Первые результаты симультанных видеохирургических операций при двухсторонних опухолях почек

Abstract

Objective. To improve the outcomes of treatment of patients with bilateral kidney tumours. Patients and methods. 30 patients with synchronous bilateral kidney tumours received laparoscopic and retroperitoneoscopic treatment in the Institute of Urology and Reproductive Health, I.M.Sechenov First Moscow State Medical University (Sechenov University) from March 2012 to August 2018. 22 patients underwent staged operative treatment, 8 patients had one-stage surgery. The patients’ stage of disease was classified as Т1аN0M0 to Т3аN0M0. In most cases, the histological type had a malignant character. Results. 22 patients underwent 3D modelling of pathological process at the stage of preoperative preparation. The classical triad of renal cancer symptoms was not found. 7 operations were performed by the retroperitoneoscopic access, the others laparoscopically. The number of operations with retro- and retro-approach was 1, retro- and laparo-approach was 3, with laparolaparo-approach was 4. Performance of bilateral laparoscopic resection takes more time as compared with the combination of retro- and laparoscopic approaches. Two resections performed from the retro- and laparoscopic accesses make possible an operation without the surgeons going to the opposite side and changing the position of the endosurgical equipment, which shortens preparation to the second step of surgery and the duration of anaesthesia. Apparently, division of the surgical approach to the kidneys into the abdominal cavity and the retroperitoneal space is preferable, since it allows an adequate evaluation of the course of the early postoperative period and a differential control over the development of complications, first of all, bleeding. Conclusion. First evaluation of the outcomes of treating 8 patients, who underwent one-stage surgery, showed that this approach is safe, since it is not associated with an increase of intraoperative blood loss or other complications as compared with two-stage operations. Also, the duration of anaesthesia is shorter in one-stage surgery than in staged treatment. Enhancement of the volume of operative treatment does not reduce the length of hospitalization but rules out the need for repeated hospitalisation. We have obtained positive results that encourage further enrolment of patients and assessment of long-term outcomes of treatment. Key words: bilateral kidney cancer, synchronous cancer, organ-preserving surgery, nephrectomy, simultaneous and staged surgery, laparoscopic and retroperitoneoscopic surgery