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Bilateral laparoscopic adrenalectomy is technically feasible and can be performed with minimal bleeding in a reasonable surgical time.

Objective: In this study, we have gathered the second largest series yet published on laparoscopic radical cystectomy in order to evaluate the incidence and cause of intra and postoperative complication, conversion to open surgery, and patient mortality. Materials and Methods: From 1997 to 2005, 59 laparoscopic radical cystectomies were performed for the management of bladder cancer at 3 institutions in South America. Twenty nine patients received continent urinary diversion, including 25 orthotopic ileal neobladders and 4 Indiana pouches. Only one case of continent urinary diversion was performed completely intracorporeally. Results: Mean operative time was 337 minutes (150-600). Estimated intraoperative blood loss was 488 mL (50-1500) and 12 patients (20%) required blood transfusion. All 7 (12%) intraoperative complications were vascular in nature, that is, 1 epigastric vessel injury, 2 injuries to the iliac vessels (1 artery and 1 vein), and 4 bleedings that occurred during the bladder pedicles control. Eighteen (30%) postoperative complications (not counting mortalities) occurred, including 3 urinary tract infections, 1 pneumonia, 1 wound infection, 5 ileus, 2 persistent chylous drainage, 3 urinary fistulas, and 3 (5%) postoperative complications that required surgical intervention (2 hernias -one in the port site and one in the extraction incision, and 1 bowel obstruction). One case (1.7%) was electively converted to open surgery due to a larger tumor that precluded proper posterior dissection. Two mortalities (3.3%) occurred in this series, one early mortality due to uncontrolled upper gastrointestinal bleeding and one late mortality following massive pulmonary embolism. Conclusions: Laparoscopic radical cystectomy is a safe operation with morbidity and mortality rates comparable to the open surgery.

Laparoscopy has experienced significant growth in the last 5 years and became more popular among practicing urologists. Even though laparoscopy is considered a safe technique it is not free of complications, some of which can be devastating. Vascular injuries are the second most frequent complication during laparoscopic surgery with a reported incidence of 0.22% to 1.1%. With the standardization of surgical techniques and the increasing proficiency of the teams performing it, serious surgical complications may be corrected without the need for conversion. We report a case in which the right external iliac artery was injured while pelvic lymph node dissection was carried out before a planned laparoscopic radical cystoprostatectomy. The complication was successfully managed entirely by means of laparoscopy.

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