RESUMO
OBJECTIVE: To describe a standing hand-assisted laparoscopic ovariohysterectomy in a mare. ANIMAL: A 15-year-old maiden Oldenburg mare. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The mare was presented for evaluation of bucking under saddle and uncharacteristic aggressive behavior. Evaluation of a 24-hour video of the mare in a stall showed behavior consistent with caudal visceral abdominal discomfort. Reproductive evaluation revealed a pyometra secondary to complete transluminal cervical adhesions. The mare was initially managed medically with disruption of the adhesions and uterine lavage, but the adhesions reformed within 6 weeks and could not be manually disrupted. TREATMENT AND OUTCOME: To eliminate the recurrence of pyometra, the mare underwent standing hand-assisted laparoscopic ovariohysterectomy through bilateral flank incisions. The only complication was a seroma at 1 flank incision that resolved after drainage. CLINICAL RELEVANCE: Complete ovariohysterectomy in the mare is a challenging procedure and has previously been performed under general anesthesia. This is the first report of the procedure being performed completely in the standing mare without inversion of the uterus through the cervix.
Assuntos
Laparoscopia Assistida com a Mão , Doenças dos Cavalos , Piometra , Cavalos , Feminino , Animais , Piometra/cirurgia , Piometra/veterinária , Laparoscopia Assistida com a Mão/efeitos adversos , Laparoscopia Assistida com a Mão/veterinária , Histerectomia/veterinária , Histerectomia/métodos , Ovariectomia/veterinária , Ovariectomia/métodos , Reprodução , Doenças dos Cavalos/cirurgiaRESUMO
ABSTRACT Objectives This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. Materials and Methods Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. Results Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. Conclusions In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Pielonefrite/cirurgia , Tuberculose Renal/cirurgia , Pionefrose/cirurgia , Laparoscopia Assistida com a Mão/efeitos adversos , Nefropatias/cirurgia , Nefrectomia/métodos , Nefrite/cirurgia , Pielonefrite Xantogranulomatosa/cirurgia , Reprodutibilidade dos Testes , Perda Sanguínea Cirúrgica , Fístula Intestinal/cirurgia , Doenças do Colo/cirurgia , Duração da Cirurgia , Fístula/cirurgia , Tempo de Internação , Pessoa de Meia-Idade , Nefrectomia/efeitos adversosRESUMO
OBJECTIVES: This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. MATERIALS AND METHODS: Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. RESULTS: Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. CONCLUSIONS: In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.
Assuntos
Laparoscopia Assistida com a Mão , Nefropatias/cirurgia , Nefrectomia/métodos , Nefrite/cirurgia , Pielonefrite/cirurgia , Pionefrose/cirurgia , Tuberculose Renal/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Doenças do Colo/cirurgia , Feminino , Fístula/cirurgia , Laparoscopia Assistida com a Mão/efeitos adversos , Humanos , Fístula Intestinal/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Duração da Cirurgia , Pielonefrite Xantogranulomatosa/cirurgia , Reprodutibilidade dos TestesRESUMO
OBJECTIVES: Hand-assisted laparoscopic nephrectomy is a relatively new procedure in our country. This article reports on one of the largest number of this procedure in kidneys with multiple vessels. MATERIALS AND METHODS: We reviewed all cases of hand-assisted laparoscopic nephrectomy from July 2002 to February 2009. Results were then descriptive, with statistical analyses performed with SPSS software (SPSS: An IBM Company, version 10.0, IBM Corporation, Armonk, NY, USA). RESULTS: From July 2002 to February 2009, 165 patients had hand-assisted laparoscopic nephrectomy, with 96.9% being the left kidney. We found a prevalence of 18.7% (n = 31) of kidneys with multiple arteries, with 8 of these having multiple principal arteries, 9 with superior polar artery, and 14 with inferior polar artery. Twenty-nine donors (17.57%) presented with more than 1 principal vein. Warm ischemia was longer in kidneys with multiple arteries (4.16 vs 3.96 min); recipient renal function (evaluated by creatinine levels at day 5 after transplant) was 1.63 mg/dL in kidneys with single artery versus 1.27 mg/dL in kidneys with multiple arteries. There were no significant differences for time of surgery, bleeding, and discharge of the donor. CONCLUSIONS: We found no differences in kidney function between single and multiple artery kidneys, resulting in the conclusion that hand-assisted laparoscopic nephrectomy offers an effective option for kidney donors, including those with multiple arteries.
Assuntos
Laparoscopia Assistida com a Mão , Transplante de Rim/métodos , Doadores Vivos , Nefrectomia/métodos , Artéria Renal/cirurgia , Adulto , Feminino , Laparoscopia Assistida com a Mão/efeitos adversos , Humanos , Transplante de Rim/efeitos adversos , Masculino , México , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Artéria Renal/anormalidades , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To describe our surgical experience and clinical outcome in laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) with level 1 renal vein tumor thrombus. PATIENTS AND METHODS: 11 patients with RCC level 1 renal vein tumor thrombus were treated by LRN plus thrombectomy. The mean age was 66.8 years (SD ±11.313); the mean body mass index was 24.76 (SD ±5.091). In all cases, the surgical technique was defined by tumor characteristics and the surgeon's preferences. RESULTS: Surgery was technically successful in all 11 patients. A hand-assisted approach was performed in 3 patients, while pure laparoscopy was used in 8. The mean surgical time was 108.3 min (SD ±28.284); the mean estimated blood loss was 108.33 ml (SD ±106.066); the average hospital stay was 2.8 days (SD ±0.707). There was 1 intraoperative complication (splenic laceration) that was managed laparoscopically. Pathologic examination confirmed RCC in all cases. There were no positive surgical margins. With a mean follow-up of 29 months (27-39), 2 patients had a recurrence. CONCLUSION: This report provides further evidence of the technical feasibility, safety and oncologic adequacy of the laparoscopic approach in RCC with level 1 renal vein involvement. A longer follow-up and multi-institutional studies are needed to adequately evaluate its potential oncologic benefit.