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The main objective of this preliminary study was to evaluate the feasibility and safety of 3-D laparoscopic living donor left nephrectomy (LDLN). The secondary objective was to compare intraoperative and postoperative outcomes between 3-D and 2-D laparoscopic LDLN. All patients who underwent a laparoscopic LDLN from January 2015 to April 2018 in a university center were included. All surgeries were performed by three experienced surgeons. Seventy three patients were included the following: 16 underwent a 3-D laparoscopic LDLN (3-D group), and 57 underwent a 2-D laparoscopic LDLN (2-D group). Operative time and warm ischemia time (WIT) were significantly lower in the 3-D group (operative time: 80.9 ± 10.2 vs 114.1 ± 32.3 minutes in the 3-D and 2-D groups, P = .0002) (WIT: 1.7 ± 0.6 vs 2.3 ± 0.9 minutes in the 3-D and 2-D groups, P = .02). No conversion to open surgery occurred in both groups. Length of hospital stay was significantly shorter in the 3-D group. No major postoperative complications (Clavien ≥ III) occurred. One-year postoperative GFR was similar to 3-D and 2-D groups. Our preliminary study demonstrates that 3-D laparoscopic LDLN is a feasible and safe surgical procedure. Intraoperative and postoperative outcomes were similar in both 2-D and 3-D vision systems, but 3-D vision systems allow reduction in WIT and operative time., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate and compare perioperative outcomes in patients undergoing either transperitoneal (TP) or retroperitoneal (RP) laparoscopic nephrectomy for autosomal dominant polycystic kidney disease (ADPKD)., Methods: All patients with ADPKD who underwent unilateral laparoscopic nephrectomy between 2000 and 2012 in two academic departments were retrospectively included. The perioperative parameters were compared between the TP and RP groups., Results: A total of 82 patients were included, 43 patients in the TP group and 39 in the RP group. The patients' characteristics were similar between TP set and RP set, except for the time from dialysis onset to nephrectomy (p = 0.02). Complication rates (25.6 vs 33.3 %, p = 0.44), transfusion rates (11.6 vs 20.5 %, p = 0.27) and conversion to open surgery (4.6 vs 7.7 %, p = 0.56) were similar between the TP and RP groups, respectively. Operative time was shorter for TP procedures (171.6 vs 210.5 min, p = 0.002), but there was no difference between the two approaches after 20 surgeries (p = 0.06). Patients in TP group had a shorter length of hospital stay (5.3 ± 1.9 vs 7.2 ± 2.5 days, p = 0.002). However, there was a trend towards shorter return of bowel function in the RP group (2.1 ± 0.9 vs 2.4 ± 0.8 days, p = 0.09)., Conclusion: TP and RP laparoscopic nephrectomies provide good outcomes in patients with ADPKD. The choice of a TP route could decrease the length of hospital stay and the operative time during the beginning of the learning curve period.

Objective: To evaluate the feasibility and morbidity of laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPK)., Patients and Method: This is a retrospective multi-centre study (University Hospitals of Lyons, Toulouse, Nantes and Rennes). Sixty-eight patients who had undergone laparoscopic nephrectomy for polycystic kidney disease between November 1999 and May 2009 were included. This involved unilateral nephrectomy 64 cases, one-stage bilateral in one case and two-stage bilateral in three cases., Results: The mean operating time was 218±74min (100-420) Conversion was necessary in 7 cases. The mean weight of the removed kidney was 1291±646g (240-3400). We regret to report 20 postoperative complications, including one death on postoperative day 50, following an abscess in the renal pelvis, 6 retroperitoneal haemoatomas and 5 arteriovenous fistula thromboses. Postoperative analgesia involved PCA treatment with morphine for a mean period of 1.59±0.8 days (0.5-4). The mean length of hospital stay was 8.3±6.1 days (3-50)., Conclusion: This study shows the feasibility of the laparoscopic approach for nephrectomy in ADPK. This procedure should be performed by experienced laparoscopic surgeons. Indeed, the complication rate is moderate but there is still a risk of severe complications., Level of Evidence: 5., (Copyright © 2013. Published by Elsevier Masson SAS.)

Objective: To compare the perioperative outcomes of laparoscopic/robotic radical cystectomy (LRRC) for urothelial cancer of bladder (UCB) between elderly (≥ 70 years) and younger (<70 years) patients., Materials and Methods: A retrospective review of 146 patients who underwent LRRC between 2003 and 2010 at 2 academic institutions (Cleveland, Ohio, United States and Toulouse, France) was performed. Of these, 74 patients were classified as elderly (≥ 70 years) and 72 patients were considered younger (<70 years). Perioperative outcomes, final pathology results, overall survival (OS), and cancer specific survival (CSS) were compared between the 2 groups., Results: Both groups had similar clinical stage at diagnosis, American Society of Anesthesiologists score, body mass index, and gender distribution. Ileal conduit-type diversion was favored in the older vs younger group, 84% vs 36%, respectively. Overall conversion rate to open procedures was 4% in both groups. Perioperative complication rate was not significantly different between the younger and older patients. Positive margin rate was 5% in both groups. The 5-year OS for older and younger patients was 75% and 87%, respectively (P = .03), and the 5-year CSS for the 2 groups was 51% and 54%, respectively (P = .7)., Conclusion: Laparoscopic/robotic radical cystectomy in the elderly does not have worse perioperative complications or pathologic outcomes compared with younger patients and therefore can be offered as treatment option in select older patients., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: Neurogenic bladder dysfunction has a negative impact on the patient's quality of life (QoL). Cystectomy with ileal conduit urinary diversion is a treatment option in patients in failure after conservative management. The objective of this study was to evaluate the impact of ileal conduit urinary diversion on the QoL of patients with neurogenic bladder dysfunction., Materials and Methods: From March 2004 to November 2010, 48 patients (36 women and 12 men with a mean age of 50.6  ±  11.8 years) treated by cystectomy with ileal conduit urinary diversion for neurogenic bladder dysfunction, prospectively completed, before and after surgery, two self-administered QoL questionnaires. Neurological diseases were multiple sclerosis in 38 cases, spinal cord injury in 7 cases, and other neurological disease in 3 cases. Cystectomy was performed by laparoscopy in all patients. QoL was measured by using two self-administered questionnaires, one questionnaire specific for urinary disorders validated in neurological patients, Qualiveen®, and the generic SF36-v2® questionnaire. Data were compared by Student's t test., Results: Comparison of the Qualiveen® self-administered questionnaire scores and indices before and after surgery showed that, after surgery, patients presented a significant reduction of limitations (0.57 ± 0.64 vs. 1.55 ± 1.35, P < 0.001), constraints (2.12  ±  0.83 vs. 2.64  ±  1.12, P = 0.046) scores and the SIUP index (1.29 ± 0.65 vs. 1.79 ± 0.95, P = 0.015). No significant change in SF36-v2® scores was observed postoperatively., Conclusions: Ileal conduit urinary diversion improves the urinary QoL of patients with neurogenic bladder dysfunction by decreasing limitations and constraints induced by urinary disorders, but has no impact on general QoL., (Copyright © 2011 Wiley Periodicals, Inc.)

Objective: To compare both approaches of laparoscopic pyeloplasty, transperitoneal vs retroperitoneoscopy., Methods: A total of 65 procedures were performed in 62 patients, 36 females and 26 males. Laparoscopic pyeloplasty with Anderson Hynes technique was performed transperitoneal in 34 cases and retroperitoneal in 31 cases. Parameters studied were the operative duration, the rate of conversion to open approach, transposition of crossing vessel, complications and reintervention, results, and the duration of hospitalization. Then, overall success rate for both approaches was evaluated in the presence or absence of crossing vessels, and if transposition of crossing vessel was performed vs without., Results: The overall success rate for both procedures was 85% (87% for the retroperitoneal vs 82% for the transperitoneal approach). The mean operative duration was 231.69 ± 59.97 and 194.76 ± 25.37 minutes for the retroperitoneal and transperitoneal approaches, respectively (P = .029). The rate of conversion was 19.35% (6 of 31) and 2.9% (1 of 34) for the retroperitoneal and transperitoneal approaches, respectively (P = .047). No significant statistical difference was noted between both techniques related to the age of patient, the hospital stay, and intraoperative and postoperative complications. Transposition of crossing vessel had no effect on the results (81.25% with transposition and 80% if not, P = .93)., Conclusions: Retroperitoneoscopic approach is associated with longer operative time and more conversion rate than transperitoneoscopy. However, the overall outcomes of laparoscopic transperitoneal pyeloplasty vs retroperitoneoscopic were comparable., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the feasibility and morbidity and mortality of laparoscopic radical cystectomy for bladder cancer in elderly patients., Methods: Prospective study conducted between January 2003 and May 2009 in 22 patients, one woman and 21 men, who underwent laparoscopic radical cystectomy for bladder cancer. Mean patient age was 76.2+/-4.3 years. The median preoperative ASA score was 2 (1-3). The indication for surgery was an invasive muscle bladder tumour in 18 cases and noninvasive muscle bladder cancer refractory to conservative treatment (chemotherapy, immunotherapy) in four cases. Ileal conduit was carried out in 15 cases. An ileal neobladder was fashioned in six cases using Camey's technique. One bilateral cutaneous ureterostomy was performed., Results: There was one conversion to open surgery. One intraoperative complication was noted (left obturator nerve injury). Mean blood loss was 377.5+/-341.2ml. No perioperative death was observed. Mean time to resumption of oral fluids was 2.4+/-1.6 days and mean time to resumption of solids was 4.5+/-1.6 days. Mean time to resumption of bowel movements was 3.9+/-1.9 days. Mean critical care unit was 4.2+/-1.4 days. Five patients (22.7 %) had postoperative complications. Postoperative narcotic analgesics were necessary in 60 % of cases. Mean hospital stay was 11.0+/-3.0 days. Mean patient follow-up was 46.4+/-20.8 months., Conclusions: Laparoscopic radical cystectomy for bladder cancer in elderly patients is associated with low morbidity, and a limited hospital stay., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Purpose: We compared the morbidity and mortality of laparoscopic vs open surgery in radical cystectomy for bladder cancer., Materials and Methods: This prospective, nonrandomized study was conducted between January 2003 and July 2007 in 68 patients (7 women and 61 men) who underwent radical cystectomy for bladder cancer. A total of 38 cystectomies were performed laparoscopically and 30 by open surgery. Mean patient age was 68.0 +/- 9.0 years. Median preoperative American Society of Anesthesiologists score was 2 (range 1 to 3) in both groups., Results: Intraoperative blood loss and transfusion rate were significantly lower in the laparoscopic surgery group. Postoperatively the incidence of minor complications and mortality were also significantly lower. Postoperative opioid consumption was significantly less in the laparoscopic surgery group in amount and duration. Resumption of oral fluid and solid intake as well as return to normal bowel function were significantly more rapid in the laparoscopic surgery group, and mean hospital stay was significantly shorter. Mean patient followup was 30.5 +/- 17.2 months., Conclusions: Laparoscopic radical cystectomy for bladder cancer has a lower morbidity rate than cystectomy by open surgery. It allows more rapid resumption of oral fluid and solid intake as well as return to normal bowel function and shorter hospital stay.

The objective of this case report is to describe the laparoscopic insertion of an artificial periprostatic urinary sphincter. We report the case of a paraplegic patient in whom an artificial urinary sphincter was inserted in a periprostatic position by way of laparoscopy to treat stress urinary incontinence. In addition to laparoscopy being minimally invasive, its advantages include the excellent quality of retroprostatic dissection and the perfect visualization it gives at the level of cuff positioning with respect to the anatomic landmarks. It is more appropriate to be able to cleave the interprostatorectal space to ensure passage of the cuff under perfectly safe conditions.

Objectives: To evaluate the morbidity and mortality of laparoscopic cystectomy combined with transileal ureterostomy to treat neurogenic vesicosphincteric disorders., Material: Prospective study performed between february 2004 and april 2006 on 26 consecutive patients with a mean age of 55.0 +/- 12.7 years treated by laparoscopic cystectomy for neurogenic vesicosphincteric disorders. The underlying neurological disease was multiple sclerosis (MS) in 20 cases, spinal cord injury in 4 cases and transverse myelitis in 2 cases. The median preoperative ASA score was 3 (range: 2-3)., Results: No open conversion was necessary. One intraoperative complication was observed (vascular injury). No perioperative death was observed. The nasogastric tube was maintained postoperatively for an average of 8.69 +/- 5.9 hours. The mean time to resumption of oral fluids was 1.4 +/- 0.7 days and mean time to resumption of solids was 2.6 +/- 1.0 days. The mean time to resumption of bowel movements was 3.8 +/- 3.2 days. The mean intensive care stay was 3.9 +/- 1.1 days. Two postoperative complications were observed in the same patient (ileus and bronchial congestion). Postoperative narcotic analgesics were necessary in 60% of cases. The mean hospital stay was 10.3 +/- 4.1 days. Two late postoperative complications were observed in the same patient (two episodes of pyelonephritis)., Conclusion: Laparoscopic cystectomy has a low morbidity in neurological patients, allowing early return of feeding and a moderate length of hospital stay.

Objectives: The purpose of our study was to demonstrate, describe, and assess the results of the technique of laparoscopic cystectomy sparing the uterus, fallopian tubes, ovaries, and vagina., Patients and Methods: Between July 2004 and December 2005, 13 women with neurogenic vesical dysfunction (mean age: 53.3+/-13.0 yr) underwent laparoscopic cystectomy sparing the uterus, fallopian tubes, ovaries, and vagina. A noncontinent transileal Bricker diversion was performed extracorporeally in each case. Parameters studied were the pre-, peri- and postoperative data., Results: Mean duration of the operation was 325+/-36 min, and mean blood loss was 323.1+/-246.3 ml. No conversion was required. One perioperative complication was observed: a tear in a branch of the right hypogastric vein, which was sutured under laparoscopy. One patient was transfused during surgery (2 units of blood). No early or late postoperative complications were observed. One patient required transfusion of 2 units of red blood cell concentrate on the first day after surgery. None of the patients required opiate analgesia in the postoperative period. The analgesic regimen used was paracetamol and nefopam in all cases. The pain score on an analogic visual scale was less than 4 in all cases. Resumption of transit was not delayed in any of the patients. Mean hospital stay was 11.6+/-1.9 d. Over an average follow-up of 7.4+/-5.4 mo, none of the patients developed late complications. Before surgery, 77% of the women were sexually active; 80% of them were sexually active 4 mo after the surgery., Conclusions: Laparoscopic cystectomy sparing the uterus, fallopian tubes, ovaries, and vagina is feasible. This operation has low morbidity and requires only a limited stay in hospital.

Objective: To report the results of laparoscopic live donor nephrectomy (LLDN) and to describe our technique., Material and Methods: We retrospectively reviewed 47 laparoscopic live donor nephrectomies performed between January 1999 and July 2005. Several parameters were studied: donor clinical characteristics, intraoperative and postoperative complications, operating time and warm ischaemia time. This series comprised 26 women (55.31%) and 21 men (44.68%) with a mean age of 48 +/- 20 years. Donor nephrectomy was mainly performed on the left kidney (85.37%). It was performed by lumbar endoscopy in the first 20 cases and by laparoscopy in 27 cases. Kidney extraction was performed via an incision between two trocar orifices for the first cases and via an iliac incision for the last 18 cases., Results: The mean operating time was 189 min with a mean blood loss of 127 ml. Warm ischemia time was 6 minutes. Open conversion was required in two cases: renal vein injury in one case and an obese donor with difficulties of dissection in the other case. Surgical revision was required in only one case (haemoperitoneum secondary to genital vein injury). A trocar orifice abscess was observed in one case and prolonged ileus was reported in 2 cases. In the recipient, a urinary anastomotic fistula was observed secondary to ischaemic necrosis of the distal segment of the ureter. Late complications were essentially vascular (19.14%). A right renal graft was lost due to an error of compatibility. Mean serum creatinine was 132 +/- 6.5 micromol/l at 3 months for the other recipients., Conclusion: Our experience confirms the feasibility and efficacy of laparoscopic live donor nephrectomy. Intraoperative and postoperative complications and the conversion rate were low. Renal function was rapidly restored in the recipient. The morbidity of this technique is low, but there is a high risk of vascular complications at the beginning of the operator's experience.

Introduction: Various routes are used to extract the operative specimen during laparoscopic nephrectomy. The main points are compliance with rules of cancer surgery, when applicable, and minimum wall destruction. The objective of this study was to prospectively evaluate the low iliac approach., Material and Method: Prospective follow-up of 23 laparoscopic nephrectomies (17 tumours and 6 living donor kidney harvestings) in which the kidney was extracted via a low iliac incision measuring 5 to 7 cm., Results: The mean operating time was 188 +/- 50 min with a mean blood loss of 112 +/- 126 ml. The mean duration of the incision was 10 minutes. In the case of a tumour the mean weight of the operative specimen was 571 +/- 127 g in and the mean diameter of the mass was 5.7 +/- 1.9 cm. All grafted kidneys functioned normally. No surgical conversion was necessary. The mean follow-up was 9.6 +/- 1.2 months. No late postoperative complications were observed., Conclusion: Radical nephrectomy or living donor kidney harvesting can be performed via laparoscopy with extraction of the operative specimen via a low iliac incision. This incision ensures extraction of very large specimens while preserving the aesthetic and functional advantages of laparoscopy with no increased cancer risk. They are simple to perform and easily reproducible via a transperitoneal or retroperitoneal approach. Absence of muscle section maintains the integrity of the abdominal wall. No postoperative incisional hernia has been observed.

From July 2003 to February 2004, 13 laparoscopic radical cysto-prostatectomies have been achieved in our department. The technique is describe, the ablation of the bladder and prostate is done through a pure laparoscopic approach when the reconstruction is done trough a small incision under the umbilicus. The uretro-neobladder anastomoses are performed under laparoscopy after re-integration of the bladder. All procedures have been successfully achieved; the mean operative time is 400 minutes, 320 for the cutaneous diversions and 450 for the Camey 2 procedures. Blood loss were 390 ml, blood transfusion was d for only one patient. No major complication was observed, the mean hospital stay was 14.2 days (+3.5). In our experience laparoscopic radical cystectomy is a safe option, associated with shorter hospital stays and gentler postoperative recovery.