Laparoscopic Adrenalectomy: the New York-Presbyterian Hospital Experience

Journal of Endourology / Endourological Society. Oct, 2002  |  Pubmed ID: 12470468

Laparoscopic adrenalectomy has become the standard technique for the surgical removal of the adrenal gland. The advantages of the laparoscopic approach include shorter length of stay (LOS), a decrease in postoperative pain, faster return to preoperative activity level, improved cosmesis, and reduced complications. We report our experience with laparoscopic adrenalectomy via a lateral transperitoneal approach.

Pleural Injury During Laparoscopic Renal Surgery: Early Recognition and Management

The Journal of Urology. Jan, 2003  |  Pubmed ID: 12478098

Injury to the diaphragm is an uncommon yet recognized complication of several laparoscopic procedures, including laparoscopic renal surgery. As these procedures increase in popularity and use, laparoscopic surgeons should be aware of techniques for avoiding this complication as well as methods of identifying pleural injury and managing it appropriately. We report our experience with the detection and intraoperative management of pleural injury sustained during laparoscopic renal surgery and its subsequent treatment.

Transabdominal Laparoscopic Adrenalectomy

Current Urology Reports. Feb, 2003  |  Pubmed ID: 12537946

Laparoscopic adrenalectomy has become the standard technique for the surgical removal of the adrenal gland at many centers worldwide. Functional adrenal tumors such as aldosteronoma, glucocorticoid, androgen/estrogen-producing adenomas, and small-to-moderate sized solitary pheochromocytomas are amenable to removal via a laparoscopic approach. The advantages of laparoscopic adrenalectomy over open adrenalectomy are well documented and include a shorter hospital stay, a decrease in postoperative pain, shorter interval between surgery and return to preoperative activity level, and improved cosmesis. Various laparoscopic approaches to the adrenal gland have been described. Among these are the lateral transabdominal, anterior transabdominal, lateral retroperitoneal, and posterior retroperitoneal approaches. Each of these methods has specific advantages and disadvantages. This article reviews the transperitoneal approach to laparoscopic adrenalectomy, and discusses indications, operative technique, and a survey of the available literature.

Adrenal-preserving Minimally Invasive Surgery: the Role of Laparoscopic Partial Adrenalectomy, Cryosurgery, and Radiofrequency Ablation of the Adrenal Gland

Current Urology Reports. Feb, 2003  |  Pubmed ID: 12537947

Adrenalectomy has become the standard of care for the management of hormonally active adrenal masses. Various surgical therapies have been proposed to excise completely or destroy these adrenal lesions, which may be benign or malignant. New minimally invasive, adrenal-sparing procedures have recently been introduced, among them laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation. These procedures focus on reducing patient morbidity and hastening postoperative recovery while preserving normal adrenal tissue. However, questions remain about the risks and benefits associated with routine application of minimally invasive therapies for adrenal-sparing surgery in terms of complete tumor extirpation. Clearly, more experience and longer follow-up is necessary to validate these procedures. Herein we describe the surgical techniques and early results of treatment with adrenal-sparing surgery.

Hand-assisted Laparoscopy for Large Renal Specimens: a Multi-institutional Study

Urology. Jan, 2003  |  Pubmed ID: 12559271

To present our experience with hand-assisted laparoscopy (HAL) for larger renal specimens. One of the theoretical benefits of HAL is the ability to manage large renal specimens, which we defined as tumors greater than 7 cm, and tumors in obese patients.

Minimally Invasive Surgical Management of Ureteropelvic Junction Obstruction: Laparoscopic and Robot-assisted Laparoscopic Pyeloplasty

Journal of Long-term Effects of Medical Implants. 2003  |  Pubmed ID: 14649575

Ureteropelvic junction (UPJ) obstruction is characterized by a functionally significant impairment of urinary transport caused by an intrinsic or extrinsic obstruction in the area where the ureter joins the renal pelvis. The majority of cases are congenital in origin; however, acquired conditions at the level of the ureteropelvic junction may also present with symptoms and signs of obstruction. Until recently, open pyeloplasty and endoscopic techniques have been the main surgical options, with the intent of complete excision or incision of the obstruction. The introduction of laparoscopy and robot-assisted applications has allowed for minimally invasive reconstructive surgery that mirrors open surgical techniques. These techniques offer substantial benefits to patients by reducing morbidity, hastening postoperative recovery, and improving cosmetic outcome. During the last decade, laparoscopic pyeloplasty has garnered much interest. However, because of the technically challenging nature of this procedure, it is performed only at select medical centers by surgeons with advanced laparoscopic training. The recent introduction of robotics to the field of minimally invasive surgery may facilitate this procedure and allow for more widespread implementation by surgeons of varying skill levels. This review is limited primarily to the treatment of congenital or acquired UPJ obstruction via laparoscopic and robot-assisted laparoscopic pyeloplasty. Herein, we report the early results, ongoing evolution, and potential future role for these novel surgical procedures.

Practice Patterns Among Urologic Surgeons Treating Localized Renal Cell Carcinoma in the Laparoscopic Age: Technology Versus Oncology

Urology. Dec, 2003  |  Pubmed ID: 14665345

To evaluate the effect of laparoscopy on practice patterns at a single institution in the treatment of renal cell carcinoma. Many now regard laparoscopic radical nephrectomy (LRN) as a standard of care in the management of localized renal cell carcinoma. As laparoscopy becomes more prevalent in the urologic community, practice patterns are changing.

Right Laparoscopic Live Donor Nephrectomy: a Single Institution Experience

Transplantation. Feb, 2004  |  Pubmed ID: 14966422

Laparoscopic live donor nephrectomy (LLDN) is increasingly used by transplantation centers worldwide. As in open live donor nephrectomy, the left kidney is preferred for LLDN; however, not all potential donors have anatomy conducive to left nephrectomy. The purpose of our study, therefore, was to report on a large, single-institution experience with right LLDN performed using a hand-assisted, transperitoneal approach.

The Advantages of Hand-assisted Laparoscopy

Current Urology Reports. Apr, 2004  |  Pubmed ID: 15028201

The technical challenges of performing laparoscopic renal surgery require fellowship training and are associated with a steep learning curve. For the established urologist in practice, fellowship training is not a reality. As a result of these obstacles, in the late 1990s, laparoscopic renal surgery was entering the domain of the general surgeons who had a large number of laparoscopic procedures at their disposal to develop laparoscopic skills. Hand-assisted laparoscopic renal surgery is a hybrid procedure combining the most salient features of open renal surgery and laparoscopic renal surgery. By allowing the surgeons to place their non-dominant hand into the abdominal cavity, palpation and spatial orientation became possible, lessening the learning curve for laparoscopic surgery. Moreover, hand-assisted laparoscopic surgery could be applied to a variety of renal surgeries, extirpative and reconstructive, with results similar to those already achieved by standard laparoscopy. Throughout the past 5 years, hand-assisted laparoscopy has allowed urologists to incorporate laparoscopic renal surgery into their practices to the benefit of their patients and of their specialty. This review article offers a historical review of the development of hand-assisted laparoscopy and describes the procedures commonly performed today using this technique.

Hand-assisted Laparoscopic Nephroureterectomy for Upper Urinary-tract Transitional-cell Carcinoma

Journal of Endourology / Endourological Society. May, 2004  |  Pubmed ID: 15253785

Hand-assisted laparoscopic nephroureterectomy with laparoscopic, cystoscopic, or open management of the distal ureter and bladder cuff allow anyone from the novice to the advanced laparoscopic surgeon to perform en-bloc resection of the kidney, ureter, and bladder cuff without compromising oncologic principles. Patients receive significant benefits in the form of less pain, shorter hospital stay, and rapid convalescence. As more urologic surgeons develop skills with this procedure, a more critical analysis of early and long-term results will be possible. As operative times decrease, hand-assisted laparoscopic nephroureterectomy may become the procedure of choice for upper-tract transitional-cell carcinoma. The techniques and early results are described.

Laparoscopic Pyeloplasty: History, Evolution, and Future

Journal of Endourology / Endourological Society. Oct, 2004  |  Pubmed ID: 15659896

Ureteropelvic junction (UPJ) obstruction is characterized by a functionally significant impairment of urinary transport caused by obstruction in the area where the ureter joins the renal pelvis. The majority of cases are congenital; however, acquired conditions at the level of the UPJ may also present with symptoms and signs of obstruction. Until recently, open pyeloplasty and endoscopic techniques have been the main surgical options with the intent of complete excision or incision of the obstruction. The introduction of laparoscopy has allowed minimally invasive reconstructive surgery that mirrors open surgical techniques. In the hands of experienced surgeons, laparoscopic pyeloplasty offers a less invasive alternative to open surgery with decreased morbidity, shorter hospital stay, and faster convalescence. During the last decade, laparoscopic pyeloplasty for the treatment of congenital or acquired UPJ obstruction has garnered much interest, but, as this procedure is technically challenging, it is being performed only at selected medical centers by surgeons with advanced laparoscopic training. This review describes the early results, ongoing evaluation, and future role for this novel surgical procedure.

Abnormal Selective Cytology Results Predict Recurrence of Upper-tract Transitional-cell Carcinoma Treated with Ureteroscopic Laser Ablation

Journal of Endourology / Endourological Society. Nov, 2004  |  Pubmed ID: 15659932

Endoscopic management of transitional-cell carcinoma (TCC) of the upper urinary tract remains associated with a significant rate of recurrence. We evaluated the impact of selective upper-tract cytology findings on tumor recurrence and renal salvage rate after ureteroscopic laser tumor ablation.

Robot-assisted Laparoscopic Dismembered Pyeloplasty: a Combined Experience

Journal of Endourology / Endourological Society. Apr, 2005  |  Pubmed ID: 15865532

The need for advanced laparoscopic skills limits the implementation of laparoscopic pyeloplasty to centers with extensive experience. The introduction of robotic technology into the field of minimally invasive surgery has facilitated complex surgical dissection and genitourinary reconstruction. We report our experience with robot-assisted laparoscopic pyeloplasty using the daVinci Surgical System at three New York City medical centers.

Impact of Delay to Nephroureterectomy for Patients Undergoing Ureteroscopic Biopsy and Laser Tumor Ablation of Upper Tract Transitional Cell Carcinoma

Urology. Aug, 2005  |  Pubmed ID: 16098357

To investigate whether a delay in nephroureterectomy for patients with transitional cell carcinoma of the upper urinary tract owing to ureteroscopic biopsy and/or laser tumor ablation affects postoperative disease status.

Laparoscopic Vs Open Partial Nephrectomy in Consecutive Patients: the Cornell Experience

BJU International. Oct, 2005  |  Pubmed ID: 16153207

To compare a contemporary series of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) at one institution, to evaluate the size and types of tumour in each group and the early outcome after each procedure, as LPN is replacing open radical nephrectomy as the standard of care for uncomplicated renal tumours but partial nephrectomy remains significantly more difficult laparoscopically, especially if the goal is to duplicate the open surgical technique.

Laparoscopic Adrenalectomy for Pheochromocytoma

Current Urology Reports. Feb, 2005  |  Pubmed ID: 15610701

Laparoscopic adrenalectomy has become the standard technique for the surgical removal of the adrenal gland for functional adrenal tumors including aldosteronoma, glucocorticoid, and androgen/estrogen-producing adenomas. Many laparoscopic surgeons also think that for small to moderately sized pheochromocytomas, the laparoscopic approach is as safe and effective as the open technique. Several physiologic considerations specific to pheochromocytoma must be addressed before and during surgery regardless of the operative approach. The advantages of laparoscopic adrenalectomy over open adrenalectomy remain the same for pheochromocytomas as for other pathologic conditions of the adrenal gland. These include a shorter length of stay, a decrease in postoperative pain, a shorter time to return to preoperative activity level, and improved cosmesis.

Radiographic Evaluation of the Incidental Adrenal Lesion

Current Urology Reports. Jan, 2006  |  Pubmed ID: 16480675

The detection of incidental adrenal masses has increased substantially with the advent and widespread use of high-resolution cross-sectional imaging techniques such as CT and MRI. The work-up and treatment of these incidentally found adrenal masses continue to be a clinical challenge for radiologists, endocrinologists, and adrenal surgeons. The approach to the evaluation of most of these adrenal masses depends on the radiologic appearance of the lesion, and whether the patient has a known underlying malignancy. The aim of this article is to review imaging features of pathologic abnormalities of the adrenal gland. Recent advances in noninvasive imaging methods that attempt to differentiate benign from malignant lesions also are addressed.

Hand-assisted Laparoscopic Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. Oct-Dec, 2006  |  Pubmed ID: 17575752

We report our experience with hand-assisted laparoscopic nephroureterectomy (HALN) for upper urinary tract transitional cell carcinoma and compare our results with a contemporary series of open nephroureterectomy (ON) performed at our institution.

Less Invasive Diagnosis of Cushing's Syndrome

Current Urology Reports. Jan, 2006  |  Pubmed ID: 16480671

Laparoscopic Adrenalectomy: Determining Invasiveness

Current Urology Reports. Jan, 2006  |  Pubmed ID: 16480672

Radiofrequency Ablation for Adrenal Lesions

Current Urology Reports. Jan, 2006  |  Pubmed ID: 16480673

Laparoscopic Adrenalectomy in Children

Current Urology Reports. Jan, 2006  |  Pubmed ID: 16480674

Feasibility of Laparoscopic Approach in Management of Xanthogranulomatous Pyelonephritis

Urology. Oct, 2006  |  Pubmed ID: 17070338

To report the feasibility of the laparoscopic approach for management of xanthogranulomatous pyelonephritis (XGP).

Association of Pheochromocytoma and Ganglioneuroma: Unusual Finding in Neurofibromatosis Type 1

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. Oct, 2007  |  Pubmed ID: 17954422

To report a rare case of association of pheochromocytoma and ganglioneuroma in an asymptomatic patient with neurofibromatosis type 1 (NF1) and to discuss the importance of annual biochemical and imaging studies.

Laparoscopic Adrenalectomy for Large Adrenal Masses

Current Urology Reports. Jan, 2008  |  Pubmed ID: 18366978

Open adrenalectomy has been the gold-standard therapy for adrenal neoplasms. Minimally invasive treatments, however, have assumed a more central role in the management of these lesions. The traditional benefits of laparoscopy, including reduced blood loss, shorter hospital duration, and improved convalescence, extend to adrenal disease without compromising the oncologic efficacy of the surgery. Contemporary series suggest that minimally invasive surgery is also a reasonable therapeutic modality for larger adrenal masses. Laparoscopic adrenalectomy for these large masses is a technically demanding procedure that should be undertaken by experienced laparoscopic surgeons familiar with retroperitoneal anatomy and adept with vascular techniques in the event of an open conversion. Oncologic outcomes collectively suggest that in the setting of adequate surgical resection, recurrence patterns relate more to disease-process biology than surgical approach. Neither size criteria, suspicion of malignancy, nor locally invasive disease should be considered an absolute contraindication to laparoscopic adrenalectomy.

Needlescopic Ablation of Small Adrenal Masses

Current Urology Reports. Jan, 2009  |  Pubmed ID: 19116099

Needlescopic adrenal ablative therapy is an attractive therapeutic option for the management of small adrenal masses. The spectrum of neoplasms that can be ablated includes isolated solid organ metastases (lung, kidney, liver), nonisolated but symptomatic (painful) adrenal metastasis, and small, nonmetastatic, hormonally active adrenal tumors. Moreover, needlescopic ablation offers an effective minimally morbid intervention for patients who are poor surgical candidates either due to advanced age and/or significant comorbid conditions. Ablative techniques described to date include radiofrequency ablation (RFA), cryoablation, and chemical ablation. Most procedures can be performed under percutaneous radiographic guidance on an outpatient basis. By and large, the bulk of clinical experience with adrenal ablation pertains to RFA. Successful ablation is usually dependent upon lesion size, with tumors 5 cm or smaller demonstrating the highest successful ablation rates. The most frequently described adverse sequelae of adrenal ablation are local tumor recurrences. However, many of these local recurrences can be managed by repeat ablation, with patients demonstrating durable oncologic outcomes.

Laparoscopic Radical Nephrectomy for Renal Masses 7 Centimeters or Larger

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. Apr-Jun, 2009  |  Pubmed ID: 19660207

To report our operative experience and oncologic outcomes for the laparoscopic management of large renal tumors.

Laparoendoscopic Single Site Live Donor Nephrectomy: Initial Experience

The Journal of Urology. Nov, 2010  |  Pubmed ID: 20850822

We present our initial experience in 40 patients undergoing laparoendoscopic single site donor nephrectomy.

Outcomes of Laparoscopic Donor Nephrectomy Without Intraoperative Systemic Heparinization

The Journal of Urology. Jun, 2010  |  Pubmed ID: 20400133

Intravenous heparin has traditionally been given during living donor laparoscopic nephrectomy despite the paucity of evidence supporting its use. We present the results of our experience with laparoscopic donor nephrectomy done without intraoperative systemic heparinization.

The Emerging Role of Robotics in Adrenal Surgery

Current Urology Reports. Feb, 2010  |  Pubmed ID: 20425636

Robotic surgery is being performed more frequently for a variety of urologic procedures. Since the first robotic adrenalectomy less than a decade ago, this modality has gained increased acceptance in the urologic community and has been employed with increased frequency in minimally invasive centers. This review evaluates the current literature on robotic adrenalectomy, its indications, as well as its advantages and limitations compared with other forms of surgical management of adrenal pathology.

Is Right-sided Laparoendoscopic Single-site Donor Nephrectomy Feasible?

Urology. Jun, 2011  |  Pubmed ID: 21397302

To present our initial experience with right-sided laparoendoscopic single-site donor nephrectomy (LESS-RDN). Laparoendoscopic single-site (LESS) donor nephrectomy, although in its infancy, represents a potential exciting advancement over conventional laparoscopic donor nephrectomy (LDN). Almost all of the reported cases thus far have been left-sided kidneys.

Preoperative Radiographic Parameters Predict Long-term Renal Impairment Following Partial Nephrectomy

World Journal of Urology. May, 2011  |  Pubmed ID: 21604019

PURPOSE: We analyzed radiographic parameters describing anatomic features of renal tumors to identify preoperative characteristics that could help predict long-term decline in renal function following partial nephrectomy. METHODS: We retrospectively reviewed the records of 194 consecutive patients who underwent partial nephrectomy from January 2006 to March 2009 and analyzed a cohort of 53 patients for whom complete clinical, radiographic, and operative information was available. Computed tomography images were reviewed by a single radiologist. Radiographic criteria for describing renal tumor size and location included diameter, volume, endophytic properties, proximity to collecting system, anterior/posterior location, location relative to polar lines, and R.E.N.A.L. nephrometry score. Postoperative estimated glomerular filtration rate was calculated using the MDRD study group equation with serum creatinine at last follow-up. RESULTS: The median preoperative and postoperative GFR values were 75 (IQR 65-97) and 66 (IQR 55-84) mL/min/1.73 m(2), respectively. At a median follow-up of 38 months, the median percentage decrease in GFR was 12%. On univariate analyses, tumor diameter (P = 0.002), tumor volume (P < 0.0001), nearness of tumor to collecting system (P = 0.017), and location relative to polar lines (P = 0.017) were associated with percentage decrease in GFR. Furthermore, higher R.E.N.A.L. nephrometry score was also associated with poorer renal functional outcomes following partial nephrectomy (P = 0.019). CONCLUSIONS: Anatomic features of renal tumors defined by preoperative radiographic characteristics correlate with the degree of renal functional decline after partial nephrectomy. Identification of these parameters may assist in patient counseling and clinical decision making following partial nephrectomy. Validation in larger prospective studies is necessary.

Comparison of Complications of Laparoscopic Versus Laparoendoscopic Single Site Donor Nephrectomy Using the Modified Clavien Grading System

The Journal of Urology. Oct, 2011  |  Pubmed ID: 21855950

We compared postoperative complications of laparoendoscopic single site and standard laparoscopic living donor nephrectomy using a standardized complication reporting system.

Simultaneous Bilateral Single-port Radical Nephrectomies

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. Jan-Mar, 2011  |  Pubmed ID: 21902952

The management of bilateral enhancing renal masses can be technically challenging. Simultaneous bilateral laparoscopic nephrectomies in postrenal transplant patients have been previously described, but these typically require multiple port placements in addition to a hand port. Herein, we describe simultaneous bilateral single-port laparoscopic radical nephrectomies in a postrenal transplant patient.

Current Status of Robotic Partial Nephrectomy (RPN)

BJU International. Sep, 2011  |  Pubmed ID: 21917094

• Robotic partial nephrectomy (RPN) is a minimally invasive option for patients undergoing nephron-sparing surgery (NSS). As the technique of RPN develops and matures, intraoperative and perioperative outcomes continue to be reported. In the current review, we discuss safety, efficacy, and recent technical advances in RPN.

Comparison of Laparoendoscopic Single-site Donor Nephrectomy and Conventional Laparoscopic Donor Nephrectomy: Donor and Recipient Outcomes

Urology. Dec, 2011  |  Pubmed ID: 21996107

To present a comparison of perioperative donor outcomes and recipient graft function in a series of patients undergoing laparoendoscopic single-site donor nephrectomy (LESS-DN) versus conventional laparoscopic donor nephrectomy (LDN).

Laparoendoscopic Single Site Live Donor Nephrectomy: Single Institution Report of Initial 100 Cases

The Journal of Urology. Dec, 2011  |  Pubmed ID: 22014813

Laparoendoscopic single site surgery is a recent advance in minimally invasive urology. We report outcomes from our initial 100 consecutive laparoendoscopic single site live donor nephrectomies done by a single surgeon and provide a matched comparison of conventional laparoscopic live donor nephrectomies done by the same surgeon.

Laparoendoscopic Single-site Nephrectomy in Obese Living Renal Donors

Journal of Endourology / Endourological Society. Feb, 2012  |  Pubmed ID: 22050506

Abstract Background and Purpose: Laparoendoscopic single-site (LESS) surgery has been shown to be feasible in living donor nephrectomies (DNs). Obesity is an established risk factor for perioperative morbidity. We sought to determine whether LESS-DN is safe and effective in the obese (body mass index [BMI] ≥30 kg/m(2)) population. Patients and Methods: Between August 2009 and September 2010, 125 consecutive LESS-DN were performed; 32 patients were obese. This group was matched to 32 nonobese LESS-DN (BMI <30 kg/m(2)) patients, 32 obese conventional laparoscopic DN (obese LAP-DN) patients, and 32 nonobese LAP-DN patients. Comparison parameters included organ recovery time, operative time, estimated blood loss (EBL), warm ischemia time (WIT), incision length, complications, and recipient allograft function. Results: Demographic data were similar between the groups, except BMI (P>0.0001). Organ recovery time, EBL, WIT, complications, and recipient allograft function were similar between the obese LESS-DN group and the other three groups (P>0.05). Total operative time was longer in the obese LESS-DN compared with the nonobese LAP-DN (P<0.0001); however, incision length was shorter in the obese LESS-DN group compared with either LAP group (P<0.0001). Complete LESS-DN was successful in 62 (97%) cases (two obese donor cases were converted to hand-assisted laparoscopy). Conclusions: Our results indicate that LESS-DN can be performed safely in obese donors without increased donor morbidity and similar recipient allograft outcomes compared with ideal-sized donors as well as with conventional LAP-DN patients.