Collecting System Injury Research Articles

Laparoscopic partial nephrectomy for endophytic hilar tumors: feasibility and outcomes

ObjectiveTo analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients. MethodsThis is a single centre retrospective study. From May 2009 to September 2011, 208 LPNs were performed at our institution. Overall 11 (5.2%) elective LPNs were for hilar tumors not visible on kidney surface. Hilar tumor was defined as a mass located in the renal hilum and in contact with a major renal vessel on preoperative imaging. Procedures were carried out by a single experienced surgeon (G.G.) via retroperitoneal approach by clamping the only main renal artery. ResultsMean (range) age of patients was 45.3 years (38.2–64.1), tumor size 1.6 cm (1.2–2.0), warm ischemia time 24 min (19–32), operative time 140 min (110–200) and estimated blood loss 270 ml (100–750). Two collecting system injuries were observed and repaired intraoperatively. No conversion to open surgery was required. Final pathological examination revealed 10 renal cell carcinomas and 1 oncocytoma. A negative surgical margin was obtained in 10/11 (91%) patients. Renal function and serum hemoglobin were nearly unaltered pre and post-surgery. No tumor recurrence was observed at mean (range) follow-up of 34 months (15–43). ConclusionsIn experienced hands, LPN represents a feasible, safe and effective treatment for selected patients diagnosed with endophytic hilar masses. A larger number of patients and longer follow-up are required to draw definitive conclusions.

Process improvement in trauma

Appropriate imaging in renal trauma can avoid delayed recognition of collecting system injuries, allowing for prompt intervention and less morbidity. Current recommendations include obtaining abdominal and pelvic computed tomographic scans with intravenous contrast, followed by excretory images for high-grade injury or perinephric fluid. The purpose of this study was to evaluate compliance with this recommendation among adult Level I trauma centers in Utah. A retrospective review was performed on all renal trauma patients evaluated at adult Level I trauma centers in Utah from January 2005 to January 2011. For all American Association for Surgery of Trauma grade 3 to 5 renal injuries, injury characteristics and outcomes were reviewed. We defined compliance as obtaining delayed images for grade 3 injuries with perinephric fluid or any grade 4 to 5 injuries. Descriptive statistics and univariate comparisons were calculated using statistical software. A total of 147 patients were identified with injuries of grade 3 or higher, but only 126 had available images for review at the time of the study. Of the 102 patients with a perinephric fluid collection or grade 4 to 5 injuries, delayed images were obtained in 74 (73%). In these patients, 14 (19%) had a collecting system injury. In the 28 patients without delayed images, 7 (25%) were later identified to have a collecting system injury. Of the 21 collecting system injuries, 7 (33%) had a delay in diagnosis because of lack of excretory images obtained on initial evaluation. Our findings support obtaining excretory images in patients with grade 4 to 5 injuries or those with a perinephric fluid collection. Poor compliance led to delayed diagnosis, with several patients requiring intervention for persistent urinary leak. We have implemented trauma imaging guidelines within Utah Level I trauma hospitals, which seek to minimize these diagnostic problems. Epidemiologic study, level III; therapeutic study, level IV.

Percutaneous nephrolithotomy in patients with scoliosis: our institutional experience

It is challenging to treat renal stones in patients with scoliosis. The present study was designed to study the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mPCNL, 18 Fr) and standard tract PCNL (24 Fr) in patients with scoliosis. Twenty cases treated with mPCNL and 18 cases with standard tract PCNL were included in the present study. Laboratory data included preoperative routine complete blood count, serum creatinine, urine bacterial culture, etc. KUB, intravenous urography or CT scanning was done. Fifteen had lumbar and 23 had thoracolumbar scoliosis. Pulmonary function test was performed in all cases. Demographic and clinical details, operative characteristics and complications were studied and compared between two groups retrospectively. The stone burdens of two groups were averagely 754.4 and 816.2mm(2), respectively (P=0.194). Pulmonary function test indicated that 18 (47%) out of 38 patients had decreased function for surgery and anesthesia. The stone clearance rates were 55 and 67%, respectively, after the first session (P=0.522). The requirements of auxiliary treatments including second-look PCNL procedure or SWL (shock wave lithotripsy) were not significantly different for both groups. All patients from both groups achieved final stone clearance after auxiliary treatments. Complications of urinary collecting system injury or fever were observed in one and two cases in each group, respectively, (P=0.548). There were no injuries to neighboring organs or pneumothorax. The requirement of blood transfusion for four cases in mPCNL group and three cases in the standard tract PCNL group, respectively, indicated no significant difference between two groups (P=0.999). We are able to successfully and safely perform both mPCNL and standard tract PCNL in patients with scoliosis in our hospital. Compared with mPCNL, standard tract PCNL is even more efficient due to its shorter operative time.

Irreversible Electroporation: Evaluation of Nonthermal and Thermal Ablative Capabilities in the Porcine Kidney

To compare the renal ablative capabilities of nonthermal irreversible electroporation (NT-IRE) with those of thermal irreversible electroporation (T-IRE) in a porcine model. A total of 24 laparoscopic renal ablations were performed in 12 pigs using a novel generator capable of alternately delivering NT-IRE and T-IRE. Each pig underwent unilateral interpolar ablation straddling the renal pelvis and lower pole ablation, using a single modality. The pigs were killed at 24 hours and 7 and 21 days. Basic serum laboratory tests, cardiac enzyme levels, and retrograde pyelograms were obtained before and immediately after ablation and at death. Ablation adequacy and lesion size were assessed by histologic examination. All procedures were successfully completed without complications. For NT-IRE vs T-IRE, the median lesion size (long axis) at 24 hours, 7 days and 21 days was 3.0 vs 3.3 cm (P = 1.0), 2.5 vs 3.9 cm (P = .04), and 1.2 vs 2.8 cm (P = .03), respectively. Prolonged urinary extravasation and collecting system scarring were observed only for T-IRE. Both NT-IRE and T-IRE ablated the renal tissue adequately. NT-IRE was characterized by acute hemorrhagic necrosis, sparing the large blood vessels and extracellular matrix, and T-IRE by coagulation necrosis with associated moderate inflammation. NT-IRE and T-IRE both safe and effectively ablate normal porcine kidneys. NT-IRE created smaller lesions with unique histologic characteristics. Significant collecting system injury occurred with T-IRE. Additional preclinical evaluation aimed at optimizing the ablation protocols is needed.

Clinical research of retroperitoneal laparoscopic intervention ultrasound aided positioning in the treatment of adult renal cyst

Objective To explore the clinical value of retropentoneal laparoscopic interventon ultrasound aided positioning in the treatment of adult renal cyst.Methods The operating information of 327 patients with adult renal cyst was analyzed retrospectively,in which 239 cases applied the retroperitoneal laparoscopic intervention ultrasound aided positioning treatment( interventional ultrasound group),88 cases applied retroperitoneal laparoscopic intervention without ultrasound assisted positioning operation treatment ( non interventional ultrasound group).Results The operation time of the interventional ultrasound group was (3.61 ± 0.49) h,and was longer than that of the non interventionul ultrasound group[ ( 3.27 ± 0.71 ) h ] ( t =4.89,P ＜ 0.05 ).The postoperative indwelling drainage tube time,postoperative renal length of the interventional ultrasound group was (2.24 ± 0.58 ) d,( 12.01 ± 4.25 ) cm respectively,and was shorter than that of the non interventional ultrasound group[ (3.59 ±2.27 ) d、( 13.39 ±5.21 )cm ] ( t =8.49,2.45,all P ＜ 0.05 ).A postoperative ＞ 1 cm cyst residual amount of ultrasound in the intervention group was significantly less than the non-ultrasound in the intervention group (x2 =10.36,P ＜ 0.05 ).Conclusion The ultrasound assisted positioning operation could determine deep cysts position better,so the retroperitoneal laparoscopic intervention ultrasound aided positioning in the treatment of adult renal cyst could reduce cyst of residual risk,and also prevent serious vascular and renal collecting system injury and improve the operation safety. Key words: Polycystic kidney; Posterior approach; Laparoscopic

Contemporary management of renal trauma

The purpose of this study was to evaluate the contemporary practice patterns of urologists (UR) and trauma surgeons (TS) regarding controversial topics in the management of renal trauma (RT). We conducted a national survey of all Society of Genitourinary Reconstructive Surgeons members and a random sampling of American Association for the Surgery of Trauma members between October and November 2010 via email, regarding management routines for various stages of blunt and penetrating RT. Response rate was 33%. In all, 21% of TS and 3% of UR (p = 0.005) do not use any tests to confirm the presence of another kidney before exploring an expanding retroperitoneal hematoma, despite lack of preoperative imaging. To confirm the presence of another kidney, UR prefer the "one-shot" intravenous pyelogram (82%), whereas TS prefer palpation (61%; p < 0.001). TS do not obtain primary renal vascular control before opening the retroperitoneal, whereas UR do (21% vs. 71%; p < 0.001). TS utilize early angiography for the control of intravascular contrast extravasation more commonly than UR (88% vs. 55%; p < 0.001). TS overutilize ureteral stenting (50% vs. 24%; p < 0.001) for isolated collecting system injuries compared with UR. Differences in practice patterns between TS and UR tend to follow differences in published guidelines. There is an apparent lack of communication and differing treatment methods for RT. That there are two camps with differing "community standards of practice" indicates that there is a desperate need for reeducation and for large-scale, multi-institutional prospective studies on RT to "standardize" management.

Safe and Effective Obtainment of Access for Percutaneous Nephrolithotomy by Urologists: The Louisiana State University Experience

Access for percutaneous nephrolithotomy (PCNL) is critical to successful removal of stone burden and is often performed by a specialist other than a urologist. In many regions, however, there is limited availability of such personnel. We reviewed the complication rates that were related to PCNL access when performed at a teaching hospital to establish that access for PCNL may be safely taught to and performed by urology residents. Chief urology residents across the nation were also anonymously surveyed to better understand the current trends and dynamics regarding PCNL access in teaching institutions. A retrospective chart review was performed of all PCNLs performed at our institution from 1995 to 2009 for any complications that were related to surgery. Patients with access gained at outside institutions or not attempted at the time of surgery by residents were excluded. The complication rate was compared with those of the American College of Radiology. An eight-question survey was also sent by e-mail to all current urology chief residents regarding their experience with PCNL access during residency. A total of 290 patients underwent PCNL with 338 separate access sites gained at the time of surgery under the supervision of nine teaching staff. Access was gained in all cases at the time of surgery. Major complications included: Transfusion in 20 (5.9%) patients, sepsis in 2 (0.6%) patients, pseudoaneurysm necessitating intervention in 2 (0.6%) patients, hydrothorax in 2 (0.6%) patients, pneuomothorax in 1 (0.3%) patient, ureteropelvic junction disruption in 1 (0.3%) patient, and one death (0.3%) after surgery. Minor complications included: Urinary tract infection in five (1.5%) patients, and collecting system injuries in 6 (1.8%) patients necessitating placement of a ureteral stent. Our survey of residents demonstrated that 53% did not routinely gain access for PCNL at their institution. The 94% who did not get instruction on PCNL access, however, thought it would be a valuable addition to their training. Our results show that access for PCNL surgery can be safely and successfully obtained by genitourinary residents under the supervision of trained staff at the time of surgery. We think that access for PCNL is a valuable tool that should be in the armamentarium of all urologic surgeons on leaving an accredited urology training program.

Percutaneous Cryoablation of Renal Lesions With Radiographic Ice Ball Involvement of the Renal Sinus: Analysis of Hemorrhagic and Collecting System Complications

The purpose of this study was to determine the incidence of collecting system and hemorrhagic complications resulting from CT-guided percutaneous cryoablation of renal tumors in which the radiographic ice ball abuts or involves the renal sinus. From November 2005 through July 2009 at our institution, we performed 129 CT-guided percutaneous cryoablation procedures on 107 patients (mean age, 64 years) with renal masses suspicious of being renal cell carcinoma. Radiographic ice balls that abutted or overlapped the renal sinus were classified as central; the other lesions were classified as noncentral. Medical records and follow-up images were retrospectively reviewed for hemorrhage requiring intervention and for evidence of collecting system injury. The mean follow-up period was 9.3 months. The radiographic ice ball was classified as central in 67 cases. In these central ablations, the mean sinus involvement was 6.2 mm (range, 0-19 mm), 41 ice balls overlapping the renal sinus by 6 mm or more (mean, 9.4 mm). No cases of collecting system injury were identified for any ablation. Overall, there was only one hemorrhagic complication requiring intervention, and it occurred in a noncentral ablation. CT-guided percutaneous cryoablation of renal masses with ice ball overlap of the renal sinus resulted in no cases of collecting system injury or serious hemorrhagic complications in our series.

Efficacy of Laparoscopic Renal Cryoablation as an Alternative Treatment for Small Renal Mass in Patients with Poor Operability: Experience from the Korean Single Center

The aim of this work was to evaluate the efficacy and safety of laparoscopic renal cryoablation (LRC) for the treatment of incidentally found small renal masses in patients with poor operability, from our initial experience in Korea. From June 2005 to April 2009, surgical and oncologic outcomes were evaluated from a database of 45 renal tumors in 39 patients who underwent LRC due to a high American Society of Anesthesiology (ASA) physical status score (i.e., over 3) or old age (i.e., over 70 years old). Mean (range) age was 63.3 years (range, 43-81), and mean tumor size was 2.5 cm (range 0.7-3.9). Mean of ASA physical status score of whole patients was 2.8 (range, 1-4), and 79.4% (31/39) of patients had an ASA physical status score over 3. Eleven patients (28.2%) were over 70 years old. Among 45 treated lesions, 23 (51.1%) were exophytic tumors, 17 (37.8%) were endophytic tumors, and the other 5 (11.1%) were mesophytic tumors. Mean operating time was 173.7 minutes (range, 110-220), and mean blood loss was 106.3 mL (range, 40-150). None of the patients developed major complications, including adjacent organ injury, collecting system injury, open surgical conversion, or conversion to nephrectomy. Pathologic examination revealed that 60% (27/45) of lesions were renal-cell carcinoma (RCC). During a mean follow-up duration of 23.5 months (range, 6-53), radiologic evidence of tumor recurrence was found in 1 patient (3.7% for RCC). With the exception of this patient, all other patients have remained free of recurrence or metastasis, as determined by a periodic radiologic work-up. Serum creatinine remains stable, with no statistical difference, compared to preoperative levels, in both whole patients and patients with solitary kidney. In this series, LRC for small renal tumors showed favorable oncologic and surgical outcomes, including maintenance of renal function, without adverse effects in selected patients with poor operability.

1582 ACCESS FOR PERCUTANEOUS NEPHROLITHOTOMY BY UROLOGISTS: SAFE AND EFFECTIVE

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal II1 Apr 20101582 ACCESS FOR PERCUTANEOUS NEPHROLITHOTOMY BY UROLOGISTS: SAFE AND EFFECTIVE Jason Poteet, Dustin Hyatt, Leah Chiles, Rowena DeSouza, and Dennis Venable Jason PoteetJason Poteet More articles by this author , Dustin HyattDustin Hyatt More articles by this author , Leah ChilesLeah Chiles More articles by this author , Rowena DeSouzaRowena DeSouza More articles by this author , and Dennis VenableDennis Venable More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1348AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Access for PCNL surgery is critical to successful removal of stone burden and is often performed by a specialist other than a urologist. However, in many regions there is limited availability of such personnel. We reviewed the complication rates related to PCNL access when performed at a teaching hospital to establish that access for PCNL may be safely taught to and performed by urology residents. Chief urology residents across the nation were also anonymously surveyed to better understand the current trends and dynamics regarding PCNL access in teaching institutions. METHODS A retrospective chart review was performed of all PCNL surgeries performed at our institution from 1995 to 2009 for any complications related to surgery. Patients with access gained at outside institutions or not attempted at the time of surgery by residents were excluded. The complication rate was compared to those of the Society of Interventional Radiologists. An eight question survey was also sent by email to all current urology chief residents regarding their experience with PCNL access during residency. RESULTS A total of 290 patients underwent PCNL surgery with 338 separate access sites gained at the time of surgery under the supervision of nine teaching staff. Access was successfully gained in all cases at the time of surgery. Major complications included: transfusion in 20 patients (5.9%), sepsis in 2 patients (.6%), pseudoaneurysm necessitating intervention in 2 patients (.6%), hydrothorax in 2 patients (.6%), pneuomothorax in 1 patient (.3%), UPJ disruption in 1 patient (.3%) and one death after surgery (.3%). Minor complications included: UTI in 5 patients (1.5%) and collecting system injuries in 6 patients (1.8%) necessitating placement of ureteral stent. Our survey of residents demonstrated that over 65% did not routinely gain access for PCNL surgery at their institution. However, 91% who did not get instruction on PCNL access felt it would be a valuable addition to their training. CONCLUSIONS Our results show that access for PCNL surgery can be safely and successfully obtained by GU residents under the supervision of trained staff at the time of surgery. We feel that access for PCNL surgery is a valuable tool that should be in the armamentarium of all urologic surgeons upon leaving an accredited urology training program. Shreveport, LA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e611 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Poteet More articles by this author Dustin Hyatt More articles by this author Leah Chiles More articles by this author Rowena DeSouza More articles by this author Dennis Venable More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation of a Hemostatic Sponge (TachoSil®) for Sealing of the Renal Collecting System in a Porcine Laparoscopic Partial Nephrectomy Survival Model

The objective of this study was to evaluate the efficacy of TachoSil (Nycomed UK, Oxford, Buckinghamshire, UK), a hemostatic sponge, to seal major collecting system injuries (in addition to providing an adjunct to hemostasis) after partial nephrectomy in a porcine chronic survival model. Laparoscopic upper-pole partial nephrectomies were performed in 10 farm pigs (>40 kg). After hilar clamping, an energyless incision was made at a point halfway between the hilum and the upper pole of the kidney and the collecting system was opened widely. TachoSil was applied to cover the defect; 15 to 20 minutes after the application of TachoSil, the hilar clamp was removed, hemostasis confirmed, and the pig survived. Assessment was made for hematoma and urinoma. Four weeks postoperatively, the pigs were euthanized. Ex-vivo retrograde studies were performed to assess collecting system leak. Weight, blood pressure, estimated blood loss, the weight of the partial and completion nephrectomy specimen, presence/absence of urinary leak on retrograde study, histopathologic findings, and complications were recorded. All pigs survived. Mean warm ischemia time was 18 minutes, mean blood loss was 90 mL, and mean resected weight was 13.7 g. There was no evidence of leak on retrograde study. Histologically, nonspecific changes were noted in all specimens, which included dystrophic calcification, scarring, and areas of fibrosis at the partial nephrectomy surgical margin. TachoSil seals the collecting system after partial nephrectomy on a porcine chronic survival model, in addition to providing an adjunct to hemostasis. More studies, including human trials, are warranted to evaluate this observation further.

Do nonspecific deep corticomedullary sutures performed during partial nephrectomy adequately control major vascular and collecting system injury?

To critically evaluate the effectiveness of placing nonspecific deep corticomedullary sutures in the setting of major vascular and collecting system injury during laparoscopic partial nephrectomy (LPN). We also aimed to evaluate the incidence of ischaemic injury to the remaining renal remnant because of these sutures, as many laparoscopic centres have adopted this practice. We performed open PN on eight porcine kidneys. Both the artery and vein were clamped. The ureter was transected and tied around an angiocatheter for evaluating collecting system integrity both before and after corticomedullary suturing. The renal artery was cannulated for angiography before and after the corticomedullary suturing. The rate of bleeding was also assessed before and after corticomedullary suturing. There was marked arterial bleeding and large collecting system injury induced in all kidneys. Two of the eight renal units continued to have significant arterial bleeding after the deep corticomedullary sutures were placed. All of the eight units had at least a small urinary leak after suturing, with three having medium-to-large leaks. In four of the renal units, there were major segmental vessels occluded by the sutures, as detected by angiography. The practice of placing nonspecific deep corticomedullary sutures, during PN, may not adequately control major vascular and collecting system injury. In addition, segmental vessels supplying remnant renal tissue are often affected; thereby further compromising function because of devascularization. The search for the best technique for LPN continues.

Cryoablation for Endophytic Renal Cell Carcinoma: Intermediate-Term Oncologic Efficacy and Safety

PurposeTo evaluate the efficacy and safety of laparoscopic renal cryoablation (LRC) of small endophytic renal cell carcinoma, for which surgical treatment is technically difficult.Materials and MethodsWe enrolled patients with endophytic tumors from a prospectively collected database of 45 renal tumors in 39 patients who had undergone LRC from June 2005 to May 2009. An endophytic tumor was defined as less than 40% of the lesion extending off the surface of the kidney. We evaluated surgical and oncological outcomes.ResultsAmong the treated tumors, 17 tumors (37.8%) were defined as endophytic tumors and 15 tumors from 14 patients were confirmed as renal cell carcinoma (RCC) in the pathologic examination of the tissue biopsy that was conducted at the time of LRC. The mean American Society of Anesthesiologists (ASA) score of the whole patient group was 2.9 (range, 1-4), and 85.7% (12/14) of the patients had an ASA physical status score over 3. The mean tumor size was 2.8 cm (range, 1.7-3.7 cm). The layout of the cryoprobe was carefully planned preoperatively on the basis of radiologic evaluation in all tumors. Multiple cryoprobes (mean, 3.2; range, 2-5) were used. No major complications, including open surgical conversion and nephrectomy due to bleeding, occurred. No patient experienced clinical symptoms of collecting system injuries. During the mean follow-up of 32.6 months (range, 12-51 months), radiologic evidence of tumor recurrence was found in one patient (6.7% for RCC). With the exception of this patient, all other patients have remained free of recurrence or metastasis, as determined by periodic radiologic workups.ConclusionsIn this series of patients with intermediate-term follow-up, LRC for endophytic renal cell carcinoma showed acceptable oncological and surgical outcomes without sequelae in the collecting system.

UP-1.022: Desmopressin: An Alternative Solution for Urinary Leakage after Ureterocaliceal Surgery

Persistent urine leakage is common following iathrogenic urinary collecting system injuries. Management of a urine leak usually involves some manipulations such as catheter drainage, ureteral stenting and percutaneous nephrostomy placement with open repair vs. nephrectomy reserved for persistent leakage. The aim of this study was investigation of beneficial effect of desmopressin in reduction of urinary leakage duration.

Desmopressin as an alternative solution for urinary leakage after ureterocaliceal surgeries.

Persistent urine leakage is common following iatrogenic urinary collecting system injuries. Management of a urine leak usually includes manipulations such as catheter drainage, ureteral stenting, and percutaneous nephrostomy placement. The aim of this study was investigation the potential beneficial effect of desmopressin in reduction of urinary leakage duration. Fifteen patients with incisional urinary leakage were enrolled in this study. They had undergone pyeloplasty (n = 9), pyelolithotomy (n = 4), and ureterocaliceal anastomosis (n = 1). All of them had ureteral stenting or nephrostomy catheters, and urinary leakage had lasted for at least 15 days. Seven patients received desmopressin spray, 1 puff, twice a day, from the 16th days of urinary leakage, and 8 patients (control group) did not receive any medical treatment. The duration of urinary leakage was compared between the two groups. The patients were 5 women and 10 men with the median age of 37 years (range, 26 to 58 years). None of the patients had urinary obstruction. There were no significant differences in age and sex distribution between the two groups. The mean urinary leakage duration was 28.7 +/- 7.2 days in the patients of desmopressin group and 47.7 +/- 8.8 days in those of the control group (P = .04). Our study showed that desmopressin can reduce the duration of incisional urinary leakage. We conclude that patients with prolonged urinary leakage after pyelocaliceal surgery who does not respond to surgical urinary drainage may benefit from desmopressin.

Probe ablative treatment for small renal masses: cryoablation vs. radio frequency ablation

Localized renal cell carcinoma has an excellent 5-year survival when treated surgically. Apart from extirpative treatment, ablative techniques are becoming more popular to minimize patient morbidity. Clinically, radio frequency ablation and cryoablation can be performed percutaneously or laparoscopically. Oncological effectiveness of ablative techniques is encouraging as 3-year data are emerging. Our review highlights the current literature demonstrating the effectiveness of cryoablation and radio frequency ablation performed laparoscopically or percutaneously. Cryoablation performed laparoscopically or percutaneously offers excellent oncological outcomes with single-session therapy. With 3-year cancer-specific survival of 98%, laparoscopic cryoablation is safe and can be performed with minimal insult to overall renal function. Local recurrence rates and metastatic progression also seem to favor cryoablation over radio frequency ablation (4.6 vs. 11.7% and 1.2 vs. 2.3%, respectively). Radio frequency ablation also offers similar survival rates; however, re-treatment rates are higher (8.8%). Radio frequency ablation also carries a higher rate of collecting system injuries when performed percutaneously. Cryoablation and radio frequency ablation are effective treatment modalities for small renal masses in the infirm patient. Given patient and technical variability, superiority of either radio frequency ablation or cryoablation cannot be confirmed based on available literature. However, there is a trend towards higher recurrence and re-treatment rates after radio frequency ablation.

55: Collecting System Injury and Repair During Laparoscopic Partial Nephrectomy: The Impact on Operative Morbidity

You have accessJournal of UrologyModerated Poster, Saturday, May 20, 2006, 1:00 - 3:00 pm1 Apr 200655: Collecting System Injury and Repair During Laparoscopic Partial Nephrectomy: The Impact on Operative Morbidity Aaron D. Berger, Jamie A. Kanofsky, Courtney K. Phillips, Samir S. Taneja, and Michael D. Stifelman Aaron D. BergerAaron D. Berger More articles by this author , Jamie A. KanofskyJamie A. Kanofsky More articles by this author , Courtney K. PhillipsCourtney K. Phillips More articles by this author , Samir S. TanejaSamir S. Taneja More articles by this author , and Michael D. StifelmanMichael D. Stifelman More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)32322-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "55: Collecting System Injury and Repair During Laparoscopic Partial Nephrectomy: The Impact on Operative Morbidity." The Journal of Urology, 175(4S), p. 19 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 19 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Aaron D. Berger More articles by this author Jamie A. Kanofsky More articles by this author Courtney K. Phillips More articles by this author Samir S. Taneja More articles by this author Michael D. Stifelman More articles by this author Expand All Advertisement PDF downloadLoading ...

Retroperitoneoscopic partial nephrectomy using radiofrequency ablation

Two patients with renal tumors underwent retroperitoneoscopic partial nephrectomy. The renal tumors were initially treated with radiofrequency ablation. This method allowed tumor excision to be achieved without clamping the renal pedicle. Residual renal function was well maintained as determined by enhanced computed tomography scanning and measurement of the serum creatinine level. There were no complications such as vascular damage or collecting system injury. The pathological diagnosis was clear cell carcinoma (pT1) in Patient 1 and was not determined in Patient 2 because of entire ablation. No recurrence has been observed after 3 years and 2 years of follow up, respectively. Radiofrequency ablation was useful for control of local bleeding during retroperitonaoscopic partial nephrectomy.

Haemostatic partial nephrectomy using bipolar radiofrequency ablation

To determine whether an electrode array with a bipolar radiofrequency ablation (RFA) energy source can be used to perform a haemostatic partial nephrectomy by simultaneously ablating and coagulating renal tissue. Lower-pole partial nephrectomy was performed in 12 porcine kidneys using a bipolar RFA system. Intraoperative ultrasonography was used to identify and avoid the collecting system. Tissues were positioned between opposing electrodes and tissue impedance monitored using a proprietary feedback and control algorithm. Ablation time and power, lesion width and length, and tissue thickness were recorded. The kidneys were assessed in vivo to show haemostasis of the remaining renal unit. Collecting system integrity was assessed with methylene blue injection, and the resected tissue analysed histologically. Partial nephrectomies were successful in all 12 porcine kidneys; the mean nephrectomy specimen was 3.2 x 2.6 cm. The total ablation time (sem) per lesion was 211 (15) s and the mean power was 23 W. Methylene blue injection showed an intact collecting system in 11 of the 12 kidneys, and haematoxylin and eosin staining showed a mean zone of necrosis of 9 mm at the resection margin. Ultrasonography revealed flow to the remaining kidneys after RFA and the in vivo assessment of haemostasis revealed no abnormal bleeding or haemorrhage from the kidneys. Applying bipolar RF energy to an electrode array can enable transmural excision of renal parenchyma in vivo in a bloodless fashion without collecting system injury.

RETROGRADE RENAL COOLING DURING RADIO FREQUENCY ABLATION TO PROTECT FROM RENAL COLLECTING SYSTEM INJURY

We evaluated the protective effect of continuous retrograde irrigation of ice-cold saline on the renal collecting system during central parenchymal temperature based radio frequency ablation (RFA). In 10 domestic pigs bilateral, centrally located renal parenchymal RFA lesions (intended 2 cm in diameter) were created that intentionally involved the collecting system. RFA probe placement was guided by fluoroscopy with retrograde collecting system opacification and simultaneous direct laparoscopic visualization. In 1 renal unit RFA was performed while infusing ice-cold saline through a previously placed ureteral access sheath and pigtail stent. RFA without renal cooling was performed in the contralateral renal unit. Kidneys were harvested at 7 days. The renal collecting system was inspected for injury by performing retrograde pyelograms and by histological examination of the collecting system adjacent to the ablation zone. The size of RFA lesions was measured. In retrograde cooling procedures the temperature of saline irrigant was -1.0C and the mean temperature of the effluent was 13C. One of 10 cooled renal units demonstrated contrast material extravasation from the collecting system involved by the ablation zone compared with 7 of 10 noncooled renal units (p = 0.025). Lesion size was comparable between cooled kidneys and controls (2.67 and 2.72 cm, respectively, p = 0.629). Retrograde renal cooling helps protect the renal collecting system from injury during RFA without a decrease in expected lesion size. Clinically retrograde renal cooling may decrease the risk of collecting system injury and subsequent complications during RFA.