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Rassweiler JJ, Frede T, Lenz E, Seemann O, Alken P.Long-term experience with laparoscopic retroperitoneal lymph node dissection in the management of low-stage testis cancer. Eur Urol 2000; 37: 251-260. 38. Leventhal JR, Deeik RK, Joehl RJ, Rege RV, Herman CH, Fryer JP, Kaufman D, Abecassis M, Laparoscopic live donor nephrectomy - is it safe? Transplantation 2000; 70: 602-606. 39. Jacobs SC, Cho E, Dunkin BJ, Flowers JL, Schweiter E, Cangro C, Fink J, Farney A, Philosophe B, Laparoscopic live donor nephrectomy: the University of Maryland 3-year experience. J Urol 2000; 164: 1494-1499. 40. Guillonneau B,Vallancien G. Laparoscopic radical prostatectomy: the Montsouris technique. J Urol 2000; 163: 1643-1649. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris experience. J Urol 2000; 163: 418-422. 42. Abbou CC, Salomon L, Hoznek A, Antiphon P, Cicco A, Saint F, Alame W,Bellot J, Chopin DK. LAPAROSCOPIC PROCEDURES Adrenalectomy From the very beginning of laparoscopy, laparoscopic adrenalectomy provided a truly beneficial approach to avoiding a large incision and extensive organ manipulation to remove small glands (1-8). Both the transperitoneal and retroperitoneoscopic approaches have proven efficacious. In fact, after only a few years of clinical experience (9-14), laparoscopy is considered to be a definitively minor invasive approach compared to open surgery, with the same efficacy and safety for removing the adrenal glands (15-19). Following the comparative experience of multicentre studies (20-21), it has been shown that laparoscopic adrenalectomy is feasible and safe with a low cost-to-benefit ratio, regardless of the pathology. Only large tumours (> 6 cm) are still under investigation (14). Because of the different anatomy of the left adrenal gland compared to the right adrenal gland, the retroperitoneal approach has been assessed as the approach of choice for the left adrenal gland. The approach for removal of the right gland is optional and depends on the surgeon's preference and familiarity with the technique being used (17). Partial adrenalectomy is feasible, provided the pathology of the lesion has been previously assessed. A summary of the current guideline recommendations for adrenalectomy is given in Table 3.1. Table 3.1 Adrenalectomy: guideline recommendations
Colposuspension In the two randomized trials comparing laparoscopic versus open colposuspension, results were inconsistent. In the study by Fatthy et al. (2001), the success rate at 18 months was 88% in the laparoscopy group and 85% in the open group (22). Blood loss, post-operative stay and time to return to work were significantly smaller in the laparoscopy group. In the study by Su et al. (1997), the success rate at 3 months was 80% in the laparoscopy group and 96% in the open group (23). The superiority of the laparoscopic procedure cannot therefore be established. Moreover, the number of patients enrolled in these series was too small for an equivalence study. On the other hand, there have been four non-randomized comparative studies in which reported results are comparable between arms (24-27). Less post-operative pain, shorter hospital stay and shorter convalescence are reported with the laparoscopic approach, but the design of the studies do not allow any scientific conclusion to be made. In the reports of series (28-47), both the transperitoneal and the extraperitoneal approaches have been assessed. Persson demonstrated that two stitches on every side produce a better result than one stitch (32). In these papers, the number of patients treated was highly variable, ranging from less than 25 patients in 11 papers to more than 50 patients in seven papers. Efficacy parameters reported by review papers (48-58) are given in Table 3.2. Table 3.2 Colposuspension: efficacy parameters(48-58)
Unfortunately, on the basis of scientific criteria, the effectiveness of open surgery for stress incontinence is itself questionable, though there is a tendency to consider the Burch procedure as the benchmark. In addition, there is also competition between the use of laparoscopic surgery and other minimally invasive procedures, e.g. tension-free vaginal tape (TVT), with the latter being probably much easier to learn. It is therefore very likely to be difficult to carry out prospective, comparative trials in the future. A summary of the current guideline recommendations for colposuspension is given in Table 3.3. Table 3.3 Colposuspension: guideline recommendations
Date: 2016-06-13; view: 5
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