|
1
|
Ragavan N, Dholakia K, Baskaran J, Ramesh M. Day-case laparoscopic nephrectomy: Feasibility and safety. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415819852278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: The method of surgery and its recovery play an important part in a success of any surgery. Implementing a minimal invasive approach with enhanced recovery protocol permits Nephrectomy to be performed as a day-case (DC) procedure. Here we report our initial experience with laparoscopic nephrectomy (LN) as DC surgery with an aim to assess its feasibility and safety. Patients and methods: In this retrospective observational study, nine patients underwent DC LN performed by a single surgeon (NR). LN was performed in the standard way followed by enhanced recovery pathway of care for DC. We collected data regarding demographic information, medical co-morbidities, preoperative outcomes, complications and readmission rates. The data was analysed and evaluated. Results: There were four (44.4%) women and five (55.5%) men with a median age of 35 years (range 17–52 years). Eight (88.9%) patients had benign diseases associated with non-functioning kidneys and one (11.1%) patient had a renal tumour. All patients (100%) were successfully discharged the same day with no major complication (Clavien Dindo Grade > I). Readmission rates were 0%. Conclusion: In our small series, DC LN is feasible and safe with a belief that the results are easily reproducible. Increasing experience in laparoscopic surgery with implementation of enhanced recovery protocol may help to increase the success rate of LN as DC.
Collapse
|
|
2
|
Kunath F, Schmidt S, Krabbe L, Miernik A, Dahm P, Cleves A, Walther M, Kroeger N. Partial nephrectomy versus radical nephrectomy for clinical localised renal masses. Cochrane Database Syst Rev 2017; 5:CD012045. [PMID: 28485814 PMCID: PMC6481491 DOI: 10.1002/14651858.cd012045.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Partial nephrectomy and radical nephrectomy are the relevant surgical therapy options for localised renal cell carcinoma. However, debate regarding the effects of these surgical approaches continues and it is important to identify and summarise high-quality studies to make surgical treatment recommendations. OBJECTIVES To assess the effects of partial nephrectomy compared with radical nephrectomy for clinically localised renal cell carcinoma. SEARCH METHODS We searched CENTRAL, MEDLINE, PubMed, Embase, Web of Science, BIOSIS, LILACS, Scopus, two trial registries and abstracts from three major conferences to 24 February 2017, together with reference lists; and contacted selected experts in the field. SELECTION CRITERIA We included a randomised controlled trial comparing partial and radical nephrectomy for participants with small renal masses. DATA COLLECTION AND ANALYSIS One review author screened all of the titles and abstracts; only citations that were clearly irrelevant were excluded at this stage. Next, two review authors independently assessed full-text reports, identified relevant studies, evaluated the eligibility of the studies for inclusion, assessed trial quality and extracted data. The update of the literature search was performed by two independent review authors. We used Review Manager 5 for data synthesis and data analyses. MAIN RESULTS We identified one randomised controlled trial including 541 participants that compared partial nephrectomy to radical nephrectomy. The median follow-up was 9.3 years.Based on low quality evidence, we found that time-to-death of any cause was decreased using partial nephrectomy (HR 1.50, 95% CI 1.03 to 2.18). This corresponds to 79 more deaths (5 more to 173 more) per 1000. Also based on low quality evidence, we found no difference in serious adverse events (RR 2.04, 95% CI 0.19 to 22.34). Findings are consistent with 4 more surgery-related deaths (3 fewer to 78 more) per 1000.Based on low quality evidence, we found no difference in time-to-recurrence (HR 1.37, 95% CI 0.58 to 3.24). This corresponds to 12 more recurrences (14 fewer to 70 more) per 1000. Due to the nature of reporting, we were unable to analyse overall rates for immediate and long-term adverse events. We found no evidence on haemodialysis or quality of life.Reasons for downgrading related to study limitations (lack of blinding, cross-over), imprecision and indirectness (a substantial proportion of patients were ultimately found not to have a malignant tumour). Based on the finding of a single trial, we were unable to conduct any subgroup or sensitivity analyses. AUTHORS' CONCLUSIONS Partial nephrectomy may be associated with a decreased time-to-death of any cause. With regards to surgery-related mortality, cancer-specific survival and time-to-recurrence, partial nephrectomy appears to result in little to no difference.
Collapse
Affiliation(s)
- Frank Kunath
- University Hospital ErlangenDepartment of UrologyKrankenhausstrasse 12ErlangenGermany91054
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
| | | | - Laura‐Maria Krabbe
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- University of Muenster Medical CenterDepartment of UrologyAlbert‐Schweitzer Campus 1, GB A1MuensterNRWGermany48149
| | - Arkadiusz Miernik
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- Medical University Centre FreiburgDepartment of UrologyHugstetterstrasse 55FreiburgBaden‐WürttembergGermany79106
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
| | - Anne Cleves
- Cardiff University Library ServicesVelindre NHS TrustVelindre Cancer CentreCardiffWalesUKCF14 2TL
| | | | - Nils Kroeger
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- University Hospital GreifswaldDepartment of Urology17489 GreifswaldGreifswaldGermany
| | | |
Collapse
|
|
3
|
Abstract
Laparoscopic radical nephrectomy has become a well-standardized and reproducible, but technically demanding procedure. It is rapidly replacing the traditional open technique in radical nephrectomy with T1-2 tumours. Open operation will mainly be reserved for T3 tumours. Nephron-sparing surgery will play a major role in small (<4 cm) peripheral tumours. Open technique is still the standard for NSS, but with the refined techniques, laparoscopy may be soon coming.
Collapse
Affiliation(s)
- K Taari
- Department of Urology, Helsinki University Hospital, Helsinki, Finland.
| | | | | |
Collapse
|
|
4
|
Pierorazio PM, Johnson MH, Patel HD, Sozio SM, Sharma R, Iyoha E, Bass EB, Allaf ME. Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis. J Urol 2016; 196:989-99. [PMID: 27157369 PMCID: PMC5593254 DOI: 10.1016/j.juro.2016.04.081] [Citation(s) in RCA: 253] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE Several options exist for management of clinically localized renal masses suspicious for cancer, including active surveillance, thermal ablation and radical or partial nephrectomy. We summarize evidence on effectiveness and comparative effectiveness of these treatment approaches for patients with a renal mass suspicious for localized renal cell carcinoma. MATERIALS AND METHODS We searched MEDLINE®, Embase® and the Cochrane Central Register of Controlled Trials from January 1, 1997 through May 1, 2015. Paired investigators independently screened articles to identify controlled studies of management options or cohort studies of active surveillance, abstracted data sequentially and assessed risk of bias independently. Strength of evidence was graded by comparisons. RESULTS The search identified 107 studies (majority T1, no active surveillance or thermal ablation stratified outcomes of T2 tumors). Cancer specific survival was excellent among all management strategies (median 5-year survival 95%). Local recurrence-free survival was inferior for thermal ablation with 1 treatment but reached equivalence to other modalities after multiple treatments. Overall survival rates were similar among management strategies and varied with age and comorbidity. End-stage renal disease rates were low for all strategies (0.4% to 2.8%). Radical nephrectomy was associated with the largest decrease in estimated glomerular filtration rate and highest incidence of chronic kidney disease. Thermal ablation offered the most favorable perioperative outcomes. Partial nephrectomy showed the highest rates of urological complications but overall rates of minor/major complications were similar among interventions. Strength of evidence was moderate, low and insufficient for 11, 22 and 30 domains, respectively. CONCLUSIONS Comparative studies demonstrated similar cancer specific survival across management strategies, with some differences in renal functional outcomes, perioperative outcomes and postoperative harms that should be considered when choosing a management strategy.
Collapse
Affiliation(s)
- Phillip M Pierorazio
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael H Johnson
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Hiten D Patel
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Ritu Sharma
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Emmanuel Iyoha
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Eric B Bass
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| |
Collapse
|
|
5
|
Montes SFP, Rodríguez IG, Ugarteburu RG, Villamil LR, Mendez BD, Gil PS, Madera JM. Intraoperative laparoscopic complications for urological cancer procedures. World J Clin Cases 2015; 3:450-456. [PMID: 25984519 PMCID: PMC4419108 DOI: 10.12998/wjcc.v3.i5.450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/30/2015] [Accepted: 04/09/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution.
METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications.
RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery (radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery (radical prostatectomy and radical cystectomy).
CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications.
Collapse
|
|
6
|
Yuge K, Miyajima A, Jinzaki M, Kaneko G, Hagiwara M, Hasegawa M, Takeda T, Kikuchi E, Nakagawa K, Oya M. How does visceral obesity affect surgical performance in laparoscopic radical nephrectomy? Jpn J Clin Oncol 2015; 45:373-377. [DOI: 10.1093/jjco/hyv001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
|
7
|
Zero ischaemia laparoscopic nephron-sparing surgery by re-suturing. Contemp Oncol (Pozn) 2014; 18:355-8. [PMID: 25477760 PMCID: PMC4248050 DOI: 10.5114/wo.2014.41385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/16/2013] [Accepted: 02/18/2014] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY To report a pre-suture technique in laparoscopic nephron-sparing surgery (LNSS), which could help reduce and even avoid ischaemia for the treatment of renal cell carcinoma. MATERIAL AND METHODS Between January and June 2013 we treated 14 patients presenting with renal tumours. The mean age was 46 years and average tumour size was 2.4 cm in diameter determined by computed tomography (CT). All the patients were treated with LNSS by pre-suturing the resection. RESULTS In 13 out of the 14 cases, no clamping was needed during the whole surgery processes, i.e. zero ischaemia was achieved. In the other case, the renal artery was clamped for only 150 seconds due to suture avulsion. The mean operating time was 75 minutes (range 50 to 110 minutes) and mean blood loss was 60 ml (range 30 to 200 ml). After removal of the drain 2-3 days after surgery, the average postoperative hospital stay time was four days. The surgery had only a minor effect on the renal function. No case of urinary leakage or postoperative bleeding occurred. Postoperative pathological reports showed that the tumours were resected completely with negative surgical margins for all cases. There were no signs of recurrence on follow-up CT performed 1-6 months after surgery. CONCLUSIONS The pre-suture technique in LNSS reported here required zero or minimal ischaemia time and hence avoided renal ischaemia-reperfusion injury. This surgical technique could be a feasible surgical option for treatment of small, exophytic and peripheral renal tutors.
Collapse
|
|
8
|
Guan WH, Han Y, Zhang X, Chen DS, Gao ZW, Feng XS. Multiple renal arteries with renal cell carcinoma: Preoperative evaluation using computed tomography angiography prior to laparoscopic nephrectomy. J Int Med Res 2013; 41:1705-15. [PMID: 24003054 DOI: 10.1177/0300060513491883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate anatomical variations in the renal arteries of patients with renal cell carcinoma (RCC) using computed tomography angiography (CTA). Methods Patients diagnosed with RCC were evaluated using CTA prior to undergoing laparoscopic nephrectomy. Any anatomical variations of the renal arteries on the side affected by the RCC were recorded. The CTA results were compared with the observations made during surgery and those produced by conventional digital subtraction angiography. Results A total of 107 patients with RCC were enrolled in the study. Multiple renal arteries were found in 11 patients (10.3%). Accessory renal inferior polar arteries were the most common type of multiple renal arteries. Multiple renal arteries acting as the feeding arteries to the RCC were found in five patients (4.7%). Conclusion CTA can be used as part of the preoperative evaluation prior to laparoscopic nephrectomy to provide anatomical information about the presence of multiple renal arteries in the affected kidney of patients with RCC. This could help with planning the surgery and reducing surgical complications.
Collapse
Affiliation(s)
- Wen-Hua Guan
- Department of Radiology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan Province, China
| | - Yan Han
- Department of Radiology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan Province, China
| | - Xuan Zhang
- Department of Radiology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan Province, China
| | - Dian-Shen Chen
- Department of Radiology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan Province, China
| | - Zhong-Wei Gao
- Department of Urology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan Province, China
| | - Xiao-Shan Feng
- Department of Oncology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan Province, China
| |
Collapse
|
|
9
|
George AK, Herati AS, Srinivasan AK, Rais-Bahrami S, Waingankar N, Sadek MA, Schwartz MJ, Okhunov Z, Richstone L, Okeke Z, Kavoussi LR. Perioperative outcomes of off-clamp vs complete hilar control laparoscopic partial nephrectomy. BJU Int 2012; 111:E235-41. [PMID: 23130741 DOI: 10.1111/j.1464-410x.2012.11573.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Arvin K George
- The Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, NY 11040, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
10
|
Hagiwara M, Miyajima A, Hasegawa M, Jinzaki M, Kikuchi E, Nakagawa K, Oya M. Visceral obesity is a strong predictor of perioperative outcome in patients undergoing laparoscopic radical nephrectomy. BJU Int 2012; 110:E980-4. [DOI: 10.1111/j.1464-410x.2012.11274.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
|
11
|
Current Practice Patterns in the Surgical Management of Renal Cancer in the United States. Urol Clin North Am 2012; 39:149-60, v. [DOI: 10.1016/j.ucl.2012.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
|
12
|
Rais-Bahrami S, George AK, Herati AS, Srinivasan AK, Richstone L, Kavoussi LR. Off-clamp versus complete hilar control laparoscopic partial nephrectomy: comparison by clinical stage. BJU Int 2011; 109:1376-81. [DOI: 10.1111/j.1464-410x.2011.10592.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
|
13
|
|
|
14
|
[Laparoscopic partial nephrectomy]. Actas Urol Esp 2011; 35:487-93. [PMID: 21641090 DOI: 10.1016/j.acuro.2011.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 03/21/2011] [Accepted: 03/29/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To analyze the surgical and oncologic outcome of prospective experience with laparoscopic partial nephrectomy. We describe the surgical technique and mid term oncological results achieved. MATERIAL AND METHODS 60 patients were operated with this technique between June 2005 and June 2009. The mean age of patients was 58.9 [38-77] years, being 40 (66.7%) males and 20 (33.3%) women. The average BMI was 26.8 [18-40]. Laterality was 28 (46.7%) tumors rights and 32 (53.3%) left, being located in the upper pole in 14 (23.3%) patients, in the middle third in 13 (21.7%) in the lower pole in 22 (36.7%) and hiliar region in 11 (18.3%). In 23 cases (38.3%) tumors were located in the anterior valve, in 24 (40%) in posterior valve, in 10 (16.7%) at the outer edge and 3 (5%) at the inner edge. The average size tumor on CT was 3.3 [1-6.4] cm and in the surgical specimen 3.1 [1.2-7] cm. RESULTS The mean operative time was 107.17 [50-185] min, with a warm ischemia time of 33 [0-70] min. In 56 cases (93.3%) had a single artery and 4 (6.7%) cases had 2 arteries. The artery was clamped alone in 15 patients (25%), artery and vein in 44 (73.3%) and no clamping was performed in 1 (1.7%). We repaired the urinary tract in 32 patients (53.3%), leaving ureteral catheter in all patients. 20% of patients (12) required transfusion. Intraoperative complications occurred in 5 patients (8.7%). These were: 1 splenic injury requiring splenectomy (1.7%), 1 tear in the vena cava, sutured laparoscopically (1.7%) and 3 cases of bleeding due to bulldog malfunction (5%). Postoperative complications occurred in 11 patients (18.7%) and these were: 1 wall hematoma that required reoperation (1.7%), 1 urinary fistula ending in renal atrophy and subsequent nephrectomy (1.7%), 3 intracavitary hematomas hich resolved conservatively (5%), 1 arteriovenous fistula that needed embolization (1.7%), 1 urinoma that was resolved with percutaneous drainage (1.7%) and 3 cases of postoperative fever (5%). Margins were positive in 1 patient (1.7%). In 49 cases (81.7%) histology was renal cell carcinoma, in 8 (13.3%) oncocytoma, in 2 (3.3%) angiomyolipoma and 1 (1.7%) metastasis. The average stay was 5 [3-29] days. Median follow up was 31 [12-61] months. There was a local recurrence at 16 months (hiliar primary tumor 2.5 cm) and an ipsilateral adrenal metastasis at 34 months (primary tumor 5.6 cm in left lower pole). CONCLUSIONS In this series of laparoscopic partial nephrectomy low rate of complications, good oncologic results and low recurrence rate in the short term are shown. More patients and further monitoring is required to strengthen the functional and oncological outcomes of this surgical technique.
Collapse
|
|
15
|
Abstract
Objectives: To report the advances in laparoscopic partial nephrectomy (LPN) for renal masses with emphasis on technically challenging cases. Methods: Literature in the English language was reviewed using the National Library of Medicine database using the key words kidney, renal, tumor, nephron sparing surgery, and laparoscopic partial nephrectomy, for the period between 1993 and 2009. Over 500 articles were identified. A total of 50 articles were selected for this review based on their relevance to the evolution of the technique and outcomes, as well as expanding indications for LPN. Results: In expert hands, LPN is safe and effective for central tumors, completely intrarenal tumors, hilar tumors, tumor in a solitary kidney, large tumors requiring heminephrectomy, cystic tumors, multiple tumors, obese patients, and even incidental stage ≥ pT2 tumors. Perioperative outcomes and 5-year oncologic outcomes after LPN are comparable to open partial nephrectomy (OPN). Conclusions: In experienced hands indications for LPN have expanded significantly. In 2009, advanced LPN remains a skill-intensive procedure that can nevertheless provide excellent outcomes for patients with renal tumors.
Collapse
Affiliation(s)
- Monish Aron
- Center for Laparoscopic and Robotic Surgery, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | |
Collapse
|
|
16
|
|
|
17
|
Hagiwara M, Miyajima A, Matsumoto K, Kikuchi E, Nakagawa K, Oya M. Benefit of Laparoscopic Radical Nephrectomy in Patients with a High BMI. Jpn J Clin Oncol 2010; 41:400-4. [DOI: 10.1093/jjco/hyq179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
|
18
|
Park DS, Jang WK. Secure reconstruction technique after partial nephrectomy irrespective of tumor size and location. Int Braz J Urol 2009; 35:416-26. [DOI: 10.1590/s1677-55382009000400004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2009] [Indexed: 11/22/2022] Open
|
|
19
|
Zam NABM, Tan YH, Sunga PAL, Yip SKH, Cheng CWS. Laparoscopic Partial Nephrectomy for Renal Tumours: Early Experience in Singapore General Hospital. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n7p576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction: To review the perioperative and short-term outcome of all laparoscopic partial nephrectomies (LPN) performed in a single institution.
Materials and Methods: Thirteen consecutive patients who underwent LPN since the beginning of the programme in March 2002 to January 2008 were enrolled. Demographic, perioperative and follow-up data were retrospectively collected. Transperitoneal approach was used in all cases, and vascular control was achieved with the use of a laparoscopic Satinsky clamp or vascular tape. The tumour was excised using cold scissors. Transected intrarenal vessels were suture ligated and the parenchymal defect was closed primarily with absorbable suture over a bolster.
Results: Thirteen patients underwent a total of 14 LPN. The median age of patients was 60 years (range, 41 to 77). The mean tumour size was 24 ± 11.4 (2SD) mm. The mean operative time was 228 ± 129 (2SD) minutes and median warm ischaemia time was 35 minutes (range, 24 to 68). Postoperatively, serum haemoglobin level decreased by a mean of 1.4 ± 2.5 (2SD) gm/dL and serum creatinine increased by a mean of 22.5 ± 25.8 (2SD) umol/L. Twelve out of 13 (92%) patients achieved their baseline serum creatinine level within 1 month postoperatively. There was 1 open conversion (7%), and 2 patients (14%) required blood transfusion perioperatively. Two patients (14%) had transient fever postoperatively due to basal atelectasis. No other complications were encountered. Median patient hospital stay was 4 days (range, 2 to 10). Eleven out of 14 (79%) of the tumours were renal cell carcinoma (RCC). At a median follow-up of 12 months (range, 6 to 53), all except 1 patient with RCC were disease-free.
Conclusions: Our experience has shown that laparoscopic partial nephrectomy is a safe, feasible technique in our centre for patients with small exophytic renal tumours. Patients can be discharged early with preservation of renal function and good early cancer control.
Collapse
|
|
20
|
Complications of laparoscopic partial nephrectomy. World J Urol 2008; 26:531-7. [PMID: 18846378 DOI: 10.1007/s00345-008-0334-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 09/16/2008] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To review the current evidence about laparoscopic partial nephrectomy (LPN) and its complications to define the role of this technique and to demonstrate specific operative modifications developed in a high volume laparoscopy centre. METHODS The most recent literature was reviewed based on a PubMed search to evaluate the current types and rates of surgical complications following laparoscopic partial nephrectomy. Own data and experiences were added. Particular alert was dedicated to detailed operative knowledge to avoid typical pitfalls. RESULTS LPN is still a challenging option for treatment of small renal cell cancer (RCC) and the technique is under development. The intermediate-term functional and oncological results of LPN can compete with the standard options at least in laparoscopy dedicated centres. The learning curve has to be considered because of its great impact on the reduction of the risk of complications. Advantages of LPN are less blood loss, shorter hospital stay and less blood loss. A careful case selection is required in reliance on the surgeons; experience. CONCLUSION LPN is an additional but still challenging option for selected cases of RCC, which should be managed by the hands of experienced surgeons. Respecting these restrictions LPN has been shown to be equivalent to open partial nephrectomy. Distinctive attention has to be dedicated for improvement and standardization of operative techniques to decrease the learning curve of future users.
Collapse
|
|
21
|
|
|
22
|
Janetschek G. Rebuttal. J Endourol 2008. [DOI: 10.1089/end.2008.9774a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Günter Janetschek
- Dept of Urology, Elisabethinen Hospital, Fadingerstr. 1, 4010-Linz, Austria E-mail:
| |
Collapse
|
|
23
|
Jeon SS, Kim IY. Laparoscopic Partial Nephrectomy without Hilar Control. J Endourol 2008; 22:1937-9; discussion 1941-2. [DOI: 10.1089/end.2008.9773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Urologic Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Isaac Yi Kim
- Division of Urologic Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| |
Collapse
|
|
24
|
Lattouf JB, Beri A, D'Ambros OF, Grüll M, Leeb K, Janetschek G. Laparoscopic Partial Nephrectomy for Hilar Tumors: Technique and Results. Eur Urol 2008; 54:409-16. [DOI: 10.1016/j.eururo.2008.04.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 04/02/2008] [Indexed: 10/22/2022]
|
|
25
|
|
|
26
|
Turna B, Aron M, Frota R, Desai MM, Kaouk J, Gill IS. Feasibility of laparoscopic partial nephrectomy after previous ipsilateral renal procedures. Urology 2008; 72:584-8. [PMID: 18579185 DOI: 10.1016/j.urology.2008.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 02/24/2008] [Accepted: 04/01/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Previous renal surgery has been considered a relative contraindication to laparoscopic partial nephrectomy (LPN) because of perirenal surgical adhesions. We present our experience with LPN in patients with previous ipsilateral renal surgery. METHODS Of 679 patients undergoing LPN for a renal mass from September 1999 to November 2006, 25 (3.7%) had undergone previous ipsilateral open or percutaneous renal procedures. The LPN technique included hilar clamping, cold tumor excision, and sutured renal reconstruction. The perioperative outcomes were retrospectively analyzed from a prospectively maintained database. RESULTS Previous renal surgery included open surgery in 12 patients (nephro/pyelolithotomy in 8, pyeloplasty in 2, and partial nephrectomy in 2) and percutaneous surgery in 13 (percutaneous nephrolithotomy in 9 and renal biopsy in 4). The mean interval from previous surgery was 6.6 years (range 0.3-34). LPN (16 transperitoneal and 9 retroperitoneal) was successful in all patients. The mean tumor size was 2.5 cm (range 1-5.6), the warm ischemia time was 35.8 minutes (range 22-57), and the estimated blood loss was 215 mL (range 25-600). The mean operative time was 3 hours (range 1.5-4.5), and the hospital stay was 3.1 days (range 1-7.6). Histopathologic examination confirmed renal cell carcinoma in 19 patients (76%). No open conversions were needed, and no kidneys were lost. No intraoperative complications and 3 postoperative complications (12%) developed, including blood transfusion in 1, nausea and epistaxis in 1, and compartment syndrome requiring fasciotomy in 1 patient. CONCLUSIONS The results of our study have shown that, in select patients, LPN is feasible after previous ipsilateral renal surgery. However, it can be technically challenging, and adequate previous experience with LPN is necessary.
Collapse
Affiliation(s)
- Burak Turna
- Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | | | |
Collapse
|
|
27
|
Reichelt O, Borkowetz A, Chyhrai A, Tanovic E, Weirich T, Müller T, Schubert H, Schubert J. Vorbereitung zur klinischen Etablierung fortgeschrittener urologischer Operationstechniken. Urologe A 2008; 47:1339-46. [DOI: 10.1007/s00120-008-1764-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
|
28
|
Verhoest G, Crepel M, Bernhard JC, Bellec L, Albouy B, Lopes D, Lacroix B, De La Taille A, Salomon L, Pfister C, Soulié M, Tostain J, Ferrière JM, Abbou C, Colombel M, Vincendeau S, Bensalah K, Manunta A, Guillé F, Patard JJ. Élargir les indications de la néphrectomie partielle induit-il un surcroît de morbidité ? Prog Urol 2008; 18:207-13. [DOI: 10.1016/j.purol.2008.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 02/25/2008] [Indexed: 11/25/2022]
|
|
29
|
Rubinstein M, Moinzadeh A, Colombo JR, Favorito LA, Sampaio FJ, Gill IS. Energy sources for laparoscopic partial nephrectomy--critical appraisal. Int Braz J Urol 2007; 33:3-10. [PMID: 17335592 DOI: 10.1590/s1677-55382007000100002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2006] [Indexed: 11/21/2022] Open
Abstract
Laparoscopic partial nephrectomy (LPN) has emerged as a viable alternative for the conventional open nephron-sparing surgery (NSS). So far, an adequate renal parenchymal cutting and hemostasis, as well as caliceal repair remains technically challenging. Numerous investigators have developed techniques using different energy sources to simplify the technically demanding LPN. Herein we review these energy sources, discussing perceived advantages and disadvantages of each technique.
Collapse
Affiliation(s)
- Mauricio Rubinstein
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | |
Collapse
|
|
30
|
Li CC, Chou YH, Wu WJ, Shih MC, Juan YS, Shen JT, Liu CC, Huang SP, Huang CH. Laparoscopic Partial Nephrectomy: The Effect of Preoperative Tumor Embolization. Kaohsiung J Med Sci 2007; 23:624-30. [DOI: 10.1016/s1607-551x(08)70061-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
|
31
|
Verhoest G, Manunta A, Bensalah K, Vincendeau S, Rioux-Leclercq N, Guillé F, Patard JJ. Laparoscopic Partial Nephrectomy with Clamping of the Renal Parenchyma: Initial Experience. Eur Urol 2007; 52:1340-6. [PMID: 17498865 DOI: 10.1016/j.eururo.2007.04.072] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 04/24/2007] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Partial nephrectomy by laparoscopy offers patients conservative surgery and a mini-invasive approach; however, clamping of the renal pedicle and the induced warm ischaemia can damage the renal parenchyma. We present a technique of laparoscopic partial nephrectomy with haemostasis obtained by clamping of the renal parenchyma. METHODS The procedure was performed by an intraperitoneal or a retroperitoneal approach. After a working space is created by pneumodissection, Gerota's fascia is incised and the kidney convexity is dissected. An endoscopic Satinsky clamp is inserted percutaneously through a 1-cm incision. The renal parenchyma is clamped and the tumour is excised in a bloodless field. The cut renal parenchyma is coated with biologic glue. RESULTS Five patients with elective indications were operated. Mean age was 67.8 yr and mean tumour diameter 3.06 cm. One lesion was located at the upper pole and four at the lower pole. Mean preoperative serum creatinine level was 10.9 mg/l. Postoperative serum creatinine level was unchanged. Mean operative time was 238 min. There was no conversion. Mean blood loss was 250 ml; no transfusions were necessary. The collecting duct system was repaired in one patient. No complication was noticed. Resection margins were tumour free in all cases. Final pathologic examination revealed clear cell carcinoma in three cases and angiomyolipoma and oncocytoma in one case each. CONCLUSION Laparoscopic partial nephrectomy with clamping of the renal parenchyma can be performed in selected patients with peripherally placed tumours. The procedure avoids warm ischaemia of the normal parenchyma while allowing the surgeon to operate in an almost bloodless field. This initial experience in five patients should be validated in a larger series.
Collapse
Affiliation(s)
- Grégory Verhoest
- Department of Urology, Rennes University Hospital, Rennes Cedex, France
| | | | | | | | | | | | | |
Collapse
|
|
32
|
Bensalah K, Zeltser I, Tuncel A, Cadeddu J, Lotan Y. Evaluation of costs and morbidity associated with laparoscopic radiofrequency ablation and laparoscopic partial nephrectomy for treating small renal tumours. BJU Int 2007; 101:467-71. [PMID: 17922853 DOI: 10.1111/j.1464-410x.2007.07276.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the costs and morbidity of laparoscopic radiofrequency ablation (LRFA) and laparoscopic partial nephrectomy (LPN) for treating small localized renal tumours. PATIENTS AND METHODS We retrospectively analysed the outcomes of 88 patients treated at our institution for a renal tumour either by LPN (50) or LRFA (38) between March 2000 and May 2006. Patients with multiple tumours, combined LRFA and LPN, and those who had other simultaneous surgical procedures were excluded. Clinical variables and outcomes were analysed for each patient. Direct cost data were available for 40 patients treated with LPN and 14 with LRFA. Continuous and categorical variables were compared using an independent t-test and chi-square test, respectively. RESULTS The tumour size was comparable in each group; patients in the LRFA group had more comorbidities (P = 0.01) and a higher overall mortality rate (P = 0.01) but no patient died from cancer. Operative duration, estimated blood loss and length of stay were significantly shorter in the LRFA group but there was no difference in complication rate. LRFA was less costly than LPN ($6103 vs $6808, P = 0.3) but not statistically significantly. The cost savings from the shorter operative duration and length of stay were reduced by the cost of probe. With a median follow-up of 20 months there was no difference in oncological outcome. CONCLUSION Patients undergoing LRFA tend to be older and have more comorbidities than those treated with LPN. The cost is minimally lower for LRFA, secondary to the added cost of the probe. LRFA might be a good alternative treatment in patients at higher risk of surgical complications, but LPN provides good results when done by an experienced surgeon.
Collapse
Affiliation(s)
- Karim Bensalah
- Department of Urology, University of Texas South-western Medical Center at Dallas, Dallas, Texas 75390-9110, USA
| | | | | | | | | |
Collapse
|
|
33
|
Patard JJ, Pantuck AJ, Crepel M, Lam JS, Bellec L, Albouy B, Lopes D, Bernhard JC, Guillé F, Lacroix B, De La Taille A, Salomon L, Pfister C, Soulié M, Tostain J, Ferriere JM, Abbou CC, Colombel M, Belldegrun AS. Morbidity and Clinical Outcome of Nephron-Sparing Surgery in Relation to Tumour Size and Indication. Eur Urol 2007; 52:148-54. [PMID: 17240036 DOI: 10.1016/j.eururo.2007.01.039] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 01/09/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyse through a large multicentre series, morbidity of nephron-sparing surgery (NSS) in relation to tumour size and surgical indication. METHODS The study included patients from eight international academic centres. Age, sex, TNM stage, tumour size, Fuhrman grade, Eastern Cooperative Oncology Group performance status (ECOG-PS), surgical margins, local and distant recurrences, and overall and cancer-specific survival rates were collected and analysed. Indication for elective or mandatory NSS, medical and surgical complication rates, mean blood loss, blood transfusion, and length of hospital stay were specifically recorded for the purpose of this study. Groups were compared for qualitative and quantitative variables by using chi(2) (Fischer exact test) and Student t tests, respectively. RESULTS A total of 1048 NSS procedures were included in this study. Mean tumour size was 3.4+/-2.1cm. In 730 elective procedures mean operative time (p=0.002), mean blood loss (p=0.01), the need for blood transfusion (p=0.001), and urinary fistula rate (p=0.01) were significantly increased for tumours >4 cm. However, these differences did not result in significantly increased medical (p=0.4), surgical complication rates (p=0.6), or length of hospital stay (p=0.9). Finally, in elective procedures for malignant tumours, positive surgical margins, local or distant recurrence rates, and cancer-specific survival were not significantly different in tumours < or =4 cm and >4 cm. CONCLUSION Excellent cancer control and outcomes can be achieved with NSS in carefully selected patients with tumours >4 cm. Expanding the size indication of elective NSS results in an increased but acceptable morbidity.
Collapse
|
|
34
|
|
|
35
|
Abstract
After initial scepticism laparoscopic radical nephrectomy has rapidly been developed to a standard of care which should be offered to all patients as an alternative to open surgery. This procedure is indicated for all renal tumours clinical stage 1-2 which are not considered for partial nephrectomy. Many studies now show that the oncologic outcome is good and comparable to open surgery. Follow-up, however, is limited to about 10 years. Laparoscopic radical nephrectomy has become a standardized procedure. Removal of the kidney by morcellation, favoured by the majority some time ago, has been abandoned to a great extent. Also the controversy about the advantages and disadvantages of the respective approach has been settled. Several prospective randomized studies proved that both the transperitoneal and retroperitoneal approaches are equally effective. Excluding the bias of the learning curve the complication rate of laparoscopy is not higher than that of open surgery, but morbidity is clearly lower. Since the rate of elective partial nephrectomy is increasing rapidly, laparoscopy may be a good choice for this indication as well. When performed during ischaemia all principles of open surgery--excision of the tumour with clear margins, haemostasis using sutures, closure of the collecting system, suture repair of the renal parenchyma--can be duplicated. The problem of long warm ischaemia time can be managed by the evolution of the surgical technique, but also by induction of hypothermia. Complication rates are comparable to open surgery. Oncologic results, with limited follow-up however, are promising.
Collapse
Affiliation(s)
- G Janetschek
- Abteilung für Urologie, Krankenhaus der Elisabethinen, Fadingerstrasse 1, A-4010 Linz.
| |
Collapse
|
|
36
|
Marberger M, Janetschek G. [Renal cell carcinoma--developments in therapy]. Urologe A 2007; 46:475-7. [PMID: 17426953 DOI: 10.1007/s00120-007-1331-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M Marberger
- Klinik für Urologie, Medizinische Universität, Währinger Gürtel 18-20, A-1090 Wien.
| | | |
Collapse
|
|
37
|
Gallucci M, Guaglianone S, Carpanese L, Papalia R, Simone G, Forestiere E, Leonardo C. Superselective Embolization as First Step of Laparoscopic Partial Nephrectomy. Urology 2007; 69:642-5; discussion 645-6. [PMID: 17445641 DOI: 10.1016/j.urology.2006.10.048] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 08/02/2006] [Accepted: 10/05/2006] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Laparoscopic partial nephrectomy is currently very hard to perform because of the great difficulty in obtaining renal parenchymal hemostasis during tumor excision and the consequent high risk of bleeding. The aim of this study was to propose a method to decrease the risk of bleeding, consisting of the superselective embolization of tumor vessels before performing the laparoscopic partial nephrectomy. METHODS Fifty patients with small, solitary, enhancing, predominantly exophytic renal tumors underwent a superselective radiographically guided embolization of tumor vessels. An average of 6 hours after embolization, the patients underwent partial laparoscopic nephrectomy, with transperitoneal access and three trocars placed, under balanced general anesthesia. The mean operative time was measured, as was the mean estimated blood loss. RESULTS The mean operative time was 90 minutes, the mean estimated blood loss was 200 mL, and the average hospital stay was 6 days. Complications were reported in only 2 patients. The final pathologic evaluation confirmed the diagnosis of renal cell carcinoma in 43 cases. The median follow-up was 11 months and, to date, the examinations have revealed no recurrences in any of the cases. CONCLUSIONS Superselective embolization is a valid option for laparoscopic partial nephrectomy. The procedure does not require any regional vascular control or clamping, reduces the estimated blood loss, and reduces the operative time.
Collapse
Affiliation(s)
- Michele Gallucci
- Department of Urology, Regina Elena Cancer Institute, Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
|
38
|
Aron M, Gill IS. Minimally Invasive Nephron-Sparing Surgery (MINSS) for Renal Tumours. Eur Urol 2007; 51:337-46; discussion 46-7. [PMID: 17095144 DOI: 10.1016/j.eururo.2006.10.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2006] [Accepted: 10/11/2006] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To review the evolution and current status of extirpative methods (laparoscopic partial nephrectomy [LPN]) of minimally invasive nephron-sparing surgery (MINSS) for renal tumors. METHODS The English language literature of the past 10 yr was reviewed by using the National Library of Medicine database and the following keywords: kidney, laparoscopic partial nephrectomy, minimally invasive, nephron-sparing surgery, renal, and tumor. Over 275 papers were identified. Of these, 55 papers were selected for this review on the basis of their contribution in advancing the field with regards to (1) evolution of concepts, (2) development and refinement of techniques, and (3) intermediate- and long-term clinical outcomes of LPN. RESULTS Open partial nephrectomy (OPN) is the reference standard for nephron-sparing surgery against which all MINSS techniques should be measured. With available skills for time-sensitive intracorporeal suturing, LPN provides perioperative results and long-term oncologic and functional outcomes comparable to the reference standard, with significantly decreased patient morbidity. The initial 5-yr data of 50 patients has just become available, and shows overall and cancer-specific survival of 84% and 100%, respectively. As global experience with this technique increases, data need to be prospectively accrued, and long-term cancer cure rates should be compared with the reference standard. CONCLUSIONS As of this writing, the technique and global acceptance of LPN is evolving, although it remains restricted by the complexity of laparoscopic renal reconstruction. In expert hands, cancer cure and renal function outcomes are similar to OPN.
Collapse
Affiliation(s)
- Monish Aron
- Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, United States
| | | |
Collapse
|
|
39
|
Kim TH, Cho WY, Kwak JJ, Yoon JH, Sung GT. Comparison of Laparoscopic Radical Nephrectomy with Open Radical Nephrectomy. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.3.259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Tae Hyo Kim
- Department of Urology, College of Medicine, Dong-A University, Busan, Korea
| | - Won Yeol Cho
- Department of Urology, College of Medicine, Dong-A University, Busan, Korea
| | - Jae Jin Kwak
- Department of Urology, College of Medicine, Dong-A University, Busan, Korea
| | - Jin Han Yoon
- Department of Urology, College of Medicine, Dong-A University, Busan, Korea
| | - Gyung Tak Sung
- Department of Urology, College of Medicine, Dong-A University, Busan, Korea
| |
Collapse
|
|
40
|
Abukora F, Albqami N, Nambirajan T, Ziegerhofer J, Leeb K, Janetschek G. Long-Term Functional Outcome of Renal Units after Laparoscopic Nephron-Sparing Surgery under Cold Ischemia. J Endourol 2006; 20:790-3. [PMID: 17094756 DOI: 10.1089/end.2006.20.790] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Renal-artery occlusion is used to control bleeding during laparoscopic nephronsparing surgery, but there are worries about ischemic damage. We compared the functional outcomes of kidneys treated under warm and cold ischemia. PATIENTS AND METHODS Twelve patients treated with warm ischemia and 14 treated with cold ischemia had renal function investigation 3 to 6 months postoperatively. Four and ten patients, respectively, also had preoperative studies. RESULTS In patients treated with warm ischemia, two kidneys had evidence of possible damage, but the kidney with the longest ischemia (56 minutes) was normal. Among patients treated with cold ischemia, function was lost in one case. Parenchymal transit time was prolonged in five patients, but in four cases, this probably was attributable to performance of a contrast-enhanced CT scan the same day. In the fifth patient, an ischemic injury is possible. CONCLUSION The parenchymal transit time is a good indicator of ischemic damage. Nephron-sparing surgery can lead to damage even if the ischemia time is short and cold ischemia is used. More data are needed on the factors determining such injury.
Collapse
Affiliation(s)
- Firas Abukora
- Department of Urology, Elizabethinen Hospital, Linz, Austria.
| | | | | | | | | | | |
Collapse
|
|
41
|
Berdjis N, Hakenberg OW, Leike S, Zastrow S, Manseck A, Oehlschläger S, Wirth MP. Comparison of Transperitoneal versus Retroperitoneal Approach in Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma: A Single-Center Experience of 63 Cases. Urol Int 2006; 77:166-9. [PMID: 16888424 DOI: 10.1159/000093913] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Accepted: 03/09/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND We report our experience with the retroperitoneal (RP) and transperitoneal (TP) approaches for laparoscopic nephrectomy for clinically localized renal cell carcinoma. METHODS Sixty-three patients with renal cell carcinoma were treated with laparoscopic nephrectomy, 34 by TP and 29 by RP approach between June 1999 and June 2003. Average age, ASA score, tumor stage and tumor size were similar in both groups. Early complications within 30 days and surgical time were retrospectively reviewed. RESULTS Surgical time was with a mean of 183 and 190 minutes equal for the TP and RP approach. Intraoperative complications occurred in 4 patients and were vascular, requiring blood transfusion in 2 patients each per group. Postoperative complications were thromboembolism in 1 patient and subcutaneous seroma in 1 patient, both in the TP group. CONCLUSIONS Although the sample size is small, it appears that the tumor control and surgical time in laparoscopic nephrectomy are not significantly influenced by the approach.
Collapse
Affiliation(s)
- Navid Berdjis
- Department of Urology, Technical University Dresden, Dresden, Germany
| | | | | | | | | | | | | |
Collapse
|
|
42
|
Oakley NE, Hegarty NJ, McNeill A, Gill IS. Minimally invasive nephron-sparing surgery for renal cell cancer. BJU Int 2006; 98:278-84. [PMID: 16879665 DOI: 10.1111/j.1464-410x.2006.06183.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Neil E Oakley
- Department of Urology, The Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire, S10 2JF, UK.
| | | | | | | |
Collapse
|
|
43
|
Venkatesh R, Weld K, Ames CD, Figenshau SR, Sundaram CP, Andriole GL, Clayman RV, Landman J. Laparoscopic partial nephrectomy for renal masses: effect of tumor location. Urology 2006; 67:1169-74; discussion 1174. [PMID: 16765174 DOI: 10.1016/j.urology.2006.01.089] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2005] [Revised: 11/06/2005] [Accepted: 01/01/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To report our single institutional experience of laparoscopic partial nephrectomy (LPN) for enhancing renal masses and evaluate outcomes and histopathologic findings with respect to the location of the renal mass. METHODS A retrospective review of LPN for 123 renal masses completed by 7 urologists was performed. Of these lesions, 49 (40%) were exophytic, 19 (15.5%) endophytic, 47 (38%) mesophytic, and 8 (6.5%) were hilar. We defined exophytic as more than 60%, mesophytic as 40% to 60%, and endophytic as less than 40% of the renal mass protruding off the surface of the kidney on radiologic imaging studies. Hilar lesions were those located within 5 mm of the renal hilar structures, regardless of the surface characteristics. RESULTS The mean tumor size was 2.6 cm (range 1 to 9). Hilar vessel clamping was performed during 55 procedures (44.7%); the mean warm ischemia time was 27 minutes (range 12 to 52). On final histopathologic examination, 3 patients (2.5%) had positive tumor resection margins. Overall, 26 (20.6%) complications occurred. The complication rate was significantly less for patients who underwent LPN for an exophytic (10%) or a mesophytic (12.8%) mass than for those with an endophytic (47%) or a hilar (50%) mass. Histopathologic examination of the renal masses revealed malignant pathologic features in 86 (69%) and benign findings in 37 (31%). In our series, only 55% of exophytic tumors were malignant and, if malignant, were invariably low grade (96%). CONCLUSIONS The complications of LPN and the malignancy rate of the renal lesions were related to the tumor location within the kidney.
Collapse
Affiliation(s)
- Ramakrishna Venkatesh
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
| | | | | | | | | | | | | | | |
Collapse
|
|
44
|
Porpiglia F, Renard J, Billia M, Morra I, Scoffone C, Cracco C, Tarabuzzi R, Terrone C, Scarpa RM. Left laparoscopic radical nephrectomy with direct access to the renal artery: technical advantages. Eur Urol 2006; 49:1004-10. [PMID: 16563609 DOI: 10.1016/j.eururo.2006.02.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 02/14/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the technical advantages of early ligature of the renal artery at the level of the Treitz ligament during left laparoscopic radical nephrectomy (LRN). MATERIAL AND METHODS Twenty-six patients underwent LRN for organ-confined lesions. We grouped measured parameters (see Results) on the basis of the first 13 and last 13 patients, and compared both subgroups. All parameters were correlated to stage of disease (pT1 vs pT2-3). The Student t test was used for statistical analysis. RESULTS The mean (range) for measured parameters are as follows: age: 56.5 +/- 11.6 (41-77) years; American Society of Anesthesiologists score: 2.4 +/- 1 (1-3); body mass index: 23.4 +/- 3.4 (21.1-33); lesion size at computed tomography: (6.2 +/- 2.4 (4-12) cm; operative skin to skin time: 130 +/- 20 (125-170) minutes; blood loss: 255 +/- 120 (100-800) ml; hospital stay: 6.5 +/- 2.0 (4-15) days; analgesic consumption (Tramadol 100 mg): 2.5 +/- 1 (2-4) vials; follow-up time: 30.5 +/- 5.6 (3-48) months. No intra-operative complications occurred. Pathologic analysis showed 12 pT1N0, five pT2N0, eight pT3aN0 and one pT3b N2 with mean lesion size of 6.2 +/- 1.6 (4-13) cm. Mean number of removed lymph nodes was 9.8 +/- 1.6 (7-17). No statistical difference was observed between the two subgroups (p > 0.05), and between pT1 and pT2-3 stage (p > 0.05) groups. CONCLUSIONS Early ligature using direct access to the renal artery at the Treitz ligament permits the surgeon to follow the classic steps and principles of radical nephrectomy.
Collapse
Affiliation(s)
- Francesco Porpiglia
- Department of Urology, University of Turin, San Luigi Hospital, Orbassano (TO), Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
45
|
|
|
46
|
Abstract
The indication of laparoscopic partial nephrectomy (LPN) has evolved considerably, and the technique is approaching established status at our institution. Over the past 5 years, the senior author has performed more than 450 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique, review contemporary data and oncological outcomes of LPN.
Collapse
Affiliation(s)
- J R Colombo
- Sección de Cirugía Laparoscópica y Robótica, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | | |
Collapse
|
|
47
|
Lee YS, Lee YH, Han WK, Soh BH, Yang SC, Rha KH. Laparoscopic Transperitoneal Radical Nephrectomy for Treating of Renal Cell Carcinoma. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.9.968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yong Seong Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hoon Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Heon Soh
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Choul Yang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
|
48
|
Weld KJ, Landman J. Comparison of cryoablation, radiofrequency ablation and high-intensity focused ultrasound for treating small renal tumours. BJU Int 2005; 96:1224-9. [PMID: 16287435 DOI: 10.1111/j.1464-410x.2005.05848.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kyle J Weld
- Division of Urology, Washington University, St. Louis, MO, USA
| | | |
Collapse
|
|
49
|
Porpiglia F, Terrone C, Cracco C, Renard J, Musso F, Grande S, Scarpa RM. Direct Access to the Renal Artery at the Level of Treitz Ligament during Left Radical Laparoscopic Transperitoneal Nephrectomy. Eur Urol 2005; 48:291-5. [PMID: 15939529 DOI: 10.1016/j.eururo.2005.03.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Accepted: 03/22/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe and demonstrate the feasibility of early ligature of the renal artery using a direct access to the renal pedicle at the level of the Treitz ligament during left transperitoneal radical laparoscopic nephrectomy. MATERIALS AND METHODS A total of 42 patient underwent left transperitoneal radical laparoscopic nephrectomies from February 2001 to July 2004. In the first consecutive 27 patients (Group A) we performed early ligature with the standard technique; in the last consecutive 15 patients (Group B) we attempted the early ligature with direct access to the renal artery at the level of the Treitz ligament. Comparative analysis was carried out between the two groups examining operative times, blood loss, intra and post operative complications, postoperative stay. RESULTS No difference was noted in gender, age and size of the lesions (6.2 versus 6.25 cm respectively, p = 0.9) in the two groups. In 12/15 (80%) of Group B cases we successfully identified and ligated the renal artery at the level of the Treitz ligament. In the other 3 cases (20%) we were constrained to revert to the more common laparoscopic approach. Mean Operative times were 131' in group A versus 137' in group B (p = 0.15). The time required to find the renal artery at the level of Treitz ligament in group B was 16' (15'-30'). No differences were noted between the two groups in terms of blood loss (222 cc versus 268 ml, p = 0.4), intraoperative and postoperative complications (p = 0.6), postoperative stay (5 days in the two groups, p = 0.9). Mean follow-up was average 24 months (15-48) in Group A and average 7 months (3-12) in Group B. No complications and no recurrence of disease at CT evaluation were recorded neither in Group A nor in Group B. CONCLUSIONS Radical laparoscopic left side nephrectomy with direct access to the renal artery at the level the Treitz ligament is technically feasible and safe and reproduces the classic principles of radical nephrectomy allowing to perform the procedure without any manipulation of the tumor.
Collapse
Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Clinical and Biological Sciences-University of Turin, "San Luigi" Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.
| | | | | | | | | | | | | |
Collapse
|
|
50
|
Ono Y, Hattori R, Gotoh M, Yoshino Y, Yoshikawa Y, Kamihira O. Laparoscopic radical nephrectomy for renal cell carcinoma: the standard of care already? Curr Opin Urol 2005; 15:75-8. [PMID: 15725928 DOI: 10.1097/01.mou.0000160619.28613.3c] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Laparoscopic radical nephrectomy has been developed and applied for patients with renal cell carcinoma since 1992. The number of patients undergoing laparoscopic radical nephrectomy has increased explosively worldwide in recent years, and laparoscopy is now extended to patients with advanced disease. It is very important to clarify the present status of laparoscopic radical nephrectomy among the treatment modalities for patients with renal cell carcinoma. RECENT FINDINGS Laparoscopic radical nephrectomy has a minimally invasive nature as well as comparable long-term cancer control in patients with pT1-3a renal cell carcinoma to open surgery. It is technically applicable for N1-2 disease and T3b disease if the tumor thrombus is within the renal vein. Also, it is feasible as a cytoreductive surgery for patients with M1 disease. SUMMARY Laparoscopic radical nephrectomy is a standard treatment modality for T1-3a renal cell carcinoma patients. It is also available for treating patients with N1-2 disease, and for patients with M1 disease as a cytoreductive surgery.
Collapse
Affiliation(s)
- Yoshinari Ono
- Department of Urology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya 466-0064, Japan.
| | | | | | | | | | | |
Collapse
|