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Use of Minimally Invasive Surgery in the Diagnosis and Treatment of Cancer in Dogs and Cats. Vet Sci 2019; 6:vetsci6010033. [PMID: 30897763 PMCID: PMC6466197 DOI: 10.3390/vetsci6010033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/31/2022] Open
Abstract
Surgical management of neoplastic disease is common in veterinary medicine. Minimally invasive surgery (MIS) has gained widespread acceptance by veterinary surgeons and is experiencing rapid growth and frequency of use. Many neoplastic diseases in the abdomen and thorax of dogs and cats can be treated as effectively with MIS as with traditional open surgery. Additionally, MIS allows for less invasive options for organ biopsy in cancer patients either for initial diagnosis or for staging to inform prognosis and treatment. Despite the recent increase in MIS, additional research is required to further characterize the benefits to oncology patients and to ensure that surgical oncologic principles and patient outcomes are not compromised by the use of MIS.
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Shen H, Tu R, Li W, He G, Huang W, Qin Z, Wang C, Yu S. Comparison of the Clinical Efficacy of Retroperitoneal Laparoscopic Partial Nephrectomy and Radical Nephrectomy for Treating Small Renal Cell Carcinoma: Case Report and Literature Review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017; 18:e23912. [PMID: 28182157 PMCID: PMC5287050 DOI: 10.5812/ircmj.23912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 06/30/2015] [Accepted: 07/23/2015] [Indexed: 01/17/2023]
Abstract
Background Renal cell carcinoma (RCC) is a common malignancy of the urinary system with high rates of morbidity and mortality. Objectives This study aimed to investigate and analyze the clinical efficacy of retroperitoneal laparoscopic partial nephrectomy and laparoscopic radical nephrectomy for the treatment of small RCC. Methods In this retrospective study of 45 patients with small RCC, the patients were divided into two treatment groups: Group A (retroperitoneal laparoscopic partial nephrectomy, 25 cases) and Group B (retroperitoneal laparoscopic radical nephrectomy, 20 cases). Results There were no statistically significant differences in the operative time, amount of intraoperative blood loss, length of hospital stay, preoperative creatinine level, postoperative creatinine level after 24 hours, and survival rate after 1, 2, and 3 years between the two groups (P > 0.05). Conclusions There were no significant differences in the survival rates and short-term postoperative complications between the laparoscopic partial nephrectomy group and the laparoscopic radical nephrectomy group for small RCC, but the former was slightly more effective.
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Affiliation(s)
- Hongfeng Shen
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Ruisha Tu
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Wei Li
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Geng He
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Wei Huang
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Zhenchang Qin
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Chongfeng Wang
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Shuyong Yu
- Department of Urology, 187 Hospital of PLA, Hainan, China
- Corresponding Author: Shuyong Yu, Department of Urology, 187 Hospital of PLA, Hainan, China. Tel: +86-13876769088, Fax: +86-13876769088, E-mail:
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Golombos DM, Chughtai B, Trinh QD, Mao J, Te A, O'Malley P, Scherr DS, Del Pizzo J, Hu JC, Sedrakyan A. Adoption of Technology and Its Impact on Nephrectomy Outcomes, a U.S. Population-Based Analysis (2008-2012). J Endourol 2016; 31:91-99. [PMID: 27809567 DOI: 10.1089/end.2016.0643] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Robot-assisted surgery has been touted as offering superior outcomes in various oncologic surgeries. We sought to evaluate the comparative effectiveness of robotic radical nephrectomy (RRN) compared with laparoscopic radical nephrectomy (LRN) in regard to hospital charges, complications, and survival. MATERIALS AND METHODS Using the Surveillance Epidemiology and End Results (SEER) Program-Medicare linked database, we identified patients over the age of 65 who underwent radical nephrectomy (RN) for nonmetastatic renal-cell carcinoma from 2008 to 2012. Patients who underwent RRN were compared with those who underwent LRN. We used propensity scoring matching to compare perioperative and survival outcomes, including overall survival, cancer-specific survival, major adverse events, and healthcare charges. RESULTS Two hundred forty-one patients underwent RRN, and 574 patients underwent LRN. After propensity score matching, the adverse events rate and length of stay were similar between two groups (Major Events: 5.7% vs 6.1%, p = 0.84; prolonged LOS: 17.8% vs 16.1%, p = 0.62). The inpatient charges following RRN were significantly higher than those of LRN ($53,681 vs $44,161, p < 0.01). The mean follow-up of the cohort was 3.2 years. Estimated overall survival (88.0% vs 87.9%, p = 0.90) and cancer-specific survival (98.1% vs 96.4%, p = 0.25) were similar between the two matched cohorts at 3 years. CONCLUSION The robotic platform showed no benefit over standard laparoscopy for RN, as we found no difference in oncologic efficacy or adverse event rates.
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Affiliation(s)
- David M Golombos
- 1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York
| | - Bilal Chughtai
- 1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York
| | - Quoc-Dien Trinh
- 2 Division of Urology, Brigham and Women's Hospital , Boston, Massachusetts
| | - Jialin Mao
- 3 Department of Healthcare Policy and Research, Weill Cornell Medical College , New York, New York
| | - Alexis Te
- 1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York
| | - Padraic O'Malley
- 1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York
| | - Douglas S Scherr
- 1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York
| | - Joseph Del Pizzo
- 1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York
| | - Jim C Hu
- 1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York
| | - Art Sedrakyan
- 3 Department of Healthcare Policy and Research, Weill Cornell Medical College , New York, New York
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Port-site transversus abdominis fascia closure reduced the incidence of incisional hernia following retroperitoneal laparoscopic nephrectomy. Hernia 2016; 20:735-40. [DOI: 10.1007/s10029-016-1508-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/09/2016] [Indexed: 01/22/2023]
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Yuge K, Miyajima A, Jinzaki M, Kaneko G, Hagiwara M, Hasegawa M, Takeda T, Kikuchi E, Nakagawa K, Oya M. How does visceral obesity affect surgical performance in laparoscopic radical nephrectomy? Jpn J Clin Oncol 2015; 45:373-377. [DOI: 10.1093/jjco/hyv001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Yang DY, Monn MF, Bahler CD, Sundaram CP. Does robotic assistance confer an economic benefit during laparoscopic radical nephrectomy? J Urol 2014; 192:671-6. [PMID: 24747652 DOI: 10.1016/j.juro.2014.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE While robotic assisted radical nephrectomy is safe with outcomes and complication rates comparable to those of the pure laparoscopic approach, there is little evidence of an economic or clinical benefit. MATERIALS AND METHODS From the 2009 to 2011 Nationwide Inpatient Sample database we identified patients 18 years old or older who underwent radical nephrectomy for primary renal malignancy. Robotic assisted and laparoscopic techniques were noted. Patients treated with the open technique and those with evidence of metastatic disease were excluded from analysis. Descriptive statistics were performed using the chi-square and Mann-Whitney tests, and the Student t-test. Multiple linear regression was done to examine factors associated with increased hospital costs and charges. RESULTS We identified 24,312 radical nephrectomy cases for study inclusion, of which 7,787 (32%) were performed robotically. There was no demographic difference between robotic assisted and pure laparoscopic radical nephrectomy cases. Median total charges were $47,036 vs $38,068 for robotic assisted vs laparoscopic surgery (p <0.001). Median total hospital costs for robotic assisted surgery were $15,149 compared to $11,735 for laparoscopic surgery (p <0.001). There was no difference in perioperative complications or the incidence of death. Compared to the laparoscopic approach robotic assistance conferred an estimated $4,565 and $11,267 increase in hospital costs and charges, respectively, when adjusted for adapted Charlson comorbidity index score, perioperative complications and length of stay (p <0.001). CONCLUSIONS Robotic assisted radical nephrectomy results in increased medical expense without improving patient morbidity. Assuming surgeon proficiency with pure laparoscopy, robotic technology should be reserved primarily for complex surgeries requiring reconstruction. Traditional laparoscopic techniques should continue to be used for routine radical nephrectomy.
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Affiliation(s)
- David Y Yang
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - M Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Clinton D Bahler
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
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Yap SA, Alibhai SMH, Margel D, Abouassaly R, Timilshina N, Finelli A. A population-based study of surgeon characteristics associated with the uptake of contemporary techniques in renal surgery. Can Urol Assoc J 2013; 7:E576-81. [PMID: 24069099 DOI: 10.5489/cuaj.182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We have witnessed the slow uptake of many contemporary techniques in the surgical management of renal tumours. We sought to evaluate surgeon-level characteristics associated with the uptake of laparoscopy, partial nephrectomy (PN) and adrenal-sparing approaches in surgically managing these tumours. METHODS Using the Ontario Cancer Registry, we identified surgeons treating renal cell carcinoma (RCC) in the province of Ontario, Canada between 2002 and 2004. We then classified individuals within this cohort as either high or low utilizers of laparoscopy, PN or adrenal-sparing approaches. Further variables analyzed included academic status, surgeon graduation year and surgical volume status. We then used univariable and multivariable logistic regression models to assess predictors of uptake. RESULTS We evaluated a total of 108 surgeons for their uptake of both laparoscopy and adrenal-sparing approaches and 94 surgeons for their uptake of PN. We identified 32 surgeons (30%) as high users of laparoscopy. Predictors of uptake of laparoscopy included graduation year after 1990 (odds ratio [OR] 4.81, confidence interval [CI] 1.57-14.8) and high-surgeon volume (OR 4.33, CI 1.60-10.4). We identified 41 surgeons (44%) as high users of PN. The only predictor of uptake of PN was academic status (OR 5.83, CI 1.96-17.3). We identified 69 surgeons (65%) as high users of adrenal-sparing approaches, but did not identify any significant predictors for uptake in this group. DISCUSSION We identify unique factors contributing to the uptake of distinct surgical techniques in the management of RCC. This information sheds lights on the underlying mechanisms and helps us understand how to further encourage the dissemination of these practices.
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Affiliation(s)
- Stanley A Yap
- Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON
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Delreux A, Verhoest G, Mathieu R, Vigneau C, Rioux-Leclercq N, Bensalah K. La néphrectomie laparoscopique pour rein polykystique est faisable et reproductible. Prog Urol 2013; 23:394-8. [DOI: 10.1016/j.purol.2012.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 12/20/2012] [Accepted: 12/23/2012] [Indexed: 01/15/2023]
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Verhoest G, Delreux A, Mathieu R, Patard JJ, Vigneau C, Rioux-Leclercq N, Bensalah K. Transperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease. JSLS 2013; 16:437-42. [PMID: 23318070 PMCID: PMC3535813 DOI: 10.4293/108680812x13462882736178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Compared to open surgery, laparoscopic nephrectomy for autosomal dominant polycystic kidney disease appears to be a feasible and safe approach. Objective: This study focuses on laparoscopic nephrectomy for autosomal dominant polycystic kidney disease (ADPKD). Material and Methods: We retrospectively reviewed 21 consecutive patients who had previously undergone laparoscopy between 2007 and 2010. Data were compared to that obtained from 19 consecutive patients who had open surgery between 2004 and 2007. Clinical parameters, operative data, perioperative mortality, postoperative complications, and length of hospital stay were compared using χ2 and Student t tests for qualitative and quantitative variables, respectively. Results: Nephrectomy is usually performed to create space for renal transplantation (81% and 79%, respectively). Operating time was longer with the laparoscopic approach (180 min vs. 128 min, P = .001). Blood loss was comparable in the 2 groups (154 vs. 222 ml, P = .359) but 3 patients were transfused in the open surgery group as compared with 1 patient in the laparoscopic group. No conversion was needed. There was a trend in the laparoscopic group with respect to lower consumption of analgesics in the postoperative period (P = .06). Delay to transit recovery (2.1 d vs 4.1 d, P < .001) and hospital stay (5.2 d vs. 8.28 d, P = .002) were significantly decreased in the laparoscopic group. The interval from surgery to renal transplantation was lower in patients operated on laparoscopically (3.1 vs. 12 mo). Complications occurred in 33% of the patients in the laparoscopic group as compared with 68% in the open surgery group (P = .22). Severe complications were less frequent in the laparoscopic group (9.5% vs. 37%, P = .04). Conclusion: Laparoscopic nephrectomy is a feasible and safe procedure for ADPKD. Morbidity is significantly reduced compared with the open approach.
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Affiliation(s)
- Grégory Verhoest
- Department of Urology, Rennes University Hospital, Cedex, France.
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Mayhew PD, Mehler SJ, Mayhew KN, Steffey MA, Culp WTN. Experimental and Clinical Evaluation of Transperitoneal Laparoscopic Ureteronephrectomy in Dogs. Vet Surg 2013; 42:565-71. [DOI: 10.1111/j.1532-950x.2013.01092.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 11/01/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Philipp D. Mayhew
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine, University of California-Davis; Davis, California
| | | | - Kelli N. Mayhew
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine, University of California-Davis; Davis, California
| | - Michele A. Steffey
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine, University of California-Davis; Davis, California
| | - William T. N. Culp
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine, University of California-Davis; Davis, California
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Hagiwara M, Miyajima A, Hasegawa M, Jinzaki M, Kikuchi E, Nakagawa K, Oya M. Visceral obesity is a strong predictor of perioperative outcome in patients undergoing laparoscopic radical nephrectomy. BJU Int 2012; 110:E980-4. [DOI: 10.1111/j.1464-410x.2012.11274.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hagiwara M, Miyajima A, Matsumoto K, Kikuchi E, Nakagawa K, Oya M. Benefit of Laparoscopic Radical Nephrectomy in Patients with a High BMI. Jpn J Clin Oncol 2010; 41:400-4. [DOI: 10.1093/jjco/hyq179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Coplen DE. Do we need more rigorous standards for validation of new technology? J Urol 2009; 182:2107-8. [PMID: 19758640 DOI: 10.1016/j.juro.2009.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A prospective comparison of laparoscopic and robotic radical nephrectomy for T1-2N0M0 renal cell carcinoma. World J Urol 2008; 27:89-94. [PMID: 18704439 DOI: 10.1007/s00345-008-0321-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 07/28/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES We prospectively evaluated the safety, feasibility, and efficiency of robotic radical nephrectomy (RRN) for localized renal tumors (T1-2N0M0) and compared this with laparoscopic radical nephrectomy (LRN). MATERIALS AND METHODS Between October 2006 to August 2007, a prospective data analysis of 15 cases of renal cell carcinoma (RCC) stage T1-2N0M0, undergoing RRN was done. These patients were compared with a contemporary cohort of 15 patients of RCC with clinical stage T1-2N0M0, undergoing LRN. To keep comparison robust, all cases were performed by a single surgeon. Demographic, intra-operative, post-operative outcomes, pathological characteristics and follow-up data of the two groups were recorded and analyzed statistically. RESULTS Patients in group A (RRN) experienced significantly (P = 0.001) long operating time than group B (LRN). However, mean estimated blood loss, intra-operative and post-operative complications, blood transfusion rate, analgesic requirement, hospital stay and convalescence were comparable in two groups (P < 0.05). There was one conversion to open surgery in group A, and none in group B. The mean follow-up was comparable in two groups (8.3 and 9.1 months, respectively, in group A and B, P = 0.09). There were no local, port-site or distal recurrences in either group. CONCLUSIONS Robotic radical nephrectomy is a safe, feasible and effective for performing radical nephrectomy for localized RCC. Both groups (RRN and LRN) had comparable intra-operative, peri-operative, post-operative and oncological outcomes except for longer operating time with increased cost for RRN. In this comparative study, there were no outstanding benefits of RRN observed over LRN for localized RCC.
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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.
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Affiliation(s)
- Ashok K Hemal
- Department of Urology, All India Institute of Medical Sciences, New Delhi 110029, India.
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