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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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Banegas MP, Harlan LC, Mann B, Yabroff KR. Toward greater adoption of minimally invasive and nephron-sparing surgical techniques for renal cell cancer in the United States. Urol Oncol 2016; 34:433.e9-433.e17. [PMID: 27321355 PMCID: PMC5035195 DOI: 10.1016/j.urolonc.2016.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/22/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine national, population-based utilization trends of nephron-sparing and minimally invasive techniques for the surgical management of patients with adult renal cell cancer (RCC) in the United States. METHODS Linked data from the National Cancer Institute׳s Patterns of Care studies and the Area Health Resource File were used to evaluate trends of nephron-sparing and minimally invasive techniques in a sample of 1,110 patients newly diagnosed with American Joint Committee on Cancer stages I-II RCC, in 2004 and 2009, who underwent surgery. Descriptive statistics were used to assess patterns of surgery between 2004 and 2009. Multivariable logistic regression analyses were used to evaluate the associations between demographic, clinical, hospital, and area-level health care characteristics with surgery utilization, stratified by the subset of patients who were potentially eligible for partial nephrectomy (PN) vs. radical nephrectomy (RN) and laparoscopic RN (LRN) vs. open RN, respectively. RESULTS Between 2004 and 2009, PN use among stage I patients with tumors≤7cm increased from 29% to 41%, respectively (P = 0.22). Among patients with stage I tumors≤4cm, use of PN significantly increased from 43% in 2004 to 55% in 2009 (P≤0.05). Among patients with stage I tumors>4 to 7cm, laparoscopic partial nephrectomy increased from 8% to 15%, whereas LRN increased from 38% to 69%, between 2004 and 2009 (P = 0.07). Significant increases in LRN use were observed for both stage I (from 43% in 2004 to 58% in 2009; P≤0.05) and stage II patients (from 16% in 2004 to 47% in 2009; P≤0.01). Patients diagnosed at an older age, with larger tumors, non-clear cell RCC and who did not receive treatment in a hospital with residency training were significantly less likely to receive PN vs. RN; whereas, those diagnosed in 2009 with stage I disease were significantly more likely to receive LRN vs. open RN. CONCLUSIONS This study highlights a significant shift toward increased use of nephron-sparing and minimally invasive surgical techniques to treat patients with RCC in the United States. Our findings are among the first population-based reports in which most eligible patients with RCC received PN over RN. In light of the long-standing evidence on the improved patient outcomes, future investigation is warranted to identify the barriers to increased adoption of these nephron-sparing and minimally invasive approaches.
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Affiliation(s)
- Matthew P Banegas
- Kaiser Permanente Northwest, The Center for Health Research, Portland, OR.
| | - Linda C Harlan
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Bhupinder Mann
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - K Robin Yabroff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Hongo F, Kawauchi A, Ueda T, Fujihara A, Naitoh Y, Nakamura T, Naya Y, Kamoi K, Okihara K, Miki T. Long-term outcome of hand-assisted laparoscopic radical nephrectomy for T1 renal cell carcinoma. Int J Urol 2014; 21:1093-6. [PMID: 25040625 DOI: 10.1111/iju.12551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/04/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the long-term outcomes of hand-assisted laparoscopic radical nephrectomy compared with those of open nephrectomy. METHODS Hand-assisted laparoscopic radical nephrectomy was carried out in 132 patients with T1 renal cell carcinoma (between November 1999 and November 2008). Their outcomes were compared with those of 61 patients treated with open nephrectomy. The durations of follow up were 6-121 months (median 65 months) and 7-146 months (median 84 months) in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively. RESULTS The 7-year recurrence-free rates were 88.5 and 85.6% in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively, showing no significant difference between the two groups. The 7-year cancer-specific survival rates were 92.3 and 91.4% in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively, showing no significant difference between the two groups. Also, the 10-year recurrence-free rates were 85.4 and 78.1% in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively. When changes in the recurrence-free rate were analyzed using the Kaplan-Meier method, no significant difference was observed between the two groups. The 10-year cancer-specific survival rates were 91.8 and 87.9% for hand-assisted laparoscopic radical nephrectomy and open nephrectomy, respectively, showing no significant difference between the groups. CONCLUSIONS Hand-assisted laparoscopic radical nephrectomy might be comparable with open nephrectomy with regard to long-term cancer control.
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Affiliation(s)
- Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Rosoff JS, Fine RG, Velez MC, Del Pizzo JJ. Laparoendoscopic single-site radical nephrectomy for large renal masses. J Endourol 2012; 27:34-9. [PMID: 22984849 DOI: 10.1089/end.2012.0115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To report our operative experience and short-term outcomes for the laparoendoscopic single-site (LESS) management of large renal tumors and tumors of advanced stage. PATIENTS AND METHODS Ten consecutive patients underwent LESS-radical nephrectomy (RN) for large (≥ 7 cm) and/or locally advanced tumors (>T(2)). Intraoperative, postoperative, and short-term follow-up data were analyzed. RESULTS Median surgical time was 146 minutes (range 73-164 min), and median estimated blood loss was 100 mL (range 25-400 mL). No procedure needed conversion to open RN or hand-assisted laparoscopic RN. The median hospital stay was 47 hours (range 42 hours-12 days). One (10%) patient had a minor complication (postoperative fever treated with antibiotics) and one (10%) patient had a major complication (small bowel obstruction necessitating reoperation). Of the 10 tumors, 2 were pathologic stage T(1b), 4 were pathologic stage T(2), and 4 were stage T(3a). At a median follow-up of 12.3 months (range 1-16 mos), six (60%) patients were alive without evidence of recurrence, and 4 (40%) patients were alive with disease. Of those four patients, all four had known metastatic disease before surgery. CONCLUSION LESS-RN for large or advanced stage renal masses is a technically challenging operation. In experienced hands, however, it is a safe and feasible therapeutic option for the management of these tumors.
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Affiliation(s)
- James S Rosoff
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10065, USA.
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Hung SF, Wang SM, Chung SD, Lai MK, Huang KH, Pu YS, Yu HJ, Huang CY. Long-term oncologic outcomes of hand-assisted retroperitoneoscopic radical nephrectomy to treat clinically localized renal cell carcinoma. J Formos Med Assoc 2012; 111:41-5. [PMID: 22333012 DOI: 10.1016/j.jfma.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 04/06/2010] [Accepted: 10/12/2010] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND/PURPOSE To evaluate the long-term oncological outcomes of hand-assisted retroperitoneoscopic radical nephrectomy (HARRN) for treating clinically localized renal cell carcinoma. METHODS We retrospectively collected and analyzed the data and clinical outcomes of 46 patients who underwent HARRN and 50 patients who underwent conventional open radical nephrectomy (ORN) at our institution for clinical localized renal cell carcinoma (RCC). RESULTS The median follow-up period of the HARRN group was 56.5 months (range: 14.6-78.7 months); for the ORN group, the median follow-up period was 110.8 months (range: 15.5-123 months). Patient age, sex, body mass index, pathologic parameters, and classification based on the guidelines of the American Society of Anesthesiologists were not significantly different between the two groups. The HARRN group had a significantly longer operative time (218 minutes vs. 178 minutes, p = 0.003) and less blood loss (203 mL vs. 670 mL, p < 0.001). The complication rates of the ORN and HARRN groups were similar (8% and 4.3%, respectively, p = 0.46). No conversions to an open procedure or intraoperative mortality occurred in the HARRN group. The disease-free and disease-specific survival rates were comparable between the two groups. CONCLUSION The results of our study indicate that HARRN is a feasible, minimally invasive treatment for managing clinically organ-confined RCC with a good long-term oncological outcome.
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Affiliation(s)
- Shun-Fa Hung
- Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Affiliation(s)
- Sutchin R. Patel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stephen Y. Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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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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Larré S, Kanso C, De La Taille A, Hoznek A, Vordos D, Yiou R, Abbou CC, Salomon L. Retroperitoneal laparoscopic radical nephrectomy: Intermediate oncological results. World J Urol 2008; 26:611-5. [DOI: 10.1007/s00345-008-0306-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 06/23/2008] [Indexed: 11/24/2022] Open
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Harano M, Eto M, Yokomizo A, Tatsugami K, Hamaguchi M, Naito S. The efficacy of laparoscopic radical nephrectomy for renal cell cancer in the elderly: An oncological outcome analysis. Int J Urol 2008; 15:577-81. [DOI: 10.1111/j.1442-2042.2008.02054.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aben KKH, Luth TK, Janssen-Heijnen MLG, Mulders PF, Kiemeney LA, van Spronsen DJ. No improvement in renal cell carcinoma survival: a population-based study in the Netherlands. Eur J Cancer 2008; 44:1701-9. [PMID: 18502115 DOI: 10.1016/j.ejca.2008.04.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/17/2008] [Accepted: 04/25/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND The increased finding of kidney 'incidentalomas' and more frequent surgery in patients with renal cell cancer (RCC) metastases may have improved survival from the disease. However, recent data on survival of unselected population-based series of patients with RCC are sparse. METHODS We collected the follow-up data for all the patients registered with RCC in the population-based cancer registry held by the Comprehensive Cancer Centre East, the Netherlands. RESULTS Patients (1504) diagnosed with RCC between 1989 and 2002 were included. Eighty-three percent of all tumours were histologically confirmed; 17% of all diagnoses were based on clinical examination only. The latter group was older, had a worse stage distribution, often did not receive any kind of therapy and showed a 5-year relative survival of 8%. Five-year relative survival for patients with a histologically confirmed RCC was 60% and did not improve over the last 15 years. A low resection rate in patients with metastasis was observed, most pronounced in elderly, without a tendency of increase in more recent years. CONCLUSION The relative survival of RCC did not improve over the years. The resection rate in patients with metastasised disease did not increase over time, despite current knowledge concerning its benefit on tumour complications, time to progression and response to immunotherapy.
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Affiliation(s)
- K K H Aben
- Comprehensive Cancer Centre East, Nijmegen, The Netherlands.
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Lai FC, Kau EL, Ng CS, Fuchs GJ. Laparoscopic Nephrectomy Outcomes of Elderly Patients in the 21st Century. J Endourol 2007; 21:1309-13. [DOI: 10.1089/end.2007.9885] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Frank C. Lai
- Minimally Invasive Urology Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Eric L. Kau
- Minimally Invasive Urology Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Christopher S. Ng
- Minimally Invasive Urology Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Gerhard J. Fuchs
- Minimally Invasive Urology Institute, Cedars Sinai Medical Center, Los Angeles, California
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Affiliation(s)
- Leslie A Deane
- Department of Urology, University of California Irvine, UCI Medical Center, Orange, CA 92868, USA
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Nelson EC, Evans CP, Lara PN. Renal cell carcinoma: Current status and emerging therapies. Cancer Treat Rev 2007; 33:299-313. [PMID: 17329029 DOI: 10.1016/j.ctrv.2006.12.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 12/19/2006] [Accepted: 12/21/2006] [Indexed: 11/16/2022]
Abstract
Renal cell carcinoma (RCC) accounts for about 3% of all adult malignancies and its incidence is increasing. Smoking, obesity, and end-stage renal disease are important risk factors. Localized RCC may be cured with surgical excision. However, over one-third of patients eventually develop metastatic disease. While chemotherapy and radiation therapy are relatively ineffective for RCC, immunotherapy modestly extends survival and may lead to tumor regression and long-term survival in a small minority of patients. Recently, research into the pathology of genetic syndromes associated with RCC has led to remarkable advances in our understanding of the pathogenesis of sporadic RCC. Rational therapeutic agents developed from this understanding have established new treatment paradigms for this disease.
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Affiliation(s)
- Eric C Nelson
- Department of Urology, University of California, Davis Medical Center, Sacramento, CA 95817, USA.
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Chung SD, Huang KH, Lai MK, Huang CY, Pu YS, Yu HJ, Chueh SC. Long-Term Follow-up of Hand-Assisted Laparoscopic Radical Nephrectomy for Organ-Confined Renal Cell Carcinoma. Urology 2007; 69:652-5. [PMID: 17445645 DOI: 10.1016/j.urology.2006.12.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Revised: 09/26/2006] [Accepted: 12/22/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the efficacy and long-term outcomes of hand-assisted laparoscopic radical nephrectomy (HALRN) in treating clinically localized renal cell carcinoma. METHODS We analyzed the data from 54 patients who underwent hand-assisted laparoscopic radical nephrectomy (HALRN) and 70 patients who underwent conventional open radical nephrectomy (ORN) in our institution from January 1998 to December 2002 for clinical Stage T1N0M0 or T2N0M0 renal cell carcinoma. The data were collected retrospectively by reviewing the medical records. All specimens were confirmed by pathologic examination. We compared the surgical results and long-term oncologic outcomes between the two groups. RESULTS The median follow-up period in the HALRN group was 44.5 months (range 16 to 73) and in the ORN group it was 68 months (range 43 to 93). Patient age, sex, body mass index, pathologic parameters, and American Society of Anesthesiologists classification were not significantly different between the two groups. The HALRN group had a significantly longer operative time (204 minutes versus 181 minutes, P = 0.03) and less blood loss (161 mL versus 630 mL, P <0.01). The complication rates for the ORN and HALRN groups were similar (10% and 7.4% respectively, P = 0.62). No conversions to an open procedure or intraoperative mortality occurred in the HALRN group. The average hospital stay, length of wound, and parenteral narcotic analgesic dose were significantly less in the HALRN group. The 5-year disease-free rate and disease-specific survival rate were comparable in the two groups. CONCLUSIONS The results of our study have shown that HALRN is a less-invasive technique with 5-year disease-free and disease-specific survival rates comparable to those after ORN in treating patients with clinically localized renal cell carcinoma.
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Affiliation(s)
- Shiu-Dong Chung
- Department of Urology, Far-Eastern Memorial Hospital, Ban Ciao, Taipei County, Taiwan
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Abstract
PURPOSE OF REVIEW Laparoscopic radical nephrectomy is an established treatment for patients with clinical T1 renal cell carcinoma who are unsuitable for nephron-sparing surgery. In this review we summarize the expanding indications for laparoscopic nephrectomy, including large tumors, locally advanced disease, venous thrombi and cytoreductive surgery. RECENT FINDINGS Laparoscopic nephrectomy remains the foremost conventional laparoscopic procedure in urologic surgery. Multiple studies have demonstrated the feasibility of laparoscopic radical nephrectomy for stage T2 tumors, showing less morbidity and earlier return to activity compared to the open approach. Confirmation of durable oncologic control requires randomized prospective trials with longer follow-up. With growing experience, laparoscopic surgery has been extended to patients with renal cell carcinoma associated with limited local invasion and lymph node metastases. Experimental studies demonstrate the technical feasibility of laparoscopic radical nephrectomy in the presence of renal vein and inferior vena cava thrombi. In well-selected patients with metastatic renal cell carcinoma, laparoscopic cytoreductive nephrectomy can be performed safely, with less morbidity than open nephrectomy. SUMMARY Minimally invasive surgery results in significantly less postoperative morbidity than does open surgery. The intermediate oncologic outcomes of laparoscopic radical nephrectomy for advanced renal cell carcinoma are comparable to those historically achieved with open radical nephrectomy. Longer follow-up is needed to confirm survival equivalence.
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Affiliation(s)
- Kamal Mattar
- Princess Margaret Hospital, UroOncology, Toronto, Ontario, Canada
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Gutiérrez Sanz-Gadea C, Mus Malleu A, Briones Mardones G, Hidalgo Pardo F, Rebassa Llull M, Conde Santos G. [Hand-assisted laparoscopic nephrectomy]. Actas Urol Esp 2006; 30:698-706. [PMID: 17058615 DOI: 10.1016/s0210-4806(06)73520-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES To present the number of cases of hand-assisted laparoscopic nephrectomy. This study evaluates our results and difficulties of starting a progresive programme of laparoscopy. MATERIAL AND METHOD Between november 2003 and november 2005, 35 hand-assisted laparoscopic nephrectomies were carried out, of a total of 45 laparoscopic nephrectomies. 22 radical nephrectomies, 3 simple nephrectomies and 10 nephroureterectomies. The average age of patients was 66 years (47-89). On average, they were overweight (IMC 28,3), with approximately 38% being obese. ASA 2.3 (1-4). The tumors measured 4.8cm on average, and 80% of these were T1. In 28.6% of the cases, they had previously undergone abdominal surgery. RESULTS One was undertaken in 2003, 17 in 2004, and 17 in 2005. The surgery time was 140 minutes, 130 minutes (80-210) in radical nephrectomies, 135 minutes (120-150) in simple nephrectomies and 163 minutes (80-240) in the nephroureterectomy. Patients began an oral diet 1.7 days later, and were able to get up 1.7 days later. In the case of obese patients, they began an oral diet 2.3 days later and were able to get up (2.4 days) later than those non obese cases. (1.5 and 1.4 days respectively). The average stay has been 5.8 days (3-15). The average stay of the cases without complications was 4.2 days and those that encountered complications 9.7 days. In no cases was there a need for a blood transfusion. In 11.4% we had major complications with an average stay of 11.7 days. In 5.7% of cases there were reconversions, and 5.7% of cases were reoperated. 17.1% had minor complications, with an average stay of 8.8 days CONCLUSIONS The advantage of hand-assisted nephrectomy is that it allows one to begin a laparoscopy, with a reduced learning time, and with satisfactory results, allowing the incorporation of laparoscopy surgery in hospitals with a reduced annual volume.
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Bibliography. Current world literature. Minimally invasive surgery in urology. Curr Opin Urol 2006; 16:112-7. [PMID: 16479214 DOI: 10.1097/01.mou.0000193398.85092.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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