1
|
Huang Y, Yi T, He H, Li Q, Long X, Hu G, Chen Q, Li Y, Chen R, Yi X. Laparoscopic specimen extraction in vitro: preliminary experience. BMC Surg 2021; 21:305. [PMID: 34210315 PMCID: PMC8246676 DOI: 10.1186/s12893-021-01300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The last procedure performed by the surgeon in laparoscopic surgery is to extract the specimen through the smallest incision possible. This experiment aimed to explore the maximum diameter of specimens that can be extracted through auxiliary incisions of different lengths and shapes by in vitro physical experiments. MATERIALS AND METHODS We used the abdominal wall with the muscle layer, fixed on a square wooden frame, to simulate the human abdominal wall. Then, specimen extraction ports were made with circular, inverted Y-shaped and straight-line incisions of different sizes and lengths, and specimens of different sizes were made from tissues of different species. These specimens were extracted from different incisions with a force gauge. The tension value (N) was measured, and records were made of the length or diameter of the smallest auxiliary incision through which a given specimen could pass, as well as the largest specimen diameter that could pass through an incision of a given size. This experiment provides us with preliminary experience-based knowledge of how to choose the appropriate auxiliary incision for surgical specimen extraction according to the diameter of the specimen. RESULTS The maximum diameters of specimens that could be extracted with circular ostomy diameters of 2.4, 2.7 and 3.3 cm were 4.0, 4.5 and 6.0 cm, respectively. Specimens with diameters of 6.0, 8.0 and 10.0 cm could be extracted through inverted Y-shaped incisions with a length around the umbilicus of 1 cm and an extension length of 1.0, 3.0, and 4.0 cm, respectively. Moreover, these same specimens could be extracted through inverted Y-shaped incisions with a length around the umbilicus of 2 cm and extension lengths of 0.0, 1.0 and 2.0 cm. Tough tissue specimens (made from chicken gizzards) with diameters of 1.0, 2.0, 4.0 and 6.0 cm, respectively, could be removed through straight-line incisions measuring 1.0, 2.0, 3.0 and 4.0 cm in length. CONCLUSION Along with preoperative imaging, surgical planning and trocar position, the shape and length of auxiliary incisions can be used to improve the extraction of specimens via laparoscopic surgery.
Collapse
Affiliation(s)
- Yuanbi Huang
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning, 530021, People's Republic of China
| | - Tian Yi
- College of Communication and Art Design, University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Huajie He
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning, 530021, People's Republic of China
| | - Qiguang Li
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning, 530021, People's Republic of China
| | - Xian Long
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning, 530021, People's Republic of China
| | - Gaohua Hu
- Department of Thyroid and Breast Surgery, Qichun People's Hosiptal, Qichun, 435300, HuBei, China
| | - Qiwei Chen
- Department of Urology, The People's Hospital of Hezhou, Hezhou, 542800, Guangxi, China
| | - Yongpeng Li
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning, 530021, People's Republic of China
| | - Rongchao Chen
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning, 530021, People's Republic of China
| | - Xianlin Yi
- Department of Urology, Cancer Hospital of Guangxi Medical University & Guangxi Cancer Research Institute, Nanning, 530021, People's Republic of China.
| |
Collapse
|
2
|
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.
Collapse
Affiliation(s)
- Hosam S Al-Qudah
- Genitourinary Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | | | | |
Collapse
|
3
|
Vaginal vault metastasis – The new enigma in port site recurrences in gynecological laparoscopic surgeries. Gynecol Minim Invasive Ther 2016. [DOI: 10.1016/j.gmit.2015.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
4
|
Manvelyan V, Khemarangsan V, Huang KG, Adlan AS, Lee CL. Port-site metastasis in laparoscopic gynecological oncology surgery: An overview. Gynecol Minim Invasive Ther 2016. [DOI: 10.1016/j.gmit.2015.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
5
|
Manzano JP, Barbosa MMDLS, Barbosa FT, Araújo SRR, Andreoni C. Reduction in Renal Specimen After Laparoscopic Radical Nephrectomy: A Histopathologic Analysis. J Endourol 2014:150127063131006. [PMID: 24924202 DOI: 10.1089/end.2014.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract Background and Purpose: There is no consensus on the most appropriate way to extract the kidney after laparoscopy. A previous study evaluated the reduction in total kidney volume and incision size (40%) after perfusion with a 5% hypertonic solution in a porcine model. The purpose of the current study was to compare the histopathologic renal tumor diagnosis before and after this perfusion. Furthermore, fluid drained from the renal vein was analyzed for the presence of neoplastic cells. Materials and Methods: After radical nephrectomy, specimens of 21 cases of renal tumors were studied. A small piece of the tumor was removed and fixed in formaldehyde. After that, 500 mL of a 5% NaCL solution was infused through the renal artery. The first 10 mL drained from the vein was collected and sent for cytologic study. The specimens and the fragment were analyzed. The parameters studied were histologic subtypes, Fuhrman grade, necrosis, and microvascular invasion. Results: Clear-cell renal carcinoma was found in 81% of the cases. Two cases of chromophobic renal carcinoma, one case of papillary tumor, and one case of oncocytoma were found. There were no differences in histologic subtypes, Fuhrman grade, necrosis, and microvascular invasion before and after perfusion in most of the cases. All cytologic analysis of drained liquid from the renal vein was negative for neoplastic cells. Conclusions: Renal perfusion with 5% NaCL solution after laparoscopic radical nephrectomy did not interfere with the histopathologic and cytologic characteristics of the kidney. In addition, all samples from the liquid drained from the renal vein were negative for neoplastic cells. These findings suggest that renal shrinkage with hypertonic saline after laparoscopic radical nephrectomy is feasible and might be useful for patients with kidney cancer. Validation of our results as well as their impact on clinical outcomes is warranted.
Collapse
Affiliation(s)
- João Padua Manzano
- 1 Division of Urology, Federal University of São Paulo , São Paulo, Brazil
| | | | | | | | | |
Collapse
|
6
|
Binsaleh S. Specimen processing during laparoscopic renal surgery: a review of techniques and technologies. Clinics (Sao Paulo) 2014; 69:862-6. [PMID: 25628000 PMCID: PMC4286670 DOI: 10.6061/clinics/2014(12)12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/01/2014] [Indexed: 12/03/2022] Open
Abstract
Laparoscopic surgery has well-defined benefits for patients and has become accepted over time as a standard access strategy for the management of benign and malignant urologic diseases. Unlike in open surgery, the surgeon is often faced with the additional challenges of specimen retrieval and extraction at the end of laparoscopic extirpative procedures. This final step often requires significant laparoscopic skill to entrap and safely extract the laparoscopic specimens. Failure to apply safe exit steps at the end of a laparoscopic procedure may lead to significant morbidity. The aim of this review is to explore the different techniques and technologies available for laparoscopic kidney retrieval, entrapment and safe extraction.
Collapse
Affiliation(s)
- Saleh Binsaleh
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
7
|
Port-site metastasis after laparoscopic surgery for urological malignancy: forgotten or missed. Adv Urol 2012; 2012:609531. [PMID: 22611383 PMCID: PMC3349242 DOI: 10.1155/2012/609531] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 10/10/2011] [Accepted: 01/16/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose. Port-site metastasis has been a concern with the common use of laparoscopy in urologic oncology. We conducted this study to provide a review of port-site metastases reported after the laparoscopy in managing urologic malignancies, possible contributing factors and preventative measures. Materials and Methods. An electronic search of MEDLINE using the combined MESH key words “port-site metastasis” and “Urology”. Results. 51 articles addressing port-site metastasis after laparoscopic surgery for urolo¬gical malignancy were identified. Conclusion. Port-site metastasis after laparoscopic surgery for urolo¬gical malignancy is rare. The incidence is comparable to the rate for surgical wound metastases.
Collapse
|
8
|
Natalin RA, Lima FS, Pinheiro T, Vicari E, Ortiz V, Andreoni C, Landman J. The final stage of the laparoscopic procedure: exploring final steps. Int Braz J Urol 2012; 38:4-16. [DOI: 10.1590/s1677-55382012000100002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2011] [Indexed: 11/21/2022] Open
|
9
|
Lloyd D, Walmsley JP, Greet TRC, Payne RJ, Newton JR, Phillips TJ. Electrosurgery as the sole means of haemostasis during the laparoscopic removal of pathologically enlarged ovaries in mares: a report of 55 cases. Equine Vet J 2010; 39:210-4. [PMID: 17520970 DOI: 10.2746/042516407x17116522] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY There is little published clinical evidence on the use of a laparoscopic approach for the removal of pathologically enlarged ovaries in standing mares. OBJECTIVES To show the orders of success and complication rates that can be expected if pathologically enlarged ovaries are removed from standing, sedated mares under laparoscopic guidance using only electrosurgical means of haemostasis. METHODS A retrospective analysis was made of 55 mares in which the removal of an enlarged ovary was attempted by applying a standard laparoscopic procedure for routine ovariectomy in standing mares including a reliance solely on one of 2 types of electrosurgical bipolar forceps with an integrated guillotine for haemostasis and transection of the ovarian pedicle. The outcomes and complications encountered were recorded. Logistic regression analysis was performed to identify the risk of any complications associated with the size of the ovary removed and the instrument used. RESULTS In 54 of the 55 mares, the surgery was successfully accomplished by the planned approach. In one mare there was significant intraoperative haemorrhage and this necessitated the additional use of a prosthetic haemostatic device. The only other complications encountered were post operative abdominal discomfort (n = 9), delayed incisional wound healing (n = 6) and iatrogenic uterine puncture (n = 2). One mare developed a rectal tear, but not as a direct complication of the surgical procedure. None of these prevented a long-term successful outcome. CONCLUSIONS The removal of pathologically enlarged ovaries (up to 30 cm diameter) from mares under standing sedation can be accomplished predictably and safely by applying the standard laparoscopic approach that is established for routine laparoscopic ovariectomy, including a reliance solely on endoscopic electrosurgery instruments for haemostasis of the ovarian pedicle. POTENTIAL RELEVANCE This study shows that the simple standing laparoscopic technique now favoured for routine ovariectomy can be used safely and reliably for the removal of pathologically enlarged ovaries. This promises to be of significant clinical advantage to mares so affected.
Collapse
Affiliation(s)
- D Lloyd
- The Liphook Equine Hospital, Forest Mere, Liphook, Hampshire GU30 7JG
| | | | | | | | | | | |
Collapse
|
10
|
Wu SD, Lesani OA, Zhao LC, Johnston WK, Wolf JS, Clayman RV, Nadler RB. A Multi-Institutional Study on the Safety and Efficacy of Specimen Morcellation After Laparoscopic Radical Nephrectomy for Clinical Stage T1 or T2 Renal Cell Carcinoma. J Endourol 2009; 23:1513-8. [DOI: 10.1089/end.2009.0387] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simon D. Wu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - O. Alex Lesani
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lee C. Zhao
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William K. Johnston
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - J. Stuart Wolf
- Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Ralph V. Clayman
- Department of Urology, University of California Irvine Medical Center, Orange, California
| | - Robert B. Nadler
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
11
|
Bird VG, Au JK, Sandman Y, Santos RDL, Ayyathurai R, Shields JM. Comparison of Different Extraction Sites Used During Laparoscopic Radical Nephrectomy. J Urol 2009; 181:1565-70. [DOI: 10.1016/j.juro.2008.11.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Vincent G. Bird
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jason K. Au
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Yekutiel Sandman
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rosely De Los Santos
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rajnikanth Ayyathurai
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - John M. Shields
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| |
Collapse
|
12
|
Goel MC, Mohammadi Y, Sethi AS, Brown JA, Sundaram CP. Pathologic Upstaging after Laparoscopic Radical Nephrectomy. J Endourol 2008; 22:2257-61. [DOI: 10.1089/end.2008.0399] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mahesh C. Goel
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| | - Yousef Mohammadi
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| | - Amanjot S. Sethi
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| | - James A. Brown
- Division of Urology, Medical College of Georgia, Augusta, Georgia
| | - Chandru P. Sundaram
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| |
Collapse
|
13
|
Castillo OA, Vitagliano G. Port Site Metastasis and Tumor Seeding in Oncologic Laparoscopic Urology. Urology 2008; 71:372-8. [DOI: 10.1016/j.urology.2007.10.064] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 09/28/2007] [Accepted: 10/26/2007] [Indexed: 11/16/2022]
|
14
|
Jamali FR, Fölscher DJ, Bailey CMH, Leroy J, Marescaux J. Rapidly reversible closure of mini-laparotomy during laparoscopic colorectal surgery. Am J Surg 2007; 194:556-8. [PMID: 17826079 DOI: 10.1016/j.amjsurg.2006.11.042] [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] [Received: 08/28/2006] [Revised: 11/07/2006] [Accepted: 11/07/2006] [Indexed: 12/21/2022]
Abstract
Specimen extraction has been described as the "Achilles heel" of laparoscopic colonic surgery. In most cases, this extraction is performed via a tailored, appropriately placed mini-laparotomy incision. Immediate closure of this mini-laparotomy following specimen extraction wastes operative time and prevents the incision from being used for access later on in the procedure. The use of hand assist devices to allow reversible closure has been reported, not without its own drawbacks including cost and difficulty of use. We hereby describe a technique of creating a rapidly reversible closure of the mini-laparotomy incision using a simple wound protector. This technique is simple, easily reproducible, inexpensive, and effective, leading to time savings in the operating room when applied properly.
Collapse
Affiliation(s)
- Faek R Jamali
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | | | | | | | | |
Collapse
|
15
|
Granberg CF, Krambeck AE, Leibovich BC, Frank I, Lohse CM, Gettman MT, Blute ML, Chow GC. Potential Underdetection of pT3a Renal-Cell Carcinoma with Laparoscopic Morcellation. J Endourol 2007; 21:1183-6. [DOI: 10.1089/end.2007.9910] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Candace F. Granberg
- Department of Urology, Mayo Medical School, Mayo Clinic, Rochester, Minnesota
| | - Amy E. Krambeck
- Department of Urology, Mayo Medical School, Mayo Clinic, Rochester, Minnesota
| | | | - Igor Frank
- Department of Urology, Mayo Medical School, Mayo Clinic, Rochester, Minnesota
| | - Christine M. Lohse
- Department of Health Sciences Research, Mayo Medical School, Mayo Clinic, Rochester, Minnesota
| | - Matthew T. Gettman
- Department of Urology, Mayo Medical School, Mayo Clinic, Rochester, Minnesota
| | - Michael L. Blute
- Department of Urology, Mayo Medical School, Mayo Clinic, Rochester, Minnesota
| | - George C. Chow
- Department of Urology, Mayo Medical School, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
16
|
Andreoni C, Araujo MB, Bomfim AC, Manzano JP, Silva FD, Scapulatempo-Neto C, Fagundes DJ, Poli-de-Figueiredo L, Ortiz V. In-vitro renal shrinkage after hypertonic saline perfusion for organ removal during laparoscopic nephrectomy. J Endourol 2007; 21:891-6. [PMID: 17867948 DOI: 10.1089/end.2006.0402] [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: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the possibility of shrinking the kidney by perfusion with hypertonic solution to facilitate organ removal in laparoscopic surgery. MATERIALS AND METHODS After 18 open nephrectomies (ONs) in 9 pigs, one of four saline solutions (5%, 7.5%, 10%, and 15%) was infused through a catheter into the renal artery for 5 minutes in four kidneys each. The volumes and weights of the kidneys were measured before and after renal perfusion; the kidneys were then sent for histologic evaluation. Eight ONs were performed, and the kidneys were removed from the abdominal cavity in a plastic bag in order to mimic organ entrapment during laparoscopy. The kidneys were perfused with hypertonic solution and were again put in a plastic bag and removed from the same animal's abdomen through another incision. The incisions were measured with calipers before and after extraction of the unperfused and perfused organs. RESULTS The kidneys that underwent perfusion with 5% saline had the greatest decrease in both weight and volume, an average of 16% and 17.8%, respectively. The average incision needed for extraction of unperfused kidneys was 44.9 mm (range 40-58 mm), whereas the mean size of the incision needed to remove perfused kidneys was 26.6 mm (range 20-30 mm) (P < 0.001). The relative reduction in the necessary incision size therefore was 44.3% (range 33.3%-55%). CONCLUSION Perfusion with 5% saline is able to shrink the kidney volume slightly with mild histologic changes. In the pig, it is possible to decrease the renal incision necessary for kidney removal by 44% using this method.
Collapse
Affiliation(s)
- Cássio Andreoni
- Division of Urology, Federal University of São Paulo, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Hemal AK, Kumar A, Gupta NP, Kumar R. Oncologic outcome of 132 cases of laparoscopic radical nephrectomy with intact specimen removal for T1-2N0M0 renal cell carcinoma. World J Urol 2007; 25:619-26. [PMID: 17786453 DOI: 10.1007/s00345-007-0210-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 08/04/2007] [Indexed: 10/22/2022] Open
Abstract
We present the short and long-term oncologic outcome of 132 patients with pathologically confirmed T1-T2, N0M0 renal cell carcinoma (RCC), who underwent laparoscopic radical nephrectomy with intact specimen removal at our institution. Beginning January 1998, we prospectively collected data of 132 patients undergoing laparoscopic radical nephrectomy, whose final pathologic stage was T1 or T2, N0M0, RCC. The clinical data of three groups categorized as group (pT1a)--36 patients, group (pT1b)--51 patients and group (pT2)--45 patients were analyzed statistically to assess oncological outcome. The specimens were removed intact without morcellation in all patients in a homemade plastic bag. The total median follow-up was 56 months (range 3-80 months) and there were no local or port-site recurrences or hernia. Patients with pT2 tumors had significantly greater operating time, blood loss and analgesic requirements than pT1a/pT1b tumor patients. The distant metastases were found in 1, 4 and 5 patients in group pT1a, pT1b and pT2, respectively. The 5-year cancer-specific survival was 97.2, 86.3 and 82.2%, respectively, in pT1a, pT1b and pT2 tumor patients (significantly lower in pT2 than pT1a, P = 0.008). The 5-year recurrence-free survival was 97.2, 84.3 and 82.2%, respectively, in pT1a, pT1b and pT2 tumor patients (significantly lower in pT2 than pT1a, P = 0.02). Laparoscopic radical nephrectomy (retroperitoneal and transperitoneal route) with intact specimen removal for localized renal cell carcinoma (T1-2N0M0) provides satisfactory short and long-term oncologic efficacy.
Collapse
Affiliation(s)
- Ashok K Hemal
- Department of Urology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | | | | | | |
Collapse
|
18
|
Abstract
Fifteen years after the first report, laparoscopic nephrectomy has demonstrated proven efficacy and safety comparable with an open approach, with a significant advantage of a faster recovery. Wide dissemination of these surgical techniques and continued improvement in instrumentation has made laparoscopy the preferred approach for treating benign pathologic conditions of the kidney. In this review, the expanding indications of laparoscopic simple nephrectomy and the outcomes of the larger clinical series are examined. We discuss the technical aspects of both transperitoneal and retroperitoneal approaches. Finally, laparoscopic cyst decortication and some of the novel applications of laparoscopic renal surgery are highlighted.
Collapse
Affiliation(s)
- Joseph C Liao
- Department of Urology, Stanford University School of Medicine and VA Palo Alto Health Care System, 3801 Miranda Avenue, MC112, Palo Alto, CA 94304, USA.
| | | | | |
Collapse
|
19
|
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.
Collapse
Affiliation(s)
- Kamal Mattar
- Princess Margaret Hospital, UroOncology, Toronto, Ontario, Canada
| | | |
Collapse
|
20
|
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]
|
21
|
Sengupta S, Zincke H. Lessons learned in the surgical management of renal cell carcinoma. Urology 2005; 66:36-42. [PMID: 16194705 DOI: 10.1016/j.urology.2005.06.004] [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] [Received: 05/23/2005] [Accepted: 06/20/2005] [Indexed: 12/18/2022]
Abstract
Surgical excision, the mainstay of management of renal cell carcinoma (RCC), has evolved significantly over the last 4 decades. Radiological imaging is crucial to the diagnosis and staging of RCC, and technological advances have facilitated more precise preoperative assessment. Additionally, wider use of cross-sectional imaging modalities has led to increasing incidental diagnosis of small, early-stage RCC. Nephron-sparing surgery (NSS), originally developed to treat RCC arising in a solitary functioning kidney, has been demonstrated to be a safe and effective alternative to radical nephrectomy. NSS is now also applicable to tumors of suitable size and anatomy in patients with a normal contralateral kidney, thus facilitating preservation of renal function and management of metachronous contralateral pathology. Laparoscopic and percutaneous approaches have developed over the last decade, thus providing minimally invasive modalities, with shortened convalescence and improved cosmesis. Advanced RCC, involving venous extension or nodal spread, is increasingly amenable to surgical management, although appropriate patient selection is crucial. Furthermore, surgical excision of the primary lesion appears to be an integral part of systemic therapy for metastatic RCC.
Collapse
Affiliation(s)
- Shomik Sengupta
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | |
Collapse
|
22
|
LiteratureWatch. J Endourol 2005; 19:1045-62. [PMID: 16253079 DOI: 10.1089/end.2005.19.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|