegen eines rezidivierten nicht-seminomatoesen Hodentumors in den Jahren 1990 bis 1997 einer erneuten Chemotherapie mit anschliessender retroperitonealer Lymphadenektomie von Tumorresten unterzogen worden waren, wurden abdominelle CT und Histologie korreliert. Ergebnisse: Die

  15. Novel Techniques for Retroperitoneal Implantation of Telemetry Transmitters for Physiologic Monitoring in Gottingen Minipigs (Sus scrofa domesticus)

    Science.gov (United States)

    2014-12-01

    that this procedure permitted effective monitoring of complex physiologic data, including transthoracic impedance, without negatively affecting the...retroperitoneal implantation of the telemetry device permitted effective monitoring of complex physiologic data, including transthoracic impedance...nerve agent and cyanide poisoning in minipigs after intraosseous administration. Ann Emerg Med 60:424–430. 26. Ngawhirunpat T, Opanasopit P

  16. Retroperitoneal necrotizing fasciitis presenting with peritonism in a 33-year-old Nepalese man: a case report

    Directory of Open Access Journals (Sweden)

    Giri Smith

    2012-02-01

    Full Text Available Abstract Introduction Retroperitoneal necrotizing fasciitis is a rare, fulminant, and potentially lethal complication of intra-abdominal suppuration. A retroperitoneal origin is very rare and very few cases have been reported in the literature. To the best of our knowledge, this case is only the fourth case reported of successful management following retroperitoneal necrotizing fasciitis. Case presentation A 33-year-old Tamang man presented to our facility with a history of five days of fever and vomiting and eight days of severe left loin pain. On examination, he had features of peritonism. A laparotomy was performed, revealing extensive necrotizing fasciitis of the retroperitoneum extending to the anterior abdominal wall. Our patient survived following extensive debridement of the necrotic tissues and supportive care. Conclusions Retroperitoneal necrotizing fasciitis can rarely present with features of peritonism, and hence should be included as a possible differential diagnosis for anyone presenting with peritonism. Although a fatal condition, early intervention and aggressive management can save the life of a patient.

  17. Pioneering Laparoscopic General Surgery in Nigeria | Misauno ...

    African Journals Online (AJOL)

    Background: Laparoscopic Surgery has revolutionized surgical operations due to its unique advantages of a shorter hospital stay, minimal surgical trauma and a better cosmetic outcome. There are a few reports from Nigeria reporting laparoscopic surgery in gynaecology. To the best of our knowledge, there has been no ...

  18. Day-case laparoscopic Nissen fundoplication.

    LENUS (Irish Health Repository)

    Khan, S A

    2012-01-01

    For day-case laparoscopic surgery to be successful, patient selection is of the utmost importance. This study aimed to assess the feasibility of day-case laparoscopic Nissen fundoplication and to identify factors that may lead to readmission and overstay.

  19. Laparoscopic partial nephrectomy for endophytic hilar tumors

    DEFF Research Database (Denmark)

    Di Pierro, G B; Tartaglia, N; Aresu, L

    2014-01-01

    To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients.......To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients....

  20. Laparoscopic versus open appendectomy in children with ...

    African Journals Online (AJOL)

    Introduction: Acute appendicitis represents one of the most common causes of urgent surgical interventions in pediatric age group. With the advances in minimal invasive surgery laparoscopic appendectomy (LA) has been introduced as a suitable line of treatment. We compare between laparoscopic and conventional open ...

  1. Force feedback and basic laparoscopic skills

    NARCIS (Netherlands)

    Chmarra, M.K.; Dankelman, J.; Van den Dobbelsteen, J.J.; Jansen, F.W.

    2008-01-01

    Background - Not much is known about the exact role offorce feedback in laparoscopy. This study aimed to determine whether force feedback influences movements of instruments during training in laparoscopic tasks and whether force feedback is required for training in basic laparoscopic force

  2. [Laparoscopic vs opened appendicovesicostomy in pediatric patients].

    Science.gov (United States)

    Landa-Juárez, Sergio; Montes de Oca-Muñoz, Lorena Elizabeth; Castillo-Fernández, Ana María; de la Cruz-Yañez, Hermilo; García-Hernández, Carlos; Andraca-Dumit, Roxona

    2014-01-01

    Appendicovesicostomy is commonly employed to facilitate drainage of urine through the catheter. Due to the tendency to less invasive procedures for the treatment of patients with neurogenic bladder, laparoscopy has been used as an alternative to open surgery, with the immediate advantages of postoperative recovery, shorter postoperative ileus, better cosmetic results, lower postoperative pain and early reintegration into everyday life. Compare the results of laparoscopic procedure with open appendicovesicostomy. We conducted an observational, analytical, longitudinal, ambispective cohort study, which included patients from 6-16 years of age diagnosed with neurogenic bladder, operated through laparoscopic and open appendicovesicostomy from January 2009 to June 2013. Information was obtained from clinical records. Six patients were operated laparoscopically and 14 by open approach. Surgical time was longer and statistically significant in the laparoscopic group with a median of 330 min (300-360 min) compared to open procedure of 255 min (180-360 min). Seven patients had complications in the open group and only one in the laparoscopic group. The difference in the dose of analgesics and time of use was statistically significant in favor of the laparoscopic group. The degree of urinary continence through the stoma was higher for laparoscopic (100%) compared to the open procedure (64%). In neurogenic bladder with urodynamic bladder capacity and leak point pressure bladder within acceptable values, laparoscopic appendicovesicostomy was a better alternative.

  3. Role of laparoscopic cholecystectomy in children

    Directory of Open Access Journals (Sweden)

    Oak Sanjay

    2005-01-01

    Full Text Available The present study is undertaken to establish the usefulness of laparoscopic cholecystectomy and to know its merits and demerits as compared to open cholecystectomy in children. In all, 28 patients who underwent cholecystectomy (8 open and 20 laparoscopic cholecystectomy in B.Y.L. Nair hospital between July 1999 and March 2004 were analyzed. Calculous cholecystitis was found to be the most common indication for surgery. Operative time for laparoscopic cholecystectomy was more than that in open cholecystectomy in the early phase of laparoscopy, which got reduced as we gained experience. The requirement of parenteral antibiotics and analgesics and the duration of stay were significantly shorter with laparoscopy. The advantages for a child in laparoscopic cholecystectomy as compared to open cholecystectomy are minimal pain, avoidance of an upper abdominal incision, cosmesis and shorter duration of hospitalization with quick return to home and school. Thus, laparoscopic cholecystectomy is safe and efficacious in children.

  4. Retroperitoneal Liposarcoma

    African Journals Online (AJOL)

    sion of the lobulated mass was performed, includ- ing a splenectomy. The ureter, which was displaced to the right of the aorta, was identified and reflected off the tumour. Vasculature to the colon was re- tained and the colon was replaced in the paracolic gutter. The mesocolon was repaired and reperitonealisation achieved.

  5. Laparoscopic revision of failed antireflux operations.

    Science.gov (United States)

    Serafini, F M; Bloomston, M; Zervos, E; Muench, J; Albrink, M H; Murr, M; Rosemurgy, A S

    2001-01-01

    A small number of patients fail fundoplication and require reoperation. Laparoscopic techniques have been applied to reoperative fundoplications. We reviewed our experience with reoperative laparoscopic fundoplication. Reoperative laparoscopic fundoplication was undertaken in 28 patients, 19 F and 9 M, of mean age 56 years +/- 12. Previous antireflux procedures included 19 open and 12 laparoscopic antireflux operations. Symptoms were heartburn (90%), dysphagia (35%), and atypical symptoms (30%%). The mean interval from antireflux procedure to revision was 13 months +/- 4.2. The mean DeMeester score was 78+/-32 (normal 14.7). Eighteen patients (64%) had hiatal breakdown, 17 (60%) had wrap failure, 2 (7%) had slipped Nissen, 3 (11%) had paraesophageal hernias, and 1 (3%) had an excessively tight wrap. Twenty-five revisions were completed laparoscopically, while 3 patients required conversion to the open technique. Complications occurred in 9 of 17 (53%) patients failing previous open fundoplications and in 4 of 12 patients (33%) failing previous laparoscopic fundoplications and included 15 gastrotomies and 1 esophagotomy, all repaired laparoscopically, 3 postoperative gastric leaks, and 4 pneumothoraces requiring tube thoracostomy. No deaths occurred. Median length of stay was 5 days (range 2-90 days). At a mean follow-up of 20 months +/- 17, 2 patients (7%) have failed revision of their fundoplications, with the rest of the patients being essentially asymptomatic (93%). The results achieved with reoperative laparoscopic fundoplication are similar to those of primary laparoscopic fundoplications. Laparoscopic reoperations, particularly of primary open fundoplication, can be technically challenging and fraught with complications. Copyright 2001 Academic Press.

  6. Do laparoscopic skills transfer to robotic surgery?

    Science.gov (United States)

    Panait, Lucian; Shetty, Shohan; Shewokis, Patricia A; Sanchez, Juan A

    2014-03-01

    Identifying the set of skills that can transfer from laparoscopic to robotic surgery is an important consideration in designing optimal training curricula. We tested the degree to which laparoscopic skills transfer to a robotic platform. Fourteen medical students and 14 surgery residents with no previous robotic but varying degrees of laparoscopic experience were studied. Three fundamentals of laparoscopic surgery tasks were used on the laparoscopic box trainer and then the da Vinci robot: peg transfer (PT), circle cutting (CC), and intracorporeal suturing (IS). A questionnaire was administered for assessing subjects' comfort level with each task. Standard fundamentals of laparoscopic surgery scoring metric were used and higher scores indicate a superior performance. For the group, PT and CC scores were similar between robotic and laparoscopic modalities (90 versus 90 and 52 versus 47; P > 0.05). However, for the advanced IS task, robotic-IS scores were significantly higher than laparoscopic-IS (80 versus 53; P robotic-PT score when compared with laparoscopic-PT (92 versus 105; P  0.05). The robot was favored over laparoscopy for all drills (PT, 66.7%; CC, 88.9%; IS, 94.4%). For simple tasks, participants with preexisting skills perform worse with the robot. However, with increasing task difficulty, robotic performance is equal or better than laparoscopy. Laparoscopic skills appear to readily transfer to a robotic platform, and difficult tasks such as IS are actually enhanced, even in subjects naive to the technology. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Laparoscopic Transcystic Common Bile Duct Exploration: Advantages over Laparoscopic Choledochotomy.

    Directory of Open Access Journals (Sweden)

    Qian Feng

    Full Text Available The ideal treatment for choledocholithiasis should be simple, readily available, reliable, minimally invasive and cost-effective for patients. We performed this study to compare the benefits and drawbacks of different laparoscopic approaches (transcystic and choledochotomy for removal of common bile duct stones.A systematic search was implemented for relevant literature using Cochrane, PubMed, Ovid Medline, EMBASE and Wanfang databases. Both the fixed-effects and random-effects models were used to calculate the odds ratio (OR or the mean difference (MD with 95% confidence interval (CI for this study.The meta-analysis included 18 trials involving 2,782 patients. There were no statistically significant differences between laparoscopic choledochotomy for common bile duct exploration (LCCBDE (n = 1,222 and laparoscopic transcystic common bile duct exploration (LTCBDE (n = 1,560 regarding stone clearance (OR 0.73, 95% CI 0.50-1.07; P = 0.11, conversion to other procedures (OR 0.62, 95% CI 0.21-1.79; P = 0.38, total morbidity (OR 1.65, 95% CI 0.92-2.96; P = 0.09, operative time (MD 12.34, 95% CI -0.10-24.78; P = 0.05, and blood loss (MD 1.95, 95% CI -9.56-13.46; P = 0.74. However, the LTCBDE group showed significantly better results for biliary morbidity (OR 4.25, 95% CI 2.30-7.85; P<0.001, hospital stay (MD 2.52, 95% CI 1.29-3.75; P<0.001, and hospital expenses (MD 0.30, 95% CI 0.23-0.37; P<0.001 than the LCCBDE group.LTCBDE is safer than LCCBDE, and is the ideal treatment for common bile duct stones.

  8. Thoracic Stent Graft Implantation for Aortic Coarctation with Patent Ductus Arteriosus via Retroperitoneal Iliac Approach in the Presence of Small Sized Femoral Artery

    Directory of Open Access Journals (Sweden)

    Ozge Korkmaz

    2016-01-01

    Full Text Available Endovascular stent graft implantation is a favorable method for complex aortic coarctation accompanied by patent ductus arteriosus. Herein, an 18-year-old woman with complex aortic coarctation and patent ductus arteriosus was successfully treated by endovascular thoracic stent graft via retroperitoneal approach. The reason for retroperitoneal iliac approach was small sized common femoral arteries which were not suitable for stent graft passage. This case is the first aortic coarctation plus patent ductus arteriosus case described in the literature which is treated by endovascular thoracic stent graft via retroperitoneal approach.

  9. Augmented reality: a new tool to improve surgical accuracy during laparoscopic partial nephrectomy? Preliminary in vitro and in vivo results.

    Science.gov (United States)

    Teber, Dogu; Guven, Selcuk; Simpfendörfer, Tobias; Baumhauer, Mathias; Güven, Esref Oguz; Yencilek, Faruk; Gözen, Ali Serdar; Rassweiler, Jens

    2009-08-01

    Use of an augmented reality (AR)-based soft tissue navigation system in urologic laparoscopic surgery is an evolving technique. To evaluate a novel soft tissue navigation system developed to enhance the surgeon's perception and to provide decision-making guidance directly before initiation of kidney resection for laparoscopic partial nephrectomy (LPN). Custom-designed navigation aids, a mobile C-arm capable of cone-beam imaging, and a standard personal computer were used. The feasibility and reproducibility of inside-out tracking principles were evaluated in a porcine model with an artificially created intraparenchymal tumor in vitro. The same algorithm was then incorporated into clinical practice during LPN. Evaluation of a fully automated inside-out tracking system was repeated in exactly the same way for 10 different porcine renal units. Additionally, 10 patients underwent retroperitoneal LPNs under manual AR guidance by one surgeon. The navigation errors and image-acquisition times were determined in vitro. The mean operative time, time to locate the tumor, and positive surgical margin were assessed in vivo. The system was able to navigate and superpose the virtually created images and real-time images with an error margin of only 0.5 mm, and fully automated initial image acquisition took 40 ms. The mean operative time was 165 min (range: 135-195 min), and mean time to locate the tumor was 20 min (range: 13-27 min). None of the cases required conversion to open surgery. Definitive histology revealed tumor-free margins in all 10 cases. This novel AR tracking system proved to be functional with a reasonable margin of error and image-to-image registration time. Mounting the pre- or intraoperative imaging properties on real-time videoendoscopic images in a real-time manner will simplify and increase the precision of laparoscopic procedures.

  10. Retroperitoneal Malignant Peripheral Nerve Sheath Tumor Replacing an Absent Kidney in a Child

    Directory of Open Access Journals (Sweden)

    Samin Alavi

    2013-01-01

    Full Text Available Malignant peripheral nerve sheath tumors (MPNSTs are nonrhabdomyosarcoma soft tissue sarcomas with rare occurrence in children specially in the retroperitoneum. We describe a young child who presented with an abdominal mass. Both ultrasound and computed tomography revealed a large right-sided abdominal mass in the anatomic place of right kidney, while no kidney or ureter was observed at that side. He underwent surgical resection of the tumor with a primary impression of Wilms tumor. To the authors’ knowledge, this is the first case of retroperitoneal malignant peripheral nerve sheath tumor and absent kidney. This case suggests the very rare probability of association of MPNSTs in children with genitourinary tract anomalies such as renal agenesis.

  11. Retroperitoneal Bleeding: An Experience During Prophylactic Anticoagulation in a Patient With Nephrotic Syndrome

    Directory of Open Access Journals (Sweden)

    Mari Okada

    2017-07-01

    Full Text Available The association between nephrotic syndrome (NS and a hypercoagulable state has been demonstrated. Controlling the blood clotting activity may therefore be attractive for patients with nephrosis in terms of thromboembolism prophylaxis. We herein report a 75-year-old woman with minimal change disease who developed pains in the right back, groin, and thigh because of retroperitoneal bleeding during prophylactic anticoagulation with unfractionated heparin. Although this procedure has not been accepted as the standard of care for patients with nephrosis, pharmacologic prophylaxis may already be practiced empirically, as in the present patient. We believe that our experience highlights the pitfalls of such a management in patients with nephrosis, implying the need for a diagnostic strategy for identifying those patients with NS who can benefit from prophylactic anticoagulation. Several concerns that emerged in this case are also discussed.

  12. Anatomy of the retroperitoneal space as shown by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Zilch, H.G.; Hammersen, F.

    1989-01-01

    More than 300 NMR examinations form the basis of the survey presented of the anatomy and topography of the retroperitoneal space. The examinations were done with the Siemens supraconducting magnet system 'Magnetom' (1.0 Tesla), with different planes of imaging chosen, according to clinical approaches (axial, sagittal, frontal). Sectional thicknesses varied between 5 and 10 mm. The spin-echo technique was applied, with repetition times between 0.3 and 2.0s, echo times between 30 and 150 ms. In addition, special means such as high-resolution coils and respiratory gating were applied, and also a contrast medium (gadolinium-DTPA). The possibilities of imaging are explained, referring to the pancreas, kidneys, adrenal glands, lymph nodes, aorta abdominalis, and vena cava inferior. (orig./MG) [de

  13. Endovascular aortic graft infection resulting in retroperitoneal abscess: report of a case

    Directory of Open Access Journals (Sweden)

    Salvatore Di Somma

    2010-06-01

    Full Text Available Infection is a rare complication of aortoiliac endovascular procedures, with an incidence inferior to 0.5%, and it may result in a retroperitoneal abscess potentially evolving to sepsis and gastrointestinal bleeding. In more than 50% of cases endovascular aortoiliac prosthetic grafts infection occur months or years after the procedure. The growing number of endovascular procedures, and as the actually midterm follow up in most cases, septic sequelae will no doubt continue to occur with increased frequency and may represent an emerging problem in the ED for the emergency physician. Endovascular graft infection begins with unspecific clinical manifestations. An high index of suspicion in any patient with an aortic stent graft presenting prolonged or recurrent fever and or abdominal or back pain and a low threshold for obtaining CT scan should increase the clinician’s ability to make a timely diagnosis in the ED setting.

  14. CT and ultrasound in the abdomen and in the retroperitoneal space: Competition or combination

    International Nuclear Information System (INIS)

    Kaick, G. van; Redlich, H.; Lorenz, D.; Kilian, J.

    1979-01-01

    Computerized tomography and sonography are competitive methods only in the intraperitoneal and retroperitoneal space. CT offers a complete cross section of the body whereas sonography is often handicapped by 'shadows' caused by gas and bone. Using contrast media, a more specific orientation is possible in CT. On the other hand, sonography provides better differentiation between solid and fluid, and longitudinal sections are easily available. The diagnostic value of both methods and the advantage of their combination are discussed, based on the experience of 120 combined examination in patients whose illnesses were later established definitely. Computer tomography provides better diagnostic results than echography; the differences, however, are not so great for this to mean a substantial loss of importance for echographic diagnostics. In principle, echography should preceded computerized tomography to save time for CT scanning as well as to reduce the patient's dose. (orig.) 891 MG/orig. 892 MB [de

  15. Predictors of viable germ cell tumor in postchemotherapeutic residual retroperitoneal masses

    Directory of Open Access Journals (Sweden)

    Khalid Al Othman

    2014-01-01

    Full Text Available Objective: The aim of this study was to identify predictors of viable germ cell tumor (GCT in postchemotherapeutic residual retroperitoneal masses. Materials and Methods: The pertinent clinical and pathologic data of 16 male patients who underwent postchemotherapeutic retroperitoneal lymph node dissection (PC-RPLND at King Faisal Specialist Hospital and Research Centre between 1994 and 2005 were reviewed retrospectively. It was found that all patients received cisplatin-based chemotherapy for advanced testicular GCT. Results: Out of the 16 male patients, 2 (13%, 8 (50%, and 6 (37% had viable GCT, fibrosis, and teratoma, respectively. Ten (10 of the patients with prechemotherapeutic S1 tumor markers did not have viable GCT, and two of the six patients who had prechemotherapeutic S2 tumor markers have viable GCT. All tumor marker levels normalized after chemotherapy even in patients with viable GCT. Four patients had vascular invasion without viable GCT. Furthermore, four patients had more than 60% embryonal elements in the original pathology, but only 1 had viable GCT at PC-RPLND. Four of the five patients with immature teratoma had teratoma at PC-RPLND but no viable GCT; however, out of the four patients with mature teratoma, one had viable GCT and two had teratoma at PC-RPLND. Of the two patients with viable GCT, one had 100% embryonal cancer in the original pathology, prechemotherapeutic S2 tumor markers, history of orchiopexy, and no vascular invasion; the other patient had yolk sac tumor with 25% embryonal elements and 40% teratoma in the original pathology, and prechemotherapeutic S2 tumor markers. Conclusion: None of the clinical or pathological parameters showed a strong correlation with the presence of viable GCT in PC-RPLND. However, patients with ≥S2 may be at higher risk to have viable GCT. Further studies are needed to clarify this.

  16. Cholecystoenteric Fistule and Laparoscopic Repair

    Directory of Open Access Journals (Sweden)

    Temel Bulut

    2014-03-01

    Full Text Available Gallbladder stones are an endemic disease of hepatobiliary system.Whereas, cholecystoenteric fistules which develop by depending on gallbladder stone are rarely seen complications. A diagnosis is usually established during an operation. As is seen in our case too, in view of acute-stoned cholecystitis, laparoscopy has been carried out and a diagnosis of cholecystoduodenal fistule has been established during laparoscopy. Our case to whom laparoscopic duodenography and cholecystectomy has been applied is a rarely seen disease in literature. So, we aimed at sharing this information.

  17. Laparoscopic management of abdominal cocoon

    Directory of Open Access Journals (Sweden)

    Makam Ramesh

    2008-01-01

    Full Text Available "Peritonitis fibrosa incapsulata", first described in 1907, is a condition characterized by encasement of the bowel with a thick fibrous membrane. This condition was renamed as "abdominal cocoon" in 1978. It presents as small bowel obstruction clinically. 35 cases of abdominal cocoon have been reported in the literature over the last three decades. Abdominal cocoon is more common in adolescent girls from tropical countries. Various etiologies have been described, including tubercular. It is treated surgically by releasing the entrapped bowel. We report a laparoscopic experience of tubercular abdominal cocoon and review the literature.

  18. Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation-volvulus.

    Science.gov (United States)

    Rivier, Pablo; Furneaux, Rob; Viguier, Eric

    2011-01-01

    This prospective study describes a simple method of combining laparoscopic ovariectomy and laparoscopic-assisted prophylactic gastropexy and determines the duration of surgery, complications, and long-term outcome including prevention of gastric dilatation-volvulus (GDV). Laparoscopic ovariectomy and laparoscopic-assisted gastropexy were performed on 26 sexually intact female dogs susceptible to GDV. The mean surgery time was 60.8 ± 12.4 min. No GDV episode was seen during the study period (mean follow-up: 5.2 ± 1.4 y). All dogs had an intact gastropexy attachment assessed by ultrasonography at 1 y. Post-operative complications were minor and owners were satisfied with the procedure. Combined laparoscopic ovariectomy and laparoscopic- assisted gastropexy appears to be a successful and low morbidity alternative procedure to both ovariectomy/ovariohysterectomy and gastropexy via open ventral-midline laparotomy.

  19. Laparoscopic ureterocalicostomy in pigs - experimental study

    Directory of Open Access Journals (Sweden)

    Paulo Fernando de Oliveira Caldas

    2015-07-01

    Full Text Available This study aimed to evaluated laparoscopic ureterocalicostomy as treatment of experimental ureteropelvic junction (UPJ obstruction in pigs. Ten male Large White pigs weighting approximately 28.4 (±1.43 kg were used in the current study. The UPJ obstruction was created laparoscopically by double-clipping of the left ureter. After 14 days the animals underwent laparoscopic ureterocalicostomy f The animals were sacrificed for subsequent retrograde pyelography in order to assess the anastomotic patency on the 28th day. The laparoscopic procedure for experimental obstruction of UPJ was successfully performed in all animals, as well as the laparoscopic ureterocalicostomy. There was intestinal iatrogenic injury in one animal. Satisfactory UPJ patency was noted in 75% of the animals. There was no stenosis of the proximal anastomosis between the ureter and the lower pole of the kidney in 37.5%, mild stenosis in 37.5% and severe stenosis in 25% of the animals. The laparoscopic approach for reestablishment he urinary flow by ureterocalicostomy was feasible in the porcine model. The ascending pyelography revealed satisfactory results of the laparoscopic ureterocalicostomy

  20. Laparoscopic Cholecystectomy in Chronic Calculus Cholecystitis

    Directory of Open Access Journals (Sweden)

    Prakash Sapkota

    2013-12-01

    Full Text Available Introduction: Laparoscopic cholecystectomy has clearly become the choice over open cholecystectomy in the treatment of hepatobiliary disease since its introduction by Mouret in 1987. This study evaluates a series of patients with chronic calculus cholecystitis who were treated with laparoscopic and open cholecystectomy and assesses the outcomes of both techniques. Objective: To evaluate the efficacy of laparoscopic vs open cholecystectomy in chronic calculus cholecystitis and establish the out-comes of this treatment modality at Lumbini Medical College and Teaching Hospital. Methods: This was a retrospective analysis over a one-year period (January 1, 2012 to December 31, 2012, per-formed by single surgeon at Lumbini Medical College and Teaching Hospital located midwest of Nepal. 166 patients underwent surgical treatment for chronic calculus cholecystitis. Patients included were only chronic calculus cholecystitis proven histopathologocally and the rest were excluded. Data was collected which included patients demographics, medical history, presentation, complications, conversion rates from laparoscopic. cholecystectomy to open cholecystectomy, operative and postoperative time. Results: Patients treated with laparoscopic cholecystectomy for chronic calculus cholecystitis had shorter operating times and length of stay compared to patients treated with open cholecystectomy for chronic calculus cholecystitis. Conversion rates were 3.54% in chronic calculus cholecystitis during the study period. Complications were also lower in patients who underwent laparoscopic cholecystectomy versus open cholecystectomy for cholelithiasis. Conclusions: Laparoscopic cholecystectomy appears to be a reliable, safe, and cost-effective treatment modality for chronic calculus cholecystitis.

  1. Laparoscopic Habib 4X: a bipolar radiofrequency device for bloodless laparoscopic liver resection.

    Science.gov (United States)

    Pai, M; Navarra, G; Ayav, A; Sommerville, C; Khorsandi, S K; Damrah, O; Jiao, L R; Habib, N A

    2008-01-01

    In recent years the progress of laparoscopic procedures and the development of new and dedicated technologies have made laparoscopic hepatic surgery feasible and safe. In spite of this laparoscopic liver resection remains a surgical procedure of great challenge because of the risk of massive bleeding during liver transection and the complicated biliary and vascular anatomy in the liver. A new laparoscopic device is reported here to assist liver resection laparoscopically. The laparoscopic Habib 4X is a bipolar radiofrequency device consisting of a 2 x 2 array of needles arranged in a rectangle. It is introduced perpendicularly into the liver, along the intended transection line. It produces coagulative necrosis of the liver parenchyma sealing biliary radicals and blood vessels and enables bloodless transection of the liver parenchyma. Twenty-four Laparoscopic liver resections were performed with LH4X out of a total of 28 attempted resections over 12 months. Pringle manoeuvre was not used in any of the patients. None of the patients required intraoperative transfusion of red cells or blood products. Laparoscopic liver resection can be safely performed with laparoscopic Habib 4X with a significantly low risk of intraoperative bleeding or postoperative complications.

  2. Laparoscopic repair of postoperative perineal hernia.

    LENUS (Irish Health Repository)

    Ryan, Stephen

    2010-01-01

    Perineal hernias are infrequent complications following abdominoperineal operations. Various approaches have been described for repair of perineal hernias including open transabdominal, transperineal or combined abdominoperineal repairs. The use of laparoscopic transabdominal repair of perineal hernias is not well-described. We present a case report demonstrating the benefits of laparoscopic repair of perineal hernia following previous laparoscopic abdominoperineal resection (APR) using a nonabsorbable mesh to repair the defect. We have demonstrated that the use of laparoscopy with repair of the pelvic floor defect using a non absorbable synthetic mesh offers an excellent alternative with many potential advantages over open transabdominal and transperineal repairs.

  3. Current status of laparoscopic central pancreatectomy

    Directory of Open Access Journals (Sweden)

    CAO Yang

    2017-04-01

    Full Text Available Central pancreatectomy is an ideal surgical procedure for the treatment of benign or low-grade malignant tumors in the pancreatic neck or the proximal body of the pancreas, and it can preserve more normal pancreatic tissue in order to reduce the incidence of endocrine and exocrine insufficiency after surgery. Although some clinical studies have demonstrated the feasibility and safety of this procedure, laparoscopic central pancreatectomy was technically challenging with a few number of cases. This article reviews the current status of laparoscopic central pancreatectomy and introduces our clinical experience of laparoscopic central pancreatectomy and pancreaticojejunostomy.

  4. Laparoscopic feeding jejunostomy: also a simple technique.

    Science.gov (United States)

    Albrink, M H; Foster, J; Rosemurgy, A S; Carey, L C

    1992-01-01

    Placement of feeding tubes is a common procedure for general surgeons. While the advent of percutaneous endoscopic gastrostomy has changed and improved surgical practice, this technique is contraindicated in many circumstances. In some patients placement of feeding tubes in the stomach may be contraindicated due to the risks of aspiration, gastric paresis, or gastric dysmotility. We describe a technique of laparoscopic jejunostomy tube placement which is easy and effective. It is noteworthy that this method may be used in patients who have had previous abdominal operations, and it has the added advantage of a direct peritoneal view of the viscera. We suggest that qualified laparoscopic surgeons learn the technique of laparoscopic jejunostomy.

  5. A new technique of laparoscopic cholangiography.

    Science.gov (United States)

    Hagan, K D; Rosemurgy, A S; Albrink, M H; Carey, L C

    1992-04-01

    With the advent and rapid proliferation of laparoscopic cholecystectomy, numerous techniques and "tips" have been described. Intraoperative cholangiography during laparoscopic cholecystectomy can be tedious, frustrating, and time consuming. Described herein is a technique of intraoperative cholangiography during laparoscopic cholecystectomy which has proven to be easy, fast, and succinct. This method utilizes a rigid cholangiogram catheter which is placed into the peritoneal cavity through a small additional puncture site. This catheter is easily inserted into the cystic duct by extracorporeal manipulation. We suggest this method to surgeons who have shared our prior frustration with intraoperative cholangiography.

  6. Rectus sheath abscess after laparoscopic appendicectomy

    Directory of Open Access Journals (Sweden)

    Golash Vishwanath

    2007-01-01

    Full Text Available Port site wound infection, abdominal wall hematoma and intraabdominal abscess formation has been reported after laparoscopic appendicectomy. We describe here a rectus sheath abscess which occurred three weeks after the laparoscopic appendicectomy. It was most likely the result of secondary infection of the rectus sheath hematoma due to bleeding into the rectus sheath from damage to the inferior epigastric arteries or a direct tear of the rectus muscle. As far as we are aware this complication has not been reported after laparoscopic appendicectomy.

  7. Commentary on "a matched comparison of perioperative outcomes of a single laparoscopic surgeon versus a multisurgeon robot-assisted cohort for partial nephrectomy." Ellison JS, Montgomery JS, Wolf Jr JS, Hafez KS, Miller DC, Weizer AZ, Department of Urology, University of Michigan, Ann Arbor, MI, USA: J Urol 2012;188(1):45-50.

    Science.gov (United States)

    Kane, Christopher

    2013-02-01

    Minimally invasive nephron sparing surgery is gaining popularity for small renal masses. Few groups have evaluated robot-assisted partial nephrectomy compared to other approaches using comparable patient populations. We present a matched pair analysis of a heterogeneous group of surgeons who performed robot-assisted partial nephrectomy and a single experienced laparoscopic surgeon who performed conventional laparoscopic partial nephrectomy. Perioperative outcomes and complications were compared. All 249 conventional laparoscopic and robot-assisted partial nephrectomy cases from January 2007 to June 2010 were reviewed from our prospectively maintained institutional database. Groups were matched 1:1 (108 matched pairs) by R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines) nephrometry score, transperitoneal vs retroperitoneal approach, patient age and hilar nature of the tumor. Statistical analysis was done to compare operative outcomes and complications. Matched analysis revealed that nephrometry score, age, gender, tumor side and American Society of Anesthesia physical status classification were similar. Operative time favored conventional laparoscopic partial nephrectomy. During the study period robot-assisted partial nephrectomy showed significant improvements in estimated blood loss and warm ischemia time compared to those of the experienced conventional laparoscopic group. Postoperative complication rates, and complication distributions by Clavien classification and type were similar for conventional laparoscopic and robot-assisted partial nephrectomy (41.7% and 35.0%, respectively). Robot-assisted partial nephrectomy has a noticeable but rapid learning curve. After it is overcome the robotic procedure results in perioperative outcomes similar to those achieved with conventional laparoscopic partial nephrectomy done by an experienced surgeon. Robot

  8. An audit of laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Khan, S.; Oonwala, Z.G.

    2006-01-01

    To evaluate the outcome of Laparoscopic Cholecystectomy in Gall stone disease, critically analyzing the complication rate, morbidity and mortality rate. All patients (>12 years) with cholelithiasis were included in this study. Patients with common bile duct dilatation (>8mm) or stones, or gall bladder mass or jaundice, and those declared unfit for anaesthesia were excluded. The detailed data of all the cases was compiled and analyzed. Out of the total of 1345 patients operated during the study period, 1234 (91.75%) were females and 111 (8.25%) males; their ages ranged from 12 to 89 years, majority were in the age bracket of 30-50 years. Our conversion rate was 6.4%. Nine (0.67%) patients developed bleeding from the port site, 30 (2.23%) port site infection, 43 (3.20%) umbilical port hernia, two bile ducty injury and one colonic injury. There was no mortality in this series. Laparoscopic Cholecystectomy is a safe and effective treatment for Cholelithiasis. (author)

  9. Successful Laparoscopic Removal of an Ingested Toothbrush

    African Journals Online (AJOL)

    Key words: Foreign body, gastronintestinal, laparoscopic, surgery ... light diet the following day. ... Figure 1: Intraoperative image: Outline of the toothbrush visible on .... China. Gastrointest Endosc 2006;64:485-92. 12. Garrido J, Barkin JS.

  10. Laparoscopic Anti-Reflux (GERD) Surgery

    Science.gov (United States)

    ... and Humanitarian Efforts Login Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon Surgery for “Heartburn” If you suffer from moderate to ...

  11. Anesthesia related complications of laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Qureshi, F.A.

    2003-01-01

    Objective: To determine the incidence of intraoperative anesthesia-related complications of laparoscopic cholecystectomy. Results: One hundred patients with male to female ratio of 1:8.09 in the age range of 20-80 years (mean 39 years) underwent general anesthesia for laparoscopic cholecystectomy. The duration of operation in 94 laparoscopic cholecystectomy was from 20 to 80 minutes (mean 60.63 minutes). The incidence of intraoperative hypotension was 9%. Four percent of the patients developed arrhythmias. Increase in end-tidal-carbon dioxide (ETCO/sub 2/) was observed in 3% of cases. Conversion rate to open cholecystectomy was 6%. Damage to intraabdominal vessels with trocar insertion occurred in 1% of cases. Conclusion: Although laparoscopic cholecystectomy has major surgical and anesthetic advantages, there are anesthesia related complications requiring specific anesthetic interventions to improve patients outcome without compromising their safety. (author)

  12. Knowledge and Perception of Laparoscopic Surgery among ...

    African Journals Online (AJOL)

    user

    prospected as the future of surgery. It offers the benefits of ... hospitalization among other benefits. .... Thus perception is a derivative of knowledge. ... and future advanced laparoscopic surgery. ... acute appendicitis: Is this a feasible option for.

  13. Endoscopic management of bile leaks after laparoscopic ...

    African Journals Online (AJOL)

    Endoscopic management of bile leaks after laparoscopic cholecystectomy. ... endoscopic management at a median of 12 days (range 2 - 104 days) after surgery. Presenting features included intra-abdominal collections with pain in 58 cases ...

  14. Acceptable outcome after laparoscopic appendectomy in children

    DEFF Research Database (Denmark)

    Stilling, Nicolaj M; Fristrup, Claus; Gabers, Torben

    2013-01-01

    An increasing proportion of childhood -appendicitis is being treated with laparoscopic appendectomy (LA). We wanted to elucidate the outcome of childhood appendicitis treated primarily by residents in a university hospital....

  15. Does playing video games improve laparoscopic skills?

    Science.gov (United States)

    Ou, Yanwen; McGlone, Emma Rose; Camm, Christian Fielder; Khan, Omar A

    2013-01-01

    A best evidence topic in surgery was written according to a structured protocol. The question addressed was whether playing video games improves surgical performance in laparoscopic procedures. Altogether 142 papers were found using the reported search, of which seven represented the best evidence to answer the clinical question. The details of the papers were tabulated including relevant outcomes and study weaknesses. We conclude that medical students and experienced laparoscopic surgeons with ongoing video game experience have superior laparoscopic skills for simulated tasks in terms of time to completion, improved efficiency and fewer errors when compared to non-gaming counterparts. There is some evidence that this may be due to better psycho-motor skills in gamers, however further research would be useful to demonstrate whether there is a direct transfer of skills from laparoscopic simulators to the operating table. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  16. Impaired postural stability after laparoscopic surgery

    DEFF Research Database (Denmark)

    Eskildsen, K Z; Staehr-Rye, A K; Rasmussen, L S

    2015-01-01

    . METHODS: We included 25 women undergoing outpatient gynaecological laparoscopic surgery in the study. Patients received standardised anaesthesia with propofol, remifentanil and rocuronium. Postural stability was assessed preoperatively, at 30 min after tracheal extubation, and at discharge from the post...

  17. Review: Robot assisted laparoscopic surgery in gynaecological ...

    African Journals Online (AJOL)

    Review: Robot assisted laparoscopic surgery in gynaecological oncology. ... robot suggests "to be able to act without human interference and being able to ... or in space), its use as telesurgery is still very limited and practically not feasible.

  18. Laparoscopic RFA with splenectomy for hepatocellular carcinoma.

    Science.gov (United States)

    Hu, Kunpeng; Lei, Purun; Yao, Zhicheng; Wang, Chenhu; Wang, Qingliang; Xu, Shilei; Xiong, Zhiyong; Huang, He; Xu, Ruiyun; Deng, Meihai; Liu, Bo

    2016-07-27

    The treatment of hepatocellular carcinoma (HCC) is complicated and challenging because of the frequent presence of cirrhosis. Therefore, we propose a novel surgical approach to minimize the invasiveness and risk in patients with HCC, hypersplenism, and esophagogastric varices. This was a retrospective study carried out in 25 patients with HCC and hypersplenism and who underwent simultaneous laparoscopic-guided radio-frequency ablation and laparoscopic splenectomy with endoscopic variceal ligation. Tumor size was restricted to a single nodule of splenectomy. Laparoscopic-guided radio-frequency ablation with laparoscopic splenectomy and endoscopic variceal ligation could be an available technique for patients with HCC <3 cm, hypersplenism, and esophagogastric varices. This approach may help to minimize the surgical risks and results in a fast increase in platelet counts with an acceptable rate of complications.

  19. RETROPERITONEAL LYMPH NODE DISSECTION AFTER INDUCTION CHEMOTHERAPY IN METASTATIC TESTICULAR NON-SEMINOMA

    Directory of Open Access Journals (Sweden)

    V. B. Matveev

    2014-07-01

    Full Text Available Objective: to evaluate the outcome of retroperitoneal lymph node dissection (RLND in disseminated testicular non-seminoma patients with residual metastases after induction chemotherapy. Material and methods. The RLND performed in 1983 to 2007 were analyzed in 367 testicular non-seminoma patients with residual retroperitoneal masses after ineffective induction chemotherapy. The median age was 26.06.9 years. Orchidectomy was performed in all patients. Category N1 was regarded in 12 (3.3% patients, N2 in 79 (21.5%, N3 in 238 (64.9%, Nx in 38 (10.4%. Distant metastases were present in 133 (36.2% cases. The baseline tumor marker level was elevated in 328 (89.4% patients (S1 in 169 (46.0%, S2 in 108 (29.4%, S3 in 51 (13.9%, Sx in 39 (10.6%. According to the IGCCCG prognostic model, 149 (40.6% patients were classified as good prognostic group, 100 (27.2% as moderate, 77 (21.0% as poor ones; the prognostic group was not defined in 41 (11.2% cases who had started treatment at another facility due to data unavailability. After orchifuniculectomy, all patients received induction cisplatin-based chemotherapy which resulted in tumor shrinkage <50% in 70 (19.1%, 51-90% in 166 (45.2%, and >90% - in 29 (7.9% cases. The response was not properly assessed in 102 (27.8% cases. CT scan revealed residual retroperitoneal masses after chemotherapy in all patients (<2 cm - 52 (14.2%, 2-5 cm - 166 (45.2%, >5 cm - 149 (40.6%. The tumor markers level remained elevated following chemotherapy in 70 (19.1% cases. All patients underwent RLND (complete in 295 (80.4% cases. Radical RLND demanded resection of adjacent organs in 22 (5.9% cases. Extraretroperitoneal metastases were removed simultaneously with retroperitoneal tumor in 22 (5.9% patients. Postoperative chemotherapy was administered in 100 (27.2% cases. The median followup was 82.1 (3-188 months. Results. Complications developed in 31 (8.5% of the 367 of patients. Mortality rate was 0.6% (2/367 cases. Resection of

  20. Spontaneous Retroperitoneal Hematoma Simulating Ruptured Infrarenal Aortic Aneurysm in a Patient with End-Stage Renal Disease

    Science.gov (United States)

    Li, JYY; Chan, YC; Qing, KX; Cheng, SW

    2014-01-01

    We reported a case of spontaneous retroperitoneal hematoma (SRH) simulating a ruptured infrarenal aortic aneurysm. A 72-year-old man with a history of infrarenal aortic aneurysm and end-stage renal disease on hemodialysis presented with malaise and nonspecific central abdominal pain and left loin discomfort. An emergency computed tomography scan showed a large retroperitoneal hematoma and clinical suspicion of ruptured infrarenal aortic aneurysm. However, the hematoma was discontinuous with the aneurysm sac and raised the clinical suspicion on dual pathology. The SRH was treated conservatively with transfusion of blood products, and the aneurysm was treated with nonemergency endovascular repair electively. This case demonstrates the importance of recognizing different clinical and radiological characteristics and be aware of dual pathology. PMID:28031651

  1. [DESCRIPTION OF A RETROPERITONEAL ACCESS ROUTE TO THE VESSELS OF THE SPLEEN FOR SPLENORENAL ARTERIAL AND VENOUS ANASTOMOSIS].

    Science.gov (United States)

    Gil-Vernet Vila, José María

    2014-01-01

    To perform arterial or venous spleno-renal anastomoses, surgeons have so far systematically used the transperitoneal way whic is burdened by a high mortality an morbility percentage. On the basis of anatomo-surgical considerations, a retroperitoneal approach has been found reaching the hilus of the spleen via the lumbar region; the first arterial spleno-renal anastomosis by this way was performed in 1972 and the first venous spleno-renal anastomosis due to portal hipertension also by this way was performed in 1974, the alter proving to be the least aggresive by avoiding damaging the páncreas, the most surgical and direct for reaching the splenic vessels thereby enabling a better exposure and an easier performing of the anastomoses. By being retroperitoneal, the loss or infección of the ascitic liquid in the cirrhotic patient is prevented.

  2. [Multivisceral organ procurement for transplantation derived mobilization maneouvres: very helpful auxiliary techniques in the excision of large retroperitoneal masses].

    Science.gov (United States)

    González, Javier; Shirodkar, S P; Ciancio, G

    2011-04-01

    The excision of large retroperitoneal masses poses a challenge for every surgeon. Sometimes the urologist must face situations that do not fit to any conventional approach or technique previously described. Obtaining adequate exposure for safe and oncologically correct management of these masses is based, on many cases, in the mobilization of anatomical adjacent structures to generate a sufficient field in abdominal areas of difficult access. Complex visceral mobilization maneuvers derived from multivisceral transplantation organ procurement surgery provides ancillary techniques that used properly facilitate their successful resolution. The main purpose of this paper is the description of these surgical maneuvers essential to increase both exposure and vascular control in addressing the ever-dreaded high-volume retroperitoneal masses.

  3. Laparoscopic Radical Extended Right Hemicolectomy Using a Caudal-to-Cranial Approach.

    Science.gov (United States)

    Zou, Liaonan; Xiong, Wenjun; Mo, Delong; He, Yaobin; Li, Hongming; Tan, Ping; Wang, Wei; Wan, Jin

    2016-08-01

    Due to the emphasis of oncologic principle, a medial-to-lateral approach for laparoscopic right hemicolectomy was recommended.1 (,) 2 This approach, however, is technically challenging and involves several limitations with overweight patients, whose mesocolon may be too thick for identification of the vessel landmarks. Moreover, it is difficult for inexperienced surgeons to enter the retroperitoneum space accurately. This report describes a caudal-to-cranial approach for laparoscopic radical extended right hemicolectomy. First, a "yellow-white borderline" between the right mesostenium and retroperitoneum in the right iliac fossa is dissected as the entry for separation of the fusion fascial space between the visceral and parietal peritoneum.3 The right Toldt's fascia is dissected and expanded medial to the periphery of the superior mesenteric vein (SMV), cranial to the pancreas head, and lateral to the ascending colon. The posterior paries of ileocolic vessels (ICVs), right colic vessels (RCVs), and Henle's trunk are exposed. Second, the mesocolon between the ICV and SMV is dissected safely, and the ICV, RCV, and right gastroepiploic vessels as well as the right branch of the middle colic vessel are divided and ligated easily because of the separated retroperitoneal space. The lymph nodes along the SMV are dissected using a caudal-to-cranial approach. Third, the greater omental is dissected for full mobilization of the mesocolon containing 10 cm of normal colon distal to the lesion followed by complete mobilization of the lateral attachments of the ascending colon. In this study, 10 men and 8 women with hepatic flexure cancer underwent laparoscopic extended right hemicolectomy using a caudal-to-cranial approach. No conversion was recorded. The overall complication rate was 11.2 %, including one case of pulmonary infection and one case of urinary tract infection, both of which were cured with conservative measures. The mean age of the patients was 61.3 ± 12.7

  4. Laparoscopic Management of Hepatic Hydatid Disease

    OpenAIRE

    Palanivelu, C; Jani, Kalpesh; Malladi, Vijaykumar; Senthilkumar, R.; Rajan, P. S.; Sendhilkumar, K.; Parthasarthi, R.; Kavalakat, Alfie

    2006-01-01

    Background: Hydatid disease is an endemic condition in several parts of the world. Owing to ease of travel, even surgeons in nonendemic areas encounter the disease and should be aware of its optimum treatment. A safe, new method of laparoscopic management of hepatic hydatid disease is described along with a review of the relevant literature. Methods: Sixty-six cases of hepatic hydatid disease were operated on laparoscopically using the Palanivelu Hydatid System. The special trocar-cannula sys...

  5. Laparoscopic correction of right transverse colostomy prolapse.

    Science.gov (United States)

    Gundogdu, Gokhan; Topuz, Ufuk; Umutoglu, Tarik

    2013-08-01

    Colostomy prolapse is a frequently seen complication of transverse colostomy. In one child with recurrent stoma prolapse, we performed a loop-to-loop fixation and peritoneal tethering laparoscopically. No prolapse had recurred at follow-up. Laparoscopic repair of transverse colostomy prolapse seems to be a less invasive method than other techniques. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  6. Acute complicated diverticulitis managed by laparoscopic lavage

    DEFF Research Database (Denmark)

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2009-01-01

    with antibiotics and laparoscopic lavage. Conversion to laparotomy was made in six (3%) patients and the mean hospital stay was nine days. Ten percent of the patients had complications. During the mean follow-up of 38 months, 38% of the patients underwent elective sigmoid resection with primary anastomosis....... CONCLUSION: Primary laparoscopic lavage for complicated diverticulitis may be a promising alternative to more radical surgery in selected patients. Larger studies have to be made before clinical recommendations can be given....

  7. Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma.

    Science.gov (United States)

    Huang, Gregory S; Chance, Elisha A; Hileman, Barbara M; Emerick, Eric S; Gianetti, Emily A

    2017-01-01

    No criteria define indications for laparoscopic splenectomy in trauma. This investigation compared characteristics of trauma patients and outcomes between laparoscopic and open splenectomies. Patients were identified retrospectively by using ICD-9 codes. Included patients were 18 or older, with a blunt splenic injury from January 1, 2011, through December 31, 2014, and required splenectomy. Excluded patients had penetrating trauma, successful nonoperative management, or successful embolization. Variables included demographics, presenting characteristics, injury severity scores, abdominal abbreviated injury scores, splenic injury grade, surgical indication and approach (open or laparoscopic), surgery length, intra-operative blood loss, transfusions, length of stay, complications, mortality, and discharge disposition. Forty-one patients underwent open splenectomy, and 11 underwent laparoscopic splenectomy. The mean age was 48.7 years, and men comprised the sample majority (36/52). The groups were well matched for age, abdominal injury scores, and admission vital signs. The open group had a significantly lower level of consciousness and more acidosis compared with the laparoscopic group. Most laparoscopic splenectomies were performed after failed nonoperative management or embolization. The indications for open splenectomy were a positive focused assessment with sonography for trauma and computed tomography results. Laparoscopic patients had significantly longer times between presentation and surgery and longer operations, but had significantly less blood loss and fewer transfusions compared with the open group. There were no differences in mortality, length of stay, complications, or discharge dispositions. Laparoscopic splenectomy is useful in patients with blunt trauma in whom conservative management produced no improvement and who do not have other injuries to preclude laparoscopy.

  8. Retroperitoneal Endometriosis: A Possible Cause of False Positive Finding at 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

    International Nuclear Information System (INIS)

    Maffione, Anna Margherita; Panzavolta, Riccardo; Lisato, Laura Camilla; Ballotta, Maria; D'Isanto, Mariangela Zanforlini; Rubello, Domenico

    2015-01-01

    Endometriosis is a frequent and clinically relevant problem in young women. Laparoscopy is still the gold standard for the diagnosis of endometriosis, but frequently both morphologic and functional imaging techniques are involved in the diagnostic course before achieving a conclusive diagnosis. We present a case of a patient affected by infiltrating retroperitoneal endometriosis falsely interpreted as a malignant mass by contrast-enhanced magnetic resonance imaging and 18 F-fluorodeoxyglucose positron emission tomography/computed tomography

  9. Case report: Retroperitoneal biliary fluid collections secondary to common bile duct rupture - an unusual complication of choledocholithiasis in a child

    International Nuclear Information System (INIS)

    Rastogi, Rajul; Rastogi, Vaibhav

    2008-01-01

    Rupture of the common bile duct (CBD) in a child secondary to choledocholithiasis is a rare event. In this article, the authors describe a child who presented with an acute abdomen due to CBD rupture, with subsequent acute retroperitoneal fluid collections, all diagnosed preoperatively on CT scan. The aim of this article is to show the pathways that such collections can take in the retroperitoneum

  10. Proinflammatory cytokines in open versus laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Abu-Eshy, Saeed A.; Al-Rofaidi, Abdallah A.; Al-Faki, Ahmed S.; Ghalib, Hashim W.; Moosa, Riyadh A.; Sadik, Ali A.; Salati, Mohammad I.

    2002-01-01

    Laparoscopic cholecystectomy, a minimal access surgery, is fast replacing open cholecystectomy and is being associated with less trauma. The objective of this study was to compare the proinflammatory cytokine levels in both laparoscopic cholecystectomy and open cholecystectomy. This study was carried out at Aseer Central Hospital, Aseer region, Abha Private Hospital and the College of Medicine and Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia, during the time period October 1998 through to November 2000. Sixty-one patients were included in the study, 27 of them had laparoscopic cholecystectomy and 34 had open cholecystectomy. Cytokines [Interleukin-6 Interleukin-1b, Tumor necrosis factor -a and Interleukin- 8] were measured in blood samples collected from the patients before, at and 24 hours post surgery, using commercially available kits. Interleukin-6 levels were significantly increased at 24 hours post surgery in the open cholecystectomy group of patients compared to the laparoscopic cholecystectomy group (P<0.04). No differences were found in the other cytokines levels (Interleukin-1b, tumor necrosis factor -a and Interleukin-8) between the open cholecystectomy and laparoscopic cholecystectomy groups. Laparoscopic cholecystectomy, a minimal access surgery, is associated with lower levels of the proinflammatory interleukin-6 cytokine compared to open cholecystectomy. (author)

  11. An Extremely Rare and Unusual Case of Retroperitoneal and Pelvic Metastasis from Squamous Cell Carcinoma of Vallecula

    Directory of Open Access Journals (Sweden)

    Abhishek Purkayastha

    2016-06-01

    Full Text Available We report an extremely rare and unusual case of retroperitoneal and pelvic metastasis from primary squamous cell carcinoma of vallecula. Generally carcinoma oropharynx metastasizes to lungs, liver and bone while retroperitoneal and pelvic metastasis is rarely heard of. To the best of our knowledge this case is one of the scantly reported cases ever of this kind in the world.  A 60-year-old male presented with dysphagia and hoarseness of voice of four month duration.  Computed tomography (CT scan face and neck showed growth right vallecula. Biopsy of lesion showed squamous cell carcinoma. Metastatic work up was negative. He received definitive chemo-radiation. Patient during follow up presented with dyspepsia, abdominal discomfort and weight loss. Whole body positron emission tomography (WB PET scan revealed retroperitoneal and pelvic lymph node deposits which were confirmed as metastasis of squamous cell carcinoma by CT guided fine needle aspiration cytology (FNAC. Patient was exhibited palliative chemotherapy but his general condition deteriorated and he finally succumbed to his metastatic illness. This case is being reported to highlight its extreme rarity, the diagnostic and therapeutic challenges it presented and its overall dismal prognosis.

  12. Laparoscopic repair of vesicovaginal fistula

    Directory of Open Access Journals (Sweden)

    Miłosz Wilczyński

    2011-06-01

    Full Text Available A vesicovaginal fistula is one of the complications that a gynaecologist is bound to face after oncological operations, especially in postmenopausal women. Over the years there have been introduced many techniques of surgical treatment of this entity, including transabdominal and transvaginal approaches.We present a case of a 46-year-old patient who suffered from urinary leakage via the vagina due to the presence of a vesicovaginal fistula that developed after radical abdominal hysterectomy and subsequent radiotherapy. The decision was made to repair it laparoscopically due to retracted, fibrous and scarred tissue in the vaginal apex that precluded a transvaginal approach. A small cystotomy followed by an excision of fistula borders was performed. After six-month follow-up no recurrence of the disease has been noted.We conclude that laparoscopy is an interesting alternative to traditional approaches that provides comparable results.

  13. Laparoscopic splenectomy using conventional instruments

    Directory of Open Access Journals (Sweden)

    Dalvi A

    2005-01-01

    Full Text Available INTRODUCTION : Laparoscopic splenectomy (LS is an accepted procedure for elective splenectomy. Advancement in technology has extended the possibility of LS in massive splenomegaly [Choy et al., J Laparoendosc Adv Surg Tech A 14(4, 197-200 (2004], trauma [Ren et al., Surg Endosc 15(3, 324 (2001; Mostafa et al., Surg Laparosc Endosc Percutan Tech 12(4, 283-286 (2002], and cirrhosis with portal hypertension [Hashizume et al., Hepatogastroenterology 49(45, 847-852 (2002]. In a developing country, these advanced gadgets may not be always available. We performed LS using conventional and reusable instruments in a public teaching the hospital without the use of the advanced technology. The technique of LS and the outcome in these patients is reported. MATERIALS AND METHODS : Patients undergoing LS for various hematological disorders from 1998 to 2004 were included. Electrocoagulation, clips, and intracorporeal knotting were the techniques used for tackling short-gastric vessels and splenic pedicle. Specimen was delivered through a Pfannensteil incision. RESULTS : A total of 26 patients underwent LS. Twenty-two (85% of patients had spleen size more than 500 g (average weight being 942.55 g. Mean operative time was 214 min (45-390 min. The conversion rate was 11.5% ( n = 3. Average duration of stay was 5.65 days (3-30 days. Accessory spleen was detected and successfully removed in two patients. One patient developed subphrenic abscess. There was no mortality. There was no recurrence of hematological disease. CONCLUSION : Laparoscopic splenectomy using conventional equipment and instruments is safe and effective. Advanced technology has a definite advantage but is not a deterrent to the practice of LS.

  14. Augmented versus virtual reality laparoscopic simulation: what is the difference? A comparison of the ProMIS augmented reality laparoscopic simulator versus LapSim virtual reality laparoscopic simulator

    NARCIS (Netherlands)

    Botden, Sanne M. B. I.; Buzink, Sonja N.; Schijven, Marlies P.; Jakimowicz, Jack J.

    2007-01-01

    BACKGROUND: Virtual reality (VR) is an emerging new modality for laparoscopic skills training; however, most simulators lack realistic haptic feedback. Augmented reality (AR) is a new laparoscopic simulation system offering a combination of physical objects and VR simulation. Laparoscopic

  15. The peritoneal fibrinolytic response to conventional and laparoscopic colonic surgery

    NARCIS (Netherlands)

    Brokelman, Walter; Holmdahl, Lena; Falk, Peter; Klinkenbijl, Jean; Reijnen, Michel

    2009-01-01

    Laparoscopic surgery is considered to induce less peritoneal trauma than conventional surgery. The peritoneal plasmin system is important in the processes of peritoneal healing and adhesion formation. The present study assessed the peritoneal fibrinolytic response to laparoscopic and conventional

  16. Laparoscopic versus open splenectomy in children with benign ...

    African Journals Online (AJOL)

    2017-06-28

    Jun 28, 2017 ... Thalassemia was present in 36 cases, idiopathic thrombocytopenic purpura ... hemoglobinopathies) and extracellular defects particu- larly autoimmune .... Thalassemia. 2. 2. Spherocytosis. 1. 0. ITP, idiopathic thrombocytopenic purpura; LS, laparoscopic splenectomy;. OS, open splenectomy. Laparoscopic ...

  17. Nintendo Wii video-gaming ability predicts laparoscopic skill.

    Science.gov (United States)

    Badurdeen, Shiraz; Abdul-Samad, Omar; Story, Giles; Wilson, Clare; Down, Sue; Harris, Adrian

    2010-08-01

    Studies using conventional consoles have suggested a possible link between video-gaming and laparoscopic skill. The authors hypothesized that the Nintendo Wii, with its motion-sensing interface, would provide a better model for laparoscopic tasks. This study investigated the relationship between Nintendo Wii skill, prior gaming experience, and laparoscopic skill. In this study, 20 participants who had minimal experience with either laparoscopic surgery or Nintendo Wii performed three tasks on a Webcam-based laparoscopic simulator and were assessed on three games on the Wii. The participants completed a questionnaire assessing prior gaming experience. The score for each of the three Wii games correlated positively with the laparoscopic score (r = 0.78, 0.63, 0.77; P skill overlap between the Nintendo Wii and basic laparoscopic tasks. Surgical candidates with advanced Nintendo Wii ability may possess higher baseline laparoscopic ability.

  18. Laparoscopic colonic surgery in Denmark 2004-2007

    DEFF Research Database (Denmark)

    Schulze, S.; Iversen, M.G.; Bendixen, A.

    2008-01-01

    OBJECTIVE: Laparoscopic colonic surgery was introduced about 15 years ago and has together with the evidence-based 'fast-track' methodology improved early postoperative outcome. The purpose of this study was to asses the organization and early outcome after laparoscopic colonic surgery in Denmark...... of laparoscopic colonic surgery but probably performed in too many low volume departments. Laparoscopic colonic surgery should be monitored and further advances secured by adjustment of perioperative care to fast-track care Udgivelsesdato: 2008/11...

  19. [Laparoscopic resection of the sigmoid colon for the diverticular disease].

    Science.gov (United States)

    Vrbenský, L; Simša, J

    2013-07-01

    Laparoscopic resection of the sigmoid colon for diverticular disease is nowadays a fully accepted alternative to traditional open procedures. The aim of this work is to summarize the indications, advantages and risks of laparoscopic sigmoid resection for diverticular disease. Review of the literature and recent findings concerning the significance of laparoscopic resection for diverticulosis of the sigmoid colon. The article presents the indications, risks, techniques and perioperative care in patients after laparoscopic resection of the sigmoid colon for diverticular disease.

  20. Scrotal and retroperitoneal lymphangioma of a 12-year-old boy: case report

    International Nuclear Information System (INIS)

    Zaleska-Dorobisz, U.; Koltowska, A.; Moron, K.; Jaworski, W.

    2005-01-01

    Lymphangiomas occurs in children quite frequently. They are most commonly localized in the head, neck, axilla, chest, abdomen, and retroperitoneum. Lymphangiomas of the scrotum are very rare and are usually clinically silent, so they are a challenge for radiologists performing US examination in children. They are obliged to differentiate the following lesions: torsion of the testicle, scrotal hernia, hydrocoele, and epididymal cyst, in addition to the masses of primary extra-testicular localization such as hemagioma, congenital vascular malformations, fibromas, and malignant tumors. Additional difficulties appear in boys who present acute scrotum syndrome. The paper reports the diagnostics and treatment of a huge multicystic lymphangioma situated in he scrotum and retroperitoneum of a 12-year-old boy who had fallen from a bicycle and presented acute scrotum. The lesion of the scrotum was surgically excised. Retroperitoneal lymphangioma was detected during this operation. Subsequent diagnostics was based on ultrasonography, computerized tomography, and magnetic resonance imaging of the abdominal cavity. The lymphangioma of the retroperitoneum was resected. The patient shows no evidence of recurrence after 7 years. Cystic lymphangiomas are rare but benign intra-scrotal, extra-testicular, painless masses in children. They are sonographically multicystic or multiloculated abnormalities and may show infiltrative extension to the perineum, retroperitoneum, or abdomen. Recognition of this entity and its extent is important for correct clinical management and may be for planning treatment. (author)

  1. Detection of metastatic tumor in normal-sized retroperitoneal lymph nodes by monoclonal-antibody imaging

    International Nuclear Information System (INIS)

    Moldofsky, P.J.; Sears, H.F.; Mulhern, C.B. Jr.; Hammond, N.D.; Powe, J.; Gatenby, R.A.; Steplewski, Z.; Koprowski, H.

    1984-01-01

    Detection of metastatic colon carcinoma is reported in retroperitoneal lymph nodes that were visible but normal in size (less than 1 cm) and number on CT scanning and at surgery. A case history is presented of 1 of 27 patients with colon carcinoma, metastatic or primary, evaluated with intravenously administered, radiolabeled monoclonal-antibody fragments and subsequent nuclear medicine imaging. Images of /sup 99m/Tc-labeled red cells corresponding to each [ 131 I]antibody view of the abdomen were obtained as a control, to avoid interpretation of simple blood-pool radioactivity as specific localization of antibody on tumor. Antibody images were evaluated both without and with computer blood-pool image substraction. Directed to the level of the left renal hilum by the antibody scan, the surgeon removed the largest palpable node, which measured slightly less than 1 cm in diameter and was not palpably or visibly abnormal to the surgeon until it was removed and sectioned. Pathological evaluation of frozen and permanent sections revealed microscopic foci of adenocarcinoma consistent with a colonic primary tumor. Immunoperoxidase staining for the 1083-17-1A colorectal-carcinoma antigen demonstrated the presence of the antigen in the lymph node. As a result of the detection of this metastasis outside the liver, the patient did not receive the planned hepatic-artery chemotherapy pump but instead received intravenous chemotherapy

  2. Retroperitoneal Perforation of the Appendix Presenting as a Right Thigh Abscess

    Directory of Open Access Journals (Sweden)

    Aditya J. Nanavati

    2015-01-01

    Full Text Available A rare case of a retroperitoneal rupture of the appendix is being reported here. A 53-year-old male presented to us with a right sided thigh abscess. There were not any abdominal complaints at presentation. There was continuous discharge after incision and drainage from the thigh. Isolation, in culture, of an enteric bacterium from the pus prompted an evaluation of the gastrointestinal tract as a possible source. An MRI scan revealed fluid tracking from the right paracolic gutter over the psoas sheath and paraspinal muscle into the thigh. A CT scan revealed the perforation at the base of the appendix into the retroperitoneum. At laparotomy the above findings were confirmed. A segmental ileocaecal resection was done. The patient made an uneventful recovery. The absence of abdominal symptoms at presentation leads to delay in diagnosis in such cases. Nonresolving thigh and groin abscesses should lead to the evaluation of the gastrointestinal tract as origin. Diagnostic clues may also be provided by culture reports what as happened in this case.

  3. Retroperitoneal Sarcoma Involving Unilateral Double Ureter: Management, Treatment and Psychological Implications

    Directory of Open Access Journals (Sweden)

    Vito Leanza

    2014-05-01

    Full Text Available The case of a 45-year-old woman who was admitted to our university hospital for polymenorrhea, weight gain and pain in the left iliac region is reported. An abdominal ultrasound revealed a 9.5 × 5.2-cm, hypoechoic and inhomogeneous mass located on the left side of the pelvis and behind the ovary. The patient underwent surgery. The pelvic mass was firmly anchored to the small intestine, colon, sigma and uterine fundus. After removing the adhesions, double ureters, which had been incorporated in the mass, were observed on the left side. Resection of the unilateral double ureters was necessary in order to remove the entire mass, and thereafter, a left salpingoophorectomy was performed. A histological examination showed a malignant retroperitoneal mass. Termino-terminal ureteral anastomosis with two double-J stents was carried out. Total hysterectomy with preservation of the right adenexum and regional lymphadenectomy was performed. The purpose of this case report is to discuss the physical and psychological implications related to the combination of two rare entities: leiomyosarcoma and a double ureter located within the mass. A literature review on the clinical management and psychological aspects from a female cancer patient's perspective undergoing surgery with the aforementioned disorders will be discussed.

  4. Retroperitoneal Necrotizing Fasciitis from Fournier’s Gangrene in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Samuel B. Weimer

    2017-01-01

    Full Text Available Introduction. Necrotizing fasciitis (NF is a devastating soft tissue disease causing fulminant clinical deterioration, and extension into the retroperitoneum has a high mortality rate. This disease process demands a strong clinical suspicion for early identification which must be coupled with frequent wide surgical debridements and intravenous antibiotics for improved outcomes. Various clinical risk factors may render a weakness in the patient’s immune status including diabetes mellitus, chronic renal failure, obesity, and autoimmune disorders, such as a human immunodeficiency virus (HIV infection. Case Report. A 55-year-old male presented with hypotension requiring a large intravenous fluid resuscitation and vasopressors. He was diagnosed with the human immunodeficiency virus upon presentation. A computerized tomographic scan revealed air and fluid in the perineum and pelvis, ascending into the retroperitoneum. Multiple surgical debridements to his perineum, deep pelvic structures, and retroperitoneum were completed. After colostomy placement, antibiotic administration, and wound care, he was closed using split-thickness skin grafting. Conclusion. NF is a sinister and fulminant disease requiring prompt diagnosis and surgical intervention. The best chance for survival occurs with emergent surgical debridement and appropriate intravenous antibiotics. While retroperitoneal NF is consistent with uniformly poor outcomes, patients are best treated in an American Burn Association-verified burn center.

  5. A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin

    Directory of Open Access Journals (Sweden)

    Ishrat N. Khan

    2015-01-01

    Full Text Available Adrenal incidentalomas (AIs are mostly benign and nonsecretory. Management algorithms lack sensitivity when assessing malignant potential, although functional status is easier to assess. We present a subject whose AI was a retroperitoneal leiomyosarcoma (RL. Case Presentation. A woman on warfarin with SLE and the antiphospholipid syndrome, presented with left loin pain. She was normotensive and clinically normal. Ultrasound scans demonstrated left kidney scarring, but CT scans revealed an AI. MRI scans later confirmed the AI without significant fat and no interval growth. Cortisol after 1 mg dexamethasone, urinary free cortisol and catecholamines, plasma aldosterone renin ratio, and 17-hydroxyprogesterone were within the reference range. Initially, adrenal haemorrhage was diagnosed because of warfarin therapy and the acute presentation. However, she underwent adrenalectomy because of interval growth of the AI. Histology confirmed an RL. The patient received adjuvant radiotherapy. Discussion. Our subject presented with an NSAI. However, we highlight the following: (a the diagnosis of adrenal haemorrhage in this anticoagulated woman was revised because of interval growth; (b the tumour, an RL, was relatively small at diagnosis; (c this subject has survived well over 60 months despite an RL perhaps because of her acute presentation and early diagnosis of a small localised tumour.

  6. A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin.

    Science.gov (United States)

    Khan, Ishrat N; Adlan, Mohamed A; Stechman, Michael J; Premawardhana, Lakdasa D

    2015-01-01

    Adrenal incidentalomas (AIs) are mostly benign and nonsecretory. Management algorithms lack sensitivity when assessing malignant potential, although functional status is easier to assess. We present a subject whose AI was a retroperitoneal leiomyosarcoma (RL). Case Presentation. A woman on warfarin with SLE and the antiphospholipid syndrome, presented with left loin pain. She was normotensive and clinically normal. Ultrasound scans demonstrated left kidney scarring, but CT scans revealed an AI. MRI scans later confirmed the AI without significant fat and no interval growth. Cortisol after 1 mg dexamethasone, urinary free cortisol and catecholamines, plasma aldosterone renin ratio, and 17-hydroxyprogesterone were within the reference range. Initially, adrenal haemorrhage was diagnosed because of warfarin therapy and the acute presentation. However, she underwent adrenalectomy because of interval growth of the AI. Histology confirmed an RL. The patient received adjuvant radiotherapy. Discussion. Our subject presented with an NSAI. However, we highlight the following: (a) the diagnosis of adrenal haemorrhage in this anticoagulated woman was revised because of interval growth; (b) the tumour, an RL, was relatively small at diagnosis; (c) this subject has survived well over 60 months despite an RL perhaps because of her acute presentation and early diagnosis of a small localised tumour.

  7. Same-day discharge after laparoscopic hysterectomy.

    Science.gov (United States)

    Perron-Burdick, Misa; Yamamoto, Miya; Zaritsky, Eve

    2011-05-01

    To estimate readmission rates and emergency care use by patients discharged home the same day after laparoscopic hysterectomy. This was a retrospective case series of patients discharged home the same-day after total or supracervical laparoscopic hysterectomy in a managed care setting. Chart reviews were performed for outcomes of interest which included readmission rates, emergency visits, and surgical and demographic characteristics. The two hysterectomy groups were compared using χ² tests for categorical variables and t tests or Wilcoxon rank-sum tests for continuously measured variables. One-thousand fifteen laparoscopic hysterectomies were performed during the 3-year study period. Fifty-two percent (n=527) of the patients were discharged home the same-day; of those, 46% (n=240) had total laparoscopic hysterectomies and 54% (n=287) had supracervical. Cumulative readmission rates were 0.6%, 3.6%, and 4.0% at 48 hours, 3 months, and 12 months, respectively. The most common readmission diagnoses included abdominal incision infection, cuff dehiscence, and vaginal bleeding. Less than 4% of patients presented for emergency care within 48 or 72 hours, most commonly for nausea or vomiting, pain, and urinary retention. Median uterine weight was 155 g, median blood loss was 70 mL, and median surgical time was 150 minutes. There was no difference in readmission rates or emergency visits for the total compared with the supracervical laparoscopic hysterectomy group. Same-day discharge after laparoscopic hysterectomy is associated with low readmission rates and minimal emergency visits in the immediate postoperative period. Same-day discharge may be a safe option for healthy patients undergoing uncomplicated laparoscopic hysterectomy.

  8. National survey of surgeons\\' attitudes to laparoscopic surgical ...

    African Journals Online (AJOL)

    Aim. Laparoscopic surgery forms an integral component of modern surgical practice. The perception exists that laparoscopic training in South Africa has been unplanned and under-resourced. This study set out to assess the opinions of surgeons and surgical trainees with regard to the various facets of laparoscopic surgical ...

  9. Laparoscopic versus open surgery for rectal cancer (COLOR II)

    DEFF Research Database (Denmark)

    van der Pas, Martijn Hgm; Haglind, Eva; Cuesta, Miguel A

    2013-01-01

    Laparoscopic surgery as an alternative to open surgery in patients with rectal cancer has not yet been shown to be oncologically safe. The aim in the COlorectal cancer Laparoscopic or Open Resection (COLOR II) trial was to compare laparoscopic and open surgery in patients with rectal cancer....

  10. The value of laparoscopic classifications in decision on definitive ...

    African Journals Online (AJOL)

    The value of laparoscopic classifications in decision on definitive surgery in patients with nonpalpable testes: our ... present our clinical experience with the laparoscopic approach in patients with nonpalpable testes (NPTs) and .... decision making during the procedure. Gatti and. Ostlie [3] have pointed out that laparoscopic ...

  11. Laparoscopic diagnostic findings in atypical intestinal malrotation in ...

    African Journals Online (AJOL)

    We present our experience with laparoscopic management of atypical presentations of intestinal malrotation in children, describing laparoscopic findings in these ... Thirty-six patients (90%) were found to have definite laparoscopic findings in the form of markedly dilated stomach and first part of duodenum, ectopic site of ...

  12. Short term benefits for laparoscopic colorectal resection.

    Science.gov (United States)

    Schwenk, W; Haase, O; Neudecker, J; Müller, J M

    2005-07-20

    Colorectal resections are common surgical procedures all over the world. Laparoscopic colorectal surgery is technically feasible in a considerable amount of patients under elective conditions. Several short-term benefits of the laparoscopic approach to colorectal resection (less pain, less morbidity, improved reconvalescence and better quality of life) have been proposed. This review compares laparoscopic and conventional colorectal resection with regards to possible benefits of the laparoscopic method in the short-term postoperative period (up to 3 months post surgery). We searched MEDLINE, EMBASE, CancerLit, and the Cochrane Central Register of Controlled Trials for the years 1991 to 2004. We also handsearched the following journals from 1991 to 2004: British Journal of Surgery, Archives of Surgery, Annals of Surgery, Surgery, World Journal of Surgery, Disease of Colon and Rectum, Surgical Endoscopy, International Journal of Colorectal Disease, Langenbeck's Archives of Surgery, Der Chirurg, Zentralblatt für Chirurgie, Aktuelle Chirurgie/Viszeralchirurgie. Handsearch of abstracts from the following society meetings from 1991 to 2004: American College of Surgeons, American Society of Colorectal Surgeons, Royal Society of Surgeons, British Assocation of Coloproctology, Surgical Association of Endoscopic Surgeons, European Association of Endoscopic Surgeons, Asian Society of Endoscopic Surgeons. All randomised-controlled trial were included regardless of the language of publication. No- or pseudorandomised trials as well as studies that followed patient's preferences towards one of the two interventions were excluded, but listed separately. RCT presented as only an abstract were excluded. Results were extracted from papers by three observers independently on a predefined data sheet. Disagreements were solved by discussion. 'REVMAN 4.2' was used for statistical analysis. Mean differences (95% confidence intervals) were used for analysing continuous variables. If

  13. Image acquisition in laparoscopic and endoscopic surgery

    Science.gov (United States)

    Gill, Brijesh S.; Georgeson, Keith E.; Hardin, William D., Jr.

    1995-04-01

    Laparoscopic and endoscopic surgery rely uniquely on high quality display of acquired images, but a multitude of problems plague the researcher who attempts to reproduce such images for educational purposes. Some of these are intrinsic limitations of current laparoscopic/endoscopic visualization systems, while others are artifacts solely of the process used to acquire and reproduce such images. Whatever the genesis of these problems, a glance at current literature will reveal the extent to which endoscopy suffers from an inability to reproduce what the surgeon sees during a procedure. The major intrinsic limitation to the acquisition of high-quality still images from laparoscopic procedures lies in the inability to couple directly a camera to the laparoscope. While many systems have this capability, this is useful mostly for otolaryngologists, who do not maintain a sterile field around their scopes. For procedures in which a sterile field must be maintained, one trial method has been to use a beam splitter to send light both to the still camera and the digital video camera. This is no solution, however, since this results in low quality still images as well as a degradation of the image that the surgeon must use to operate, something no surgeon tolerates lightly. Researchers thus must currently rely on other methods for producing images from a laparoscopic procedure. Most manufacturers provide an optional slide or print maker that provides a hardcopy output from the processed composite video signal. The results achieved from such devices are marginal, to say the least. This leaves only one avenue for possible image production, the videotape record of an endoscopic or laparoscopic operation. Video frame grabbing is at least a problem to which industry has applied considerable time and effort to solving. Our own experience with computerized enhancement of videotape frames has been very promising. Computer enhancement allows the researcher to correct several of the

  14. Initial experience of laparoscopic incisional hernia repair.

    Science.gov (United States)

    Razman, J; Shaharin, S; Lukman, M R; Sukumar, N; Jasmi, A Y

    2006-06-01

    Laparoscopic repair of ventral and incisional hernia has become increasingly popular as compared to open repair. The procedure has the advantages of minimal access surgery, reduction of post operative pain and the recurrence rate. A prospective study of laparoscopic incisional hernia repair was performed in our center from August 2002 to April 2004. Eighteen cases (n: 18) were performed during the study period. Fifteen cases (n: 15) had open hernia repair previously. Sixteen patients (n: 16) had successful repair of the hernia with the laparoscopic approach and two cases were converted to open repair. The mean hernia defect size was 156cm2. There was no intraoperative or immediate postoperative complication. The mean operating time was 100 +/- 34 minutes (75 - 180 minutes). The postoperative pain was graded as mild to moderate according to visual analogue score. The mean day of discharge after surgery was two days (1 - 3 days). During follow up, three patients (16.7%) developed seroma at the hernia sac which was resolved with conservative management after three weeks. One (5.6%) patient developed recurrence six months after surgery. In conclusion, laparoscopic repair of incisional hernia particularly recurrent hernia has been shown to be safe and effective in our centre. However, careful patient selection and acquiring the necessary advanced laparoscopic surgical skills coupled with the proper use of equipment are mandatory before embarking on this procedure.

  15. Should all distal pancreatectomies be performed laparoscopically?

    Science.gov (United States)

    Merchant, Nipun B; Parikh, Alexander A; Kooby, David A

    2009-01-01

    Despite the relatively slow start of laparoscopic pancreatectomy relative to other laparoscopic resections, an increasing number of these procedures are being performed around the world. Operations that were once considered impossible to perform laparoscopically, such as pancreaticoduodenectomy and central pancreatectomy are gaining momentum. Technology continues to improve, as does surgical experience and prowess. There are both enough experience and data (though retrospective) to confirm that LDP with or without spleen preservation appears to be a safe treatment for benign or noninvasive lesions of the pancreas. Based on the fact that LDP can be performed with similar or shorter operative times, blood loss, complication rates, and length of hospital stay than ODP, it can be recommended as the treatment of choice for benign and noninvasive lesions in experienced hands when clinically indicated. It is very difficult to make clear recommendations with regard to laparoscopic resection of malignant pancreatic tumors due to the lack of conclusive data. As long as margins are negative and lymph node clearance is within accepted standards, LDP appears to have no untoward oncologic effects on outcome. Certainly more data, preferably in the manner of a randomized clinical trial, are needed before additional recommendations can be made. Potential benefits of laparoscopic resection for cancer include the ability to inspect the abdomen and abort the procedure with minimal damage if occult metastases are identified. This does not delay the onset of palliative chemotherapy, which would be the primary treatment in that circumstance. In fact, there is evidence to suggest that there is a greater likelihood of receiving systemic therapy if a laparotomy is avoided in patients who have radiologically occult metastases. Patients may also undergo palliative laparoscopic gastric and biliary bypass if indicated. Faster wound healing may also translate into a shorter waiting time before

  16. Features for detecting smoke in laparoscopic videos

    Directory of Open Access Journals (Sweden)

    Jalal Nour Aldeen

    2017-09-01

    Full Text Available Video-based smoke detection in laparoscopic surgery has different potential applications, such as the automatic addressing of surgical events associated with the electrocauterization task and the development of automatic smoke removal. In the literature, video-based smoke detection has been studied widely for fire surveillance systems. Nevertheless, the proposed methods are insufficient for smoke detection in laparoscopic videos because they often depend on assumptions which rarely hold in laparoscopic surgery such as static camera. In this paper, ten visual features based on motion, texture and colour of smoke are proposed and evaluated for smoke detection in laparoscopic videos. These features are RGB channels, energy-based feature, texture features based on gray level co-occurrence matrix (GLCM, HSV colour space feature, features based on the detection of moving regions using optical flow and the smoke colour in HSV colour space. These features were tested on four laparoscopic cholecystectomy videos. Experimental observations show that each feature can provide valuable information in performing the smoke detection task. However, each feature has weaknesses to detect the presence of smoke in some cases. By combining all proposed features smoke with high and even low density can be identified robustly and the classification accuracy increases significantly.

  17. Music experience influences laparoscopic skills performance.

    Science.gov (United States)

    Boyd, Tanner; Jung, Inkyung; Van Sickle, Kent; Schwesinger, Wayne; Michalek, Joel; Bingener, Juliane

    2008-01-01

    Music education affects the mathematical and visuo-spatial skills of school-age children. Visuo-spatial abilities have a significant effect on laparoscopic suturing performance. We hypothesize that prior music experience influences the performance of laparoscopic suturing tasks. Thirty novices observed a laparoscopic suturing task video. Each performed 3 timed suturing task trials. Demographics were recorded. A repeated measures linear mixed model was used to examine the effects of prior music experience on suturing task time. Twelve women and 18 men completed the tasks. When adjusted for video game experience, participants who currently played an instrument performed significantly faster than those who did not (PMen who had never played an instrument or were currently playing an instrument performed better than women in the same group (P=0.002 and P<0.001). There was no sex difference in the performance of participants who had played an instrument in the past (P=0.29). This study attempted to investigate the effect of music experience on the laparoscopic suturing abilities of surgical novices. The visuo-spatial abilities used in laparoscopic suturing may be enhanced in those involved in playing an instrument.

  18. Single incision laparoscopic colorectal resection: Our experience

    Directory of Open Access Journals (Sweden)

    Chinnusamy Palanivelu

    2012-01-01

    Full Text Available Background: A prospective case series of single incision multiport laparoscopic colorectal resections for malignancy using conventional laparoscopic trocars and instruments is described. Materials and Methods: Eleven patients (seven men and four women with colonic or rectal pathology underwent single incision multiport laparoscopic colectomy/rectal resection from July till December 2010. Four trocars were placed in a single transumblical incision. The bowel was mobilized laparoscopically and vessels controlled intracorporeally with either intra or extracorporeal anastomosis. Results: Three patients had carcinoma in the caecum, one in the hepatic flexure, two in the rectosigmoid, one in the descending colon, two in the rectum and two had ulcerative pancolitis (one with high grade dysplasia and another with carcinoma rectum. There was no conversion to standard multiport laparoscopy or open surgery. The median age was 52 years (range 24-78 years. The average operating time was 130 min (range 90-210 min. The average incision length was 3.2 cm (2.5-4.0 cm. There were no postoperative complications. The average length of stay was 4.5 days (range 3-8 days. Histopathology showed adequate proximal and distal resection margins with an average lymph node yield of 25 nodes (range 16-30 nodes. Conclusion: Single incision multiport laparoscopic colorectal surgery for malignancy is feasible without extra cost or specialized ports/instrumentation. It does not compromise the oncological radicality of resection. Short-term results are encouraging. Long-term results are awaited.

  19. Laparoscopic use of laser and monopolar electrocautery

    Science.gov (United States)

    Hunter, John G.

    1991-07-01

    Most general surgeons are familiar with monopolar electrocautery, but few are equally comfortable with laser dissection and coagulation. At courses across the country, surgeons are being introduced to laparoscopy and laser use in one and two day courses, and are certified from that day forward as laser laparoscopists. Some surgeons are told that laser and electrosurgery may be equally acceptable techniques for performance of laparoscopic surgery, but that a surgeon may double his patient volume by advertising 'laser laparoscopic cholecystectomy.' The sale of certain lasers has skyrocketed on the basis of such hype. The only surprise is that laparoscopic cholecystectomy complications occurring in this country seem to be more closely related to the laparoscopic access and visualization than to the choice of laser of electrocautery as the preferred instrument for thermal dissection. The purpose of this article is to: 1) Discuss the physics and tissue effects of electrosurgery and laser; 2) compare the design and safety of electrosurgical and laser delivery systems; and 3) present available data comparing laser and electrocautery application in laparoscopic cholecystectomy.

  20. Laparoscopic simulation for all: two affordable, upgradable, and easy-to-build laparoscopic trainers.

    Science.gov (United States)

    Smith, Matthew D; Norris, Joseph M; Kishikova, Lyudmila; Smith, David P

    2013-01-01

    Laparoscopic surgery has established itself as the approach of choice for a multitude of operations in general, urological, and gynecological surgery. A number of factors make performing laparoscopic surgery technically demanding, and as such it is crucial that surgical trainees hone their skills safely on trainers before operating on patients. These can be highly expensive. Here, we describe a novel and upgradable approach to constructing an affordable laparoscopic trainer. A pattern was produced to build an upgradable laparoscopic trainer for less than $100. The basic model was constructed from an opaque plastic crate with plywood base, 2 trocars, and 2 pairs of disposable laparoscopic instruments. A laptop, a light emitting diode (LED), and a fixed webcam were utilized to visualize the box interior. An enhanced version was also created, as an optional upgrade to the basic model, featuring a neoprene-trocar interface and a simulated mobile laparoscope. The described setup allowed trainees to gain familiarity with laparoscopic techniques, beginning with simple manipulation and then progressing through to more relevant procedures. Novices began by moving easy-to-grasp objects between containers and then attempting more challenging manipulations such as stacking sugar cubes, excising simulated lesions, threading circular mints onto cotton, and ligating fastened drinking straws. These techniques have introduced the necessity of careful instrument placement and have increased trainees' dexterity with laparoscopy. Here, we have outlined an upgradable and affordable alternative laparoscopic trainer that has given many trainees crucial experience with laparoscopic techniques, allowing them to safely improve their manual skill and confidence. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  1. Laparoscopic appendicectomy for suspected mesh-induced appendicitis after laparoscopic transabdominal preperitoneal polypropylene mesh inguinal herniorraphy

    Directory of Open Access Journals (Sweden)

    Jennings Jason

    2010-01-01

    Full Text Available Laparoscopic inguinal herniorraphy via a transabdominal preperitoneal (TAPP approach using Polypropylene Mesh (Mesh and staples is an accepted technique. Mesh induces a localised inflammatory response that may extend to, and involve, adjacent abdominal and pelvic viscera such as the appendix. We present an interesting case of suspected Mesh-induced appendicitis treated successfully with laparoscopic appendicectomy, without Mesh removal, in an elderly gentleman who presented with symptoms and signs of acute appendicitis 18 months after laparoscopic inguinal hernia repair. Possible mechanisms for Mesh-induced appendicitis are briefly discussed.

  2. Internal hernia following laparoscopic colorectal surgery

    DEFF Research Database (Denmark)

    Svraka, Melina; Wilhelmsen, Michał; Bulut, Orhan

    2017-01-01

    Although internal hernias are rare complications of laparoscopic colorectal surgery, they can lead to serious outcomes and are associated with a high mortality of up 20 %. AIM OF THE STUDY: The aim of this study was to describe our experience regarding internal herniation following laparoscopic...... colorectal surgery. MATERIALS AND METHODS: From 2009 to 2015, more than 1,093 laparoscopic colorectal procedures were performed, and 6 patients developed internal herniation. Data were obtained from patients' charts and reviewed retrospectively. Perioperative course and outcomes were analyzed. RESULTS: All...... patients were previously operated due to colorectal cancer. Two patients presented with ischemia at laparotomy, and 2 had endoscopic examinations before surgery. One patient was diagnosed with cancer on screening colonoscopy. One patient died after laparotomy. CONCLUSION: Internal herniation that develops...

  3. Single-incision total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Sinha Rakesh

    2011-01-01

    Full Text Available Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

  4. Complications of laparoscopic hysterectomy: the Monash experience.

    Science.gov (United States)

    Tsaltas, J; Lawrence, A; Michael, M; Pearce, S

    2002-08-01

    A retrospective review of medical records was performed to assess the incidence and type of significant complications encountered during laparoscopic hysterectomy Two hundred and sixty-five consecutive patients were reviewed between the years 1994 and August 2001. Two hundred and thirty-two laparoscopic vaginal hysterectomies and 33 total laparoscopic hysterectomies were performed. The operations were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and two Melbourne private hospitals, by three surgeons. Ten significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, two postoperative haematomas, one case of a bladder fistula and one superficial epigastric artery injury. In-patient stay ranged from two to six days. Our complication and in-patient stay rates are consistent with previously reported rates.

  5. Penrose Drain Migration After Laparoscopic Surgery

    Directory of Open Access Journals (Sweden)

    Pazouki AbdolReza

    2009-05-01

    Full Text Available Laparoscopy has made a revolution in surgical procedures and treatment of various diseases but its complications are still under investigation. Intra-abdominal visceral and vessel injuries, trocar site hernia, and leaving foreign bodies into the peritoneal cavity are among some laparoscopic surgery complications. This is a rare report of Penrose drain migration following incomplete laparoscopic Fundoplication surgery. The patient was a 47- year- old woman, who was a candidate for Touplet Fundoplication via laparoscopic approach due to refractory gastro-esophageal reflux disease (GERD. While wrapping a Penrose drain around the esophagus, the patient had a cardiorespiratory arrest. Attempts to remove the Penrose drain were unsuccessful and the surgical procedure was terminated due to patient's condition. Four months later, after a long period of dysphagia and abdominal pain, the Penrose drain was defecated via rectum.

  6. Pancreatitis autoinmune asociada a fibrosis retroperitoneal: evolución tras dos años de seguimiento Autoimmune pancreatitis associated with retroperitoneal fibrosis: outcome after 24 months of follow-up

    Directory of Open Access Journals (Sweden)

    M. Romero

    2008-10-01

    Full Text Available Introducción: la pancreatitis autoinmune es un tipo de pancreatitis crónica caracterizado por un infiltrado linfoplasmocitario y una elevación de IgG e IgG4, que se ha descrito asociada a diversas manifestaciones extrapancreáticas y enfermedades autoinmunes, lo cual apoya la teoría de un mecanismo autoinmune fisiopatólogico de base. Caso clínico: presentamos el caso de un varón que debutó simultáneamente con una pancreatitis autoinmune asociada a fibrosis retroperitoneal y lesión de la vía biliar extrapancreática, con respuesta total tras tratamiento con corticoides durante 4 meses y ausencia de recurrencia tras 24 meses de seguimiento. Discusión: la pancreatitis autoinmune es un tipo de pancreatitis crónica que probablemente forme parte de un proceso sistémico autoinmune, cuyas manifestaciones extrapancreáticas más frecuentes son la fibrosis retroperitoneal y las lesiones de la vía biliar extrapancreática. Su correcto diagnóstico e inicio precoz del tratamiento puede favorecer la resolución completa de las lesiones, principalmente en los casos de bajo grado de actividad, con menor probabilidad de recurrencia.Introduction: autoimmune pancreatitis is a kind of chronic pancreatitis characterized by the presence of lymphoplasmacytic infiltration and severely elevated serum IgG and IgG4, which has been associated to many extrapancreatic lesions and other autoimmune disorders, leading to the theory of an autoimmune mechanism involved in the pathogenesis of this disease. Case report: we report the case of a man who simultaneously presented with autoimmune pancreatitis associated with retroperitonal fibrosis, and a lesion of the extrapancreatic bile duct, with total response to corticosteroid treatment for 4 moths and absence of recurrence after 24 months of follow-up. Discussion: autoimmune pancreatitis is a kind of chronic pancreatitis that is probably a part of a systemic autoinmune disease, with retroperitoneal fibrosis and

  7. Two-incision laparoscopic appendectomy for a severe hemophilia A child patient with coagulation factor VII deficiency: Case report and review of literature.

    Science.gov (United States)

    He, Jin Peng; Feng, Jie Xiong

    2017-10-01

    The main complication of patients with severe hemophilia is recurrent bleeding events that usually affected musculoskeletal contractures. And replacement therapy methods were continuously improved to minimize adverse impacts brought by those complications. However, only several cases reported about the appendectomy for hemophilia A. We report a case of acute appendicitis treated by two-incision laparoscopy in a boy with hemophilia A and coagulation factor VII deficiency for the first time. An 8y7m-old Chinese boy presented with half a day of right sided abdominal pain, fever, nausea, and vomiting. He received a computed tomography (CT) scan which revealed an enlarged appendix, thickened wall and appendiceal fecalith, and had received a conservative anti-bacterial treatment for his acute appendicitis but failed. He was diagnosed with hemophilia A and coagulation factor VII deficiency. Two-incision laparoscopic appendectomy was made in success with a careful management of perioperative period. We monitored the clotting factor FVIII level and gave him a replacement therapy. The patient had an uneventful recovery. It is important to exclude intraabdominal or retroperitoneal hemorrhage in patients suffering from hemophilia and acute abdominal pain. Pre-operative evaluation of validity of the FVIII replacement therapy is another effective strategy to assess the safety and feasibility of applying an operation procedure. The two-incision laparoscopic appendectomy is an effective treatment for this kind of patients for its minimal trauma and fast recovery characteristics. Our report shows that laparoscopic appendectomy is feasible in a child suffering from hemophilia after adequate blood clotting factor replacement treatment.

  8. Impact of laparoscopic surgery training laboratory on surgeon's performance

    Science.gov (United States)

    Torricelli, Fabio C M; Barbosa, Joao Arthur B A; Marchini, Giovanni S

    2016-01-01

    Minimally invasive surgery has been replacing the open standard technique in several procedures. Similar or even better postoperative outcomes have been described in laparoscopic or robot-assisted procedures when compared to open surgery. Moreover, minimally invasive surgery has been providing less postoperative pain, shorter hospitalization, and thus a faster return to daily activities. However, the learning curve required to obtain laparoscopic expertise has been a barrier in laparoscopic spreading. Laparoscopic surgery training laboratory has been developed to aid surgeons to overcome the challenging learning curve. It may include tutorials, inanimate model skills training (box models and virtual reality simulators), animal laboratory, and operating room observation. Several different laparoscopic courses are available with specific characteristics and goals. Herein, we aim to describe the activities performed in a dry and animal-model training laboratory and to evaluate the impact of different kinds of laparoscopic surgery training courses on surgeon’s performance. Several tasks are performed in dry and animal laboratory to reproduce a real surgery. A short period of training can improve laparoscopic surgical skills, although most of times it is not enough to confer laparoscopic expertise for participants. Nevertheless, this short period of training is able to increase the laparoscopic practice of surgeons in their communities. Full laparoscopic training in medical residence or fellowship programs is the best way of stimulating laparoscopic dissemination. PMID:27933135

  9. Safety Evaluation of Elderly Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Bijan Khorasani

    2008-10-01

    Full Text Available Objectives: The most common indication for abdominal surgery in elderly (65 & older is gallstone disease.The elderly are more prone to complication of such surgery due to their other co-morbidity and thus they may benefit mostly from a safer method of surgical procedure. The purpose of this study was to evaluate the safety and outcome of laparoscopic cholecystectomy in elderly compare to the conventional method. Methods & Materials: Via prospective study from June 2005 to March 2008 included all patient older than 60 years of age who underwent cholecystectomy by open (Group A and laparoscopic (Group B method in Milad Hospital.The demographic data (sex age, American Society of Anesthesiologists’ (ASA score, postoperative mortality morbidity, length of stay and operative time were recorded for each patient and were compared between two methods. Data of patient’s analysis by SPSS with chi-square and t test. Results: The study included 311 elderlies (34% men and 66% women. Hundred fifty-seven patients underwent open cholecystectomy; 154 patients underwent laparoscopic cholecystectomy. The mean age was 7141 years. The outcome in group B (laparoscopic included: morality 0%, morbidity 2%, postoperative hospital stay 1 days, mean operation time was 40 minutes. In group A(open: mortality and morbidity rate were 21% and 12% respectively with postoperative hospital stay 331 days and similar operation time as group A. Conclusion: Laparoscopic cholecystectomy is the gold standard treatment and safe procedure in elderly patient and aging is not considered to be a contraindication laparoscopic surgery in such patients.

  10. PRINCIPLES OF SAFETY IN LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Tomaž Benedik

    2003-12-01

    Full Text Available Background. After more than decade of routine use of laparoscopic cholecystectomy for treatment of symptomatic gallbladder stones, the incidence of biliary injuries, which are potentially life threatening and cause prolonged hospitalization and major morbidity, seems to be increased in laparoscopic cholecystectomy compared with open operation. Injury rate was from some reports 2.5 to 4 times higher than with open operation. There are many proposed classifications of types of biliary injuries.The most frequent direct causes of laparoscopic biliary injury are misidentification of the common bile duct, cautery injuries to the bile duct and improper application of clips to the cystic duct.Conclusions. To avoid misidentification of ducts one should conclusively identify cystic duct and artery, the structures to be divide, in every laparoscopic cholecystectomy. To achieve that goal, Calot’s triangle must be dissected free of fat and fibrous – tissue and the lower end of the gallbladder must be dissected of the liver bed. The only two structures entering the gallbladder should be visible – cystic duct and artery. With avoidance of blind application of cautery and clips to control bleeding one should avoid injury of bile duct. Low cautery settings should be used in portal dissections to prevent arc.With meticulous care in dissection and conclusive identification of cystic duct and artery we can prevent injuries of bile duct, which still have impermissible high incidence. In the article 504 laparoscopic cholecystectomies performed at the Department of abdominal surgery in BPD in 2002 were analysed. We follow priciples of safety in laparoscopic cholecystectomy. There were no biliary injuries reports.

  11. Robotic versus laparoscopic resection of liver tumours

    Science.gov (United States)

    Berber, Eren; Akyildiz, Hizir Yakup; Aucejo, Federico; Gunasekaran, Ganesh; Chalikonda, Sricharan; Fung, John

    2010-01-01

    Background There are scant data in the literature regarding the role of robotic liver surgery. The aim of the present study was to develop techniques for robotic liver tumour resection and to draw a comparison with laparoscopic resection. Methods Over a 1-year period, nine patients underwent robotic resection of peripherally located malignant lesions measuring <5 cm. These patients were compared prospectively with 23 patients who underwent laparoscopic resection of similar tumours at the same institution. Statistical analyses were performed using Student's t-test, χ2-test and Kaplan–Meier survival. All data are expressed as mean ± SEM. Results The groups were similar with regards to age, gender and tumour type (P = NS). Tumour size was similar in both groups (robotic −3.2 ± 1.3 cm vs. laparoscopic −2.9 ± 1.3 cm, P = 0.6). Skin-to-skin operative time was 259 ± 28 min in the robotic vs. 234 ± 17 min in the laparoscopic group (P = 0.4). There was no difference between the two groups regarding estimated blood loss (EBL) and resection margin status. Conversion to an open operation was only necessary in one patient in the robotic group. Complications were observed in one patient in the robotic and four patients in the laparoscopic groups. The patients were followed up for a mean of 14 months and disease-free survival (DFS) was equivalent in both groups (P = 0.6). Conclusion The results of this initial study suggest that, for selected liver lesions, a robotic approach provides similar peri-operative outcomes compared with laparoscopic liver resection (LLR). PMID:20887327

  12. Intensity modulated radiation-therapy for preoperative posterior abdominal wall irradiation of retroperitoneal liposarcomas

    International Nuclear Information System (INIS)

    Bossi, Alberto; De Wever, Ivo; Van Limbergen, Erik; Vanstraelen, Bianca

    2007-01-01

    Purpose: Preoperative external-beam radiation therapy (preop RT) in the management of Retroperitoneal Liposarcomas (RPLS) typically involves the delivery of radiation to the entire tumor mass: yet this may not be necessary. The purpose of this study is to evaluate a new strategy of preop RT for RPLS in which the target volume is limited to the contact area between the tumoral mass and the posterior abdominal wall. Methods and Materials: Between June 2000 and Jan 2005, 18 patients with the diagnosis of RPLS have been treated following a pilot protocol of pre-op RT, 50 Gy in 25 fractions of 2 Gy/day. The Clinical Target Volume (CTV) has been limited to the posterior abdominal wall, region at higher risk for local relapse. A Three-Dimensional conformal (3D-CRT) and an Intensity Modulated (IMRT) plan were generated and compared; toxicity was reported following the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events v3.0. Results: All patients completed the planned treatment and the acute toxicity was tolerable: 2 patients experienced Grade 3 and 1 Grade 2 anorexia while 2 patients developed Grade 2 nausea. IMRT allows a better sparing of the ipsilateral and the contralateral kidney. All tumors were successfully resected without major complications. At a median follow-up of 27 months 2 patients developed a local relapse and 1 lung metastasis. Conclusions: Our strategy of preop RT is feasible and well tolerated: the rate of resectability is not compromised by limiting the preop CTV to the posterior abdominal wall and a better critical-structures sparing is obtained with IMRT

  13. Spatial and volumetric changes of retroperitoneal sarcomas during pre-operative radiotherapy

    International Nuclear Information System (INIS)

    Wong, Philip; Dickie, Colleen; Lee, David; Chung, Peter; O’Sullivan, Brian; Letourneau, Daniel; Xu, Wei; Swallow, Carol; Gladdy, Rebecca; Catton, Charles

    2014-01-01

    Purpose: To determine the positional and volumetric changes of retroperitoneal sarcomas (RPS) during pre-operative external beam radiotherapy (PreRT). Material and methods: After excluding 2 patients who received chemotherapy prior to PreRT and 15 RPS that were larger than the field-of-view of cone-beam CT (CBCT), the positional and volumetric changes of RPS throughout PreRT were characterized in 19 patients treated with IMRT using CBCT image guidance. Analysis was performed on 118 CBCT images representing one image per week of those acquired daily during treatment. Intra-fraction breathing motions of the gross tumor volume (GTV) and kidneys were measured in 22 RPS patients simulated using 4D-CT. Fifteen other patients were excluded whose tumors were incompletely imaged on CBCT or who received pre-RT chemotherapy. Results: A GTV volumetric increase (mean: 6.6%, p = 0.035) during the first 2 weeks (CBCT1 vs. CBCT2) of treatment was followed by GTV volumetric decrease (mean: 4%, p = 0.009) by completion of radiotherapy (CBCT1 vs. CBCT6). Internal margins of 8.6, 15 and 15 mm in the lateral, anterior/posterior and superior/inferior directions would be required to account for inter-fraction displacements. The extent of GTV respiratory motion was significantly (p < 0.0001) correlated with more superiorly positioned tumors. Conclusion: Inter-fraction CBCT provides important volumetric and positional information of RPS which may improve PreRT quality and prompt re-planning. Planning target volume may be reduced using online soft-tissue matching to account for interfractional displacements of GTVs. Important breathing motion occurred in superiorly placed RPS supporting the utility of 4D-CT planning

  14. Retroperitoneal Sarcoma Target Volume and Organ at Risk Contour Delineation Agreement Among NRG Sarcoma Radiation Oncologists

    Energy Technology Data Exchange (ETDEWEB)

    Baldini, Elizabeth H., E-mail: ebaldini@partners.org [Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); Bosch, Walter [Department of Radiation Oncology, Washington University, St. Louis, Missouri (United States); Roberge, David [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Haas, Rick L.M. [Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam (Netherlands); Catton, Charles N. [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Indelicato, Daniel J. [Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida (United States); Olsen, Jeffrey R. [Department of Radiation Oncology, Washington University, St. Louis, Missouri (United States); Deville, Curtiland [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Chen, Yen-Lin [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Finkelstein, Steven E. [Translational Research Consortium, 21st Century Oncology, Scottsdale, Arizona (United States); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Wang, Dian [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States)

    2015-08-01

    Purpose: The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. Methods and Materials: Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. Conclusions: For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed.

  15. Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

    Energy Technology Data Exchange (ETDEWEB)

    Baldini, Elizabeth H., E-mail: ebaldini@partners.org [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, Massachusetts (United States); Wang, Dian [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); Haas, Rick L.M. [Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Catton, Charles N. [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Indelicato, Daniel J. [Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida (United States); Kirsch, David G. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Roberge, David [Department of Radiation Oncology, Centre Hospitalier de l' Université de Montreal, Montreal, Quebec (Canada); Salerno, Kilian [Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York (United States); Deville, Curtiland [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Sidney Kimmel Cancer Center, Washington, DC (United States); Guadagnolo, B. Ashleigh [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); O' Sullivan, Brian [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Le Pechoux, Cecile [Department of Radiotherapy, Institut Gustave-Roussy, Villejuif (France); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2015-07-01

    Purpose: Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS. Methods and Materials: An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results: Treatment guidelines for preoperative RT for RPS are presented. Conclusions: An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy

  16. Combined Modality Management of Retroperitoneal Sarcomas: A Single-Institution Series of 121 Patients

    International Nuclear Information System (INIS)

    Bishop, Andrew J.; Zagars, Gunar K.; Torres, Keila E.; Hunt, Kelly K.; Cormier, Janice N.; Feig, Barry W.; Guadagnolo, B. Ashleigh

    2015-01-01

    Purpose: The purpose of this study was to investigate local control, survival outcomes, and complication rates of patients treated with aggressive surgery and radiation therapy (RT) for retroperitoneal sarcomas (RPS). Methods and Materials: We reviewed the medical records of 121 consecutive patients treated for RPS with surgery and RT between 1965 and 2012. The most common histology was liposarcoma (n=42; 35%). The median follow-up was 100 months (range: 20-467 months). Eighty-six patients (71%) were treated for initial presentation of RPS, and 35 patients (29%) presented with and were treated for RPS recurrence. RT was preoperative in 88 patients (73%; median dose: 50.4 Gy) and postoperative in 33 patients (27%; median dose: 55 Gy). Results: Five-year local control and overall survival rates were 56% and 57%, respectively. Two factors were associated with higher risk of any intra-abdominal recurrence at 5 years: positive or uncertain margins (58% vs 30% for negative margins, P<.001; hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.6-4.8) and disease recurrence after previous resection (76% vs 31% for de novo RPS, P<.001; HR: 4.4; 95% CI: 2.5-7.5). The 10-year complication rate was 5%, and RT-related complications were associated with postoperative RT (P<.001) and RT dose of ≥60 Gy (P<.001). Conclusions: Intra-abdominal RPS recurrence continues to be a significant challenge despite the use of aggressive surgery and radiation therapy. Given the complications associated with postoperative radiation therapy, we recommend that preoperative radiation therapy is the preferred strategy when combined modality therapy is recommended

  17. Retroperitoneal liposarcoma; The role of adjuvant radiation therapy and the prognostic factors

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hong Seok; Yu, Jeong Il; Lim, Do Hoon; Kim, Sung Joo [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2016-09-15

    To evaluate the benefit of adjuvant radiation therapy (RT) for retroperitoneal liposarcoma (RPLS) following gross tumor removal. We reviewed 77 patients with primary RPLS surgically treated between January 2000 and December 2013. Cases with gross residual disease were excluded. Tumor grade was evaluated according to the French Federation of Cancer Centers Sarcoma Group (FNCLCC) system. Adjuvant RT was delivered to 32 patients (42%) using external beam RT alone. Median follow-up time was 36 months (range, 5 to 169). Among 77 patients, 33 (43%) presented with well-differentiated, 31 (40%) with de-differentiated, 8 (10%) with myxoid/round and 4 (5%) with pleomorphic morphology. The RT group included less well-differentiated subtype than surgery group (28% vs. 53%). During follow up, 34 patients (44%) showed local recurrence. Local recurrence rate was lower in the RT group (38%) compared to the surgery group (49%). The 3-year local control rate (LC) was 55.6%, and the 3-year overall survival (OS) was 82.1%. Tumor histology and FNCLCC grade were significantly associated with local recurrence. There was no statistical significance of adding adjuvant RT in LC (p = 0.312). However, patients with tumor histology other than well-differentiated subtype showed marginally decreased local recurrence rate after adjuvant RT (3-year LC, RT 43.9% vs. no RT 35.3%; p = 0.087). RPLS patients receiving RT experienced less local recurrence. We suggest that the addition of adjuvant RT may be related to improvement of LCs, especially in patients with non-favorable histologic subtypes.

  18. Retroperitoneal soft tissue sarcoma: An analysis of radiation and surgical treatment

    International Nuclear Information System (INIS)

    Ballo, Matthew T.; Zagars, Gunar K.; Pollock, Raphael E.; Benjamin, Robert S.; Feig, Barry W.; Cormier, Janice N.; Hunt, Kelly K.; Patel, Shreyaskumar R.; Trent, Jonathan C.; Beddar, Sam; Pisters, Peter W.T.

    2007-01-01

    Purpose: To evaluate the clinical outcomes of patients with localized retroperitoneal soft tissue sarcoma (STS) treated with complete surgical resection and radiation. Methods and Materials: The medical records of 83 patients were reviewed retrospectively. Sixty patients presented with primary disease and the remaining 23 had recurrence after previous surgical resection. Results: With a median follow-up of 47 months, the actuarial overall disease-specific survival (DSS), distant metastasis-free survival, and local control (LC) rates were 44%, 67%, and 40%, respectively. Of the 38 patients dying of disease, local disease progression was the sole site of recurrence for 16 patients and was a component of progression for another 11 patients. Multivariate analysis indicated that histologic grade was associated with the 5-year rates of DSS (low-grade, 92%; intermediate-grade, 51%; and high-grade, 41%, p = 0.006). Multivariate analysis also indicated an inferior 5-year LC rate for patients presenting with recurrent disease, positive or uncertain resection margins, and age greater than 65 years. The data did not suggest an improved local control with higher doses of external-beam radiation (EBRT) or with the specific use of intraoperative radiotherapy (IORT). Radiation-related complications (10% at 5 years) developed in 5 patients; all had received their EBRT postoperatively. Conclusions: Although preoperative radiation therapy and aggressive surgical resection is well tolerated in patients, local disease progression continues to be a significant component of disease death. In this small cohort of patients, the use of higher doses of EBRT or IORT did not result in clinically apparent improvements in outcomes

  19. Retroperitoneal Sarcoma Target Volume and Organ at Risk Contour Delineation Agreement Among NRG Sarcoma Radiation Oncologists

    International Nuclear Information System (INIS)

    Baldini, Elizabeth H.; Abrams, Ross A.; Bosch, Walter; Roberge, David; Haas, Rick L.M.; Catton, Charles N.; Indelicato, Daniel J.; Olsen, Jeffrey R.; Deville, Curtiland; Chen, Yen-Lin; Finkelstein, Steven E.; DeLaney, Thomas F.; Wang, Dian

    2015-01-01

    Purpose: The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. Methods and Materials: Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. Conclusions: For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed

  20. Laparoscopic retrieval of impacted Dormia basket

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2017-01-01

    Full Text Available For choledocholithiasis, endoscopic management is the first line of treatment. Both Dormia basket and balloon catheter are used to retrieve common bile duct (CBD stones. Here we present a case of impaction of the Dormia basket during an endoscopic procedure. The patient was managed through laparoscopic choledochotomy, and the basket was found to be impacted with a common bile stone of size 18 mm. The stone was disengaged from the basket and, by holding the tip of the basket, was removed through one of the laparoscopic ports.

  1. Laparoscopic Heller Myotomy for Achalasia Technical Aspects.

    Science.gov (United States)

    Schlottmann, Francisco; Allaix, Marco E; Patti, Marco G

    2018-04-01

    Esophageal achalasia is a primary esophageal motility disorder defined by the lack of esophageal peristalsis, and by a lower esophageal sphincter that fails to relax in response to swallowing. Patients' symptoms include dysphagia, regurgitation, aspiration, heartburn, and chest pain. Achalasia is a chronic condition without cure, and treatment options are aimed at providing symptomatic relief, improving esophageal emptying, and preventing the development of megaesophagus. Presently, a laparoscopic Heller myotomy with a partial fundoplication is considered the best treatment modality. A properly executed operation is key for the success of a laparoscopic Heller myotomy.

  2. Transperitoneal laparoscopic approach for retrocaval ureter

    Directory of Open Access Journals (Sweden)

    Nagraj H

    2006-01-01

    Full Text Available We had a 14 year old boy, who presented with recurrent attacks of right loin pain. Investigations revealed a retrocaval ureter. A transperitoneal three port laparoscopic approach was undertaken. The retrocaval portion of ureter was excised. A double J stent was placed laparoscopically and ureteroureterostomy was done with intracorporeal suturing. The patient was discharged after 72 hours and the stent was removed on the 15th day. Follow up showed regression of hydronephrosis. We recommend this approach compared to open surgery, as it offers several advantages compared to conventional open surgery like decreased postoperative pain, decreased hospital stay and a cosmetically more acceptable surgical scar.

  3. Laparoscopic insertion of the Moss feeding tube.

    Science.gov (United States)

    Albrink, M H; Hagan, K; Rosemurgy, A S

    1993-12-01

    Placement of enteral feeding tubes is an important part of a surgeon's skill base. Surgical insertion of feeding tubes has been performed safely for many years with very few modifications. With the recent surge in interest and applicability of other laparoscopic procedures, it is well within the skills of the average laparoscopic surgeon to insert feeding tubes. We describe herein a simple technique for the insertion of the Moss feeding tube. The procedure described has a minimum of invasion, along with simplicity, safety, and accuracy.

  4. Analgesic Treatment in Laparoscopic Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Andersen, Lars P H; Werner, Mads U; Rosenberg, Jacob

    2014-01-01

    This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines. The litera......This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines...

  5. Laparoscopic Splenectomy in Patients With Spleen Injuries.

    Science.gov (United States)

    Ermolov, Aleksander S; Tlibekova, Margarita A; Yartsev, Peter A; Guliaev, Andrey A; Rogal, Mikhail M; Samsonov, Vladimir T; Levitsky, Vladislav D; Chernysh, Oleg A

    2015-12-01

    Spleen injury appears in 10% to 30% of abdominal trauma patients. Mortality among the patients in the last 20 years remains high (6% to 7%) and shows no tendency to decline. Nowadays nonoperative management is widely accepted management of patients with low-grade spleen injury, whereas management of patients with high-grade spleen injury (III and higher) is not so obvious. There are 3 methods exist in treatment of such patients: conservative (with or without angioembolization), spleen-preserving operations, and splenectomy. Today laparoscopic splenectomy is not a widely used operation and only few studies reported about successful use of laparoscopic splenectomy in patients with spleen injury.The aim of the study was to determine indications and contraindications for laparoscopic splenectomy in abdominal trauma patients and to analyze results of the operations. The study involved 42 patients with spleen injury grade III who were admitted in our institute in the years of 2010 to 2014. The patients were divided in 2 groups. Laparoscopic splenectomy was performed in 23 patients (group I) and "traditional" splenectomy was carried out in 19 patients (group II). There was no difference in the demographic data and trauma severity between the 2 groups. Noninvasive investigations, such as laboratory investigations, serial abdominal ultrasound examinations, x-ray in multiple views, and computed tomography had been performed before the decision about necessity of an operation was made. Patients after laparoscopic operations had better recovering conditions compared with patients with the same injury after "traditional" splenectomy. Neither surgery-related complications nor mortalities were registered in both groups. Laparoscopic splenectomy was more time-consuming operation than "traditional" splenectomy. We suggest that as experience of laparoscopic splenectomy is gained the operation time will be reduced. Laparoscopic splenectomy is a safe feasible operation in patients

  6. Radical Nephrectomy for Primary Retroperitoneal Liposarcoma Near the Kidney has a Beneficial Effect on Disease-Free Survival.

    Science.gov (United States)

    Rhu, Jinsoo; Cho, Chan Woo; Lee, Kyo Won; Park, Hyojun; Park, Jae Berm; Choi, Yoon-La; Kim, Sung Joo

    2018-01-01

    The purpose of this study is to analyze the clinical impact of radical nephrectomy on retroperitoneal liposarcoma near the kidney. Data of patients who underwent surgery for unilateral primary retroperitoneal liposarcoma near the kidney were retrospectively collected. Patients were divided into four groups according to whether they underwent nephrectomy and combined resection of other organs. Kaplan-Meier survival analysis was used to estimate disease-free survival and overall survival. Multivariable Cox analysis was used to analyze factors related to disease-free survival and overall survival. Nephrectomy (HR = 0.260, CI = 0.078-0.873, p = 0.029) had a beneficial effect on disease-free survival, while interaction model of nephrectomy*other organ resection (HR = 4.655, CI = 1.767-12.263, p = 0.002) showed poor disease-free survival. Other organ resection was not related to disease-free survival (HR = 1.543, CI = 0.146-16.251, p = 0.718). Operation method (p = 0.007) and FNCLCC grade (p free survival. While combined organ resection without nephrectomy group (HR = 1.604, CI = 0.167-15.370, p = 0.682) and radical nephrectomy with combined organ resection group (HR = 1.309, CI = 0.448-3.825, p = 0.622) did not show significant difference in disease-free survival from the mass excision only group, radical nephrectomy without combined organ resection group (HR = 0.279, CI = 0.078-0.991, p = 0.048) showed superior disease-free survival. Radical nephrectomy of unilateral primary retroperitoneal liposarcoma near the kidney has a beneficial effect on disease-free survival.

  7. Diagnostic Accuracy of Selective 3-T MR Neurography-guided Retroperitoneal Genitofemoral Nerve Blocks for the Diagnosis of Genitofemoral Neuralgia.

    Science.gov (United States)

    Fritz, Jan; Dellon, A Lee; Williams, Eric H; Rosson, Gedge D; Belzberg, Allan J; Eckhauser, Frederick E

    2017-10-01

    Purpose To determine if 3-T magnetic resonance (MR) neurography-guided retroperitoneal genitofemoral nerve (GFN) blocks are safe and effective for the diagnosis of genitofemoral neuralgia. Materials and Methods Following institutional review board approval and informed consent, 26 subjects (16 men, 10 women; mean age, 42 years [range, 24-78 years]; mean body mass index, 28 kg/m 2 [range, 20-35 kg/m 2 ]) with intractable groin pain were included. By using a 3-T MR imaging system, intermediate-weighted turbo spin-echo pulse sequences, and MR-conditional needles, diagnostic MR neurography-guided GFN blocks were performed in the retroperitoneum. Outcome variables included technical success, procedure time, complications, and rates of positive and negative GFN blocks in association with therapeutic outcomes. For the assessment of a learning curve, Mann-Whitney test was used. P values ≤ .05 were considered to indicate a statistically significant difference. Results In 26 subjects, 30 retroperitoneal GFN blocks were performed. Twelve (40%) were performed with an anterior needle path, 12 (40%) with a lateral needle path, and six (20%) with a posterior needle path. GFN blocks were technically successful in 24 of 26 (92%) subjects, achieving appropriate scrotal anesthesia. No complications occurred. The time required for a GFN block was 40 minutes (range, 18-67 minutes). The rate of a successful GFN intervention after a positive GFN block was 88% (14 of 16). The rate of a successful intervention of an alternative target after a negative GFN block was 71% (five of seven). Conclusion Selective retroperitoneally directed MR neurography-guided GFN blocks are safe and effective with high technical success and positive effect on surgical decision making in patients with presumed genitofemoral neuralgia. © RSNA, 2017 Online supplemental material is available for this article.

  8. Late effects of intraoperative radiation therapy on retroperitoneal tissues, intestine, and bile duct in a large animal model

    Energy Technology Data Exchange (ETDEWEB)

    Sindelar, W.F.; Tepper, J.E.; Kinslla, T.J.; Barnes, M.; DeLuca, A.M.; Terrill, R.; Matthews, D.; Johnstone, P.A.S. [National Institutes of Health, Bethesda, MD (United States); Anderson, W.J. [Terre Haute Center for Medical Education, IN (United States); Bollinger, B.K. [National Naval Medical Center, Bethesda, MD (United States)

    1994-07-01

    The late histopathological effects of intraoperative radiotherapy (IORT) on retroperitoneal tissues, intestine, and bile duct were investigated in dogs. Fourteen adult foxhounds were subjected to laparotomy and varying doses (0-45 Gy) of IORT (11 MeV electrons) delivered to retroperitoneal tissues including the great vessels and ureters, to a loop of defunctionalized small bowel, or to the extrahepatic bile duct. One control animal received an aortic transection and reanastomosis at the time of laparotomy; another control received laparotomy alone. This paper describes the late effects of single-fraction IORT occurring 3-5 years following treatment. Dogs receiving IORT to the retroperitoneum through a 4 X 15 cm portal showed few gross or histologic abnormalities at 20 Gy. At doses ranging from 30-45 Gy, radiation changes in normal tissues were consistently observed. Retroperitoneal fibrosis with encasement of the ureters and great vessels developed at doses {ge}30 Gy. Radiation changes were present in the aorta and vena cava at doses {ge}40 Gy. A 30 Gy dog developed an in-field malignant osteosarcoma at 3 years which invaded the vertebral column and compressed the spinal cord. A 40 Gy animal developed obstruction of the right ureter with fatal septic hydronephrosis at 4 years. Animals receiving IORT through a 5 cm IORT portal to an upper abdominal field which included a defunctionalized loop of small bowel, showed few gross or histologic abnormalities at a dose of 20 Gy. At 30 Gy, hyaline degeneration of the intestinal muscularis layer of the bowel occurred. At a dose of 45 Gy, internal intestinal fistulae developed. One 30 Gy animal developed right ureteral obstruction and hydronephrosis at 5 years. A dog receiving 30 Gy IORT through a 5 cm portal to the extrahepatic bile duct showed diffuse fibrosis through the gastroduodenal ligament. These canine studies contribute to the area of late tissue tolerance to IORT. 7 refs., 3 figs., 5 tabs.

  9. Late effects of intraoperative radiation therapy on retroperitoneal tissues, intestine, and bile duct in a large animal model

    International Nuclear Information System (INIS)

    Sindelar, W.F.; Tepper, J.E.; Kinslla, T.J.; Barnes, M.; DeLuca, A.M.; Terrill, R.; Matthews, D.; Johnstone, P.A.S.; Anderson, W.J.; Bollinger, B.K.

    1994-01-01

    The late histopathological effects of intraoperative radiotherapy (IORT) on retroperitoneal tissues, intestine, and bile duct were investigated in dogs. Fourteen adult foxhounds were subjected to laparotomy and varying doses (0-45 Gy) of IORT (11 MeV electrons) delivered to retroperitoneal tissues including the great vessels and ureters, to a loop of defunctionalized small bowel, or to the extrahepatic bile duct. One control animal received an aortic transection and reanastomosis at the time of laparotomy; another control received laparotomy alone. This paper describes the late effects of single-fraction IORT occurring 3-5 years following treatment. Dogs receiving IORT to the retroperitoneum through a 4 X 15 cm portal showed few gross or histologic abnormalities at 20 Gy. At doses ranging from 30-45 Gy, radiation changes in normal tissues were consistently observed. Retroperitoneal fibrosis with encasement of the ureters and great vessels developed at doses ≥30 Gy. Radiation changes were present in the aorta and vena cava at doses ≥40 Gy. A 30 Gy dog developed an in-field malignant osteosarcoma at 3 years which invaded the vertebral column and compressed the spinal cord. A 40 Gy animal developed obstruction of the right ureter with fatal septic hydronephrosis at 4 years. Animals receiving IORT through a 5 cm IORT portal to an upper abdominal field which included a defunctionalized loop of small bowel, showed few gross or histologic abnormalities at a dose of 20 Gy. At 30 Gy, hyaline degeneration of the intestinal muscularis layer of the bowel occurred. At a dose of 45 Gy, internal intestinal fistulae developed. One 30 Gy animal developed right ureteral obstruction and hydronephrosis at 5 years. A dog receiving 30 Gy IORT through a 5 cm portal to the extrahepatic bile duct showed diffuse fibrosis through the gastroduodenal ligament. These canine studies contribute to the area of late tissue tolerance to IORT. 7 refs., 3 figs., 5 tabs

  10. Massive splenomegaly in children: laparoscopic versus open splenectomy.

    Science.gov (United States)

    Hassan, Mohamed E; Al Ali, Khalid

    2014-01-01

    Laparoscopic splenectomy for massive splenomegaly is still a controversial procedure as compared with open splenectomy. We aimed to compare the feasibility of laparoscopic splenectomy versus open splenectomy for massive splenomegaly from different surgical aspects in children. The data of children aged splenectomy for hematologic disorders were retrospectively reviewed in 2 pediatric surgery centers from June 2004 until July 2012. The study included 32 patients, 12 who underwent laparoscopic splenectomy versus 20 who underwent open splenectomy. The mean ages were 8.5 years and 8 years in the laparoscopic splenectomy group and open splenectomy group, respectively. The mean operative time was 180 minutes for laparoscopic splenectomy and 120 minutes for open splenectomy. The conversion rate was 8%. The mean amount of intraoperative blood loss was 60 mL in the laparoscopic splenectomy group versus 110 mL in the open splenectomy group. Postoperative atelectasis developed in 2 cases in the open splenectomy group (10%) and 1 case in the laparoscopic splenectomy group (8%). Oral feeding postoperatively resumed at a mean of 7.5 hours in the laparoscopic splenectomy group versus 30 hours in the open splenectomy group. The mean hospital stay was 36 hours in the laparoscopic splenectomy group versus 96 hours in the open splenectomy group. Postoperative pain was less in the laparoscopic splenectomy group. Laparoscopic splenectomy for massive splenomegaly in children is safe and feasible. Although the operative time was significantly greater in the laparoscopic splenectomy group, laparoscopic splenectomy was associated with statistically significantly less pain, less blood loss, better recovery, and shorter hospital stay. Laparoscopic splenectomy for pediatric hematologic disorders should be the gold-standard approach regardless of the size of the spleen.

  11. Schwannoma in the porta hepatis - laparoscopic excision under laparoscopic ultrasound guidance.

    Science.gov (United States)

    Sebastian, Maciej; Sroczyński, Maciej; Donizy, Piotr; Rudnicki, Jerzy

    2017-09-01

    Schwannomas are usually benign tumors attached to peripheral nerves and are rarely found in the gastrointestinal tract. Schwannomas in the porta hepatis are extremely rare, with only 15 cases described in the literature to date. A 22-year-old female patient presented with colicky upper abdominal pain lasting 3 months. Magnetic resonance imaging of the abdominal cavity revealed a tumor in the porta hepatis. The patient was qualified for laparoscopy. The tumor was totally excised laparoscopically under guidance of laparoscopic ultrasound without intra- or postoperative complications. Postoperative histopathological examination confirmed the porta hepatic schwannoma. The patient recovered uneventfully with very good cosmetic results. In the follow-up period of 5 months we have not observed any abdominal or general health problems. The present case is the first report in the world of laparoscopic ultrasound guided laparoscopic excision of a porta hepatic schwannoma.

  12. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions

    Science.gov (United States)

    Rodríguez-Sanjuán, Juan C; Gómez-Ruiz, Marcos; Trugeda-Carrera, Soledad; Manuel-Palazuelos, Carlos; López-Useros, Antonio; Gómez-Fleitas, Manuel

    2016-01-01

    Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen’s fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated. PMID:26877605

  13. Retroperitoneal arteriovenous malformation extending through the inferior vena cava into the heart and causing inferior vena cava dissection

    International Nuclear Information System (INIS)

    Sung, Yon Mi; Choe, Yeon Hyeon; Park, Seung Woo; Park, Pyo Won; Sung, Chang Ohk

    2005-01-01

    We present a case of retroperitoneal arteriovenous malformation extending through the inferior vena cava into the heart, which was associated with dissection of the inferior vena cava in a 32-year-old female. Computed tomography and magnetic resonance imaging showed a double-lumen inferior vena cava and a rod-like solid component attached to a sac-like lesion in the right heart chambers. Digital subtraction angiography showed an arteriovenous malformation draining to the inner lumen of the inferior vena cava. (orig.)

  14. [Primary sclerosing cholangitis associated with Sjögren's syndrome, retroperitoneal fibrosis and chronic pancreatitis. Report of a case].

    Science.gov (United States)

    Barreda, F; Contardo, C; León, A; Navarrete, J; Figueroa, R; Attanasio, F

    1989-01-01

    Primary Sclerosing Cholangitis (PSC) is an unusual chronic, cholestatic disease of unknown etiology, more frequently seen in young adults in close relationship with Chronic Ulcerative Colitis. We report the case of a 30 year old woman, coming from the peruvian amazon with PSC associated with Sjögren Syndrome, Chronic Pancreatitis and Retroperitoneal Fibrosis, without colonic involvement. She was treated with external biliary drainage and controlled for 12 months. In this paper, clinical, biochemical, radiological, histological and therapeutic features are reviewed as well as its possible immunologie autoimmune origin.

  15. Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy.

    Science.gov (United States)

    Kawanaka, Hirofumi; Akahoshi, Tomohiko; Nagao, Yoshihiro; Kinjo, Nao; Yoshida, Daisuke; Matsumoto, Yoshihiro; Harimoto, Norifumi; Itoh, Shinji; Yoshizumi, Tomoharu; Maehara, Yoshihiko

    2018-01-01

    Laparoscopic gastric devascularization(Lap GDS) and splenectomy (SPL) for gastric varices is technically challenging because of highly developed collateral vessels and bleeding tendency. We investigated the feasibility of customization of Lap GDS and SPL based on CT vascular anatomy. We analyzed 61 cirrhotic patients with gastric varices who underwent Lap GDS and SPL between 2006 and 2014. Lap GDS was customized according to the afferent feeding veins (left gastric vein (LGV) and/or posterior gastric vein (PGV)/short gastric vein (SGV)) and efferent drainage veins (gastrorenal shunt and/or gastrophrenic shunt, or numerous retroperitoneal veins) based on CT imaging. Thirty-four patients with efferent drainage veins suitable for balloon-occluded retrograde transvenous obliteration (B-RTO) underwent B-RTO instead of surgical GDS, with subsequent Lap SPL. Among 27 patients with gastric varices unsuitable for B-RTO, 15 patients with PGV/SGV underwent Lap GDS of the greater curvature and SPL, and 12 patients with LGV or LGV/PGV/SGV underwent Lap GDS of the greater and lesser curvature and SPL. The mean operation time was 294 min and mean blood loss was 198 g. There was no mortality or severe morbidity. Gastric varices were eradicated in all 61 patients, with no bleeding or recurrence during a mean follow-up of 55.9 months. The cumulative 3-, 5-, and 7-year survival rates were 92, 82, and 64%, respectively. Lap GDS and SPL customized based on CT vascular anatomy is a safe and effective procedure for treating gastric varices.

  16. Chylous ascites as a complication of left sided robot-assisted laparoscopic partial nephrectomy

    Directory of Open Access Journals (Sweden)

    Gaurav Pahouja

    2016-10-01

    Full Text Available Objective: The aim of the study was to present a case series of the sparsely reported complication of chylous ascites (CA after left sided robot-assisted laparoscopic partial nephrectomy (RALPN, identify possible risk factors for the development of postoperative CA, and explore current recommendations for identification, management and prevention of CA. Material and methods: A retrospective review of patients that were treated with a RALPN during a one year time period (August 2012 to August 2013 by one surgeon at our institution was conducted. A total of 12 patients were included in the study. Demographics, tumor characteristics, and perioperative outcomes were assessed. Results: Three patients in the study experienced postoperative CA. All three patients had left sided surgery. The initial clinical suspicion for CA was raised due to complaints of abdominal pain with increased milky appearance of JP fluid. JP triglycerides were elevated in all three patients. The patients responded to conservative measures, with two patients treated with medium chain triglyceride diets and one patient treated with total parenteral nutrition (TPN. Among the patients treated with RALPN, the group that was diagnosed with postoperative CA (CA group was found to have a statistically significant lower average body mass index (BMI as compared to the group that did not have CA (non-CA group (24.67 kg/m2 in the CA group versus 31.77 kg/m2 in the non-CA group; P = 0.026. Other demographic data, tumor characteristics, and perioperative outcomes were similar in both groups. Conclusions: CA as a result of RALPN is a newly reported and rare postoperative complication. As utilization of RALPN continues to increase, urologists should be aware of this possible complication and be adept at diagnosing and managing CA. We suggest that left sided retroperitoneal surgery and a lower BMI preoperatively be considered risk factors for developing this complication.

  17. Laparoscopic nephrectomy in live donor

    Directory of Open Access Journals (Sweden)

    Mitre Anuar I.

    2004-01-01

    Full Text Available OBJECTIVE: To present the initial experience of videolaparoscopic nephrectomy in live renal donor. MATERIALS AND METHODS: In the period from April 2000 to August 2003, 50 left nephrectomies in live donor were performed by videolaparoscopy for transplantation. Twenty-eight patients were male (56% and 22 female (44%. Mean age was 37.2 years, and the mean body mass index (BMI was 27.1 kg/m². RESULTS: Mean surgical time was 179.5 minutes, and warm ischemia time of the graft was 3.79 minutes. The mean estimated bleeding was 141 mL. There was no need of blood transfusion or conversion to open surgery. In 42 cases (84%, the vascular portion of the graft was considered good by the recipient's surgical team and in all cases, the ureter was considered of proper size, though in one of them (2% its vascularization was considered improper. The transplanted kidneys produced urine still in the surgical room in 46 of the 50 transplantations considered. In only 2 cases opioid was required for analgesia. In average, 3.1 doses of dipyrone were used for each patient during hospital stay, and hospital discharge occurred, in average, after 3.2 days post-operatively. Two patients required re-operations and one of them evolved to death. CONCLUSIONS: The laparoscopic nephrectomy in live donor for renal transplantation is an alternative to conventional open surgery. In relation to the graft, no alteration, either anatomic or functional, was detected. Though there is already a large documentation in the international literature regarding this procedure, in our setting a prospective randomized study with the usual surgical study is still necessary in order to prove the advantages and disadvantages of the method.

  18. Laparoscopic nephrectomy in live donor

    Directory of Open Access Journals (Sweden)

    Anuar I. Mitre

    2004-02-01

    Full Text Available OBJECTIVE: To present the initial experience of videolaparoscopic nephrectomy in live renal donor. MATERIALS AND METHODS: In the period from April 2000 to August 2003, 50 left nephrectomies in live donor were performed by videolaparoscopy for transplantation. Twenty-eight patients were male (56% and 22 female (44%. Mean age was 37.2 years, and the mean body mass index (BMI was 27.1 kg/m². RESULTS: Mean surgical time was 179.5 minutes, and warm ischemia time of the graft was 3.79 minutes. The mean estimated bleeding was 141 mL. There was no need of blood transfusion or conversion to open surgery. In 42 cases (84%, the vascular portion of the graft was considered good by the recipient's surgical team and in all cases, the ureter was considered of proper size, though in one of them (2% its vascularization was considered improper. The transplanted kidneys produced urine still in the surgical room in 46 of the 50 transplantations considered. In only 2 cases opioid was required for analgesia. In average, 3.1 doses of dipyrone were used for each patient during hospital stay, and hospital discharge occurred, in average, after 3.2 days post-operatively. Two patients required re-operations and one of them evolved to death. CONCLUSIONS: The laparoscopic nephrectomy in live donor for renal transplantation is an alternative to conventional open surgery. In relation to the graft, no alteration, either anatomic or functional, was detected. Though there is already a large documentation in the international literature regarding this procedure, in our setting a prospective randomized study with the usual surgical study is still necessary in order to prove the advantages and disadvantages of the method.

  19. Laparoscopic nephrectomy: initial experience with 120 cases.

    LENUS (Irish Health Repository)

    Cheema, I A

    2012-02-01

    Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity

  20. Pneumodilation versus laparoscopic Heller's myotomy for achalasia

    LENUS (Irish Health Repository)

    Slattery, E

    2011-08-04

    Boeckxstaens et al. (May 12 issue)1 compare single laparoscopic myotomy with a series of pneumodilation procedures for patients with achalasia. They found no significant difference in outcomes between the two groups, although perforation occurred in 4% of patients in the pneumodilation group and often required emergency treatment. No significant clinical adverse outcomes occurred in the surgical group.\\r\

  1. Laparoscopic Pelvic Floor Repair Using Polypropylene Mesh

    Directory of Open Access Journals (Sweden)

    Shih-Shien Weng

    2008-09-01

    Conclusion: Laparoscopic pelvic floor repair using a single piece of polypropylene mesh combined with uterosacral ligament suspension appears to be a feasible procedure for the treatment of advanced vaginal vault prolapse and enterocele. Fewer mesh erosions and postoperative pain syndromes were seen in patients who had no previous pelvic floor reconstructive surgery.

  2. Laparoscopic hernia repair and bladder injury.

    Science.gov (United States)

    Dalessandri, K M; Bhoyrul, S; Mulvihill, S J

    2001-01-01

    Bladder injury is a complication of laparoscopic surgery with a reported incidence in the general surgery literature of 0.5% and in the gynecology literature of 2%. We describe how to recognize and treat the injury and how to avoid the problem. We report two cases of bladder injury repaired with a General Surgical Interventions (GSI) trocar and a balloon device used for laparoscopic extraperitoneal inguinal hernia repair. One patient had a prior appendectomy; the other had a prior midline incision from a suprapubic prostatectomy. We repaired the bladder injury, and the patients made a good recovery. When using the obturator and balloon device, it is important to stay anterior to the preperitoneal space and bladder. Prior lower abdominal surgery can be considered a relative contraindication to extraperitoneal laparoscopic hernia repair. Signs of gas in the Foley bag or hematuria should alert the surgeon to a bladder injury. A one- or two-layer repair of the bladder injury can be performed either laparoscopically or openly and is recommended for a visible injury. Mesh repair of the hernia can be completed provided no evidence exists of urinary tract infection. A Foley catheter is placed until healing occurs.

  3. Knowledge and Pperception of laparoscopic surgery among ...

    African Journals Online (AJOL)

    Background: Laparoscopic surgery is the gold standard in developed countries. Challenges indeveloping countries apart from the cost of instrumentation include a low acceptance level among patients. The consequent low volume of surgical cases debars cost reduction for surgery. Objective: The aim of this study is to ...

  4. Understanding perceptual boundaries in laparoscopic surgery.

    Science.gov (United States)

    Lamata, Pablo; Gomez, Enrique J; Hernández, Félix Lamata; Oltra Pastor, Alfonso; Sanchez-Margallo, Francisco Miquel; Del Pozo Guerrero, Francisco

    2008-03-01

    Human perceptual capabilities related to the laparoscopic interaction paradigm are not well known. Its study is important for the design of virtual reality simulators, and for the specification of augmented reality applications that overcome current limitations and provide a supersensing to the surgeon. As part of this work, this article addresses the study of laparoscopic pulling forces. Two definitions are proposed to focalize the problem: the perceptual fidelity boundary, limit of human perceptual capabilities, and the Utile fidelity boundary, that encapsulates the perceived aspects actually used by surgeons to guide an operation. The study is then aimed to define the perceptual fidelity boundary of laparoscopic pulling forces. This is approached with an experimental design in which surgeons assess the resistance against pulling of four different tissues, which are characterized with both in vivo interaction forces and ex vivo tissue biomechanical properties. A logarithmic law of tissue consistency perception is found comparing subjective valorizations with objective parameters. A model of this perception is developed identifying what the main parameters are: the grade of fixation of the organ, the tissue stiffness, the amount of tissue bitten, and the organ mass being pulled. These results are a clear requirement analysis for the force feedback algorithm of a virtual reality laparoscopic simulator. Finally, some discussion is raised about the suitability of augmented reality applications around this surgical gesture.

  5. Laparoscopic Conservative Management Of A Spontaneously ...

    African Journals Online (AJOL)

    A case of an acute abdomen secondary to a ruptured spleen managed laparoscopically is presented. Laparoscopy is currently widely used for the initial diagnosis and management of such cases as an alternative to laparotomy due to the numerous advantages of the minimal access techniques. With widespread availability ...

  6. Safe laparoscopic colorectal surgery performed by trainees

    DEFF Research Database (Denmark)

    Langhoff, Peter Koch; Schultz, Martin; Harvald, Thomas

    2013-01-01

    Laparoscopic surgery for colorectal cancer is safe, but there have been hesitations to implement the technique in all departments. One of the reasons for this may be suboptimal learning possibilities since supervised trainees have not been allowed to do the operations to an adequate extent...

  7. Laparoscopic cholecystectomy in adult cystic fibrosis.

    LENUS (Irish Health Repository)

    McGrath, D S

    2012-02-03

    Two female patients with Cystic Fibrosis, attending the Adult Regional Cystic Fibrosis centre at the Cork University Hospital, were investigated for upper abdominal pain and found to have gallstones at ultrasonography. Laparoscopic cholecystectomy was performed successfully and, without complication, in both patients.

  8. Varicocoelectomy in adolescents: Laparoscopic versus open high ...

    African Journals Online (AJOL)

    Background: Treatment of varicocoele is aimed at eliminating the retrograde reflux of venous blood through the internal spermatic veins. The purpose of this investigation was to compare laparoscopic varicocoelectomy (LV) with open high ligation technique in the adolescent population. Materials and Methods: We ...

  9. Management of mechanical ventilation during laparoscopic surgery.

    Science.gov (United States)

    Valenza, Franco; Chevallard, Giorgio; Fossali, Tommaso; Salice, Valentina; Pizzocri, Marta; Gattinoni, Luciano

    2010-06-01

    Laparoscopy is widely used in the surgical treatment of a number of diseases. Its advantages are generally believed to lie on its minimal invasiveness, better cosmetic outcome and shorter length of hospital stay based on surgical expertise and state-of-the-art equipment. Thousands of laparoscopic surgical procedures performed safely prove that mechanical ventilation during anaesthesia for laparoscopy is well tolerated by a vast majority of patients. However, the effects of pneumoperitoneum are particularly relevant to patients with underlying lung disease as well as to the increasing number of patients with higher-than-normal body mass index. Moreover, many surgical procedures are significantly longer in duration when performed with laparoscopic techniques. Taken together, these factors impose special care for the management of mechanical ventilation during laparoscopic surgery. The purpose of the review is to summarise the consequences of pneumoperitoneum on the standard monitoring of mechanical ventilation during anaesthesia and to discuss the rationale of using a protective ventilation strategy during laparoscopic surgery. The consequences of chest wall derangement occurring during pneumoperitoneum on airway pressure and central venous pressure, together with the role of end-tidal-CO2 monitoring are emphasised. Ventilatory and non-ventilatory strategies to protect the lung are discussed.

  10. Laparoscopic nephrectomy: initial experience with 120 cases.

    LENUS (Irish Health Repository)

    Cheema, I A

    2010-02-01

    Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity

  11. [25 years of laparoscopic surgery in Spain].

    Science.gov (United States)

    Moreno-Sanz, Carlos; Tenías-Burillo, Jose María; Morales-Conde, Salvador; Balague-Ponz, Carmen; Díaz-Luis, Hermógenes; Enriquez-Valens, Pablo; Manuel-Palazuelos, Juan Carlos; Martínez-Cortijo, Sagrario; Olsina-Kissler, Jorge; Socas-Macias, María; Toledano-Trincado, Miguel; Vidal-Pérez, Oscar; Noguera-Aguilar, Juan Francisco; Salvador-Sanchís, José Luis; Feliu-Pala, Xavier; Targarona-Soler, Eduard M

    2014-04-01

    The introduction of laparoscopic surgery (LS) can be considered the most important advancement in our specialty in the past 25 years. Despite its advantages, implementation and consolidation has not been homogenous, especially for advanced techniques. The aim of this study was to analyse the level of development and use of laparoscopic surgery in Spain at the present time and its evolution in recent years. During the second half of 2012 a survey was developed to evaluate different aspects of the implementation and development of LS in our country. The survey was performed using an electronic questionnaire. The global response rate was 16% and 103 heads of Department answered the survey. A total of 92% worked in the public system. A total of 99% perform basic laparoscopic surgery and 85,2% advanced LS. Most of the responders (79%) consider that the instruments they have available for LS are adequate and 71% consider that LS is in the right stage of development in their environment. Basic laparoscopic surgery has developed in our country to be considered the standard performed by most surgeons, and forms part of the basic surgical training of residents. With regards to advanced LS, although it is frequently used, there are still remaining areas of deficit, and therefore, opportunities for improvement. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  12. Visualisation of Rouviere's Sulcus during Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Thapa, P B; Maharjan, D K; Tamang, T Y; Shrestha, S K

    2015-01-01

    Safe dissection of Calot's Triangle is important during the performance of laparascopic cholucystectomy. The purpose of the study is to determine the frequency of demonstrable Rouviere's sulcus in patients with symptomatic gall stones and its role in safe dissection in Calot's triangle. This is a prospective descriptive study design done in Department of surgery, Kathmandu Medical College Teaching Hospital from Jan 2013 to Jan 2015. Patients who were posted for laparoscopic cholecystectomy were included. During laparoscopy, Rouviere's sulcus was noted in the operative note and classified according to following: Type I: Open type was defined as a cleft in which the right hepatic pedicle was visualized and the sulcus was opened throughout its length. Type II: if the sulcus was open only at its lateral end. Type III If the sulcus was open only at its medial end. Type IV: Fused type was defined as one in which the pedicle was not visualized.  A total of 200 patients underwent laparoscopic cholecystectomy during period of 2 years. Out of which Rouviere's sulcus was visualized in 150 patients (75 %).Type I (open type) was commoner in 54%, type II in 12%, Type III in 9% and type IV (fused type) in 25%. Rouviere's Sulcus is an important extra biliary land mark for safe dissection of Calot's triangle during laparoscopic cholecystectomy.  Rouviere's Sulcus, Laparoscopic cholecystectomy, Bile duct injury.

  13. Laparoscopic nephrectomy: analysis of 34 patients

    Directory of Open Access Journals (Sweden)

    Domingos André Luís Alonso

    2003-01-01

    Full Text Available OBJECTIVE: To analyze the clinical experience of laparoscopic nephrectomy for benign and malignant diseases at a university hospital. METHODS: From February 2000 to March 2003, 34 patients (14 men and 20 women underwent transperitoneal laparoscopic total nephrectomy at the Hospital das Clinicas - FMRP-USP: 28 (82.3% patients had benign diseases and 6 (17.7% malignant neoplasias. Benign diseases were represented by: urinary stones (N-9, 32.1%, chronic pyelonephritis (N-8, 28.6%, vesicoureteral reflux (N-4, 14.3%, ureteropelvic obstruction (N-3, 10.7%, multicystic kidney (N-2, 7.1% and pyonephrosis (N-2, 7.1%. Patients age range was 2-79 years (mean - 35,1 years. RESULTS: In 32/34 patients the procedures were accomplished successfully. In 2 (5.8% cases of pyonephrosis, open conversion was necessary due to perinephric abscess and difficulties in dissection of renal hilum. Two patients had intraoperative complications (1 duodenum serous laceration an 1 vascular lesion of renal hilum, but both were managed laparoscopically. Two (5.8% post operative complications (1 delayed bleeding and 1 pancreatic fistula required open surgical exploration. The mean time of hospital stay was 58h (18 to 240h. CONCLUSION: Laparoscopic nephrectomy proved to be a method safe and associated with a low rate of morbidity, shorter hospital stay and no casualties.

  14. Zero ischemia laparoscopic partial thulium laser nephrectomy.

    LENUS (Irish Health Repository)

    Thomas, Arun Z

    2013-11-01

    Laser technology presents a promising alternative to achieve tumor excision and renal hemostasis with or without hilar occlusion, yet its use in partial nephrectomy has not been significantly evaluated. We prospectively evaluated the thulium:yttrium-aluminum-garnet laser in laparoscopic partial nephrectomy (LPN) in our institution over a 1-year period.

  15. Metabolic and oncological consequences of laparoscopic surgery

    NARCIS (Netherlands)

    N.D. Kannekens-Bouvy (Nicole)

    1997-01-01

    textabstractIn 1986, Philip Mouret and his colleagues performed the first laparoscopic cholecystectomy. They initiated the most revolutionary change in traditional surgery, since the introduction of anaesthesia, asepsis, antibiotics and blood-transfusion. At the same time, industry propelled this

  16. Single versus multimodality training basic laparoscopic skills

    NARCIS (Netherlands)

    Brinkman, W.M.; Havermans, S.Y.; Buzink, S.N.; Botden, S.M.B.I.; Jakimowicz, J.J.; Schoot, B.C.

    2012-01-01

    Introduction - Even though literature provides compelling evidence of the value of simulators for training of basic laparoscopic skills, the best way to incorporate them into a surgical curriculum is unclear. This study compares the training outcome of single modality training with multimodality

  17. Wound Complications Following Laparoscopic Surgery in a ...

    African Journals Online (AJOL)

    Laparoscopic surgery offers many proven advantages over conventional open surgery for many procedures.[1,2] These advantages have increased the utilization and acceptability of laparoscopy and indeed other forms of .... chemotherapy and had no recurrence at the site after 13 months follow‑up. The extraction site in ...

  18. ureteric perforation following laparoscopic assisted vaginal

    African Journals Online (AJOL)

    2011-03-03

    Mar 3, 2011 ... Ureteric injury is one of the most common complications of hysterectomy, both in open and laparoscopic and is a source of serious morbidity. Laparoscopy carries a higher risk because of increased use of electro-surgery close to the ureter when securing the uterine artery and it is more likely to be ...

  19. [Laparoscopic Heller myotomy for esophageal achalasia].

    Science.gov (United States)

    Ibáñez, Luis; Butte, Jean Michel; Pimentel, Fernando; Escalona, Alex; Pérez, Gustavo; Crovari, Fernando; Guzmán, Sergio; Llanos, Osvaldo

    2007-04-01

    Achalasia is characterized by an incomplete relaxation of the lower esophageal sphincter. The best treatment is surgical and the laparoscopic approach may have good results. To assess the results of laparoscopic Heller myotomy among patients with achalasia. Prospective study of patients subjected to a laparoscopic Heller myotomy between 1995 and 2004. Clinical features, early and late operative results were assessed. Twenty seven patients aged 12 to 74 years (12 females) were operated. All had disphagia lasting for a mean of 32 months. Mean lower esophageal sphincter pressure ranged from 18 to 85 mmHg. Eight patients received other treatments prior to surgery but symptoms persisted or reappeared. The preoperative clinical score was 7. No patient died and no procedure had to be converted to open surgery. In a follow up of 21 to 131 months, all patients are satisfied with the surgical results and the postoperative clinical score is 1. Only one patient with a mega esophagus maintained a clinical score of six. In this series of patients, laparoscopic Heller myotomy was an effective and safe treatment for esophageal achalasia.

  20. Laparoscopic surgery: A pioneer's point of view.

    Science.gov (United States)

    Périssat, J

    1999-08-01

    For a surgeon who performed some of the first laparoscopic cholecystectomies, laparoscopic surgery is undoubtedly the main revolution in the last decade of this century. It is impossible not to be fascinated by the extraordinary changes introduced in our profession in less than 10 years. However, looking back in history, one realizes that laparoscopy is but one of those leaps forward that have always punctuated the evolution of our profession. Since the last century we have witnessed the advent of painless surgery, infectionless surgery, reconstructive surgery, microsurgery, surgery under extracorporeal circulation, organ replacement, and so on. We are in the time of scarless surgery, with no lengthy postoperative handicap. Maybe tomorrow will see surgery performed by remote-controlled robots and surgery at the molecule level. The laparoscopic revolution is particularly important because for the first time surgery no longer involves any physical contact between the surgeon's hand and the patient. Let us hope that this will not lead to total absence of a human relationship in the surgical operation. To avoid this possibility we must remain resolutely involved in the development of laparoscopic surgery; we must keep our minds open to the future advances of science and technology and integrate them in our operative procedures.

  1. Laparoscopic repair of strangulated Morgagni hernia

    Directory of Open Access Journals (Sweden)

    Kelly Michael D

    2007-10-01

    Full Text Available Abstract A 73 year old man presented with vomiting and pain due to a strangulated Morgagni hernia containing a gastric volvulus. Laparoscopic operation allowed reduction of the contents, excision of necrotic omentum and the sac, with mesh closure of the large defect. A brief review of the condition is presented along with discussion of the technique used.

  2. Laparoscopic right hemicolectomy for intestinal intussuception.

    LENUS (Irish Health Repository)

    Kiernan, F

    2012-09-01

    Adult intussusception is rare and usually associated with carcinoma in 50% of the cases. These have traditionally been managed using an open technique. We herein describe a laparoscopic extended right hemicolectomy in a 62-year-old lady with an intussuception secondary to a transverse colonic tumor.

  3. Laparoscopic Treatment of Intestinal Malrotation in Children

    NARCIS (Netherlands)

    Ooms, N.; Matthyssens, L.E.; Draaisma, J.M.T.; Blaauw, I. de; Wijnen, M.H.

    2016-01-01

    Purpose Intestinal malrotation is a congenital intestinal rotation anomaly, which can be treated by either laparotomy or laparoscopy. Our hypothesis is that laparoscopic treatment leads to less small bowel obstruction because of the fewer adhesions in comparison to laparotomy, without increasing the

  4. Laparoscopic Whipple procedure: review of the literature.

    Science.gov (United States)

    Gagner, Michel; Palermo, Mariano

    2009-01-01

    Laparoscopic pancreatic surgery represents one of the most advanced applications for laparoscopic surgery currently in use. In the past, minimally invasive techniques were only used for diagnostic laparoscopy, staging of pancreatic cancer, and palliative procedures for unresectable pancreatic cancer. With new advances in technology and instrumentation, some sophisticated procedures are currently available, such as the Whipple procedure, one of the most sophisticated applications of minimally invasive surgery. A review of the literature shows that 146 laparoscopic Whipple procedures have been published worldwide since 1994. The authors analyzed blood loss, mean operating time, hospital stay, conversion rate, mean age, mortality rate, lymph nodes in the pathologic findings, follow up, and complications. Mean age was 59.1 years; mean operating time was 439 min. The average blood loss for the reviewed literature was 143 mL; median hospital stay was 18 days; conversion rate was 46%; number of lymph nodes in the pathologic findings was 19; and mortalities related to the procedure was low, 2 patients (1.3%) and the complication rate was 16% (23/46 patients). Complications included 2 hemorrhages, 4 bowel obstructions, 1 stress ulcer, 1 delay of gastric emptying, 4 pneumonias, and 11 leaks. This review demonstrates that the laparoscopic Whipple procedure is not only feasible but also safe, with low mortality and acceptable rates of complications.

  5. A comparison of pelvic retroperitoneal pneumography and computed tomography in the assessment of extramural invasion of rectal carcinoma

    International Nuclear Information System (INIS)

    Kaibara, Nobuaki; Kimura, Osamu; Nishidoi, Hideaki; Ikeguchi, Masahide; Sugezawa, Akira; Sumi, Kenichi; Ohta, Michio; Koga, Shigemasa

    1988-01-01

    Pelvic retroperitoneal pneumography (PRP) and pelvic computed tomography (CT) were performed on 33 patients with rectal carcinoma in order to compare the usefulness of the two diagnostic procedures in the preoperative assessment of local malignant extramural invasion. Six PRP-negative patients in whom no free air was visualized in the retroperitoneal space surrounding the mass, were all assessed as having extramural invasion by CT scan and all had histologic evidence of invasion. Of 27 PRP-positive patients in whom free air was seen surrounding the mass, 18 were diagnosed as having extramural invasion on CT, 15 of whom had histologic proof of invasion. In the remaining 9 PRP-positive patients, there was no evidence of extramural invasion on the CT scans, but 5 patients showed evidence of invasion histologically. PRP, when positive, had an unacceptably high rate of being false positive and was therefore unreliable in assessing extramural invasion, whereas CT was able to detect, to some extent, extramural invasion which PRP failed to demonstrate. Based on these findings, we conclude that CT is more useful than PRP in the preoperative assessment of extramural invasion of rectal carcinoma, but is of limited diagnostic value when negative. (author)

  6. Content of the canceroembryonal antigen in tumours of the organs of the abdominal cavity and the retroperitoneal space

    Energy Technology Data Exchange (ETDEWEB)

    Tkacheva, G A; Klimenkov, A A; Gladikov, Yu V; Gabuniya, R I [Akademiya Meditsinskikh Nauk SSSR, Moscow. Onkologicheskij Nauchnyj Tsentr

    1979-08-01

    The concentration of the canceroembryonal antigen (CEA) has been determined in vitro by the radioimmunological analysis of the blood plasma of 70 donors and 130 patients with malignant tumours of the intestine (6 persons), stomach (77), with relapsing gastric carcinoma (12), tumours of the pancreas (7), retroperitoneal space (18) and with inflammatory disease of the gastrointestinal tract (12). It is established that the radioimmunological test in vitro for CEA can be used not only for primary diagnosis of cancer of the rectum but also as a substantial supplement to the clinical diagnosis of carcinoma of the stomach and the pancreas. A relationship revealed between the rise in the content of CEA and the extent of malignancy provides additional information for correct diagnosing the stage of gastric carcinoma and a choice of an adequate method of treatment. Tolerance of the CEA level in the blood in retroperitoneal tumours and inflammatory diseases of the gastrointestinal tract may serve as a criterion for differential diagnosis of malignant newgrowths in the abdominal cavity.

  7. Stereoscopic augmented reality for laparoscopic surgery.

    Science.gov (United States)

    Kang, Xin; Azizian, Mahdi; Wilson, Emmanuel; Wu, Kyle; Martin, Aaron D; Kane, Timothy D; Peters, Craig A; Cleary, Kevin; Shekhar, Raj

    2014-07-01

    Conventional laparoscopes provide a flat representation of the three-dimensional (3D) operating field and are incapable of visualizing internal structures located beneath visible organ surfaces. Computed tomography (CT) and magnetic resonance (MR) images are difficult to fuse in real time with laparoscopic views due to the deformable nature of soft-tissue organs. Utilizing emerging camera technology, we have developed a real-time stereoscopic augmented-reality (AR) system for laparoscopic surgery by merging live laparoscopic ultrasound (LUS) with stereoscopic video. The system creates two new visual cues: (1) perception of true depth with improved understanding of 3D spatial relationships among anatomical structures, and (2) visualization of critical internal structures along with a more comprehensive visualization of the operating field. The stereoscopic AR system has been designed for near-term clinical translation with seamless integration into the existing surgical workflow. It is composed of a stereoscopic vision system, a LUS system, and an optical tracker. Specialized software processes streams of imaging data from the tracked devices and registers those in real time. The resulting two ultrasound-augmented video streams (one for the left and one for the right eye) give a live stereoscopic AR view of the operating field. The team conducted a series of stereoscopic AR interrogations of the liver, gallbladder, biliary tree, and kidneys in two swine. The preclinical studies demonstrated the feasibility of the stereoscopic AR system during in vivo procedures. Major internal structures could be easily identified. The system exhibited unobservable latency with acceptable image-to-video registration accuracy. We presented the first in vivo use of a complete system with stereoscopic AR visualization capability. This new capability introduces new visual cues and enhances visualization of the surgical anatomy. The system shows promise to improve the precision and

  8. Port Site Infections After Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Mumtaz KH Al-Naser

    2017-06-01

    Full Text Available Background: Port site infection (PSI is an infrequent surgical site infection that complicates laparoscopic surgery but has a considerable influence in the overall outcome of laparoscopic cholecystectomy. The aim of this study was to evaluate factors that influence PSI after laparoscopic cholecystectomies and to analyze which of these factors can be modified to avoid PSI in a trail to achieve maximum laparoscopic advantages. Methods: A prospective descriptive qualitative study conducted on patients who underwent laparoscopic cholecystectomies. Swabs were taken for culture & sensitivity in all patients who developed PSI. Exploration under general anaesthesia, for patients, had deep surgical site infections and wound debridement was done, excisional biopsies had been taken for histopathological studies, and tissue samples for polymerase chain reaction for detection of mycobacterium tuberculosis was done. All patients were followed up for six months postoperatively. Factors as gender, site of infected port, type of microorganism, acute versus chronic cholecystitis, type of infection (superficial or deep infection and intraoperative spillage of stones, bile or pus were analyzed in our sample. Results: Port site infection rate was recorded in 40/889 procedures (4.5%, higher rates were observed in male patients 8/89 (8.9%, in acute cholecystitis 13/125 (10.4%, when spillage of bile, stones or pus occurred 24/80 (30%, and at epigastric port 32/40 (80%. Most of the PSI were superficial infections 77.5% with non-specific microorganism 34/40 (85%. Conclusion: There is a significant association of port site infection with spillage of bile, stones, or pus, with the port of gallbladder extraction and with acute cholecystitis. Especial consideration should be taken in chronic deep surgical site infection as mycobacterium tuberculosis could be the cause. Most of the PSIs are superficial and more common in males.

  9. Laparoscopic repair of large suprapubic hernias.

    Science.gov (United States)

    Sikar, Hasan Ediz; Çetin, Kenan; Eyvaz, Kemal; Kaptanoglu, Levent; Küçük, Hasan Fehmi

    2017-09-01

    Suprapubic hernia is the term to describe ventral hernias located less than 4 cm above the pubic arch in the midline. Hernias with an upper margin above the arcuate line encounter technical difficulties, and the differences in repair methods forced us to define them as large suprapubic hernias. To present our experience with laparoscopic repair of large suprapubic hernias that allows adequate mesh overlap. Nineteen patients with suprapubic incisional hernias who underwent laparoscopic repair between May 2013 and January 2015 were included in the study. Patients with laparoscopic extraperitoneal repair who had a suprapubic hernia with an upper margin below the arcuate line were excluded. Two men and 17 women, with a mean age of 58.2, underwent laparoscopic repair. Most of the incisions were midline vertical (13/68.4%). Twelve (63.1%) of the patients had previous incisional hernia repair (PIHR group); the mean number of previous incisional hernia repair was 1.4. Mean defect size of the PIHR group was higher than in patients without previous repair - 107.3 cm 2 vs. 50.9 cm 2 (p < 0.05). Mean operating time of the PIHR group was higher than in patients without repair - 126 min vs. 77.9 min (p < 0.05). Although all complications occurred in the PIHR group, there was no statistically significant difference. Laparoscopic repair of large suprapubic hernias can be considered as the first option in treatment. The low recurrence rates reported in the literature and the lack of recurrence, as observed in our study, support this view.

  10. Laparoscopic Cholecystectomy by Sectorisation of Port Sites

    International Nuclear Information System (INIS)

    Sindhu, M. A.; Haq, I.; Rehman, S.

    2013-01-01

    Objectives: To evaluate the results of 160 consecutive laparoscopic cholecystectomy using sectorisation based port site selection to improve ergonomics for surgeons. Design: Descriptive study. Place and Duration of study: PNS Shifa Karachi, Pakistan from Feb 2011 to Feb 2012. Patients and Methods: In this prospective study, 160 consecutive patients had undergone laparoscopic cholecystectomy in a tertiary care hospital using sectorisation for trocar placement. All patients with symptomatic gallstones, acute calculous cholecystitis and empyema gallbladder were included. Patients with choledocholithiasis were excluded from the study. The collected data included age, sex, diagnosis, history of previous surgery, conversion to open surgery and its reasons, operative time, post-operative hospital stay, complications and laparoscopy related complications to the surgeon such as shoulder pain, wrist stress and pain, finger joint pain and stress exhaustion. Result: One hundred and sixty patients underwent laparoscopic cholecystectomy with mean age 45 +- 12.9 years. Female to male ratio was 7.8:1. A total of 110 patients had chronic cholecystitis / biliary colic, 34 patients were with acute cholecystitis and 16 patients had diagnosis of empyema gallbladder. The mean operative time was 35.3+-14.6 min. Conversion rate to open surgery was 1.2%. Complications included bleeding from cystic artery (n=1) and injury to common hepatic duct (CHD) (n=1). One patient developed port site hernia post operatively. There was no incidence of laparoscopy related complications in surgeon such as pain shoulder, strains on the wrist joint, stress exhaustion and hand-finger joint pain. Conclusion: Sectorisation technique can be used in laparoscopic cholecystectomy in order to avoid the physical constraints of laparoscopic shoulder, hand finger joint pain, tenosynovitis, stress exhaustion, and hand muscle injury without increasing any morbidity to the patients. (author)

  11. Comparison of posterior retroperitoneal and transabdominal lateral approaches in robotic adrenalectomy: an analysis of 200 cases.

    Science.gov (United States)

    Kahramangil, Bora; Berber, Eren

    2018-04-01

    Although numerous studies have been published on robotic adrenalectomy (RA) in the literature, none has done a comparison of posterior retroperitoneal (PR) and transabdominal lateral (TL) approaches. The aim of this study was to compare the outcomes of robotic PR and TL adrenalectomy. This is a retrospective analysis of a prospectively maintained database. Between September 2008 and January 2017, perioperative outcomes of patients undergoing RA through PR and TL approaches were recorded into an IRB-approved database. Clinical and perioperative parameters were compared using Student's t test, Wilcoxon rank-sum test, and χ 2 test. Multivariate regression analysis was performed to determine factors associated with total operative time. 188 patients underwent 200 RAs. 110 patients were operated through TL and 78 patients through PR approach. Overall, conversion rate to open was 2.5% and 90-day morbidity 4.8%. The perioperative outcomes of TL and PR approaches were similar regarding estimated blood loss, rate of conversion to open, length of hospital stay, and 90-day morbidity. PR approach resulted in a shorter mean ± SD total operative time (136.3 ± 38.7 vs. 154.6 ± 48.4 min; p = 0.005) and lower visual analog scale pain score on postoperative day #1 (4.3 ± 2.5 vs. 5.4 ± 2.4; p = 0.001). After excluding tumors larger than 6 cm operated through TL approach, the difference in operative times persisted (136.3 ± 38.7 vs. 153.7 ± 45.7 min; p = 0.009). On multivariate regression analysis, increasing BMI and TL approaches were associated with longer total operative time. This study shows that robotic PR and TL approaches are equally safe and efficacious. With experience, shorter operative time and less postoperative pain can be achieved with PR technique. This supports the preferential utilization of PR approach in high-volume centers with enough experience.

  12. A novel prototype 3/5 laparoscopic needle driver: A validation study with conventional laparoscopic needle driver.

    Science.gov (United States)

    Ganpule, Arvind P; Deshmukh, Chaitanya S; Joshi, Tanmay

    2018-01-01

    The challenges in laparoscopic suturing include need to expertise to suture. Laparoscopic needle holder is a" key" instrument to accomplish this arduous task. The objective of this new invention was to develop a laparoscopic needle holder which would be adapted to avoid any wobble (with a shaft diameter same as a 5mm port), ensure accurate and dexterous suturing not just in adult patients but pediatric patients alike (with a short shaft diameter) and finally ensure seamless throw of knots with a narrow tip configuration. We did an initial evaluation to evaluate the validity of the prototype needle holder and its impact on laparoscopic suturing skills by experienced laparoscopic surgeons and novice laparoscopic Surgeons. Both the groups of surgeons performed two tasks. The first task was to grasp the needle and position it in an angle deemed ideal for suturing. The second task was to pass suture through two fixed points and make a single square knot. At the end of the tasks each participant was asked to complete a 5- point Likert's scale questionnaire (8 items; 4 items of handling and 4 items of suturing) rating each needle holder. In expert group, the mean time to complete task 1 was shorter with prototype 3/5 laparoscopic needle holder (11.8 sec Vs 20.8 sec). The mean time to complete task 2 was also shorter with prototype 3/5 laparoscopic needle holder (103.2 sec Vs 153.2 sec). In novice group, mean time to complete both the task was shorter with prototype 3/5 laparoscopic needle holder. The expert laparoscopic surgeons as well as novice laparoscopic surgeons performed laparoscopic suturing faster and with more ease while using the prototype 3/5 laparoscopic needle holder.

  13. Laparoscopic evaluation of female infertility

    International Nuclear Information System (INIS)

    Haiderr, G.; Rani, S.; Zehra, N.; Munir, A.

    2010-01-01

    (20%) had irregular cycles. The commonest cause observed in patients with primary infertility was endometriosis spots which accounted for 11 (55%). In secondary infertility tubal occlusion was more common which accounted for 3 (30%). Conclusion: Laparoscopic procedures are less invasive, more convenient and more precise for diagnosis of sub-fertility in women. (author)

  14. Feasibility of Reduced Port Laparoscopic Colectomy for Colon Cancer.

    Science.gov (United States)

    Tsutsumi, Soichi; Morita, Hiroki; Fujii, Takaaki; Suto, Toshinaga; Yajima, Reina; Takada, Takahiro; Asao, Takayuki; Kuwano, Hiroyuki

    2015-06-01

    Reduced port laparoscopic surgery has recently emerged as a method to improve the cosmetic results of conventional laparoscopic surgery. We reported our technique of reduced port laparoscopic colectomy using 3-port and short-time outcomes. Between 2005 and 2012, we performed 161 reduced port laparoscopic colectomies using the 3-port technique. Data analyzed in-cluded age, gender, body mass index (BMI), duration of surgery, number of harvested lymph nodes, and duration of hospital stay. All of the cases were successfully performed using the 3-port procedure. The median durations of surgery and postoperative hospital stay were 140 mm (range 75-463 mm) and 9 days (range 5-38 days), respectively. No mortality was associated with this technique. Reduced port laparoscopic colectomy is feasible and may have advantages over conventional laparoscopic colectomy.

  15. Laparoscopic Approach for Metachronous Cecal and Sigmoid Volvulus

    Science.gov (United States)

    Greenstein, Alexander J.; Zisman, Sharon R.

    2010-01-01

    Background: Metachronous colonic volvulus is a rare event that has never been approached laparoscopically. Methods: Here we discuss the case of a 63-year-old female with a metachronous sigmoid and cecal volvulus. Results: The patient underwent 2 separate successful laparoscopic resections. Discussion and Conclusion: The following is a discussion of the case and the laparoscopic technique, accompanied by a brief review of colonic volvulus. In experienced hands, laparoscopy is a safe approach for acute colonic volvulus. PMID:21605523

  16. Application of modified R.E.N.A.L. nephrometry score system in evaluating the retroperitoneal partial nephrectomy for T1 renal cell carcinoma.

    Science.gov (United States)

    Wang, Qinzhang; Qian, Biao; Li, Qiang; Ni, Zhao; Li, Yinglong; Wang, Xinmin

    2015-01-01

    This study aims to investigate the application of the modified R.E.N.A.L. nephrometry score system in evaluating the operation difficulty of retroperitoneal partial nephrectomy in T1 renal cell carcinoma patients. A total of 52 patients with T1 renal cell carcinoma were enrolled. They all had retroperitoneal partial nephrectomy. Their clinical data was retrospectively analyzed. R.E.N.A.L. nephrometry score system was modified based on the features of retroperitoneal partial nephrectomy. The specificity, sensitivity and Youden index were compared between R.E.N.A.L. nephrometry score system and the modified R.E.N.A.L. nephrometry score system. The effect of the modified R.E.N.A.L. nephrometry score system on perioperative outcomes was analyzed. Three degrees of operation difficulty were defined by the modified R.E.N.A.L. nephrometry score system, which included the low, medium and high degree of operation difficulty. The specificity, sensitivity and Youden index of the modified R.E.N.A.L. nephrometry score system were better than those of the original R.E.N.A.L. nephrometry score system. Compared with low degree of operation difficulty, patients with medium and high degree of operation difficulty had significantly higher levels of operative time, warm ischemia time, and intraoperative blood loss (P system has a good effect in evaluating the operation difficulty of retroperitoneal partial nephrectomy.

  17. Solitary Bone Plasmacytoma Progressing into Retroperitoneal Plasma Cell Myeloma with No Related End Organ or Tissue Impairment: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Gargi Tikku

    2014-09-01

    Full Text Available Solitary bone plasmacytomas and plasma cell myeloma are clonal proliferations of plasma cells. Many patients with solitary bone plasmacytomas develop plasma cell myeloma on follow-up. We present a case of a 70-year-old man who presented with fracture and a lytic lesion in the subtrochanteric region of the left femur and was assigned a diagnosis of solitary bone plasmacytoma. He received local curative radiotherapy. However, 4 months later his serum M protein and β2-microglobulin levels increased to 2.31 g/dL and 5.965 mg/L, respectively. He complained of abdominal fullness and constipation. Ultrasound and non-contrast CT imaging revealed multiple retroperitoneal masses. Colonoscopic examination was normal. Biopsy of the a retroperitoneal mass confirmed it to be a plasmacytoma. Repeat hemogram, blood urea, serum creatinine, skeletal survey, and bone marrow examination revealed no abnormalities. This is an unusual presentation of plasma cell myeloma, which manifested as multiple huge extramedullary retroperitoneal masses and arose from a solitary bone plasmacytoma, without related end organ or tissue impairment and bone marrow plasmacytosis. The patient succumbed to his disease 8 months after the appearance of the retroperitoneal masses. This case highlights the importance of close monitoring of patients diagnosed with solitary bone plasmacytoma with increased serum M protein and serum β2-microglobulin levels, so that early therapy can be instituted to prevent conversion to plasma cell myeloma.

  18. Effectiveness of box trainers in laparoscopic training

    Directory of Open Access Journals (Sweden)

    Dhariwal Anender

    2007-01-01

    Full Text Available Rationale and Objectives: Various devices are used to aid in the education of laparoscopic skills ranging from simple box trainers to sophisticated virtual reality trainers. Virtual reality system is an advanced and effective training method, however it is yet to be adopted in India due to its cost and the advanced technology required for it. Therefore, box trainers are being used to train laparoscopic skills. Hence this study was undertaken to assess the overall effectiveness of the box-training course. Study Procedure: The study was conducted during six-day laparoscopic skills training workshops held during 2006. Twenty five surgeons; age range of 26 to 45 years, of either sex, who had not performed laparoscopic surgery before; attending the workshop were evaluated. Each participant was given a list of tasks to perform before beginning the box-training course on day one and was evaluated quantitatively by rating the successful completion of each test. Evaluation began when the subject placed the first tool into the cannula and ended with task completion. Two evaluation methods used to score the subject, including a global rating scale and a task-specific checklist. After the subject completed all sessions of the workshop, they were asked to perform the same tasks and were evaluated in the same manner. For each task completed by the subjects, the difference in the scores between the second and first runs were calculated and interpreted as an improvement as a percentage of the initial score. Statistical Analysis: Wilcoxon matched-paired signed-ranks test was applied to find out the statistical significance of the results obtained. Results: The mean percentage improvement in scores for both the tasks, using global rating scale, was 44.5% + 6.930 (Mean + SD. For task 1, using the global rating scale mean percentage improvement was 49.4% + 7.948 (Mean + SD. For task 2, mean percentage improvement using global rating scale was 39.6% + 10.4 (Mean

  19. Laparoscopic redo fundoplication for intrathoracic migration of wrap

    Directory of Open Access Journals (Sweden)

    Maheshkumar G

    2007-01-01

    Full Text Available Laparoscopic fundoplication is fast emerging as the treatment of choice of gastro-esophageal reflux disease. However, a complication peculiar to laparoscopic surgery for this disease is the intrathoracic migration of the wrap. This article describes a case of a male patient who developed this particular complication after laparoscopic total fundoplication. Following a trauma, wrap migration occurred. The typical history and symptomatology is described. The classical Barium swallow picture is enclosed. Laparoscopic redo fundoplication was carried out. The difficulties encountered are described. Postoperative wrap migration can be suspected clinically by the presence of a precipitating event and typical symptomatology. Confirmation is by a Barium swallow. Treatment is by redo surgery.

  20. Single-incision laparoscopic cecectomy for low-grade appendiceal mucinous neoplasm after laparoscopic rectectomy

    Science.gov (United States)

    Fujino, Shiki; Miyoshi, Norikatsu; Noura, Shingo; Shingai, Tatsushi; Tomita, Yasuhiko; Ohue, Masayuki; Yano, Masahiko

    2014-01-01

    In this case report, we discuss single-incision laparoscopic cecectomy for low-grade appendiceal neoplasm after laparoscopic anterior resection for rectal cancer. The optimal surgical therapy for low-grade appendiceal neoplasm is controversial; currently, the options include appendectomy, cecectomy, right hemicolectomy, and open or laparoscopic surgery. Due to the risk of pseudomyxoma peritonei, complete resection without rupture is necessary. We have encountered 5 cases of low-grade appendiceal neoplasm and all 5 patients had no lymph node metastasis. We chose the appendectomy or cecectomy without lymph node dissection if preoperative imaging studies did not suspect malignancy. In the present case, we performed cecectomy without lymph node dissection by single-incision laparoscopic surgery (SILS), which is reported to be a reduced port surgery associated with decreased invasiveness and patient stress compared with conventional laparoscopic surgery. We are confident that SILS is a feasible alternative to traditional surgical procedures for borderline tumors, such as low-grade appendiceal neoplasms. PMID:24868331