Twenty-one patients with clinically localized prostate cancer underwent minilaparotomy radical retropubic prostatectomy through a single 5-cm midline or Pfannenstiel incision. A 30 ° laparoscope was usually positioned around the edge of the incision to facilitate the procedure. The mean operating time was 255 min. The mean blood loss was 859 mL, and no patient required an allogenic blood transfusion. Postoperative pain was noticeably reduced, especially in the Pfannenstiel incision group. Endoscope-assisted minilaparotomy did not involve a learning curve, and could be useful for most urologic surgeons as minimally invasive surgery.

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A 76-year-old woman had been aware of lower abdominal distension for several years and reported having no clear desire to void. The day before being admitted to a local hospital in a coma she had begun to vomit and became disoriented; she also had a lowgrade fever. An indwelling catheter was placed in the bladder and 1 L of urine was drained immediately, but the urine was not analysed or cultured. CT of the brain showed no manifest abnormalities. Serum creatinine levels and liver function tests were normal but the serum ammonia level was high, at 3.77 mg/L (normal <0.75 mg/L). Abdominal CT showed no evidence of liver cirrhosis or portal-caval shunt. Aminoleban1 (an amino-acid preparation for hepatic insuf®ciency; Table 1) and an antibiotic (cefotiam hydrochloride, 2 g/ day) were given intravenously. She became increasingly alert and the serum ammonia level decreased rapidly, reaching 0.52 mg/L on the second day after admission. An examination of serum amino acids showed a normal Fischer ratio (the molar ratio of [valine + leucine + isoleucine]/[tyrosine+phenylala-nine]), which would be expected to decrease in hepatic encephalopathy. No cause for her hyperammonaemic encephalopathy was discovered. A month later she noticed asymptomatic gross haematuria; CT showed a cystic mass in the pelvis (Fig. 1) and she was referred to our department for further examination. Urine analysis revealed sterile urine and no malignant cells; excretory urography showed normal upper tracts. However, cystoscopy revealed many large diverticula of the bladder. The residual urine volume was 800 mL; an indwelling catheter was placed in the bladder, with intermittent catheterization being introduced later. The serum ammonia level remained normal.

Background : To perform radical nephrectomy or adrenalectomy through a minimal incision over the 12th rib and to compare this with the traditional supracostal or transcostal approach. We review and clarify the related surgical anatomy through close observation. Methods : We performed radical nephrectomy in six patients with upper urinary tract carcinoma through a minimal incision over the 12th rib and in five patients with renal cell carcinoma through a medium-sized incision, and adrenalectomy in five patients (bilaterally in one) again through a minimal incision over the 12th rib. During surgery, special points were noted to find out the differences between the new minimal-incision approach and the conventional approach.Results : The procedures were accomplished smoothly with no complications through either a minimal or medium-sized incision. From our observation, it is clear that most of the procedures involved in the minimal-incision approach were and should be carried out within the space created in the retroperitoneum beneath the lateroconal fascia. Conclusion : Entering the correct anatomical planes posteriorly and anteriorly in the renal fasciae is a prerequisite for full mobilization of the kidney, together with the perinephric fat. To perform this, recognition of the lateroconal fascia and incising it along the correct lines are of the utmost importance for minimal-incision radical nephrectomy and adrenalectomy. Furthermore, this anatomical approach is also important for the conventional open approach and laparoscopic approach.

Background: We compared the efficacy and safety in prostate cancer patients of 1-and