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Saouli A, Karmouni T, El Khader K, Koutani A, Attya Andaloussi AI. Total clipless laparoscopic nephrectomy carried out with the LigaSure device: Preliminary experience. Prog Urol 2023; 33:344-347. [PMID: 37080876 DOI: 10.1016/j.purol.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 02/24/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Total laparoscopic nephrectomy has become the standard method for the removal of diseased kidneys. OBJECTIVES The purpose of this study was to evaluate the feasibility of the LigaSure vessel closure system during laparoscopic nephrectomy. METHODS From January 2018 to June 2018, the LigaSure device was used in 5 patients undergoing laparoscopic nephrectomy for non functional kidney. Nephrectomy was carried out without the use of clips or sutures for vessel closure. We report intraoperative findings, conversion rates, blood loss, operative time, morbidity, and postoperative outcomes. RESULTS Median operative time was 45minutes (range 25 to 60min). Median blood loss was 30mL (range 10 to 50mL). No conversions to open surgery were necessary. No patients experienced major bleeding intraoperatively or postoperatively. All patients left the hospital one day after the procedure. Histopathological examination of the removed kidneys was in favor of chronic non specific pyelonephritis. CONCLUSIONS For the treatment of the renal pedicle during total laparoscopic nephrectomy of a destroyed kidney, the LigaSure device appears to be feasible and effective. Our experience is the first to demonstrate the advantages of LigaSure® in laparoscopic nephrectomy: reduction in operating time, blood loss, transfusions and length of stay in hospital.
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Affiliation(s)
- Amine Saouli
- Service d'urologie B, CHU Ibn Sina, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Morocco.
| | - Tarik Karmouni
- Service d'urologie B, CHU Ibn Sina, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Morocco
| | - Khalid El Khader
- Service d'urologie B, CHU Ibn Sina, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Morocco
| | - Abdellatif Koutani
- Service d'urologie B, CHU Ibn Sina, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Morocco
| | - Ahmed Iben Attya Andaloussi
- Service d'urologie B, CHU Ibn Sina, faculté de médecine et de pharmacie, université Mohamed V, Rabat, Morocco
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Guo X, Wang H, Xiang Y, Jin X, Jiang S. Comparison of laparoscopic and hand-assisted laparoscopic nephrectomy for inflammatory renal disease: which is the preferred approach? Ther Adv Urol 2021; 13:1756287220984046. [PMID: 33633798 PMCID: PMC7841654 DOI: 10.1177/1756287220984046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/05/2020] [Indexed: 11/21/2022] Open
Abstract
Aims: Management of inflammatory renal disease (IRD) can still be technically challenging for laparoscopic procedures. The aim of the present study was to compare the safety and feasibility of laparoscopic and hand-assisted laparoscopic nephrectomy in patients with IRD. Patients and methods: We retrospectively analyzed the data of 107 patients who underwent laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) for IRD from January 2008 to March 2020, including pyonephrosis, renal tuberculosis, hydronephrosis, and xanthogranulomatous pyelonephritis. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between the LN and HALN groups. Multivariable logistic regression analysis was conducted to identify the independent predictors of adverse outcomes. Results: Fifty-five subjects in the LN group and 52 subjects in the HALN group were enrolled in this study. In the LN group, laparoscopic nephrectomy was successfully performed in 50 patients (90.9%), while four (7.3%) patients were converted to HALN and one (1.8%) case was converted to open procedure. In HALN group, operations were completed in 51 (98.1%) patients and conversion to open surgery was necessary in one patient (1.9%). The LN group had a shorter median incision length (5 cm versus 7 cm, p < 0.01) but a longer median operative duration (140 min versus 105 min, p < 0.01) than the HALN group. There was no significant difference in blood loss, intraoperative complication rate, postoperative complication rate, recovery of bowel function, and hospital stay between the two groups. Multivariable logistic regression revealed that severe perinephric adhesions was an independent predictor of adverse outcomes. Conclusion: Both LN and HALN appear to be safe and feasible for IRD. As a still minimally invasive approach, HALN provided an alternative to IRD or when conversion was needed in LN.
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Affiliation(s)
- Xudong Guo
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hanbo Wang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yuzhu Xiang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xunbo Jin
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677, East Jingshi Road, Jinan, 250014, P.R. China
| | - Shaobo Jiang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677, East Jingshi Road, Jinan, 250014, P.R. China
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Koc G, Ekin GR, Ergani B, Ilbey YO. A comparison of renal vascular control techniques during laparoscopic nephrectomy. J Minim Access Surg 2021; 17:192-196. [PMID: 33723183 PMCID: PMC8083737 DOI: 10.4103/jmas.jmas_287_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: We compared outcomes of en bloc stapler ligation of the renal hilum with separate Hem-o-lok polymer clip ligation of the renal vessels during laparoscopic nephrectomy (LN). Materials and Methods: Clinical data of patients who underwent LN for renal surgery from January 2009 to December 2015 were collected. Operation time, estimated blood loss, device malfunction rate, open conversion rate, complications and arteriovenous fistula (AVF) formation were evaluated. Results: En bloc stapler ligation and separate clip ligation were performed in 64 and 66 patients, respectively. The mean operative time was 106.8 ± 20.8 min (range: 70–165) in the en bloc stapler ligation group compared with 112.5 ± 24.1 min (range: 70–180) in the separate clip ligation group (P = 0.147). The mean estimated blood loss was 141.4 ± 124.1 ml (range: 25–600) in the en bloc stapler ligation group compared with 147.6 ± 112.4 ml (range: 25–450) in the separate clip ligation group (P = 0.767). The open conversion was required in 7/64 (10.9%) and 2/66 (3.0%) patients in the en bloc stapler ligation and separate clip ligation groups, respectively (P = 0.093). Stapler device malfunction occurred in 6 patients (9.3%). There were no statistically significant differences in overall complications (P = 0.726), minor (Grade 1–2) complications (P = 0.698) and major (Grade 3–5) complications (P = 0.716). No patient was diagnosed with AVF formation during overall median 33-month (interquartile range: 30, range: 24–96) follow-up. Conclusions: En bloc stapler ligation of the renal hilum during nephrectomy is an effective and safe technique. Although there is no reported AVF formation with en bloc stapler ligation of the renal hilum, longer follow-up is necessary.
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Affiliation(s)
- Gokhan Koc
- Department of Urology, Tepecik Teaching and Research Hospital, Izmir, Turkey
| | | | - Batuhan Ergani
- Department of Urology, Tepecik Teaching and Research Hospital, Izmir, Turkey
| | - Yusuf Ozlem Ilbey
- Department of Urology, Tepecik Teaching and Research Hospital, Izmir, Turkey
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Liu Y, Wang C, Wu X, Kong L, Ni S. The Harbin Medical University nephrectomy score: a quantitative system for evaluating the complexity of laparoscopic retroperitoneal simple nephrectomy. Int Braz J Urol 2019; 45:1144-1152. [PMID: 31808402 PMCID: PMC6909875 DOI: 10.1590/s1677-5538.ibju.2018.0634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 08/16/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Laparoscopic retroperitoneal simple nephrectomy (LRSN) has been widely accepted as a mainstay option for benign non-functioning kidney. The complexity of the procedure, however, differs and remains a subject of controversy. OBJECTIVE To develop a standardised Harbin Medical University nephrectomy score (HMUNS) system for evaluating LRSN complexity. SUBJECTS AND METHODS A total of 6 variables with different factors comprising primary diseases, history of upper urinary tract surgery, body mass index (BMI), surgeon's learning curve, kidney volume, and Mayo Adhesive Probability (MAP) scores were included in the HMUN score. 95 consecutive patients who underwent LRSN at our institution were divided into low (2 to 6 points) and high (7 to 17 points) complexity groups with HMUNS and investigated the differences of operative time (OT), estimated blood loss (EBL), postoperative hospitalisation time (PHT), rate of intraoperative conversion to open surgery, and the Clavien-Dindo classifi cation (CDC) between both groups. RESULTS Longer mean operative times (193.2±69.3 min vs. 151.9±46.3 min, p <0.05), more median estimated blood loss (100.0mL vs. 50.0mL, p <0.05), and higher rates of conversion to open surgery (1.2% vs. 25%, p <0.05) were observed in the high-complexity group (n=12) than in the low-complexity group (n=83). However, there were no remarkable differences between the two groups related to the baseline characteristics, post-surgical hospitalisation times, and postoperative complications. CONCLUSIONS The HMUNS can effectively reflect LRSN complexity, thus providing a quantitative system for risk estimation and treatment decisions. Because of some limitations, further well-designed studies are necessary to confirm our fi ndings. Patient summary: The HMUNS, including primary diseases, history of upper urinary tract surgery, BMI, surgeon's learning curve, kidney volume, and MAP score, can provide an effective quantitative tool to evaluate the complexity of LRSN.
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Affiliation(s)
- Yiwen Liu
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Chunyang Wang
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Xiuhai Wu
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Linglong Kong
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Shaobin Ni
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
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Huang KC, Lin WR, Chen M, Chiu AW, Chen CW. Does the stapler for en bloc resection of renal pedicles during kidney removal surgery increase the risk of arteriovenous fistula? J Chin Med Assoc 2019; 82:221-224. [PMID: 30908414 DOI: 10.1097/jcma.0000000000000032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It was previously thought that renal hilum en bloc ligation during kidney removal may increase the risk of renal arteriovenous fistula (AVF) formation. We evaluated the safety and effectiveness of en bloc ligation of the renal pedicle using a stapler during laparoscopic nephrectomy and nephroureterectomy. METHODS Ninety patients underwent en bloc renal hilar ligation using 45-mm endo-gastrointestinal anastomosis stapler and 2.5-mm staples during laparoscopic nephrectomy and nephroureterectomy from 2002 to 2015. Perioperative outcomes including estimated blood loss, operative time, and perioperative complications were documented. RESULTS Twenty-seven patients underwent nephrectomy and 63 patients underwent nephroureterectomy. Thirty patients (33.3%) had perioperative complications. The majority of complications were of Clavien grade II. Six patients had Clavien Dindo grade III and none of the patients had grade IV complications. There were no significant differences in complication rates between right- and left-sided procedures (p = 0.233). Median blood loss was 190.1 ml and mean operative time was 227.1 minutes in nephrectomy and 256.6 minutes in nephroureterectomy. None of the patients had evidence of AVF formation on postoperative computerized tomography scan. Only three patients had a new diagnosis of heart failure. One of them was eventually lost to follow up. The remaining two patients had no evidence of AVF formation in imaging studies and physical examination. CONCLUSION En bloc ligation of the renal pedicle during laparoscopic nephrectomy and nephroureterectomy using a stapler is safe. None of our patients developed an AVF during follow up.
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Affiliation(s)
- Kuan-Chun Huang
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Wun-Rong Lin
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- Mackay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan, ROC
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- Mackay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan, ROC
| | - Allen W Chiu
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chien-Wen Chen
- Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan, ROC
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Al-Qudah HS, Rodriguez AR, Sexton WJ. Laparoscopic Management of Kidney Cancer: Updated Review. Cancer Control 2017; 14:218-30. [PMID: 17615527 DOI: 10.1177/107327480701400304] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Laparoscopy has emerged as the preferred option for the surgical management of kidney cancer. Although many reports have been published regarding the operative outcome of renal cell carcinoma (RCC) and upper-tract transitional cell carcinoma (TCCA) treated laparoscopically, few review the oncologic outcome of these pathologies treated with laparoscopic techniques. METHODS We review the literature regarding the laparoscopic approaches, the complications related to laparoscopic surgery, and the long-term oncologic results of laparoscopic radical nephrectomy, partial nephrectomy, and nephroureterectomy. RESULTS Laparoscopic radical nephrectomy has become the new standard of care for most patients with suspected RCCs that are not amenable to nephron-sparing procedures. Laparoscopic techniques for managing RCC and TCCA are safe, follow well-established guidelines for surgical dissection, and meet or exceed perioperative convalescence and oncologic outcomes compared to traditional open procedures. The surgical techniques and the long-term outcome data for laparoscopic partial nephrectomy continue to mature. CONCLUSIONS Laparoscopy is a minimally invasive option available to most patients with kidney cancer. The immediate benefits of laparoscopy are well established and include less estimated blood loss, decreased pain, shorter perioperative convalescence, and improved cosmesis. Long-term oncologic outcomes of patients treated laparoscopically for kidney tumors resemble those of the open surgical approach.
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Affiliation(s)
- Hosam S Al-Qudah
- Genitourinary Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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7
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Sherer BA, Chow AK, Newsome MJ, Coogan CL, Prasad SM, Latchamsetty KC. En Bloc Stapling of the Renal Hilum During Laparoscopic Nephrectomy: A Double-institutional Analysis of Safety and Efficacy. Urology 2017; 105:69-75. [PMID: 28366703 DOI: 10.1016/j.urology.2017.01.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the safety and efficacy of en bloc stapling of the renal hilum (EBSH) during laparoscopic nephrectomy (LNx) in a large double-institution cohort with an extended follow-up period. METHODS We performed a retrospective review of patients undergoing LNx with EBSH between 2008 and 2014 at 2 academic medical centers. Data analyzed included tumor size, tumor pathology, operative time, estimated blood loss, and perioperative or postoperative complications. Evaluation of arteriovenous fistula (AVF) formation was assessed by postoperative imaging studies, physical examination, or new-onset diastolic hypertension. RESULTS A total of 428 patients (mean age: 63 years) underwent LNx, of which there were a total of 433 renal units with EBSH (226 left renal units, 207 right renal units). Mean operative time was 169 minutes (range: 51-489 minutes). Mean estimated blood loss was 155 mL (range: 5 mL-2000 mL). Mean tumor size was 5.6 cm (range: 0.9-14.5 cm). EBSH was performed on 69 patients with chronic infectious and inflammatory benign conditions. Three hundred (70%) patients received post-procedural imaging. No patients developed clinical or radiographic evidence of AVF at a mean follow-up of 51 months. CONCLUSION EBSH during LNx is efficient, effective, and safe. This large series lends further support that EBSH during LNx may not be associated with any significant risk of AVF formation at extended follow-up. We advocate that this technique is a safe alternative to ligating the renal artery and vein during LNx.
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Lai WS, Rais-Bahrami S. Safety and Efficacy of En Bloc Renal Hilar Vascular Staple Ligation: A Meta-Analysis. J Urol 2016; 197:175-181. [PMID: 27457261 DOI: 10.1016/j.juro.2016.07.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE We reviewed the literature on the safety of en bloc ligation. We also performed a meta-analysis of the effect of using this technique with vascular staplers on perioperative factors compared to conventional renal pedicle dissection and isolated staple ligation of the renal artery and vein. MATERIALS AND METHODS A literature search was performed to include all primary studies related to the safety of en bloc ligation of the renal hilum. After exclusion criteria were applied 9 studies were identified for review, of which 4 included a control group and were used in the meta-analysis. The primary end point was the incidence of arteriovenous fistula. Secondary end points were procedure duration, blood loss and the number of perioperative complications. RESULTS None of the total population of 595 patients in whom en bloc ligation was performed for nephrectomy were diagnosed with arteriovenous fistula formation at an average postoperative followup of 26.5 months. When comparing en bloc and isolated ligation of the renal artery and vein, the meta-analysis showed a significant improvement in procedure duration for en bloc nephrectomy. There was no difference in estimated blood loss or the number of complications. CONCLUSION En bloc ligation appears to be as safe as and potentially more beneficial in terms of perioperative factors than conventional renal pedicle dissection and isolated vascular ligation.
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Affiliation(s)
- Win Shun Lai
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
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Tian X, Wang M, Niu Y, Zhang J, Song L, Xing N. Retroperitoneal Laparoscopic Nephroureterectomy for Tuberculous Nonfunctioning Kidneys: a single-center experience. Int Braz J Urol 2015; 41:296-303. [PMID: 26005971 PMCID: PMC4752093 DOI: 10.1590/s1677-5538.ibju.2015.02.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 06/23/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To present our surgical techniques and experiences of retroperitoneal laparoscopic nephroureterectomy for the treatment of tuberculous nonfunctioning kidneys. MATERIALS AND METHODS From March 2005 to March 2013, a total of 51 patients with tuberculous nonfunctioning kidney underwent retroperitoneal laparoscopic nephroureterectomy at our medical center. The techniques included early control of renal vessels and dissection of the diseased kidney along the underlying layer outside the Gerato's fascia. The distal ureter was dissected through a Gibson incision and the entire specimen was removed en bloc from the incision. Patient demographics, perioperative characteristics and laboratory parameters as well as postoperative outcome were retrospectively reviewed. RESULTS Retroperitoneal laparoscopic nephroureterectomy was successfully performed in 50 patients, whereas one case required conversion to open surgery due to non-progression of dissection. The mean operating time was 123.0 minutes (107-160 minutes) and the mean estimated blood loss was 134 mL (80-650 mL).The mean postoperative hospital stay was 3.6 days (3-5 days) and the mean return to normal activity was 11.6 days (10-14 days). Most intra-operative and post-operative complications were minor complications and can be managed conservatively. After 68 months (12-96 months) follow-up, the outcome was satisfactory, and ureteral stump syndrome did not occur. CONCLUSIONS Retroperitoneal laparoscopic nephroureterectomy as a minimally invasive treatment option is feasible for treatment of tuberculous nonfunctioning kidneys.
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Affiliation(s)
- Xiquan Tian
- Department Of Urology, Affiliated Beijing Chao-Yang Hospital Of Capital Medical University, Beijing, China
| | - Mingshuai Wang
- Department Of Urology, Affiliated Beijing Chao-Yang Hospital Of Capital Medical University, Beijing, China
| | - Yinong Niu
- Department Of Urology, Affiliated Beijing Chao-Yang Hospital Of Capital Medical University, Beijing, China
| | - Junhui Zhang
- Department Of Urology, Affiliated Beijing Chao-Yang Hospital Of Capital Medical University, Beijing, China
| | - Liming Song
- Department Of Urology, Affiliated Beijing Chao-Yang Hospital Of Capital Medical University, Beijing, China
| | - Nianzeng Xing
- Department Of Urology, Affiliated Beijing Chao-Yang Hospital Of Capital Medical University, Beijing, China
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Resorlu B, Oguz U, Polat F, Yesil S, Unsal A. Comparative analysis of pedicular vascular control techniques during laparoscopic nephrectomy: en bloc stapling or separate ligation? Urol Int 2014; 94:79-82. [PMID: 25139114 DOI: 10.1159/000363250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 04/25/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the safety and efficacy of en bloc stapling and separate ligation techniques for renal vascular control during laparoscopic nephrectomy. PATIENTS AND METHODS Clinical data were collected from 60 patients who underwent laparoscopic nephrectomies using en bloc stapling (n = 27, group 1) or the separate ligation method (n = 33, group 2). Comparative analysis was carried out between the two groups, examining operative times, blood loss, intra- and postoperative complications and hospital stay. RESULTS Compared with the separate ligation method, the en bloc hilar control technique was associated with a shorter total operating time (98 vs. 121 min, p = 0.029). However, both groups were similar in terms of estimated blood loss, hemoglobin drop, changes in creatinine level and postoperative hospital stay. The total complication rates in group 1 and 2 were 3.7 and 15.1%, respectively, with a statistically significant difference. There were no complications related to the use of the endo-GIA stapler and no patients required conversion to open surgery in group 1. In group 2, 2 patients required conversion to open surgery, including 1 due to renal vein bleeding secondary to inaccurate vascular control and the other due to bleeding from the vena cava during dissection. In addition, 1 patient had a superficial bowel injury that was repaired laparoscopically and another had a superficial liver tear that was managed without conversion or transfusion. CONCLUSION En bloc ligation of the renal hilum is an easy and reliable technique that allows safe and fast control of the renal pedicle.
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Affiliation(s)
- Berkan Resorlu
- Department of Urology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
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Chung JH, Lee SW, Lee KS, Cho WY, Kim TH. Safety of en bloc ligation of the renal hilum during laparoscopic radical nephrectomy for renal cell carcinoma: a randomized controlled trial. J Laparoendosc Adv Surg Tech A 2013; 23:489-94. [PMID: 23621831 DOI: 10.1089/lap.2012.0444] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM To evaluate the safety of en bloc stapler ligation of the renal vascular pedicle during laparoscopic radical nephrectomy for renal cell carcinoma. SUBJECTS AND METHODS Clinical data were collected prospectively from 70 patients who underwent either en bloc stapling of the renal hilum (n=35) (Group A) or the separate ligation method (n=35) (Group B) to treat renal cell carcinoma. To evaluate the incidence of arteriovenous fistula (AVF), blood pressure and heart rate were measured, and abdominal auscultation was performed at 1 month, 3 months, 6 months, and 12 months post-surgery. Abdominal computed tomography was also performed at 6 and 12 months post-surgery. In addition, preoperative characteristics and postoperative outcomes (such as operation time and estimated blood loss [EBL]) were examined. RESULTS Both operation time and EBL were lower for Group A: operative time, Group A versus Group B, 60.26±10.94 minutes versus 67.51±10.49 minutes (P=.007); EBL, Group A versus Group B, 33.53±13.46 mL versus 49.14±32.21 mL (P=.011). No statistically significant differences were noted in either of the postoperative variables (blood pressure and heart rate), and there was no clinical evidence of bruit or AVF at 12 months post-surgery. CONCLUSIONS No AVF was observed after en bloc ligation upon clinical follow-up or on radiological evaluation.
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Affiliation(s)
- Jae Hoon Chung
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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Abstract
Hemorrhage is a potential risk at any step of laparoscopic nephrectomies (LNs). The advances in surgical equipment and tissue sealants have increased the safety and efficiency of performing LN and laparoscopic partial nephrectomy (LPN). However, hemostasis remains a major issue and there is still scope for further development to improve haemostatic techniques and devices. In this article a literature review of the current methods and techniques of hemostasis was carried out using the MEDLINE ®/PubMed® resources. The results of the review were categorized according to the three main operative steps: Dissection, control of renal pedicle and excision of the renal lesion.
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Affiliation(s)
- Hussam A Hassouna
- Urology Department, Wrightington, Wigan and Leigh NHS Foundation Trust, UK
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13
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Direct upper kidney pole access and early ligation of renal pedicle significantly facilitates transperitoneal laparoscopic nephrectomy procedures: Tunc technique. Surg Laparosc Endosc Percutan Tech 2012; 21:453-7. [PMID: 22146171 DOI: 10.1097/sle.0b013e31823badc1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We modified our technique in transperitoneal laparoscopic nephrectomies and compared its results with the classical technique. Classical technique was performed in 85 cases (group 1). Modified technique (n=98) included direct kidney upper pole access and early ligation of renal pedicle (group 2). No significant differences were detected regarding mean patient age, intraoperative blood loss, and duration of hospital stay between the 2 groups (P>0.05). Mean operation time was 64.9 ± 19.3 and 28.2 ± 7.7 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including right nephrectomies was 68.7 ± 23.4 and 24.2 ± 6.3 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including left nephrectomies was 63.8 ± 17.1 and 33.6 ± 5.1 minutes, respectively in groups 1 and 2 (P=0.001). Similarly, mean operation time was significantly shorter in group 2 when analysis was performed among right and left radical and simple nephrectomies between the 2 groups (P=0.001). Direct upper kidney pole access and early ligation of renal pedicle seems to be significantly facilitating transperitoneal laparoscopic nephrectomy procedures.
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Schatloff O, Lindner U, Lindner A. Current status of en bloc stapling of the renal hilum during laparoscopic nephrectomy. J Laparoendosc Adv Surg Tech A 2011; 20:631-3. [PMID: 20687854 DOI: 10.1089/lap.2009.0435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Increasing literature has been published lately addressing the safety and efficacy of en bloc stapling of the renal hilum during laparoscopic nephrectomy and nephroureterectomy. The aim of this review was to analyze the available literature on en bloc stapling of the renal hilum and to complement it with technical issues that are required, according to our vast experience in en bloc and separate stapling, to safely control the hilum with this technique. MATERIALS AND METHODS A PubMed search using the terms "en bloc," "nephrectomy," and "laparoscopy" was conducted. We identified seven publications that have looked into hilar stapling technique. RESULTS Seven publications were found, which included a total of 434 patients who underwent en bloc stapling of the renal hilum. No complications specifically ascribable to this type of hilar control were encountered. No cases of postoperative arteriovenous fistula have been reported. CONCLUSIONS En bloc stapling has become an established method to secure the renal hilum during laparoscopic nephrectomy and laparoscopic nephroureterectomy. Although no cases of postoperative arteriovenous fistula formation have been reported with the use of modern titanium staplers, longer follow-up is necessary to ascertain that it does not occur in the late postoperative period. We believe that well-trained laparoscopic surgeons should master this technique in both emergency and elective situations.
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Affiliation(s)
- Oscar Schatloff
- Department of Urology, Assaf Harofeh Medical Center , Zerifin, Israel.
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Transperitoneal laparoscopic right radical nephrectomy for renal cell carcinoma and end-stage renal disease: a case report. CASES JOURNAL 2009; 2:200. [PMID: 20062705 PMCID: PMC2803865 DOI: 10.1186/1757-1626-2-200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 11/18/2009] [Indexed: 11/10/2022]
Abstract
Nephron-sparing surgery (partial nephrectomy) results are similar to those of radical nephrectomy for small (<4 cm) renal tumors. However, in patients with end-stage renal disease, radical nephrectomy emerges as a more efficient treatment for localized renal cell cancer. Laparoscopic radical nephrectomy (LRN) increasingly is being performed. The objective of the present study was to present a case of a patient under hemodialysis who was submitted to LRN for a small renal mass and discuss the current issues concerning this approach. It appears that radical nephrectomy should be the standard treatment in dialysis patients even for small tumors. The laparoscopic technique is associated with acceptable cancer-specific survival and recurrence rate along with shorter hospital stay, less postoperative pain and earlier return to normal activities.
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Conradie MC, Urry RJ, Naidoo D, Mahmood K, Jogiat Z, Alsharef M, Mierzwinski R. Advantages of en bloc hilar ligation during laparoscopic extirpative renal surgery. J Endourol 2009; 23:1503-7. [PMID: 19673656 DOI: 10.1089/end.2009.0380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE By evaluating the technical challenges encountered during 123 laparoscopic nephrectomies, we have been able to modify the surgical technique to allow general urologists to effectively perform the procedure with minimal complications. DESIGN AND METHOD A retrospective chart review was performed on 123 patients who consecutively underwent laparoscopic nephrectomy or nephroureterectomy. Using a modified dissection approach to the hilum and en bloc ligation of the renal pedicle with a vascular stapler, a new standard of laparoscopic nephrectomy was developed at our institution. In 30 cases, the conventional technique was used, whereas in 93 cases the en bloc technique was used. Operating time, blood loss, transfusion requirements, intra- and postoperative complications, and the incidence of arteriovenous fistula (AVF) were documented. Follow-up included serial clinical evaluation and computed tomography angiogram at 3 months and repeated at 3-monthly intervals where indicated. RESULTS Operative and postoperative parameters were improved in the en bloc group compared with the conventional group. In the en bloc group, the average operating time was 56 minutes and the average blood loss was 32 mL. No patients required a blood transfusion and only two cases required conversion to open nephrectomy. No late vascular complications related to this method were observed with a mean follow-up of 28 months. There were no perioperative deaths. Postoperative complications were self-limiting and no patients developed postnephrectomy AVF. CONCLUSION The results of using the en bloc ligation technique for laparoscopic nephrectomy have been favorable in terms of operating time, risk to the patient, and surgeon's surgical preference. The risk of AVF formation after en bloc ligation of the renal pedicle and ligation by the conventional method appears to be equal based on the clinical follow-up and radiological evaluation. Therefore, long-term radiological follow-up is not mandatory in most cases.
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Affiliation(s)
- Marius C Conradie
- Department of Urology, Greys Hospital, Pietermaritzburg, South Africa.
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Schatloff O, Ramon J, Lindner U, Kitrey N, Dotan Z, Nahtomi-Shick O, Nadu A. Is Postoperative Arteriovenous Fistula Still a Concern After En Bloc Stapling of the Renal Hilum During Laparoscopic Nephrectomy? J Endourol 2009; 23:639-43. [DOI: 10.1089/end.2008.0528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Oscar Schatloff
- The Sackler School of Medicine, Tel Aviv University, Israel
- Department of Urology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Ramon
- The Sackler School of Medicine, Tel Aviv University, Israel
- Department of Urology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Uri Lindner
- The Sackler School of Medicine, Tel Aviv University, Israel
- Department of Urology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Noam Kitrey
- The Sackler School of Medicine, Tel Aviv University, Israel
- Department of Urology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Zohar Dotan
- The Sackler School of Medicine, Tel Aviv University, Israel
- Department of Urology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Orit Nahtomi-Shick
- The Sackler School of Medicine, Tel Aviv University, Israel
- Department of Anesthesiology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Andrei Nadu
- The Sackler School of Medicine, Tel Aviv University, Israel
- Department of Urology, The Chaim Sheba Medical Center, Ramat Gan, Israel
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Reply by the Authors. Urology 2009. [DOI: 10.1016/j.urology.2008.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Breda A, Finelli A, Janetschek G, Porpiglia F, Montorsi F. Complications of laparoscopic surgery for renal masses: prevention, management, and comparison with the open experience. Eur Urol 2009; 55:836-50. [PMID: 19168276 DOI: 10.1016/j.eururo.2009.01.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 01/09/2009] [Indexed: 01/06/2023]
Abstract
CONTEXT The initial excitement about the laparoscopic treatment of renal masses has been tempered by concerns related to increased operative time, technical complexity, and the suitability of laparoscopic approaches to oncologic surgery. OBJECTIVE To provide a comprehensive review of intraoperative and postoperative complications and their prevention and management during laparoscopic surgery of renal tumors. EVIDENCE ACQUISITION A literature review of the Medline and Google Scholar databases was performed, searching for renal cell carcinoma, renal mass, laparoscopy, laparoscopic radical nephrectomy, open radical nephrectomy, laparoscopic partial nephrectomy, open partial nephrectomy, laparoscopic cryoablation, laparoscopic radiofrequency ablation, complications, intra-operative, and post-operative. English-language articles published between 1990 and 2008 were reviewed. EVIDENCE SYNTHESIS Laparoscopic radical nephrectomy (LRN), whether transperitoneal or retroperitoneal, can be performed safely. The overall complication rate is low and does not significantly differ from that of the open experience. Laparoscopic partial nephrectomy (LPN), in contrast, is a technically challenging procedure. Although the intermediate oncologic outcomes are comparable to those of the open experience, there are concerns related to warm ischemia time, and there is a risk of major complications such as urinary leakage and hemorrhage requiring transfusion. Laparoscopic-assisted ablative therapies (cryotherapy and radiofrequency) are being performed more commonly for the treatment of small exophytic renal lesions with a low complication rate and intermediate oncologic outcomes similar to LRN and LPN. CONCLUSIONS Complications associated with the laparoscopic management of renal masses vary among the different procedures and with surgeon experience. The rate of complication appears to be similar to that of open surgery.
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Affiliation(s)
- Alberto Breda
- Department of Urology, University of California, Los Angeles, CA 90095, United States.
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Ou CH, Yang WH, Tzai TS. En Bloc Stapling of Renal Hilum During Hand-Assisted Retroperitoneoscopic Nephroureterectomy in Dialysis Patients. Urology 2008; 72:589-92. [DOI: 10.1016/j.urology.2008.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 02/24/2008] [Accepted: 05/13/2008] [Indexed: 11/30/2022]
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Thwaini A, Ravichandran S, Nambirajan T. En bloc stapler ligation of the renal vascular pedicle during laparoscopic nephrectomy. BJU Int 2008; 102:401; author reply 401-2. [PMID: 18702785 DOI: 10.1111/j.1464-410x.2008.07856_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Duarte RJ, Mitre AI, Chambô JL, Arap MA, Srougi M. Laparoscopic nephrectomy outside gerota fascia for management of inflammatory kidney. J Endourol 2008; 22:681-6. [PMID: 18324896 DOI: 10.1089/end.2007.0291] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE A nonfunctioning inflammatory kidney is a challenging surgical condition for urologists. Some investigators recommend open surgery because of the surgical difficulties caused by the inflammatory process, whereas others try to apply the advantages of a "simple" non-hand-assisted laparoscopic approach. We report our experience with simple laparoscopic nephrectomy for inflammatory kidney management. PATIENTS AND METHODS From July 2002 through December 2006, 50 pure laparoscopic nephrectomies were performed for inflammatory kidney (43 because of pyelonephritis, 5 for xanthogranulomatous pyelonephritis (XGP), and 2 for pyonephrosis). Histopathologic analysis was the criterion used for inflammatory kidney diagnosis. Pain or recurrent urinary tract infection associated with a nonfunctioning excluded kidney was the eligibility criterion for the procedure. Preoperatively, all patients underwent complete image and functional renal assessment. Morcellation was used to remove surgical specimens. Conversion index, surgical difficulties, operative time, and postoperative complications were evaluated. RESULTS Conversion was performed in 14 of 50 (28%) patients, including two with XGP and one with pyonephrosis. Adhesions, vascular (two inferior vena cava) lesions, and intestinal lesions (two colon) were the main causes of conversion. Acute pancreatitis developed in one patient, and one patient had a wound infection. Reoperations were unnecessary, and no deaths occurred. CONCLUSION Pure laparoscopic nephrectomy was successful in 72% of patients with inflammatory kidneys. The laparoscopic dissection was useful even in those cases converted to open surgery. This is a high-risk procedure, however, and both surgeon and patient must be aware of that before the decision is made for this approach.
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Affiliation(s)
- Ricardo J Duarte
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
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Buse S, Gilfrich C, Pfitzenmaier J, Bedke J, Haferkamp A, Hohenfellner M. En bloc stapler ligation of the renal vascular pedicle during laparoscopic nephrectomy. BJU Int 2008; 101:878-82. [DOI: 10.1111/j.1464-410x.2007.07371.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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White WM, Klein FA, Gash J, Waters WB. Prospective radiographic followup after en bloc ligation of the renal hilum. J Urol 2007; 178:1888-91; discussion 1891. [PMID: 17868731 DOI: 10.1016/j.juro.2007.07.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Indexed: 11/21/2022]
Abstract
PURPOSE We determined the risk of arteriovenous fistula after en bloc ligation of the renal hilum. MATERIALS AND METHODS A prospective evaluation of all patients who underwent en bloc ligation of the renal hilum during nephrectomy for malignant disease was performed. Pertinent operative data were recorded and patients were followed for clinical evidence of arteriovenous fistula formation, including hypertension, abdominal bruit and new onset congestive heart failure. Patients with at least 12 months of followup underwent computerized tomographic arteriography to assess arteriovenous fistula formation. RESULTS A total of 94 patients underwent en bloc renal hilar ligation during open (43) and laparoscopic (51) nephrectomy using a 45 mm titanium endovascular stapler. Of this cohort 11 patients were lost to followup and 3 died of disease. The remaining 80 patients were followed an average of 35.2 months with no clinical evidence of arteriovenous fistula formation. Specifically there was no statistically significant difference in preoperative and postoperative blood pressure (p = 0.18 and 0.62, respectively), no evidence of abdominal bruit on examination and no new onset congestive heart failure. A total of 32 had increased serum creatinine and, therefore, they were excluded from followup computerized tomographic arteriography. Eight patients had a followup of less than 1 year and they were not yet eligible for evaluation. In the 40 patients who underwent computerized tomographic arteriography no fistulas were noted. CONCLUSIONS Based on clinical followup and prospective radiographic evaluation there appears to be a low risk of arteriovenous fistula formation after en bloc ligation of the renal hilum using a titanium endovascular stapler.
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Affiliation(s)
- Wesley M White
- Department of Urology, University of Tennessee Medical Center, Knoxville, Tennessee 37920, USA.
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