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We present a case of laparoscopic transperitoneal heminephrectomy involving a large renal cell carcinoma of 7 cm centrally located on the left side of a horseshoe kidney in a 48 years old male patient detected by ultrasound scan and CT scan.

We report a case of chylous ascites developing the first post-operative day after laparoscopic adrenalectomy. The early initiation of treatment with total parenteral nutrition and somatostatin analog led to rapid resolution of the ascites. To the best of our knowledge, this is the first case of chylous ascites after laparoscopic adrenalectomy and we report it to stress the need for greater awareness and attention (meticulous dissection, permanent use of hemoclips and/or suture ligatures instead of electrocautery) even for simpler laparoscopic urologic procedures.

Vesico-urethral anastomosis is a technically challenging part of the laparoscopic radical prostatectomy. Our aim was to simplify the anastomosis-step by adopting a new device "Capio" (Boston Scientific), already known in open surgery, together with "Alesix" (Applied), a device used in hand assisted laparoscopy.

Laparoscopic Nephron Sparing Surgery (LNSS) is a technically challenging procedure. Technical aspects and the outcome of LNSS are investigated. A total of 592 LNSS procedures were collected from 12 Centres, either in extraperitoneal or transperitoneal fashion. Mean tumor size was 2.2 cm. Eight centers reported on tumor position for a total of 407 cases with 338 exophytic tumors (83%) and 69 deep lesions (17%). Four centers, accounting for 185 cases, did not report on tumor position. All the centers performed their LNSS by clamping the hilum. The warm ischemia time was < 30 min in all the centers. The positive margin rate was 2% (12/592). Hemostatic agents and/or sealant or tissue glues were used in 86% of cases (511/592). Types of sealants used included: gelatine matrix (Floseal), fibrin gel (Tissucol), bovine serum albumin (BioGlue) and cianacrylate (Glubran). Two Centres never used sealants, one center used only sealants without suturing and 9 centers used a combination of sealants and bolstering-sutures. The intraoperative open conversion rate was 3.5% (21/592). Postoperative complications included bleeding in 15/592 (2.5%) and urine leak in 13/592 (2.1%). No tumor seeding was reported. LNSS has similar results of open partial nephrectomy. The use of hemostatic agents and/or sealants or tissue glues during LNSS is largely diffuse in European centers and may be an effective add on reducing bleeding and urine leakage when used in combination with bolstering-suturing.

A middle aged male patient (39 year old) presented with right renal pain. During evaluation a small renal stone was found in the right kidney, and a mass 6 cm in diameter related to the upper pole of the left kidney was discovered. An endocrinologic evaluation was negative and a laparoscopic transperitoneal adrenalectomy was performed. Final pathology was adrenocortical oncocytoma with malignant potential.

Congenital ureteropelvic junction (UPJ) obstruction is a well recognized pathology. It typically occurs due to the presence of an aperistaltic segment of the ureter, very frequently aggravated by a strangling vessel defined by different authors as "anomalous", "aberrant" or "crossing". An embryologic review of the development of the kidney, ureter and renal vessels reveals that such definitions are etiologically inadequate since such vessels almost always run anterior to the UPJ and therefore in reality are not anomalous or aberrant. It would be, therefore, more appropriate to speak of a "vascular bar" rather that congenital vascular anomaly. A series of 23 patients treated by a laparoscopic technique (15 using the Anderson-Hynes pyeloplasty, 4 Fenger's technique, 3 a simple ureterolysis, 1 necessitating a conversion to open procedure (due to bleeding) are presented. An inferior polar vessel was found in 15 cases and this was running anterior to the UPJ in 14. The mean operative time was 235 min., while the mean hospital stay 7 (3-15) days. The mean follow-up was 47.7 months. Twenty-one pts. (95.5%) were symptom-free with imaging studies confirming relief from obstruction.