Background: Although more than a decade of experience with laparoscopic radical nephrectomy indicates it is an alternative to open surgery for localized renal-cell carcinoma (RCC), the long-term oncologic effectiveness of this procedure remains to be established. Materials and Methods: A thorough MEDLINE and PubMed literature research on long-term outcomes of laparoscopic radical nephrectomy was performed, and all pertinent articles were reviewed in detail. This review was formulated on the current cancer indication, the oncologic basis, the oncologic efficacy, and the longterm oncologic effectiveness of the procedure, including laparoscopic cytoreductive nephrectomy, with regard to metastasis, port-site tumor recurrence, and the relation to laparoscopic partial nephrectomy. Furthermore, the authors' previous report on the intermediate-term efficacy of laparoscopic radical nephrectomy was updated. Results: With increasing experience, the indications for laparoscopic radical nephrectomy continue to expand. There were many reports of intermediate-term, two reports of long-term, and our up-to-date outcomes analyzing the management of localized RCC that showed effective cancer control with no statistically significant difference between laparoscopic and open radical nephrectomy in the true 5- and 10-year survival analysis. Conclusion: Long-term data, critical in the evaluation of any treatment for cancer, are currently available with respect to laparoscopic radical nephrectomy for localized RCC.
The surgical management of retroperitoneal fibrosis has traditionally involved open ureterolysis. We compared laparoscopic and open ureterolysis to determine if the minimally invasive approach offered advantages with respect to perioperative morbidity and treatment efficacy.We reviewed our retroperitoneal fibrosis database at a single institution to identify all patients who underwent open or laparoscopic ureterolysis between 1995 and 2005. Clinical, perioperative and outcome data were prospectively collected and compared between the open and laparoscopic ureterolysis cohorts. Subgroup analysis was performed on patients with primary retroperitoneal fibrosis comparing outcomes in open and laparoscopic ureterolysis groups.We identified 36 (51.4%) patients who underwent open ureterolysis and 34 (48.6%) who underwent laparoscopic ureterolysis. Conversion to open surgery was required in 17.6% of the laparoscopic ureterolysis cohort. The etiology of obstruction was primary idiopathic retroperitoneal fibrosis in 35 (50%) patients, whereas the remainder had secondary retroperitoneal fibrosis, largely related to gynecological malignancy. There was no difference between the 2 groups when comparing operative time, estimated blood loss, length of hospital stay, complications, transfusion requirements and postoperative resolution of ureteral obstruction. Subgroup analysis limited to patients with primary idiopathic retroperitoneal fibrosis demonstrated that those who underwent laparoscopic ureterolysis had a shorter hospital stay (3.4 vs 10.8, p <0.001) and were less likely to require transfusion (3.7% vs 13.7%, p = 0.007) compared to patients who underwent open surgery.Laparoscopic ureterolysis is an excellent option for patients with retroperitoneal fibrosis of all causes with morbidity and efficacy comparable to open surgery. In patients with primary idiopathic retroperitoneal fibrosis laparoscopy offers the added advantages of shorter hospital stay and reduced transfusion requirements.
Fazit Eine langjährige Testosteron-Substitution mit Testosteron Undecanoat scheint sich bei Männern mit Late-onset-Hypogonadismus positiv auf die meisten mit Adipositas verbundenen Stoffwechselparameter auszuwirken – auch wenn der BMI nicht beeinflusst wird. Dabei erwies sich die Behandlung als gut verträglich und sicher – schwerwiegende kardiovaskuläre Ereignisse und Prostatakarzinome traten nicht gehäuft auf.
Assess the feasibility, safety, and outcome of laparoendoscpic single-site (LESS) nephrectomy in high-risk patients with end-stage renal disease (ESRD), who have undergone continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) treatment.Between October 2009 and January 2010, a 62-year-old female and a 36-year-old male that had undergone CAPD and HD, respectively, consecutively underwent LESS nephrectomies. The medical records of the two patients were retrospectively reviewed. The indications for nephrectomy were that the non-functioning kidney was associated with a ureteric stone and distal ureteric stricture, respectively. Parameters examined were patient demographics, medical co-morbidities, operative outcomes, and complications.All procedures were completed successfully via transumbilical LESS laparoscopy. The operative times were 160 and 200 minutes, blood loss 200 and 50 mL, and postoperative hospital stay 6 and 14 days, respectively. No intraoperative complications were reported. The first patient who used CAPD before LESS nephrectomy for whom CAPD was successfully reinstated within two weeks postoperatively. No other catheter-related complications occurred. The second patient required a reoperation to evaluate the active bleeding on the fifth post-operative day, but could not find any blood vessel injuries. The bleeding was stopped from the platelet replacement. Pathological evaluation revealed chronic glomerulonephritis in each case.Less nephrectomy is a feasible technique with the advantages of less pain, shortened convalescence, improved cosmesis, and absence of wound complications.
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