From laparoscopic training on an animal model to retroperitoneoscopic or coelioscopic adrenal and renal surgery in human

Abstract

So far, laparoscopic approaches to kidney and adrenal have been limited because of their retroperitoneal location. We here report eight renal and adrenal endoscopic procedures performed in seven patients: two adrenalectomies for hyperaldosteronism, one adrenalectomy for isolated metastasis from an adenocarcinoma of the lung; two nephrectomies for end-stage infected hydronephrosis, two partial nephrectomies for small circumscribed lesions of the kidney, and one endoscopic resection for pain relief of a voluminous cyst at the kidney. The approach was transperitoneal in two cases and retroperitoneal in five cases using the retropneumoperitoneum insufflation technique. One patient was operated by a combined approach using the retro- and transperitoneal routes. All procedures were successfully completed endoscopically. The retroperitoneoscopic approach of the kidney is safe and does not interfere with the peritoneal organs. Its working space is tenuous, but allows a direct access on the kidney with good exposure of its pedicle. For adrenal surgery, the retroperitoneoscopic dissection is more difficult, because movements of instruments are often impaired by the closeness of the costal margin and the iliac crest. However, in case of difficulties we found it very convenient to switch from a retroperitoneal endoscopic approach to a combined coelioscopic and retroperitoneoscopic operation. Far from excluding each other, both approaches are complementary, particularly for difficult situations (i.e., previous peritoneal or retroperitoneal surgery).

Laparoscopic adrenalectomy: a report on 50 operations

“…This minimally invasive method makes it possible to reduce perioperative morbidity and to achieve faster recovery, and improves postoperative quality of life and cosmetic results (3,8,9). The aim of this study was to evaluate the clinical results of 51 laparoscopic adrenalectomies performed in a heterogeneous group of patients suffering from secreting and silent adrenal lesions.…”

Retroperitoneal approach in laparoscopic adrenalectomy

“…This technique has the advantage of a minimal access procedure together with direct access to the adrenal without interference with the intraperitoneal organs [2,10,12,15,18,19,23,24]. However, analysis of the hemodynamic changes associated with CO 2 insufflation, comparing transperitoneal or retroperitoneoscopic approaches, has been reported only in patients with Cushing's syndrome [4].…”

Multicentric experience of the Belgian Group for Endoscopic Surgery (BGES) with endoscopic adrenalectomy

“…However, adrenalectomy is not a frequent operation. Therefore the newly developed laparoscopic approach is sporadically performed by surgeons dealing with endocrine disorders.Since experience with endoscopic adrenalectomy is limited and long-term results are not yet available [3,6,7,9,12,14], we conducted, within the framework of the ''Belgian Group for Endoscopic Surgery (BGES),'' a prospective multicentric study in order to assess the benefits and drawbacks of endoscopic adrenalectomy. The surgeons involved in this study were experienced in laparoscopic techniques and also familiar with the rules and potential drawbacks of open adrenal surgery for endocrine disorders.…”