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So far, laparoscopic approaches to kidney and adrenal have been limited because of their retroperitoneal location. We here report eight renal and adrenal endoscopic procedures performed in seven patients: two adrenalectomies for hyperaldosteronism, one adrenalectomy for isolated metastasis from an adenocarcinoma of the lung; two nephrectomies for end-stage infected hydronephrosis, two partial nephrectomies for small circumscribed lesions of the kidney, and one endoscopic resection for pain relief of a voluminous cyst at the kidney. The approach was transperitoneal in two cases and retroperitoneal in five cases using the retropneumoperitoneum insufflation technique. One patient was operated by a combined approach using the retro- and transperitoneal routes. All procedures were successfully completed endoscopically. The retroperitoneoscopic approach of the kidney is safe and does not interfere with the peritoneal organs. Its working space is tenuous, but allows a direct access on the kidney with good exposure of its pedicle. For adrenal surgery, the retroperitoneoscopic dissection is more difficult, because movements of instruments are often impaired by the closeness of the costal margin and the iliac crest. However, in case of difficulties we found it very convenient to switch from a retroperitoneal endoscopic approach to a combined coelioscopic and retroperitoneoscopic operation. Far from excluding each other, both approaches are complementary, particularly for difficult situations (i.e., previous peritoneal or retroperitoneal surgery).

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A 64-yr-old asthmatic patient underwent a two-vessel aortocoronary vein grafting. Before surgery, the patient received cimetidine 400 mg and labetalol 650 mg. During the first 60 min of bypass, hypotension (40-45 mm Hg) was observed in spite of phenylephrine 14 mg. This initial hypotension was followed, during rewarming, by a slow increase in arterial pressure to 150 mm Hg. On cessation of bypass, bronchospasm was observed and was protracted. It is assumed that labetalol clearance and metabolism were reduced by cimetidine, that labetalol alpha-antagonism was responsible for the vasodilatation withstanding the phenylephrine, and that a combination of labetalol beta-antagonism and phenylephrine alpha-agonism initiated the bronchospasm. These observations indicate that, after labetalol therapy, higher doses of vasopressor agents such as phenylephrine may be necessary, but that such therapy may lead to bronchospasm in asthmatic patients.