Retroperitoneum Adrenalectomy
Tumors and hyperplasia of the adrenal gland occur with a frequency of 1-5% seen. The adrenal adenoma with or without endocrine symptoms is the main indication for adrenalectomy. Because of its unfavorable localization, the Adrenal gland open surgery only via a large abdominal and/or retroperitoneal access to reach especially in hormonally active ones.
Laparoscopic Training simulation with Laparoscopic Needle Driver is a prudent choice.
Laparoscopy Adrenal Glands
Adrenal tumor is a gentle, blood-saving approach to avoidance to demand unnecessary manipulation of the tumor. Laparoscopy offers the adrenal gland benefits with a significantly reduced to achieve access trauma. In addition, with good visibility and more subtle preparation technique, the adrenal glands precisely separate from the environment and the blood supply. Several comparative studies have demonstrated the superiority of the laparoscopy regarding reduced analgesic needs, shortened hospital length of stay and faster overall convalescence.
Postoperative Results
We performed the laparoscopic adrenalectomy in 16 patients’ Adrenal tumors between 2-7 cm across and compared intra- and postoperative results with a historical collective of 20 patients after open surgery adrenalectomy. The transperitoneal technique we chose offered the advantage of better anatomical orientation and direct access to the adrenal vessels (veins). The results of our study (operation time, blood loss, postoperative pain, and hospitalization) confirm the benefits of Laparoscopy in the surgical therapy of adrenal tumors.
Due to its superiority in terms of lower morbidity, laparoscopic Adrenalectomy is currently the method of first choice for adrenal tumors of a size of tumors 2-7 cm.
Nephrectomy
Laparoscopic nephrectomy first describes in 1990 by, who removed a kidney bearing an oncocytoma. In the case of nephrectomy, the advantages of the laparoscopic technique are particularly evident, since this procedure requires an extensive open surgical access. In the case of benign underlying diseases, the indications for this operation are essentially the same as for the open incision operation.
Transperitoneal Approach
Our own experience includes 39 procedures in both pediatric and adult patients. We favor the transperitoneal approach because of the larger working space and the direct access to the renal vessels. Another advantage of this procedure is the possibility of bilateral nephrectomy in a session we performed in 11 transplanted patients because of renal hypertension caused by the own kidneys have performed.
Laparoscopic Nephrectomy
The results of the present evaluations of our patient collective about operation times, complications and conversion rate indicate that laparoscopic nephrectomy standardizes represents a minimally invasive alternative, with appropriate experience with the technique carries out safely and with few complications.
The main benefit of this less invasive procedure lies primarily in the reduced morbidity, a better cosmetic result and the shorter Rehabilitation period compared to open surgery, which is why the laparoscopic Nephrectomy in benign diseases is also the treatment option of first choice represents.
The donor nephrectomy the intensification of living kidney donation can lead to the discrepancy between patients on the transplant waiting list requiring dialysis and the lack of supply of kidneys from deceased donors is not constantly increasing. With the Filling of the legal vacuum by passing the Transplantation, there was also a significant increase kidney transplantation from living donors.
Laparoscopic Donor Nephrectomy
In 1995 reports on laparoscopic donor nephrectomy in clinical practice. Because of the clearly proven benefits in terms of reduced morbidity, faster convalescence and improved cosmetics compared to open surgery, this minimally invasive alternative has the Kidney harvesting is rapidly gaining popularity in some major centers won. There are now reports showing that laparoscopy has most likely led to an increase in donor willingness because of its advantages over incisional surgery.
Intracorporeal (Warm) Ischemia
We added laparoscopic donor nephrectomy to our program in February 1999. The evaluation of our first 15 minimally invasive donor nephrectomies showed that the transplant function was excellent after a year and comparable to the function rate of the open kidneys. Although we have developed a special organ retrieval technique. However, it is important to keep the intracorporeal (warm) ischemia time as short as possible twice as long (162 seconds) as with the conventional sampling technique (84 seconds). Previous fears that prolonged warm ischemia time could be the negatively affect transplant function and transplant survival both from our own and from other authors refutes.
Laparoscopically Assisted Kidney Harvests
What is striking, however, is the dominance of left-sided donor nephrectomy with 97% in published series of laparoscopically assisted kidney harvests. The reason for this is the comparatively short right renal vein. In standard laparoscopic removal with the use of endo staplers to cut through the renal vessels, one loses approx. 1-1.5 cm vessel length.
In the case of the already short right renal vein, this further loss of length makes the transplantation technically difficult. This fact has also led to organ loss in the past. We developed one laparoscopic surgical technique to remove the right kidney, which is the open one Technique copied and preservation of the entire vein length of the right kidney guaranteed.
Use of Laparoscopic Satinsky Clamp
For this we use a laparoscopic Satinsky clamp, with which the vena cava pinched out and the right renal vein directly to the vena cava with the scissors severs. After removal of the organ and closure of the extirpation wound, the cavotomy makes intracorporeally with a running suture locked. In all 4 interventions performed so far, this technique could carry out without any problems and the removed kidneys successfully transplants.
Laparoscopic Donor Nephrectomy Technique
This technique developed by us allows the right kidney to considers more frequently for laparoscopic donor nephrectomy and helps to fully implement the principle that the better kidney remains with the donor even when using the laparoscopic technique.
Conclusion
Due to the altruistic character of living donation, the highest quality standards must apply to the selected surgical procedure. Therefore, there is still a certain reluctance regarding the acceptance of the minimally invasive type of kidney removal, due to a lack of laparoscopic experience in most transplantation centers.
Nevertheless, the results we have presented so far suggest that laparoscopic donor nephrectomy meets the above standards. In addition, it corresponds most closely to the donor's desire for the least possible traumatization with faster rehabilitation and good cosmetic result.
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