Laparoscopic partial adrenalectomy for bilateral pheochromocytomas in a boy with von Hippel-Lindau disease

Objectives: In adults, increasing numbers of adrenalectomies for pheochromocytomas are performed laparoscopically. We report for the first time laparoscopic bilateral subtotal adrenalectomy for pheochromocytomas in an 8-year-old boy with von Hippel-Lindau disease. Methods, In July 1998, an 8-year-old boy with von Hippel-Lindau disease underwent laparoscopic adrenal-sparing surgery for bilateral pheochromocytomas. The boy presented with severe hypertension and two pheochromocytomas on both sides. Results: The child could be solely treated with laparoscopic adrenal-sparing surgery. The procedure was completed as planned. There were absolutely no intraoperative or postoperative complications. Postoperatively, catecholamine levels and hypertension went back to normal. At follow-up no residual tumor could be detected and no steroid replacement therapy was necessary. Conclusions: In experienced hands, laparoscopic adrenal-sparing surgery for pheochromocytomas is feasible and safe. Moreover, this minimal invasive approach represents an exceptional improvement in life quality, especially in children with von Hippel-Lindau disease since surgery will probably be necessary again and again in their future life. Copyright (C) 2000 S. Karger AG, Basel

Laparoscopic retroperitoneal lymph-node dissection in the management of clinical stage I and II testicular cancer

Summary. To lower the morbidity of retroperitoneal lymphadenectomy, the procedure was modified over the past 35 years from extended suprahilar to bilateral infrahilar, and subsequently a modified laparoscopic unilateral approach then a nerve-sparing technique was introduced. There was no increase in relapse rates associated with the introduction of these operative refinements; significant factors for relapse were pathological stage (P < 0.001) and adjuvant chemotherapy in stage II disease (P < 0.001

Laparoscopic retroperitoneal lymph node dissection: does it still have a role in the management of clinical stage I nonseminomatous testis cancer? A European perspective

Laparoscopic retroperitoneal lymph node dissection (L-RPLND) is not recommended as standard tool in European Association of Urology (EAU) guidelines. To update the role of L-RPLND in patients with clinical stage I nonseminomatous germ cell tumour (NSGCT) compared to open retroperitoneal lymph node dissection (O-RPLND). A systematic literature search from 1992 to 2008 was performed in Medline, EMBASE, and Cochrane. The largest series from each group was considered. Comparative analysis was based on raw data of series published in 2000 and later. Results of >800 patients treated by L-RPLND reported in 34 articles were analyzed. Lymph node dissection (LND) was based on modified templates, removing an average of 16 (5-36) lymph nodes. At experienced centres, complication rates were 15.6% (9.4-25.7), including 2% (0-5) retrograde ejaculation and 1.7% (0-6) reintervention. Operating room times are longer compared to O-RPLND (204 vs 186min). Five publications with a follow-up of 63 (36-89) mo include 557 patients. One hundred twenty-six of 140 (90%) patients with positive nodes (25%, range: 17-38) received adjuvant chemotherapy, resulting in a local relapse rate of 1.4% (0.7-2.3) with no in-field recurrence; rate of distant relapses was 3.3% (1.8-4.6), including one port-site metastasis; and rate of biochemical failure was 0.9% (0.7-2.3). Two of 14 patients with positive nodes (pN1) who did not receive adjuvant chemotherapy relapsed, both 8 mo after surgery, and were salvaged by chemotherapy. Compared with O-RPLND, there was no difference in relapse rates, percentage of patients receiving chemotherapy (29% vs 31%), chemotherapy (CTx) cycles per cohort (0.6), rate of salvage surgery (1.2% vs 1.5%), and patients with no evidence of disease (NED; 100% vs 99.7%). L-RPLND offers similar staging accuracy and long-term outcome to O-RPLND. In a late series of experienced L-RPLND centres, there was a trend towards fewer complications. L-RPLND represents a valuable tool for experienced laparoscopic surgeons. Further studies must focus on the curative potential of the procedure in pathologic stage II