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Perioperative Events and Complications in Minimally Invasive Live Donor Nephrectomy: A Systematic Review and Meta-Analysis. Transplantation 2017; 100:2264-2275. [PMID: 27428715 DOI: 10.1097/tp.0000000000001327] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimally invasive live donor nephrectomy has become a fully implemented and accepted procedure. Donors have to be well educated about all risks and details during the informed consent process. For this to be successful, more information regarding short-term outcome is necessary. METHODS A literature search was performed; all studies discussing short-term complications after minimally invasive live donor nephrectomy were included. Outcomes evaluated were intraoperative and postoperative complications, conversions, operative and warm ischemia times, blood loss, length of hospital stay, pain score, convalescence, quality of life, and costs. RESULTS One hundred ninety articles were included in the systematic review, 41 in the meta-analysis. Conversion rate was 1.1%. Intraoperative complication rate was 2.3%, mainly bleeding (1.5%). Postoperative complications occurred in 7.3% of donors, including infectious complications (2.6%), of which mainly wound infection (1.6%) and bleeding (1.0%). Reported mortality rate was 0.01%. All minimally invasive techniques were comparable with regard to complication or conversion rate. CONCLUSIONS The used techniques for minimally invasive live donor nephrectomy are safe and associated with low complication rates and minimal risk of mortality. These data may be helpful to develop a standardized, donor-tailored informed consent procedure for live donor nephrectomy.
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Does laparoscopic transperitoneal simple nephrectomy for inflammatory and non-inflammatory kidneys differ? SPRINGERPLUS 2016; 5:1358. [PMID: 27588251 PMCID: PMC4988960 DOI: 10.1186/s40064-016-2945-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022]
Abstract
Background Laparoscopic simple nephrectomy is the standard procedure for the removal of non-functioning benign kidney. It can be performed transperitoneally or retroperitoneally. There are several studies comparing the results of transperitoneally or retroperitoneally laparoscopic nephrectomy but there are limited numbers of study comparing results of laparoscopic transperitoneal simple nephrectomy in non-inflammatory and inflammatory non-functioning kidneys. The aim of this study was to compare the results of laparoscopic transperitoneal simple nephrectomy in non-inflammatory and inflammatory non-functioning kidneys. Results We retrospectively reviewed the records of patients who underwent laparoscopic nephrectomy for various inflammatory and non-inflammatory renal conditions at our institution from May 2012 to October 2015. We divided the patients in two groups. Group 2 involved the kidneys with stone disease and/or hydronephrosis, patients with previous renal surgery and patients with the history of recurrent infections. Group 1 involved the patients who had non-functioning kidney without these properties. All the surgeries were performed by transperitoneal approach and peroperative blood loss, operation time, hospitalization time, postoperative creatinine changes and haemoglobin drop were compared between groups. There were 22 patients with inflammatory and 27 patients with non-inflammatory non-functioning kidney. Operation time, peroperative blood loss, hospitalization time, postoperative haemoglobin drop and creatinine difference were not statistically different between groups. Surgical side and the presence of previous surgery did not affect the surgical results of inflammatory and non-inflammatory kidney nephrectomy. The only difference was postoperative fever which was more frequent after the nephrectomy of inflammatory kidney. Conclusions On the basis of our experience, surgical results of transperitoneal laparoscopic simple nephrectomy did not differ between inflammatory and non-inflammatory kidneys. Surgical times were higher in inflammatory group even if the difference was not significant.
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Salomon L, Rozet F, Soulié M. La chirurgie du cancer de la prostate : principes techniques et complications péri-opératoires. Prog Urol 2015; 25:966-98. [DOI: 10.1016/j.purol.2015.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/06/2015] [Indexed: 11/25/2022]
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Henderson JM, Fabricius MJ, Fowler S, Keeley FX, Dickinson A. The complications of laparoscopic renal surgery: A review of 10 years of audit data in the UK. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415815585211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To report the complications of laparoscopic renal surgery from the British Association of Urological Surgeons (BAUS) database over ten years. Patients and methods: All entries for laparoscopic renal surgery between 2002 and 2012 were included for analysis. Data was refined, collated and presented in graphical or tabular form. The primary outcome measures were intra-operative, post-operative and overall complications rates. Secondary outcome measures were length of stay, conversion to open surgery and operative time. Results: A total of 16,869 cases were included for analysis. The overall complication rate was 14.7%, with intra-operative complications reported for 3.5% of procedures and post-operative complications reported for 12.1% of procedures. The overall complication rate decreased throughout the audit period, from 16.6% in 2002 to 15.1% in 2012. The capture rate is estimated at 30% and the group of surgeons motivated to self-report may not be representative of the whole group. Comparison with other series is difficult due to a lack of a standardized reporting format. Conclusion: This is the largest surgeon-reported series of laparoscopic renal surgery to date. There is an inherent bias in self-reported data which limits the conclusions that can be drawn, although the safe introduction of this technique and the continuing improvement in complication rates are suggested.
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Sotelo R, Nunez Bragayrac LA, Machuca V, Garza Cortes R, Azhar RA. Avoiding and managing vascular injury during robotic-assisted radical prostatectomy. Ther Adv Urol 2015; 7:41-8. [PMID: 25642293 DOI: 10.1177/1756287214553967] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented.
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Affiliation(s)
- René Sotelo
- Instituto Médico La Floresta, Urbanización La Floresta, Calle Santa Ana, Clínica La Floresta, Caracas 1060, Venezuela
| | - Luciano A Nunez Bragayrac
- Instituto Médico La Floresta, CIMI Centro de Cirugía Robótica y de Invasión Mínima, Caracas, Venezuela
| | - Victor Machuca
- Instituto Médico La Floresta, CIMI Centro de Cirugía Robótica y de Invasión Mínima, Caracas, Venezuela
| | - Roberto Garza Cortes
- Instituto Médico La Floresta, CIMI Centro de Cirugía Robótica y de Invasión Mínima, Caracas, Venezuela
| | - Raed A Azhar
- Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA, and 2- Urology Department, King Abdulaziz University, Jeddah, Saudi Arabia
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Lasser MS, Ghavamian R. Surgical complications of laparoscopic urological surgery. Arab J Urol 2012; 10:81-8. [PMID: 26558008 PMCID: PMC4442892 DOI: 10.1016/j.aju.2011.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 11/16/2011] [Accepted: 11/16/2011] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To describe the incidence, identification and management of common intraoperative complications, including vascular, urological, bowel and visceral complications, of laparoscopic urological surgery. METHODS We searched the databases of PubMed and Medline for relevant English language reports, using the keywords 'laparoscopy', 'urologic' and 'complication'. RESULTS The search yielded 967 papers in all, and a review of these yielded a total of 42 relevant papers. CONCLUSION Despite its advantages, laparoscopic urological surgery is associated with complications having rates as high as 22%. As surgical volumes increase, the incidence and magnitude of complications have increased progressively. Meticulous surgical technique, surgeon experience, and a high degree of suspicion are necessary throughout the surgical endeavour. The intraoperative recognition and management of complications is mandatory.
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Affiliation(s)
| | - Reza Ghavamian
- Corresponding author. Address: The Urologic Oncology Program, Section of Minimally Invasive and Robotic Urologic Surgery, Montefiore Medical Center, Department of Urology, 3400 Bainbridge Ave., 5th Floor, Bronx, NY 10467, USA. Tel.: +1 718 920 6245; fax: +1 718 547 2902.
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Wadström J, Martin AL, Estok R, Mercaldi CJ, Stifelman MD. Comparison of hand-assisted laparoscopy versus open and laparoscopic techniques in urology procedures: a systematic review and meta-analysis. J Endourol 2011; 25:1095-104. [PMID: 21740261 DOI: 10.1089/end.2010.0348] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Hand-assisted laparoscopic surgery (HALS) is an integral part of the urologist's armamentarium. We aimed to perform a comprehensive meta-analysis comparing HALS renal surgery with open and laparoscopic techniques. METHODS A systematic review and meta-analysis of HALS renal procedures (donor nephrectomy, nephrectomy, or nephroureterectomy) from 1996 to 2007 was performed. RESULTS Sixty-two studies of 30 donor nephrectomy, 21 radical nephrectomy, and 14 nephroureterectomy procedures in 5446 patients were included in the analysis. In donor nephrectomy, estimated blood loss (EBL) was statistically significant for HALS vs the open and laparoscopic cohorts, -69.0 mL (95% confidence interval [CI], -129.7, -8.2) and -40.1 mL (95% CI, -68.2, -12.0), respectively. Length of stay (LOS) was shorter compared with the open group, -1.7 days (95% CI, -2.3, -1.1). For nephroureterectomy, EBL (-29.9 mL (95% CI, -242.3, 182.5)), and LOS (-1.5 d [95% CI, -2.8, -0.3]) again favored HALS vs open procedures. Operating room (OR) time and warm ischemia time (WIT) were statistically significant in favor of HALS donor nephrectomy vs the laparoscopic cohort; -36.8 minutes (95% CI, -61.3, -12.3) and -1.3 minutes (95% CI, -1.8, -0.7), respectively. For radical nephrectomy, both EBL -232.9 mL (95% CI, -383.6, -82.2) and LOS -2.4 days (95% CI, -3.5, -1.3) were statistically significant, favoring HALS vs the open group. CONCLUSION We report the largest meta-analysis of HALS renal surgery to date. When compared with open surgery, HALS allows for a significant decrease in EBL and LOS. Compared with laparoscopic donor nephrectomy, HALS resulted in a significant decrease in blood loss, OR time, and WIT.
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Affiliation(s)
- Jonas Wadström
- Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
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Introducing Hand-Assisted Retroperitoneoscopic Live Donor Nephrectomy: Learning Curves and Development Based on 413 Consecutive Cases in Four Centers. Transplantation 2011; 91:462-9. [DOI: 10.1097/tp.0b013e3182052baf] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Biglarnia AR, Tufveson G, Lorant T, Lennmyr F, Wadström J. Efficacy and safety of continuous local infusion of ropivacaine after retroperitoneoscopic live donor nephrectomy. Am J Transplant 2011; 11:93-100. [PMID: 21199350 DOI: 10.1111/j.1600-6143.2010.03358.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Morphine-based analgesia is effective but can compromise donor safety. We investigated whether continuous infusion of local anesthetics (CILA) can provide sufficient pain control and reduce morbidity related to opiate analgesics after hand-assisted retroperitoneoscopic (HARS) live donor nephrectomy. Forty consecutive live kidney donors underwent HARS and were treated with the ON-Q system providing CILA with 0.5% ropivacaine through two SilvaGard catheters placed in the retroperitoneal cavity and the rectus sheath, respectively. The case control group consisted of 40 donors matched with regard to sex, age, BMI and surgical technique. All donors were maintained on standardized multimodal analgesia combining nurse-controlled oxycodone treatment and acetaminophen. CILA donors had lower median cumulative consumption of morphine equivalents (CCME) (7 mg [0-56] vs. 42 mg [15-127]; p < 0.0000001), lower incidence of nausea (18 [45%] vs. 35 [87.5%] donors; p < 0.001), shorter time in postoperative care unit (160 vs. 242.5 min; p < 0.001) and shorter hospital stay (4 [4-7] vs. 6 [4-11] days; p < 0.001). In 32.5% of CILA donors the CCME was 0 mg (0% in matched control group, p < 0.001). CILA with 0.5% ropivacaine provides effective postoperative pain relief, reduces the need for opioid treatment and promotes postoperative recovery.
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Affiliation(s)
- A-R Biglarnia
- Department of Surgical Sciences, Section of Transplantation Surgery, Uppsala University Hospital, Uppsala, Sweden.
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Schwartz MJ, Faiena I, Cinman N, Kucharczyk J, Meriggi JS, Waingankar N, Richstone L, Kavoussi LR. Laparoscopic Bowel Injury in Retroperitoneal Surgery: Current Incidence and Outcomes. J Urol 2010; 184:589-94. [DOI: 10.1016/j.juro.2010.03.133] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Michael J. Schwartz
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Izak Faiena
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Nadya Cinman
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - John Kucharczyk
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Jenna S. Meriggi
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Nikhil Waingankar
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Lee Richstone
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Louis R. Kavoussi
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
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Kim BS, Yoo ES, Kim TH, Kwon TG. Chylous ascites as a complication of laparoscopic nephrectomy. J Urol 2010; 184:570-4. [PMID: 20639020 DOI: 10.1016/j.juro.2010.03.128] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Indexed: 01/02/2023]
Abstract
PURPOSE Chylous ascites is a rare complication after major retroperitoneal surgery. Recently chylous ascites has developed more often after laparoscopic nephrectomy since that is increasingly done for various indications at many centers. We reviewed our cases of chylous ascites after laparoscopic nephrectomy. MATERIALS AND METHODS Between January 2002 and December 2008 we performed 622 transperitoneal laparoscopic nephrectomies. We retrospectively analyzed factors related to chylous ascites as a complication of laparoscopic nephrectomy. RESULTS The overall incidence of chylous ascites was 5.1% (32 of 622 cases), including 4 severe refractory cases (0.6%). The difference in incidence by operation type was not statistically different (p = 0.251). Chylous ascites developed more often after left than right nephrectomy (7.3% or 25 of 343 cases vs 2.5% or 7 of 279, p = 0.010). In patients with radical nephrectomy and nephroureterectomy the incidence was higher in those who did vs did not undergo lymphadenectomy (13.9% or 10 of 72 vs 4.0% or 11 of 275, p = 0.027). Only 1 patient underwent explorative laparotomy due to persistent severe chylous ascites despite 8-week conservative management. The other cases were successfully managed conservatively by total parenteral nutrition and a low fat diet. CONCLUSIONS Chylous ascites is not a rare complication after laparoscopic nephrectomy and most cases can be managed conservatively. To prospectively prevent this complication we recommend meticulous clipping of all perihilar and retroperitoneal fibrous fatty tissue during major vessel dissection, especially for left nephrectomy or extensive lymphadenectomy.
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Affiliation(s)
- Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
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12
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Inoue T, Takaaki I, Kinoshita H, Satou M, Oguchi N, Kawa G, Muguruma K, Murota T, Matsuda T. Complications of urologic laparoscopic surgery: a single institute experience of 1017 procedures. J Endourol 2010; 24:253-60. [PMID: 20064000 DOI: 10.1089/end.2009.0322] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We evaluated complications of urologic laparoscopic surgery at our institution. PATIENTS AND METHODS From December 1991 to January 2009, 1017 urologic laparoscopic surgical procedures were performed in Kansai Medical University, including 277 radical prostatectomies, 13 donor nephrectomies, 74 partial nephrectomies, 158 radical nephrectomies, 55 pyeloplasties, 97 nephrouretectomies, 54 simple nephrectomies, 128 adrenalectomies, 34 varicocelectomies, and 127 other procedures. Medical records of each procedure were retrospectively evaluated. The difficulty of each procedure was classified according to the European Scoring System (ESS). Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications, respectively. RESULTS Among the 1017 laparoscopic procedures, 148 complications occurred in 123 patients, resulting in a total complication rate of 14.6%. Conversion to open surgery occurred in 20 (1.9%) patients. Nephrouretectomy had the highest incidence of complications at 23.7%, which was significantly higher than that of other procedures classified as "difficult" group, according to the ESS (P < 0.05). Clavien grades I and II accounted for 73.8% of all the postoperative complications. We experienced one fatality that was caused by air embolism. CONCLUSION We evaluated the complications of each procedure using the ESS for classification of technical difficulty. Based on the results of our retrospective study, nephrouretectomy should be upgraded as "very difficult" group according to the ESS. Appropriate grading by technical difficulty is beneficial for the prevention of complications from laparoscopic surgery.
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Affiliation(s)
- Takaaki Inoue
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Dols LFC, Kok NFM, Terkivatan T, Tran KTC, Alwayn IPJ, Weimar W, Ijzermans JNM. Optimizing left-sided live kidney donation: hand-assisted retroperitoneoscopic as alternative to standard laparoscopic donor nephrectomy. Transpl Int 2010; 23:358-63. [DOI: 10.1111/j.1432-2277.2009.00990.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Aerts J, Matas A, Sutherland D, Kandaswamy R. Chylous ascites requiring surgical intervention after donor nephrectomy: case series and single center experience. Am J Transplant 2010; 10:124-8. [PMID: 19958336 PMCID: PMC3634560 DOI: 10.1111/j.1600-6143.2009.02883.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chylous ascites as a result of laparoscopic donor nephrectomy (LDN) is a rare complication that carries significant morbidity, including severe protein-calorie malnutrition and an associated immunocompromised state. We report a patient who underwent hand-assisted left LDN and subsequently developed chylous ascites. He failed conservative therapy including low-fat diet with medium-chain triglycerides (LFD/MCT) and oral protein supplementation as well as strict NPO status with intravenous (IV) total parenteral nutrition (TPN) and subcutaneous (SQ) somatostatin analogue administration. Laparoscopic re-exploration and intracorporeal suture ligation and clipping of leaking lymph channels successfully sealed the chyle leak. We review the literature to date including diagnosis, incidence, management options, psychosocial aspects and clinical outcomes of chylous ascites after LDN.
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Affiliation(s)
- J Aerts
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
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Jeon SH, Han KS, Yoo KH, Choe BK, Seo IY, Lim JS, Ono Y. How Many Cases Are Necessary to Develop Competence for Laparoscopic Radical Nephrectomy? J Endourol 2009; 23:1965-9. [DOI: 10.1089/end.2008.0636] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Seung Hyun Jeon
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyung-Sik Han
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Koo Han Yoo
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Bong-Keun Choe
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ill Young Seo
- Departments of Urology, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae Sung Lim
- Department of Urology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yoshinari Ono
- School of Medical Welfare, Aichi Shukutoku University, Aichi, Japan
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Hsi RS, Ojogho ON, Baldwin DD. Analysis of Techniques to Secure the Renal Hilum During Laparoscopic Donor Nephrectomy: Review of the FDA Database. Urology 2009; 74:142-7. [DOI: 10.1016/j.urology.2008.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 10/03/2008] [Accepted: 11/04/2008] [Indexed: 11/28/2022]
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Wong JFS, Ho HSS, Tan YH, Cheng CWS. Rare cause of intestinal obstruction after laparoscopic radical nephrectomy: internal herniation via a mesenteric defect. Urology 2008; 72:716.e13-4. [PMID: 18597821 DOI: 10.1016/j.urology.2007.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/07/2007] [Accepted: 12/10/2007] [Indexed: 12/11/2022]
Abstract
A 43-year-old man had painless macroscopic hematuria and was diagnosed with a 9-cm renal carcinoma in the lower pole of the left kidney. He underwent laparoscopic transperitoneal left radical nephrectomy (LRN) with an uneventful recovery. Eleven days later, he developed intestinal obstruction (IO). Abdominal computed tomography scan showed dilated small bowels occupying the left renal fossa. Laparotomy revealed closed-loop small bowel obstruction resulting from internal intestinal herniation via a 5-cm mesenteric defect. It was repaired after the herniated bowels were reduced. This case illustrates a rare cause of IO after LRN, in which mesenteric defect is necessary.
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Affiliation(s)
- Joelle F S Wong
- Department of Urology, Singapore General Hospital, Singapore
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Hyams ES, Kanofsky JA, Stifelman MD. Laparoscopic Doppler technology: applications in laparoscopic pyeloplasty and radical and partial nephrectomy. Urology 2008; 71:952-6. [PMID: 18455632 DOI: 10.1016/j.urology.2007.11.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 09/29/2007] [Accepted: 11/13/2007] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The identification and isolation of vascular structures are crucial and technically demanding aspects of laparoscopic renal surgery. Doppler technology has been used for this purpose in laparoscopic varicocele repair, renal cryoablation, and adrenalectomy. However, it has not been formally described for use in laparoscopic radical nephrectomy, partial nephrectomy, or pyeloplasty. We report our initial experience with Doppler technology in 20 patients undergoing these procedures. TECHNICAL CONSIDERATIONS A laparoscopic Doppler probe was used in laparoscopic radical nephrectomy (n = 6), partial nephrectomy (n = 8), nephroureterectomy (n = 3), and robotic-assisted pyeloplasty (n = 3). The Doppler system consisted of a disposable 8-MHz probe passed through a 5-mm port and a battery-powered transceiver. The probe was used to guide dissection/isolation of the renal hilum and aberrant vasculature in radical and partial nephrectomy, confirm parenchymal ischemia before resection in partial nephrectomy, and identify crossing vessels during pyeloplasty. Nine accessory vessels were detected in 6 (35%) of 17 patients undergoing radical/partial nephrectomy or nephroureterectomy. In 1 case of partial nephrectomy, persistent parenchymal flow despite renal artery clamping required clamp repositioning. In 1 case of pyeloplasty, the Doppler probe detected a crossing vessel despite negative preoperative imaging findings. Use of the probe altered management in 7 (35%) and saved time in 15 (75%) of 20 cases. No complications were associated with the use of the probe. CONCLUSIONS Doppler ultrasound technology might have extended applications in laparoscopic renal surgery by facilitating the dissection and evaluation of vasculature. A prospective study with objective endpoints would be helpful in confirming the utility of this technology in these settings.
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Affiliation(s)
- Elias S Hyams
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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20
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Strebel RT, Müntener M, Sulser T. Intraoperative complications of laparoscopic adrenalectomy. World J Urol 2008; 26:555-60. [PMID: 18481069 DOI: 10.1007/s00345-008-0272-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 04/19/2008] [Indexed: 12/12/2022] Open
Abstract
A laparoscopic or retroperitoneoscopic access to the adrenal gland is the standard of care for adrenalectomy in most cases. Although in laparoscopic adrenalectomy the approach is minimally invasive, the procedure is challenging. This is reflected in the scope of possible complications. The surgeon must consider complications related to the anatomical topography of the adrenal gland, which typically encompasses the complications known from open surgery and complications related to the minimal invasive access. In this topic paper we will address the most frequently encountered complications of adrenalectomy: vascular injuries, injuries of the bowel, pleural tears, and injuries to the liver, spleen and pancreas. Fortunately, these complications occur rarely. However, many of these complications can have devastating consequences. Therefore, it's the surgeon's obligation to be aware of the possible complications he might encounter during laparoscopic adrenalectomy. This awareness is essential for their prevention and it helps the laparoscopic surgeon to identify complications intraoperatively.
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Affiliation(s)
- Raeto T Strebel
- Department of Urology, Kantonsspital Graubünden, Loëstr. 170, 7000, Chur, Switzerland.
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Abou-Elela A, Ghonaimy M, Reyad I, Abdelrazak O, Bedair AS. Outcome and complications of laparoscopic nephrectomy in patients with previous renal surgery. J Laparoendosc Adv Surg Tech A 2008; 18:237-43. [PMID: 18373450 DOI: 10.1089/lap.2007.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the technical difficulties, limitations, outcome, and complications of laparoscopic nephrectomy in patients with previous ipsilateral renal surgery. MATERIALS AND METHODS Eighteen patients with a history of epsilateral renal surgery underwent laparoscopic simple nephrectomy for benign renal disease at our center between November 2001 and March 2005. All patients were informed about the details of the laparoscopic procedure, and an informed consent was obtained that included the possibility of an emergency laparotomy. All procedures performed were carried out through a transperitoneal approach. A separate table with a laparotomy set was available in the room and ready for open conversion. RESULTS The procedure was completed in 13 patients. Excluding the cases converted to open surgery, the operative time ranged from 120 to 210 minutes, with a mean of 170 +/- 32.9. The intraoperative blood loss ranged from 30 to 400 cc, with a mean blood loss of 100. Complications included minor visceral injury (liver) in 1 patient, minor bleeding in 2, major bleeding (open conversion) in 1, technical failure (open conversion) in 4, postoperative bleeding (reexploration) in 1, and postoperative renal bed collection in 1. CONCLUSIONS Laparoscopic nephrectomy is an alternative to the open nephrectomy for the removal of nonfunctioning kidneys in benign diseases and results in less morbidity and a shorter hospital stay. A higher conversion to open and complication rate should be expected in patients with previous open or endoscopic renal surgery and postinflammatory conditions.
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Bae SR, Kim TH, Sung GT. Efficacy of Laparoscopic and Percutaneous Radiofrequency Ablation of Renal Tumor. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.4.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sang Rak Bae
- Department of Urology, Dong-A University School of Medicine, Busan, Korea
| | - Tae Hyo Kim
- Department of Urology, Dong-A University School of Medicine, Busan, Korea
| | - Gyung Tak Sung
- Department of Urology, Dong-A University School of Medicine, Busan, Korea
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Mejean A, Correas JM, Escudier B, de Fromont M, Lang H, Long JA, Neuzillet Y, Patard JJ, Piechaud T. [Kidney tumors]. Prog Urol 2007; 17:1101-44. [PMID: 18153989 DOI: 10.1016/s1166-7087(07)74782-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Hsi RS, Saint-Elie DT, Zimmerman GJ, Baldwin DD. Mechanisms of hemostatic failure during laparoscopic nephrectomy: review of Food and Drug Administration database. Urology 2007; 70:888-92. [PMID: 17919695 DOI: 10.1016/j.urology.2007.06.1116] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2007] [Revised: 03/22/2007] [Accepted: 06/29/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare the complications with endovascular stapling devices, nonlocking titanium clips, and nonabsorbable polymer ligating (Hem-o-lok) clips during laparoscopic nephrectomy. METHODS The Food and Drug Administration Manufacturer and User Facility Device Experience Database was retrospectively reviewed for reports dated from January 1992 to March 2006 using the key words "nephrectomy" and "kidney." All episodes of pure and hand-assisted laparoscopic nephrectomy were evaluated. RESULTS Of 2172 total nephrectomy or kidney-related reports, 352 reported failure using laparoscopic hemostatic devices to secure the renal vasculature, and 223 complications (63%) resulted during the use of endovascular stapling devices, 111 (33%) from nonlocking titanium clips and 18 (5%) from locking clips. The leading causes of failure reported in stapling devices were staple line malformation (47%) and locking up (29%). In titanium clips, jamming/feeding difficulties (27%) and trouble closing or "scissoring" clips (26%) were the most common. In locking clips, dislodgement (44%) was most frequently reported. Three, one, and three deaths were reported after the use of the stapling device, titanium clip, and locking clip device, respectively. CONCLUSIONS All three methods used to secure the renal hilum in laparoscopic nephrectomy can result in malfunction. Because the overall denominator of use is not known, it would be inappropriate to conclude that one device is safer than another. When they occurred, these device malfunctions were potentially serious. Knowledge of the possible mechanisms of failure seen with each device could allow surgeons to anticipate potential complications and, therefore, perform laparoscopic surgery more safely.
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Affiliation(s)
- Ryan S Hsi
- Division of Urology, Loma Linda University Medical Center, Loma Linda, California 92354, USA
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Feifer A, Anidjar M. [Laparoscopic nephrectomy in a living donor]. ANNALES D'UROLOGIE 2007; 41:158-172. [PMID: 18260606 DOI: 10.1016/j.anuro.2007.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Kidney transplantation is the therapeutic option of choice for patients with end-stage renal disease. With the advent of safer harvesting techniques and immunosuppression, both donor and recipient outcomes have markedly improved in recent years. Kidney donation from Living donors remains the single most important factor responsible for improving patient and graft survival. The laparoscopic donor nephrectomy has revolutionized renal transplantation, allowing expansion of the donor pool by diminishing surgical morbidity while maintaining equivalent recipient outcome. This technique is now becoming the gold-standard harvesting procedure in transplant centres worldwide, despite its technical challenge and ongoing procedural maturation, especially early in the learning curve. Previous contraindications to laparoscopic donor nephrectomy are no longer absolute. In the following analysis, the procedural aspects of the laparoscopic donor nephrectomy are detailed including pre-operative assessment, operative technique and a review of the current literature delineating aspects of both donor and recipient morbidity and mortality compared with open harvesting techniques.
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Affiliation(s)
- A Feifer
- McGill University Health Center, Royal Victoria Hospital, Department of urology, S6.88 Pine Avenue West, Montréal, Québec, Canada
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Abstract
Laparoscopy has become commonplace in the management of genitourinary malignancies and, in some institutions, has largely replaced open surgery as the primary treatment method for renal tumors. Outside of laparoscopic radical nephrectomy, other modalities, such as nephron-sparing partial nephrectomy and energy-based ablative procedures, have been extended to laparoscopy. In this article, we present our experience and review the literature regarding the utility of laparoscopy in the management of renal tumors.
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Affiliation(s)
- Edward M Gong
- Section of Urology, Department of Surgery University of Chicago, IL 60637, USA.
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Vanderbrink BA, Ost MC, Rastinehad A, Anderson A, Badlani GH, Smith AD, Levine MA, Lee BR. Laparoscopic versus open radical nephrectomy for xanthogranulomatous pyelonephritis: Contemporary outcomes analysis. J Endourol 2007; 21:65-70. [PMID: 17263611 DOI: 10.1089/end.2006.0188] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Early experience with laparoscopic nephrectomy for xanthogranulomatous pyelonephritis (XGP) was associated with high conversion and complication rates. We describe our institution's experience with this procedure compared with a contemporary cohort of patients with XGP treated by open nephrectomy. PATIENTS AND METHODS Retrospective review of surgical pathology reports from radical nephrectomies at our institution between 1995 and 2005 yielded a diagnosis of XGP in 12 patients, 6 of whom had undergone laparoscopic surgery. Each patient's medical records were reviewed, with intraoperative and postoperative parameters, including complications, being recorded. RESULTS Transperitoneal laparoscopic nephrectomy was successful in five patients (83%). Hand-assist ports were utilized in two patients because of failure to progress. The operative times were 301 +/- 106 minutes and 167 +/- 40 minutes in the laparoscopic and open-surgery groups, respectively (P = 0.03). There was no statistical difference with regard to estimated blood loss, transfusion rate, or parenteral analgesic requirements, but there was a trend toward a shorter stay for the laparoscopic group. Complications were noted in three and two patients in the laparoscopic and open-surgery groups, respectively. CONCLUSIONS The outcomes of nephrectomy for XGP were similar regardless of surgical approach. The results in patients with XGP were similar to initial reports in the literature and may be dependent on surgeon experience. We believe that in experienced hands, laparoscopic nephrectomy may be offered to patients with XGP.
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Affiliation(s)
- Brian A Vanderbrink
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA
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Gong EM, Lyon MB, Orvieto MA, Lucioni A, Gerber GS, Shalhav AL. Laparoscopic radical nephrectomy: Comparison of clinical Stage T1 and T2 renal tumors. Urology 2006; 68:1183-7. [PMID: 17169642 DOI: 10.1016/j.urology.2006.08.1077] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 05/31/2006] [Accepted: 08/17/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the outcomes after laparoscopic radical nephrectomy (LRN) at our institution to treat Stage T1 and T2 renal tumors. LRN for Stage T1 renal tumors (less than 7 cm) has become the standard of care at many institutions. The feasibility of performing more complex LRNs on higher stage tumors is continually evolving. METHODS A retrospective review was performed of a prospective database of patients undergoing LRN at the University of Chicago from October 2002 to January 2006. The data on 141 unilateral LRNs, 98 for clinical Stage T1 tumors and 43 for clinical Stage T2 tumors, were analyzed. The demographic, operative, and postoperative data were compared between the two groups. RESULTS The demographic data between the two groups was comparable. Operatively, patients with larger tumors had significantly greater blood loss, a longer operative time, and a longer surgical incision. Open conversions (1% versus 12%, P = 0.013) and intraoperative complications (5% versus 19%, P = 0.006) were more likely in patients with clinical Stage T2 tumors. Most intraoperative complications were hemorrhage requiring transfusion. However, the postoperative complication rates (25% versus 21%, P = 0.646) and hospital stay (2.0 versus 2.4 days, P = 0.134) were similar between the two groups. CONCLUSIONS In experienced centers, clinical Stage T2 renal tumors can be managed efficiently with laparoscopy. LRN for larger tumors demonstrated equivalent perioperative safety compared with LRN for smaller tumors.
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Affiliation(s)
- Edward M Gong
- Department of Surgery, Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.
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Hickey L, Rendon RA. Safe and Novel Technique for Peritoneal Access in Urologic Laparoscopy without Prior Insufflation. J Endourol 2006; 20:622-6. [PMID: 16999612 DOI: 10.1089/end.2006.20.622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Access to the peritoneum for transperitoneal laparoscopic surgery can be achieved using a variety of techniques, each of which has advantages and disadvantages as well as risks of complications. The endoscopic threaded imaging port (EndoTIP) is a metal, reusable, threaded visual-access cannula that is inserted by rotational rather than axial force. When the technique was described initially, capnoperitoneum was obtained prior to trocar insertion. We describe the results of our series using the EndoTIP port without prior capnoperitoneum. PATIENTS AND METHODS All 165 patients who underwent urologic transperitoneal laparoscopic procedures using the EndoTIP performed by a single surgeon from October 2001 through June 2005 were reviewed. Twentyfive patients were morbidly obese, and 32 had had previous abdominal surgical procedures. All data regarding patient demographics, details of the procedures, and outcomes were obtained from a database developed for prospective data collection at our institution. RESULTS There were no complications associated with peritoneal access or trocar insertion. The average time required to obtain capnoperitoneum was <1 minute. CONCLUSIONS Insertion of the EndoTIP port without prior capnoperitoneum is a safe, quick, and reliable method for peritoneal access in laparoscopic surgery. By avoiding blind punctures of the abdominal cavity, the risk of complications during access is minimized. We believe this technique should be considered in preference to techniques where trocars are inserted blindly.
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Affiliation(s)
- Liam Hickey
- Department of Urology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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Kanno T, Shichiri Y, Oida T, Kanamaru H, Takao N, Shimizu Y. Complications and the learning curve for a laparoscopic nephrectomy at a single institution. Int J Urol 2006; 13:101-4. [PMID: 16563130 DOI: 10.1111/j.1442-2042.2006.01239.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We assessed our experiences in performing a laparoscopic nephrectomy, with regard to complications and the learning curve, during a 4-year period. METHODS Between November 2000 and October 2004, a total of 78 laparoscopic nephrectomies were performed at our institution (37 radical nephrectomies, 30 nephroureterectomies and 11 simple nephrectomies). The patient charts were retrospectively reviewed to identify any operative and postoperative complications, and also to evaluate the operating time. RESULTS A total of eleven complications (14.1%) occurred in our series (nine operative and two postoperative complications). All operative complications were due to vascular injuries (n=9), five (2.6%) of which required an open conversion. The operating time and the rates of complications decreased significantly as the surgeons' experiences increased. CONCLUSION A laparoscopic nephrectomy could be performed as safely as previously reported. In addition, the learning curve for a laparoscopic nephrectomy appeared to be good over the initial 50 procedures at our institution.
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Affiliation(s)
- Toru Kanno
- Department of Urology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan.
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Türkeri LN, Temiz Y, Ozgur A, Onol FF. A new approach for the surgery of large renal masses: abdominal wall flap incision. Urol Int 2006; 76:296-300. [PMID: 16679828 DOI: 10.1159/000092050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 01/05/2006] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The type of skin incision affects the course of surgery during radical nephrectomy. We investigated the efficacy of a new type of incision for the surgical approach to large renal masses. PATIENTS AND METHODS Fourty patients (23 males and 17 females, mean age 63 years) who underwent radical nephrectomy in our department between 2002 and 2004 were evaluated. The outcomes in the groups with chevron incision and abdominal wall flap incision (AFI) were compared in terms of greatest tumor diameter, operation duration, perioperative blood loss, postoperative complications, and duration of hospitalization. Statistical analysis was made by independent-samples t test. RESULTS Chevron incision was used in the first 15 patients, while subsequent 25 patients were operated via AFI. The operation duration was slightly longer in the AFI group (3.78 vs. 3 h); however, the mean largest tumor diameter was significantly greater in patients operated via AFI (11.3 vs. 7.4 cm, p < 0.05). The mean blood losses were 1,100 and 590 ml in the chevron incision and AFI groups, respectively (p < 0.05). There was no significant difference in terms of duration of hospitalization and postoperative morbidity. CONCLUSION In our experience, AFI provides the best exposure and improved control of renal vessels and vena cava during radical nephrectomy and enables a safe dissection even in very large tumors with minimal blood loss.
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Affiliation(s)
- Levent N Türkeri
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
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Pareek G, Hedican SP, Gee JR, Bruskewitz RC, Nakada SY. Meta-analysis of the complications of laparoscopic renal surgery: comparison of procedures and techniques. J Urol 2006; 175:1208-13. [PMID: 16515961 DOI: 10.1016/s0022-5347(05)00639-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE We performed a meta-analysis of the literature to define the current expectations of complications during laparoscopic renal surgery. MATERIALS AND METHODS References were searched in the MEDLINE database from 1995 to 2004 using the terms complications and laparoscopic nephrectomy. Inclusion criteria were any series with greater than 20 cases, patient age older than 16 years and any complications listed for certain procedures, including laparoscopic radical nephrectomy, HA laparoscopic radical nephrectomy, LPN, HALPN, laparoscopic donor nephrectomy, HA laparoscopic donor nephrectomy, laparoscopic simple nephrectomy, laparoscopic nephroureterectomy and retroperitoneal laparoscopic nephrectomy. A data extraction form was created to categorize major or minor complications. A 5 member panel adhered to the strict criteria and extracted data from articles that met inclusion criteria. Data were entered into a spreadsheet and a meta-analysis was performed. RESULTS Initial review identified 73 of 405 references that were acceptable for retrieval and data extraction, of which 56 met inclusion criteria. The overall major and minor complication rates of laparoscopic renal surgery were 9.5% and 1.9%, respectively. There was a significant difference between the major complication rates of LPN and HALPN (21.0% vs 3.3%, p <0.05). CONCLUSIONS Our results show that patients who undergo laparoscopic renal surgery may have an overall major complication rate of 9.5%. The highest major complication rate is associated with technically challenging LPN (21%). There appears to be a significantly higher wound complication rate associated with HA surgery in comparison to that of standard laparoscopy (1.9% vs 0.2%, p <0.05).
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Affiliation(s)
- Gyan Pareek
- Division of Urology, Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin, USA.
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Kalra P, Glassman DT, Gomella LG, Strup SE, McGinnis DE, Simon DR, Chang MF, Byrne DS, Kuo RL. Outcomes of hand-assisted laparoscopic nephrectomy in technically challenging cases. Urology 2006; 67:45-9. [PMID: 16413330 DOI: 10.1016/j.urology.2005.07.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Revised: 06/21/2005] [Accepted: 07/22/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the outcomes of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. METHODS We performed a retrospective review of 322 hand-assisted laparoscopic nephrectomy cases that were completed at a single institution from 1998 to 2004. Patients with a history of extensive abdominal surgery or prior procedures on the affected kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombus were included. RESULTS A total of 42 patients were included in this series. Of these, 16 patients had a lesion 10 cm or larger, 10 had a renal vein thrombus, and 10 had undergone prior major abdominal surgery. Many patients had more than one complicating factor. Another 6 patients had a history of prior renal procedures or chronic inflammatory processes involving the affected kidney. One Stage T4 renal tumor with paraspinous muscle invasion was successfully managed without conversion. The overall mean operative time and estimated blood loss was 235 minutes and 439 mL, respectively, with a mean hospital stay of 4 days. Four patients (9.5%) required open conversion (one renal hilar injury, two failure to progress, and one persistent bleeding from the renal fossa). Postoperative complications included pulmonary embolism in 1, ileus in 1, and chronic obstructive pulmonary disease exacerbation in 1 patient. One patient developed an incarcerated port site hernia requiring reoperation. CONCLUSIONS Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option in the setting of significant complicating factors. This technique may facilitate the successful laparoscopic completion of these challenging cases with reasonable operative times, blood loss, and complication rates.
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Affiliation(s)
- Pankaj Kalra
- Department of Urology, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
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Castillo O, Bejarano C, Cortés O, Pinto I, Hoyos J, Vitagliano G. Complicaciones de la nefrectomía laparoscópica. Actas Urol Esp 2006; 30:812-8. [PMID: 17078578 DOI: 10.1016/s0210-4806(06)73538-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the complications and their respective management in our series of laparoscopic nephrectomy. MATERIAL AND METHODS Between November 1992 and March 2004, 319 patients underwent laparoscopic ablative renal surgery: 152 were women and 167 were men, mean age was 45 years (range: 0,5-82 years). There were 70 radical nephrectomies, 16 radical nephroureterectomies, 63 partial nephrectomies, 124 simples nephrectomies, 15 simples nephroureterectomies, 8 heminephrectomies and 23 living donor nephrectomies. RESULTS The complication rate was 5.64%. The most frequent complications were bleeding (2.5%) and retroperitoneal haematoma (1.2%). There was not statically difference in complications rate by age, sex, or approach via: transperitoneal versus retroperitoneal. Complication rate was alike with laparoscopic or hand assisted technique. There was not mortality in the series. CONCLUSIONS We have a low complication rate in laparoscopic nephrectomy. We believe that laparoscopy is a safe technique for patients that require ablative renal surgery when the surgical team has experience in advanced laparoscopic surgery.
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Affiliation(s)
- O Castillo
- Unidad de Urología, Clínica Santa María, Departamento de Urología, Facultad de Medicina, Universidad de Chile, Santiago.
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Tobias-Machado M, Lasmar MT, Batista LT, Forseto PH, Juliano RV, Wroclawski ER. Laparoscopic nephrectomy in inflammatory renal disease: proposal for a staged approach. Int Braz J Urol 2005; 31:22-8. [PMID: 15763004 DOI: 10.1590/s1677-55382005000100005] [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] [Received: 09/09/2004] [Accepted: 12/17/2004] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The present study shows and discusses the preliminary experience of customized and staged approach in the minimally invasive treatment of inflammatory renal diseases, using either pure laparoscopic surgery or the hand-assisted technique. MATERIALS AND METHODS We prospectively assessed 17 patients with inflammatory renal diseases operated by laparoscopic approach. Mean age was 41 years and the surgical indication was repeated pyelonephritis in 8 cases, pyonephrosis in 4 cases and renal exclusion due to staghorn stone in 5 cases. The staged laparoscopic approach was chosen based on kidney size and on the presence or not of tomographic findings showing significant perirenal infiltration. Thus, retroperitoneal access was chosen in cases where the kidney was smaller than 12 cm or in the absence of signs of significant perirenal infiltration on the computerized tomography. For the remainder, transperitoneal access was employed. RESULTS Of the 17 patients, 11 underwent laparoscopic nephrectomy by retroperitoneal access, and all cases were successful. Mean surgical time was 160 minutes. In 6 cases where the nephrectomy was performed by laparoscopic transperitoneal access, the use of hand assistance was required. Four surgeries were successfully completed with mean time of 190 minutes and 2 were converted to open surgery with mean time of 220 minutes. CONCLUSION The laparoscopic nephrectomy for inflammatory renal disease is feasible, but presents a high degree of complexity, requiring a customized approach. The use of hand assistance is an attractive option when the inflammatory process is intense, and can avoid conversions, maintaining the advantages of minimally invasive treatments.
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Affiliation(s)
- M Tobias-Machado
- Division of Urology, ABC Medical School, Santo André, Sao Paulo, Brazil.
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Reisiger K, Tran V, Figenshau RS, Andriole GL, Landman J. Single-setting bilateral laparoscopic renal surgery: assessment of single-stage procedure. Urology 2005; 65:892-7; discussion 897. [PMID: 15882718 DOI: 10.1016/j.urology.2004.11.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Revised: 10/27/2004] [Accepted: 11/23/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess the safety and efficacy of single-setting bilateral laparoscopic renal procedures. The continued advancement of laparoscopic surgical technology and surgeon expertise has allowed increasingly technically challenging procedures to be completed laparoscopically. Little has been reported on patient outcome, morbidity, and mortality of bilateral laparoscopic single-stage procedures. METHODS Between May 2000 and February 2004, 13 patients underwent synchronous bilateral renal surgery. Both retroperitoneal (n = 5) and transperitoneal (n = 8) approaches were used. The data were retrospectively analyzed for operative time, morbidity, mortality, and postoperative course. RESULTS Bilateral laparoscopic procedures were successfully completed in 11 (85%) of 13 patients. One patient required conversion to an open procedure because of significant adhesions. Another patient with von Hippel-Lindau disease had unexpected extensive pathologic features in each kidney and was therefore treated in a staged fashion. The mean operative time was 5.5 hours (range 4.7 to 8.5). The mean estimated blood loss was 268 mL (range 50 to 950). Patients resumed oral intake and ambulated within 24 hours after surgery. The mean analgesic requirement was 40.5 mg MSO4 equivalents (range 2 to 178). The mean hospital stay was 3.1 days (range 1 to 6). Patients returned to partial activity within the first week and enjoyed full activity at 3 weeks. One intraoperative complication and five postoperative complications occurred in 5 patients. CONCLUSIONS Our results have demonstrated that single-setting bilateral laparoscopic renal surgery is safe and can expedite resolution of urologic pathologic findings without increased morbidity. Bilateral single-setting laparoscopic surgery should only be performed if the primary procedure has been completed expeditiously and without complications.
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Affiliation(s)
- Karen Reisiger
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Wadström J. Hand-Assisted Retroperitoneoscopic Live Donor Nephrectomy: Experience from the First 75 Consecutive Cases. Transplantation 2005; 80:1060-6. [PMID: 16278586 DOI: 10.1097/01.tp.0000176477.81591.6f] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The two major life-threatening complications associated with laparoscopic live donor nephrectomy are sudden severe bleeding and intestinal injury. A combined technique-hand-assisted and retroperitoneoscopic (HARS)-reduces the risk of these life-threatening complications. In this study, we report on our experience from the first 75 consecutive HARS operations. METHODS The data has been collected prospectively according to intention to treat and includes all consecutive donors operated with the HARS technique. Warm ischemia time, operating time, and blood loss were recorded. Complications, convalescence, and allograft outcome were followed postoperatively with a mean follow-up of 701 (range 60-1438) days. RESULTS The mean operating time was 138 (range 85-260) minutes and the mean warm ischemia time 175 (85-510) seconds. The operative time was significantly longer in male donors. The mean bleeding was 176 (50-700) ml. There were no conversions to open surgery. Major complications comprised one pulmonary embolus and one donor required 2 units of blood transfusion. One donor was reoperated due to suspicion of trocar hernia. Nine patients experienced minor complications (fever, n=4; urinary tract infection, n=2; chylous ascites, n=1; orchialgia, n=1; subcostal pain, n=1). All except two kidneys had immediate onset of function. Neither of these could, however, be attributed to the donor operation. One recipient experienced urinary leakage and one a stenosis. Recipient and graft survival were 99% and 96%, respectively. CONCLUSIONS We conclude that HARS facilitates the procedure by enabling short operating times and at the same time significantly reducing the risks associated with endoscopic live donor nephrectomy.
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Affiliation(s)
- Jonas Wadström
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
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Alston C, Spaliviero M, Gill IS. Laparoscopic donor nephrectomy. Urology 2005; 65:833-9. [PMID: 15882706 DOI: 10.1016/j.urology.2004.10.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 09/22/2004] [Accepted: 10/11/2004] [Indexed: 10/25/2022]
Affiliation(s)
- Celeste Alston
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Neipp M, Jackobs S, Becker T, zu Vilsendorf AM, Winny M, Lueck R, Klempnauer J, Nashan B. Living Donor Nephrectomy: Flank Incision Versus Anterior Vertical Mini-Incision. Transplantation 2004; 78:1356-61. [PMID: 15548975 DOI: 10.1097/01.tp.0000140975.96729.a7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Currently, many centers perform laparoscopic donor nephrectomy (DN). We studied the outcome of donors and recipients following open DN using either flank incision (ODN) or mini-incision (MIDN). METHODS Data of 196 living kidney donors were recorded prospectively. In 127 cases ODN and 69 cases MIDN were performed. RESULTS Demographic details of donors were comparable for both groups. The left kidney was procured in 58% for ODN and in 64% for MIDN. Multiple arteries were more frequently present when MIDN (11% vs. 28%) was performed. The mean operating time was 129 min for ODN and 133 min for MIDN. Early complications occurred in 7% following ODN and in 4% following MIDN. Late complications were observed in 21% after ODN and 1% after MIDN. The mean hospital stay was significantly longer following ODN compared with MIDN (7.5 vs. 6.4 days). The primary graft function rate was 97% in both groups. One-year graft survival was 97% after ODN and 100% after MIDN. CONCLUSIONS Results following MIDN are superior to those following ODN. Even in case of multiple renal vessels MIDN can be safely applied. In comparison with laparoscopic DN advantages of MIDN may be reduced costs, shorter operating time, and comparable cosmetic results.
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Affiliation(s)
- Michael Neipp
- Department of Transplantation, Medizinische Hochschule Hannover, Hannover, Germany.
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Keoghane SR, Keeley FX, Timoney AG, Tolley DA, Joyce A, Downey P. The British Association of Urological Surgeons Section of Endourology audit of laparoscopic nephrectomy. BJU Int 2004; 94:577-81. [PMID: 15329116 DOI: 10.1111/j.1464-410x.2004.05004.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To report the first UK national audit of laparoscopic nephroureterectomy, radical and simple nephrectomy. METHODS All members of the British Association of Urological Surgeons (BAUS) undertaking laparoscopic nephrectomy were invited to submit prospectively collected data from their centres to a nationally established database, using a standard proforma. The period covered by the audit was 1 July 2001 to 30 June 2002. The indications for surgery, peri- and postoperative data, and some demographic details were collected. RESULTS Data were received from 25 centres; 13 had undertaken five or fewer cases per year; 263 procedures were reported, including 20 of hand-assisted nephrectomy. Most cases were for nonfunctioning kidneys, or renal cell carcinoma, with transitional cell cancer and stones forming a smaller proportion. The mean (range) operative duration was 173 (89-335) min. The median postoperative stay was 4 days, with a wide range reflecting clinical and other reasons for delayed discharge. Two deaths were reported, giving a mortality of 0.7%. The mean conversion rate was 5.7% and the mean complication rate 16.8%; these rates were no higher in centres undertaking fewer than five cases per year than in the centres with a greater volume. CONCLUSION Encouragingly, this first UK audit of laparoscopic nephrectomy shows similar results to those published worldwide. The lack of any difference in outcome between smaller and larger centres may be explained by case selection and the use of mentors, as recommended by the BAUS Section of Endourology.
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McAllister M, Bhayani SB, Ong A, Jaffe W, Malkowicz SB, VanArsdalen K, Chow GK, Jarrett TW. Vena caval transection during retroperitoneoscopic nephrectomy: report of the complication and review of the literature. J Urol 2004; 172:183-5. [PMID: 15201767 DOI: 10.1097/01.ju.0000132143.33340.51] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Major vascular injuries are uncommon but serious complications of laparoscopic surgery. Early recognition and conversion to an open procedure may be required to avoid further complications. We report 2 cases in which the vena cava was transected during retroperitoneoscopic nephrectomy, and review the literature. MATERIALS AND METHODS All urological laparoscopic cases from 1993 to 2002 at 2 institutions were reviewed to identify major vessel transection. Two cases of inadvertent transection of the vena cava were identified. Medical records were reviewed for clinical and pathological information to identify factors leading to this complication. A MEDLINE search was performed to identify similar reports in the literature. RESULTS Two patients at 2 institutions were identified with vena caval transection during retroperitoneoscopic nephrectomy. In both cases the vena cava was misidentified as a renal vein. The injury was recognized immediately in both cases and an open repair was performed by vascular surgery. Both patients recovered with no sequelae. In both cases a rotated camera on an angled laparoscope in addition to the relative lack of retroperitoneal landmarks may have contributed to a loss of orientation within the operative field. A similar report of an aortic transection was also found in the literature. CONCLUSIONS Disorientation of the operating surgeon within the surgical field secondary to rotation of the camera lens and lack of retroperitoneal landmarks may contribute to vena caval transection during retroperitoneoscopic nephrectomy. This injury has not been found in transperitoneal nephrectomy, likely because more intra-abdominal landmarks exist, aiding in maintenance of orientation. Prompt intraoperative recognition and repair of the transection results in a favorable outcome.
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Affiliation(s)
- Marc McAllister
- Brady Urologic Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-8915, USA
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Simon SD, Castle EP, Ferrigni RG, Lamm DL, Swanson SK, Novicki DE, Andrews PE. Complications of laparoscopic nephrectomy: the Mayo clinic experience. J Urol 2004; 171:1447-50. [PMID: 15017195 DOI: 10.1097/01.ju.0000117942.61971.41] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE We present the incidence of complications and conversions during laparoscopic nephrectomy performed for various indications and discuss methods to help prevent future complications. MATERIALS AND METHODS From June 1999 to February 2003 at our institution 285 laparoscopic nephrectomy cases were performed, consisting of 113 radical nephrectomies, 101 donor nephrectomies, 27 simple nephrectomies, 23 partial nephrectomies and 21 nephroureterectomies. We reviewed the data base of patients who underwent laparoscopic nephrectomy to examine complications and analyze factors related to conversion to an open surgical procedure. RESULTS Major complications occurred in 16 patients (5.6%). Major complications were surgical in 12 patients and medical in 4. Of the major surgical complications 3, 6, 1, 1 and 1 occurred during laparoscopic radical nephrectomy, donor nephrectomy, nephroureterectomy, simple nephrectomy and partial nephrectomy, respectively. The predominant major surgical complication was bleeding requiring conversion to an open surgical procedure. The overall conversion rate was 4% (12 patients), consisting of 6 emergency and 6 elective conversions. The remaining 27 patients experienced minor surgical or postoperative medical problems, such as urinary retention or wound infection. The mortality rate in our series was 0%. CONCLUSIONS Laparoscopic renal surgery is becoming a routine procedure in the armamentarium of many urologists. Complications that are unique to laparoscopy exist but they should decrease with time with repetition and experience. We have learned many different precautions and procedures that should help decrease the risk of future complications associated with laparoscopic renal surgery.
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Affiliation(s)
- Scott D Simon
- Department of Urology, Mayo Clinic, Scottsdale, Arizona, USA
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Abstract
Since the first urologic case was reported in 1997, hand-assisted laparoscopic surgery (HALS) has proven to be useful for both the experienced and the inexperienced laparoscopic surgeon. In a recent series of 196 cases at three major medical institutions, 18 patients (9.2%) suffered 32 major complications, and 28 patients (14.3%) had 31 minor complications. The most common major complications were small-bowel injury, requirement for open conversion to control bleeding, and need for reintubation. The most frequent minor complications were urinary retention, splenic capsular injury, and prolonged ileus. The author discusses ways of recognizing and managing the complications of HALS, including physiologic, access-related, intraoperative, and post-operative problems.
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Affiliation(s)
- Sean P Hedican
- Department of Surgery, The University of Wisconsin Medical School, Madison, Wisconsin 53792-3236, USA.
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Abreu SC, Sharp DS, Ramani AP, Steinberg AP, Ng CS, Desai MM, Kaouk JH, Gill IS. THORACIC COMPLICATIONS DURING UROLOGICAL LAPAROSCOPY. J Urol 2004; 171:1451-5. [PMID: 15017196 DOI: 10.1097/01.ju.0000116352.15266.57] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We documented thoracic related complications during urological laparoscopic surgery. MATERIALS AND METHODS A total of 1129 patients underwent major urological laparoscopic procedures in a 5-year period. Operative reports and postoperative radiographic reports were retrospectively reviewed to identify patients with thoracic related medical and surgical sequelae. Of the patients 619 (55%) underwent at least 1 chest x-ray in the immediate or early postoperative period. In the remaining 510 patients (45%) there was no clinical indication to perform chest x-ray. RESULTS Of 619 patients undergoing chest x-ray 438 (71%) were completely normal. Medical pulmonary complications, surgical thoracic complications and subclinical, incidentally detected gas collections in the chest were identified in 12.6%, 0.5% and 5.5% of patients, respectively. Medical complications in 12.6% of cases included pulmonary infiltrate/atelectasis in 9.7%, pleural effusion in 4.8% and pulmonary embolus in 0.3%. Surgical complications included symptomatic pneumothorax in 4 patients (0.35%), hemothorax in 1 (0.08%) and chylothorax in 1 (0.08%). Subclinical abnormal thoracic gas collections were radiographically noted in 34 of the 619 patients (5.5%) on chest x-ray, including pneumomediastinum in 19 (3.1%), pneumothorax in 10 (1.6%) and pneumopericardium in 5 (0.8%). Overall 36 of 40 (90%) thoracic surgical complications (3) and subclinical, incidentally detected gas collections (33) occurred during retroperitoneal laparoscopy. Re-intervention was necessary in 6 patients (0.5%), namely pulmonary embolus requiring vena caval filter placement in 3 (0.3%), pneumothorax requiring a chest tube in 2 (0.17%) and hemothorax requiring emergency open thoracotomy in 1 (0.08%). No patient underwent open conversion to complete the initial proposed operation. CONCLUSIONS Due to its high solubility the expectant management of incidental CO2 pneumothorax, pneumopericardium and pneumomediastinum is recommended initially in the clinically stable patient. Inadvertent diaphragmatic entry can be satisfactorily repaired laparoscopically without open conversion. Although it is rare, surgical thoracic complications are potentially life threatening, requiring prompt identification and management.
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Affiliation(s)
- Sidney C Abreu
- Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Stephenson AJ, Hakimi AA, Snyder ME, Russo P. Complications of Radical and Partial Nephrectomy in a Large Contemporary Cohort. J Urol 2004; 171:130-4. [PMID: 14665860 DOI: 10.1097/01.ju.0000101281.04634.13] [Citation(s) in RCA: 214] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Standardized criteria for reporting the early complications of urological procedures are lacking. We reviewed the early complications of radical nephrectomy (RN) and partial nephrectomy (PN) in a large contemporary cohort using a standardized complication grading scale. MATERIALS AND METHODS Between 1995 and 2002, 1,049 patients underwent RN (66%) or PN (34%) for renal cortical neoplasm. Records were reviewed for perioperative complications. Complications were graded using a 5-tiered scale based on the severity of impact or intensity of therapy required. RESULTS A total of 235 complications occurred in 180 patients (17%). Overall 55% and 31% of complications were grade I and grade II, respectively. There were 3 perioperative deaths (0.2%). PN was not associated with more complications compared to RN when accounting for other variables. PN cases had more procedure related complications compared to RN (9% versus 3%, respectively, p = 0.0001) due to complications of urinary leak and the reintervention rate was subsequently higher (2.5% versus 0.6%, p = 0.02). All but 1 of the reinterventions for PN involved either endoscopy or radiology. By multivariate analysis operative time (p <0.0001) and solitary kidney (p = 0.06) were associated with procedure related complications of PN. CONCLUSIONS RN and PN are associated with low rates of serious morbidity and mortality. Compared to RN, PN is associated with higher rates of procedure related complications, the majority of which are minor. Overall, however, PN is not associated with more complications than RN.
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Affiliation(s)
- Andrew J Stephenson
- Department of Urology, Sidney Kimmel Cancer Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Orvieto M, Breyer B, Sokoloff M, Shalhav AH. Aortic Injury During Initial Blunt Trocar Laparoscopic Access For Renal Surgery. J Urol 2004; 171:349-50. [PMID: 14665922 DOI: 10.1097/01.ju.0000099759.92878.3e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marcelo Orvieto
- Department of Surgery, University of Chicago Pritzker School of Medicine, Illinois 60637, USA
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Affiliation(s)
- Hsiao-Jen Chung
- Division of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
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Abstract
PURPOSE OF REVIEW In the past decade, minimally invasive therapy options for renal cell carcinoma have been devised in an attempt to minimize operative morbidity while achieving comparable oncologic and functional outcomes. Herein, we evaluate the new developments related to the modern surgical and energy ablative techniques for renal cell carcinoma. RECENT FINDINGS When compared with the open counterpart, laparoscopic radical and partial nephrectomies have equivalent operative time, decreased blood loss, superior recovery, and improved cosmesis. Nowadays, laparoscopic radical nephrectomy can be performed for pT2 tumors (up to 15 cm), and level I renal vein thrombus is not a formal contraindication for the laparoscopic procedure. Ongoing advances in laparoscopic techniques and operator skills have allowed the development of a reliable technique of laparoscopic partial nephrectomy, which includes the ability to achieve effective intracorporeal renal hypothermia. Cryoablation and radiofrequency ablation therapies have been performed through a laparoscopic or percutaneous approach, using a combination of fine probes and high-resolution imaging studies to precisely target the lesions and accurately monitor the freezing or heating ablation process. Noninvasive tumor ablation can now be achieved by extracorporeally induced high-intensity focused ultrasound. SUMMARY These minimally invasive techniques represent the modern surgical approach for renal cell carcinoma, aiming to decrease patient morbidity. Laparoscopic radical and partial nephrectomy techniques duplicate the open approach. Results obtained with energy ablative techniques are encouraging. Based on the known slow growth rates of small renal cell carcinoma, one should be cautious when interpreting the short-term results of energy ablative therapies monitored by imaging only.
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Affiliation(s)
- Sidney C Abreu
- Section of Laparoscopic and Minimally Invasive Surgery, Urologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Ng CF, Tolley D. Re: Transperitoneal laparoscopy into the previously operated abdomen: effect on operative time, length of stay and complications. J Urol 2003; 170:548; author reply 548-9. [PMID: 12853822 DOI: 10.1097/01.ju.0000077209.50971.8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bibliography Current World Literature. Curr Opin Obstet Gynecol 2003. [DOI: 10.1097/01.gco.0000084240.09900.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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