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Günter Janetschek

Publications and source records attributed to Günter Janetschek.

26 records · Page 2Linked to original sources
PubMed2004

Laparoscopic partial nephrectomy in cold ischemia: renal artery perfusion.

PURPOSE: Laparoscopic partial nephrectomy represents a feasible option for patients with small renal masses. We describe our initial experience with laparoscopic partial nephrectomy in cold ischemia achieved by renal artery perfusion. MATERIALS AND METHODS: From November 2001 to March 2003 laparoscopic partial nephrectomy in cold ischemia was performed in 15 patients with renal cell carcinoma. Cold ischemia was achieved by continuous perfusion of Ringers lactate at 4C through the renal artery, which was clamped. Tumor excision was performed in a bloodless field with biopsy taken from the tumor bed. The collecting system was repaired if needed. Renal reconstruction was performed by suturing over hemostatic bolsters. RESULTS: All procedures were successfully completed laparoscopically by our new technique. Mean operative time was 185 minutes (range 135 to 220). Mean ischemia time was 40 minutes (range 27 to 101). Estimated mean intraoperative blood loss was 160 ml (range 30 to 650). Entry to the collecting system in 6 patients was repaired intraoperatively. Additional vascular repair was done in 2 patients. There were no significant postoperative complications. Postoperative followup in 8 patients showed that the renal parenchyma was not damaged by the ischemic period. CONCLUSIONS: Our initial experience of incorporating cold ischemia via arterial perfusion into laparoscopic partial nephrectomy shows the feasibility and safety of the technique. We believe that this approach has the potential to make laparoscopic partial nephrectomy for renal cell carcinoma safe and reliable.

Adult↗
PubMed2004

Varicocele.

Explore the source record for details and available documents.

Embolization, Therapeutic↗
PubMed2003

Laparoscopic wedge resection for renal cell carcinoma.

PURPOSE OF REVIEW: Because an increasing number of small renal cell tumors suitable for nephron sparing surgery are being diagnosed incidentally, the standardization of laparoscopic wedge resection has now become a major issue. RECENT FINDINGS: In this article we reviewed mainly recent literature published since November 2001 focusing our interest to clearly present the different techniques for wedge resection. These techniques are shown under two main subtitles: resection with or without ischemia. Also new alternative techniques for resection without ischemia are reviewed. SUMMARY: Wedge resection can be done laparoscopically by different techniques. Each technique has its inherent advantages and disadvantages. Further studies and modifications on each technique are expected in the future.

Carcinoma, Renal Cell↗
PubMed2003

Ligation of the renal vein during laparoscopic nephrectomy: an effective and reliable method to replace vascular staplers.

PURPOSE: Application of the endovascular gastrointestinal anastomosis stapler has become a standard procedure to control renal vein during laparoscopic nephrectomy. However, device malfunction resulting in significant complications has been reported. We present a safe and cost-effective technique for renal vein ligation during laparoscopic nephrectomy. MATERIALS AND METHODS: From October 2002 to April 2003 we applied our new technique of renal vein ligation in 20 cases. After renal pedicle dissection the renal artery was secured with Hem-o-lok (Weck Closure Systems, Research Triangle Park, North Carolina) clips. The renal vein was encircled with a suture, which was knotted extracorporeally and pushed down by a knot pusher to shrivel a vein of any size. Subsequently 10 mm Hem-o-lok clips were applied to the vein to occlude it completely. RESULTS: All procedures were successfully completed. The operative costs of vein ligation were decreased. There was no significant increase in mean operative time. CONCLUSIONS: Our approach is a safe, reliable, rapid and inexpensive method to ligate the renal vein during laparoscopic nephrectomy. Therefore, this technique has replaced endovascular gastrointestinal anastomosis stapler use at our center.

Humans↗
PubMed2002

Laparoscopic partial adrenalectomy for recurrent pheochromocytoma after open partial adrenalectomy in von Hippel-Lindau disease.

BACKGROUND AND PURPOSE: Unilateral total adrenalectomy is the standard treatment for benign unilateral adrenal tumors. Partial adrenalectomy has to be considered for bilateral adrenal tumors. Recently, our group has reported the feasibility of unilateral and bilateral partial adrenalectomy by means of laparoscopy. Now, we present a case of recurrent pheochromocytoma after open bilateral adrenalectomy and demonstrate that laparoscopic cortex-sparing surgery is feasible for a recurrence after open surgery. CASE REPORT: At the age of 10 years, a boy was found to have bilateral adrenal pheochromocytoma and was treated by open bilateral partial adrenalectomy. Eight years later, the patient presented with palpitation, sweating, and severe hypertension. Investigations biochemically and radiologically demonstrated functional recurrent pheochromocytoma in the left adrenal gland. Genetic studies confirmed mutation of the von Hippel-Lindau (VHL) gene. The patient was prepared for surgery preoperatively by phenoxybenzamine and metropolol. The surgery was performed as planned, and the normal adrenal tissue was spared. The patient had an uneventful postoperative course. His blood pressure was normal on the day of discharge. CONCLUSIONS: In a specialized center with experienced laparoscopic surgeons, laparoscopic partial adrenalectomy for recurrent pheochromocytoma is feasible even after previous open surgery on the ipsilateral adrenal gland. Adrenal-sparing surgery is indicated in hereditary syndromes such as VHL and MEN II to avoid the problems of life-long steroid replacement. Recurrences have to be expected, but further surgery may be less difficult by the previous laparoscopic approach.

Adolescent↗
PubMedDate not supplied

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

BACKGROUND AND PURPOSE: Laparoscopic retroperitoneal lymph-node dissection (RPLND) has been advocated for and utilized in the management of testicular cancer. In this overview, we present our technique and results in comparison with the worldwide experience with laparoscopic RPLND in the management of clinical stage I and II cancers. PATIENTS AND METHODS: Over the last 13 years, 162 patients with testicular cancer clinical stage I (N = 103) or II (N = 43 IIB, 16 IIC) underwent laparoscopic RPLND. All intraoperative and postoperative data were evaluated, as well as the worldwide experience with the procedure. With a mean follow-up of 62 months (range 6-113 months) for clinical stage I and 53 months (range 10-89 months) for clinical stage II, oncologic efficiency was evaluated. RESULTS: The procedure was feasible even after chemotherapy, with only three conversions to open RPLND in clinical stage I. The mean operative time was 217, 216, and 281 minutes for clinical stages I, IIB, and IIC, respectively. The mean blood loss was 144 mL and 165 mL for clinical stage I and II, respectively. The hospital stays were 3.6 and 3.8 days, respectively. During follow-up, we had two retroperitoneal relapses (1.2%) and four distant relapses (2.5%). CONCLUSION: Laparoscopic RPLND has demonstrated its surgical and oncologic efficacy. The morbidity and the complication rate are low. Recurrence rates are comparable to those of open surgery. Laparoscopic RPLND is safe, with less postoperative morbidity, quicker convalescence, better cosmetic results, and a diagnostic accuracy equal that of the open technique.

Adolescent↗