Ultrasound-guided Transversus Abdominis Plane Block Improves Postoperative Analgesia and Early Recovery in Patients Undergoing Retroperitoneoscopic Urologic Surgeries:A Randomized Controlled Double-blinded Trial

Objective To evaluate the effects of ultrasound-guided transversus abdominis plane(TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.Methods This was a randomized,controlled,double-blinded trial.Eligible patients scheduled for retroperitoneoscopic urologic surgeries were randomly assigned to two groups.Group TAP received ultrasound-guided TAP block with 0.5% ropivacaine 20 ml at 30 minutes before surgery,and Group C received TAP sham block with normal saline.All patients received retroperitoneoscopic urologic surgeries under general anesthesia.The primary outcome was the severity of pain after surgery.Secondary outcomes included opioids consumption,analgesics,postoperative nausea and vomiting,time to Foley catheter removal and to passage of flatus,length of post-anesthesia care unit stay and hospital stay.Results Eighty patients completed the study,forty cases in each group.Compared to the Group C,the Group TAP had lower visual analogue scale pain scores within two postoperative days(all P<0.05).They also had less consumption of intraoperative fentanyl(2.0±0.5 vs. 3.8±0.7 μg/kg,P<0.05),reduced incidence of postoperative rescue analgesic usage(12.5% vs. 45.0%,P<0.05),and lower incidence of postoperative nausea and vomiting within postoperative 48 hours(12.5% vs. 25.0%,P<0.05) when compared to the Group C.In addition,Group TAP had a shortened post-anesthesia care unit stay(25±8 vs. 49±12 minutes,P<0.05),and a greater proportion of patients discharged within postoperative three days(57.5% vs. 35.0%,P<0.05).Conclusion Preoperative ultrasound-guided TAP block is an effective technique to improve postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.

Anatomical retroperitoneoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors： initial operative experience

To introduce the technique of anatomical retroperitoneoscopic retroperitoneal lymph node dissection （ARRPLND） was performed in 12 consecutive patients with a clinical stage I nonseminomatous germ-cell tumor （NSGCT） between February 2008 and October 2010. All procedures were performed using a modified template nerve-sparing approach. The retroperitoneal space was adequately expanded using double gasbags. After the retroperitoneal fat was cleared, two relatively bloodless planes were entered consecutively to expose the lymph node and permit dissection. Dissection proceeded first in the plane between the anterior renal fascia and posterior peritoneum, and secondly in the avascular plane between the posterior renal fascia and transversalis fascia. The proximal spermatic vein was clipped at the initial stage. En bloc resection of the lymph tissue and fat between the anterior renal fascia and posterior renal fascia were performed. Three patients （25%） had pathologic stage IIA disease and received adjuvant chemotherapy. No recurrence was observed during follow-up ranging from 26 to 58months. The median operative time was 205min （range： 165-430min） and median estimated blood loss was 320ml （range： 100-1200ml）. There were two intraoperative complications （Clavien grade II） and one open conversion due to perforation of the peritoneum. Postoperative complications （Clavien I） developed in three patients. Normal antegrade ejaculation recovered by 1 month following the operation. Our preliminary results indicate that ARRPLND is technically feasible and associated with satisfactory clinical outcomes for clinical stage I NSGCT. Further studies are necessary to evaluate this technique.

Applied anatomy of the path of retroperitoneoscopic surgery

Objective To discover the anatomical basis of retroperitoneoscopic surgery. Methods Twenty Chinese adult cadavers including 12 men and 8 women were anatomized. The relationship between nerves, vessels of the lateral abdominal wall, retroperitoneal structures and the path of retroperitoneoscopic surgery were measured. Results In male cadavers, the distance between the iliac crest and trigonum lumbale was 4.02±1.26 cm on the left, and 3.83 ± 0.90 cm on the right. The distance between the iliac crest and iliohypogastricus nerve was 0.82 ± 0.13 cm on the left and 0.84±0.08 cm on the right. The distance between the subcostal nerve and Ⅻ rib in the posterior axillary line and midaxillary line was 0.79 ±0.26 cm,1.65± 1.12 cm on the left and 0.78 ± 0.30 cm, 1.59 ± 1.07 cm on the right respectively. The distance between the ureter of inferior pole of kidney and extra-border of psoas was 2.24 ± 0.67 cm on the left and 2.19 ± 0.73 cm on the right. The distance between crossing of the ureter and iliac

A study of anatomy of renal pedicle during retroperitoneoscopic nephrectomy

Objective To study anatomical characteristics of renal pedicle and its clinical application during retroper-itoneoscopic nephrectomy. Methods The imaging,surgical video and clinical data of 278 cases undergoing retroperitoneoscopic nephrectomy between July 2007 and September 2009 were retrospectively analyzed. The

Retroperitoneoscopic heminephroureterectomy for treatment of duplex kidney anomalies(report of 9 cases)

Objective To investigate the efficacy of retroperitoneal laparoscopic heminephroureterectomy for duplex kidney anomalies. Methods Retroperitoneoscopic heminephroureterectomy was performed on nine patients,six males and three females. The average age of the

Retroperitoneoscopic adrenalectomy in semilateral supine position

Objective To discuss semilateral supine position for retroperitoneoscopic adrenalectomy. Methods From Jan. 2006 to Dec. 2008,36 patients ( 20 males and 16 females with mean age of 43 years) underwent retroperito-neoscopic adrenalectomy in 60° - 70°semilateral

Retroperitoneoscopic Microwave Ablation of Renal Hamartoma:Middle-term Results

The safety and efficacy of retroperitoneoscopic microwave ablation (MWA) in the treatment of renal hamartoma were evaluated.From July 2007 to July 2009, a total of 16 cases of renal hamartoma were treated with retroperitoneoscopic MWA.Peri-and post-operative findings were observed.Middle-term efficacy was assessed by contrast-enhanced computerized tomography (CT) in follow-up period.All patients received MWA of 1-5 points.The mean operative time was 85 min and the mean blood loss was 65 mL.During a median follow-up of 16 months, no evidence of disease recurrence was observed despite of incomplete ablation in 1 case.Retroperitoneoscopic MWA is a relatively simple procedure with less impact to renal function and less complication.The outcome of middle-term follow-up is satisfactory.Thus, retroperitoneoscopic MWA appears to be a safe and effective technique for renal hamartoma in selected patients.

Clinical analysis of retroperitoneoscopic nephroureterectomy for renal tuberculosis

Objectives:To explore the feasibility and safety of retroperitoneoscopic nephroureterectomy for kidney tuberculosis.Methods:Forty-eight retroperitoneoscopic nephroureterectomies and thirty-five nephroureterectomies for kidney tuberculosis procedures were performed from June 2008 to December 2014.The patients consisted of 53 males and 30 females with a mean age of 36 years (range:26-51 years).The patients' data were reviewed and analyzed.Results:The retroperitoneoscopic nephroureterectomy procedures were completed successfully in 48 cases with no conversions to open surgery.The mean operating time was 170 minutes (range:121-258 minutes),the mean blood loss was 110 ml (range:70-250 ml),and the mean hospital stay was 5.70 days (range:5-14 days); these were all much less than nephroureterectomy procedures (P ＜ 0.05).A total of five minor complications (10.4％) occurred,injury to the peritoneum was observed in three patients,and infection at the incision site was observed in two patients,there were no obvious difference between the two surgical methods (P ＞ 0.05).Seventy-five patients were followed up,and the average follow-up time was 12.5 months (range:6-20 months).All the patients recovered without any lesions remaining.Conclusions:The results of this study indicate that retroperitoneoscopic nephroureterectomy is a feasible,safe,effective,and less invasive treatment modality for treating renal tuberculosis.

Minimally invasive techniques in benign and malignant adrenal tumors

Minimally invasive adrenalectomy has become the main treatment modality for most adrenal lesions.Both laparoscopic transabdominal and retroperitoneoscopic approaches are safe and feasible options,each with respective advantages,including better surgical outcomes,fewer complications,and faster recovery over open adrenalectomy.While open surgery remains a valid modality in treatment of adrenocortical cancer in the presence of some findings such as invasion,robotic platforms,and minimally invasive surgery have gained popularity as technology continues to evolve.Organ preservation during adrenalectomy is feasible in some conditions to prevent adrenal insufficiency.Ablative technologies are increasingly utilized in benign and malignant tumors,including the adrenal gland,with various outcomes.A multidisciplinary team,an experienced surgeon,and a highvolume center are recommended for any surgical approaches and management of adrenal lesions.This review article evaluated recent findings and current evidence on minimally invasive adrenalectomy.

Clinical Experience in the Treatment of Nephroptosis Using Retroperitoneal Laparoscopic Nephropexy

Background: Retroperitoneal laparoscopic nephropexy has been applied to nephroptosis. We investigate the approach and treatment effect of retroperitoneal laparoscopic nephropexy. Methods:?From May 1990 to October 2013, 45 patients with nephroptosis treated in our hospital were retrospectively analyzed. Among them, 25 patients underwent nephropexy (open surgery group), the other 20 patients underwent?retroperitoneal laparoscopic nephropexy (laparoscopic surgery group). In open surgery group,?there were 24 females and 1 male, aged 20 - 35 years. In laparoscopic surgery group, there were 19 females and 1 male, aged 20 - 35 years.?All of them with?nephroptosis of the right kidney were combined with lower back pain or hematuria and underwent intravenous pyelography (IVP) and color?ultrasound?in?orthostatic and supine position for a specific diagnosis. In open surgery group, patients underwent open surgery. Their kidneys were?fully dissociated,?then, the upper and?middle pole of the dorsal kidney was?sutured?with?lumbar fascia?for two stitches for fixation respectively. While in?laparoscopic surgery group,?kidneys were fully dissociated in Gerota’s fascia during laparoscopic surgery, and?the upper pole of the dorsal kidney was sutured?with the?lumbar fascia for?two?stitches using a?2-0 absorbable suture. They were all in the supine position for a week after surgery.?The?body mass index (BMI), operation time, bleeding?amount,?postoperative hospital stay,?wound complication rate and other indicators were compared between two groups. Results:?BMI in open surgery group was 16.77 ± 0.80 kg/m2, BMI in?laparoscopic surgery group was 16.73 ± 0.78 kg/m2, P > 0.05 showed no statistical difference;the operation time in open surgery group was 70.96 ± 10.61 min, that in laparoscopic surgery group was 34.65 ± 4.87 min, P?< 0.001?showed highly statistical significance;the bleeding amount in open surgery group was 20.65 ± 6.48 ml, that in laparoscopic surgery group was 4.85 ± 1.63ml, P < 0.001 showed highly statistical significance;the postoperative hospital stay in open surgery group was 7.54 ± 1.28 d, that in laparoscopic surgery group was 7 d, P > 0.05 showed no statistical difference. In open surgery group, four patients had?wound infection which delayed the healing, and the wound complication rate was 16% (4/25). In laparoscopic surgery group,?wound complications did not appear, the incidence was 0%, X2 = 1.8144, P > 0.05 showed no statistical difference. The mean follow-up visit lasted 1.5 years after surgery (3 months to 2 years), B-mode ultrasound in orthostatic and supine position showed kidneys were in the normal position. Compared with those before surgery, postoperative uncomfortable symptoms completely disappeared in all patients. Conclusions: Retroperitoneal laparoscopic nephropexy has a good effect on?symptomatic?nephroptosis. The two stitches?of suture between the upper pole of the dorsal kidney and the lumbar fascia show?convenient operation, less damage and?faster postoperative recovery, which are better than open surgery.

Effects of retroperitoneal laparoscopic radical nephrectomy on stress indexes, tumor markers and renal function in patients with renal cancer

Objective: To study the Laparoscopic kidney cancer after Radical prostatectomy, Laparoscopic Radical Nephrectomy, LRN) stress index, tumor markers, and renal function in patients with kidney cancer. Methods: A total of 80 patients with renal cancer treated in our hospital were randomly divided into control group and study group (40 patients in each group). The changes of stress index, tumor marker and renal function before and after operation were compared between the two groups. Results: After operation, stress index, tumor marker and other indicators in both groups were significantly reduced, while the levels of FT3 and FT4 in patients undergoing retroperitoneal laparoscopic radical nephrectomy were significantly lower than those in the control group. After laparoscopic radical resection, tumor inflammatory factors such as CA50, CEA and CA125, as well as inflammatory factors such as TNF-α, serum cortisol and c-reactive protein (CRP) were significantly reduced compared with the control group. Meanwhile, the decreased levels of blood urea nitrogen (BUN) and blood creatinine (SCr) in the study group were significantly higher than those in the control group, indicating that the recovery of renal function in the study group was better than that in the control group. Conclusions: Compared with open radical nephrectomy, retroperitoneal laparoscopic radical nephrectomy can effectively reduce the stress response, inflammatory factors, inflammatory reaction and tumor markers, and significantly improve the recovery of renal function.

Early Identification and Diagnosis of Adrenal Crisis after Retroperitoneal Laparoscopic Unilateral Adrenalectomy

The occurrence of adrenal crisis after retroperitoneal laparoscopic unilateral adrenalectomy is usually concealed.If not timely diagnosis and treatment,it may cause shock,and even lead to death.It is very difficult to distinguish the clinical manifestations of adrenal crisis from nausea,vomiting,fatigue,gas separation from the lower diaphragm,abdominal pain,hypotension,hypertension,fever and hypothermia after operation.This makes it very difficult to identify and diagnose adrenal crisis early.This article mainly discusses the early recognition,diagnosis and treatment of adrenal crisis after unilateral adrenalectomy by retroperitoneoscope.