INTRODUCTION AND OBJECTIVES: Laparoscopic adrenalectomy is the standard treatment for adrenal tumors.Described here is the authors’ 10-year experience with laparoscopic adrenalectomy in a single center. METHODS: A retrospective chart review was done on all patients who underwent laparoscopicadrenalectomy from January 2006 to January 2016 at the National Kidney and Transplant Institute.The authors determined the patient demographics (age and gender), tumor characteristics (size,functionality and laterality) and surgical outcomes (operative time, estimated blood loss, conversionto open and complications according to the Clavien-Dindo classification). RESULTS: A total of 90 patients underwent laparoscopic adrenalectomy. The female to male ratio was1.4:1. Most tumors were left-sided [48/90 (53%)], with a mean size of 3.0 ± 0.75cm. The operativetime was 145 ± 35 minutes. The mean estimated blood loss was 50 ± 100cc. The length of hospitalstay was 3.0 ± 1 days. Forty six percent (42/90) of the adrenals were functioning: Hyperaldosteronism(26), Pheochromocytoma (14), and Cushing's syndrome (2). Ninety eight percent(88/90) were benign. There were 2 (2.2%) conversions to open. There were 8 complications (8.89%)(all Dindo-Clavien Class II), all of which were managed conservatively. There was no mortality. CONCLUSION The authors’ experience with laparoscopic adrenalectomy shows that it is safe and effectivefor adrenal tumors.
Laparoscopy

OBJECTIVE: The primordial principle in living kidney donation is leaving the better functioning kidney (BFK) with the donor. However, when laparoscopic donor nephrectomy (LDN) is utilized, certain conditions may warrant removing the BFK. These include lesser complex vasculature, renal calculi, or left-sidedness. Reported here are the long-term outcomes of removing the BFK among living donors. METHODS: Chart review was done on all donor nephrectomy patients over a five-year period. Patients whose BFK were removed via LDN were identified. Clinical indications, patient demographics, perioperative and postoperative outcomes were summarized. Creatinine and eGFR at one-day, one-month and one-year follow-up were used to determine renal functional outcomes. RESULTS: Between January 2011 to December 2015, 810 donor nephrectomies were performed: 366 (45.2%) and 444 (54.8%) had open donor nephrectomy and LDN, respectively. BFK was removed in 26 (5.8%) in the LDN and none in the open group. Mean age was 28.9+7.5 (18-49), with a male to female ratio of 4:1. The clinical indications were less complex vasculature in 18 (69%), left-sided BFK in 7 (27%) and renal calculi in 1 (3.8%). The mean operative time was 173 +25 (130–272) minutes, with a mean blood loss of 111 +96 (50-200)cc. The mean length of stay was 3.0+0.2 (2.8-4) days. Grade 1 complications were seen in 5 (19%) patients. There was no mortality. The eGFR after 1 year is 79.4+14.1 (54-91) cc/min. CONCLUSION Removing the BFK during LDN does not impact negatively on the safety and renal functional outcomes of living kidney donors.

Previous abdominal surgeries have been viewed as a relative contraindication to laparoscopy. The authors report a case of a distal third ureteral stricture previously managed by multiple endoscopic and open procedures and successfully repaired with an exclusively laparoscopic approach.

A 37-year-old female, diagnosed case of chronic endometriosis had previously undergone an open excision of left ovarian cyst and an ipsilateral open psoas hitch reimplantation. Her right distal third ureteral stricture had been on chronic ureteral stent replacement for the past three years. After a comprehensive preoperative evaluation, the patient underwent a successful and uncomplicated laparoscopic ureteral reimplantation on the left. The authors describe their surgical technique and the challenges they encountered therein.

Recurrent distal third ureteral stricture previously managed by multiple open and endoscopic surgeries is a challenging disease to manage. An experienced minimally-invasive surgical team can successfully manage this problem laparoscopically without immediately resorting to open.

Human ; Female ; Adult: 25-44 Yrs Old ; Laparoscopy