Laparoscopic Simple Enucleation Research Articles

Robotic-assisted Laparoscopic Simple Enucleation in a Horseshoe Kidney. A Case Report and Review of the Literature

Robotic-assisted Laparoscopic Simple Enucleation in a Horseshoe Kidney. A Case Report and Review of the Literature

Endoscopic Robot-assisted Simple Enucleation Versus Laparoscopic Simple Enucleation With Single-layer Renorrhaphy in Localized Renal Tumors: A Propensity Score-matched Analysis From a High-volume Centre

ObjectiveTo compare perioperative results and early oncological outcomes of endoscopic robot-assisted simple enucleation (ERASE) and laparoscopic simple enucleation (LSE) by using a propensity score-matched analysis. MethodsWe evaluated 383 patients who underwent transperitoneal ERASE or LSE for renal tumors from November 2012 to October 2016. Propensity score matching was performed on age, gender, body mass index, Eastern Cooperative Oncology Group score, tumor side and size, preoperative estimated GFR and PADUA score. ResultsIn total, 278 and 105 patients underwent ERASE and LSE, respectively. The PADUA score was ≥10 for 61 (21.9%) and 13 (12.4%), respectively (P = .034). After matching, mean operative time and warm ischemic time were significantly lower with ERASE than LSE (171.9 vs 188.2 minutes; P = 0.016 and 20.9 vs 24.2 minutes; P = .001). The estimated mean blood loss was similar (167.7 vs 183.3 mL; P = .315). The conversion rate to open surgery or radical nephrectomy was similar with ERASE and LSE (1.0% vs 5.0%, P = .214) and the rate of intraoperative complications was lower (2.0% vs 8.9%, P = .030). The overall incidence of positive surgical margins was similar (P = .614). The median follow-up was less for ERASE than LSE patients (22 vs 38 months). Recurrence did not differ between the 2 groups: 2 ERASE cases (2.0%) versus 4 LSE cases (4.0%) (P = .679). ConclusionERASE is a safe and acceptable alternative to LSE. ERASE appears to confer shorter operative time, shorter warm ischemic time and lower rate of intraoperative complication.

Approach for Renal Tumors With Low Nephrometry Score Through Unclamped Sutureless Laparoscopic Enucleation Technique: Functional and Oncologic Outcomes.

We report an unclamped sutureless laparoscopic simple enucleation (LSE) technique for renal tumors with low nephrometry score and analyze complication rates as well as functional and oncologic outcomes. We reviewed the data of 143 consecutive patients who underwent sutureless laparoscopic tumor enucleation with zero ischemia by a single experienced laparoscopic surgeon. The inclusion criteria for LSE with zero ischemia were tumor size≤ 5 cm and RENAL nephrometry score of 4 to 6. The following data were collected: age, gender, body mass index, tumor side, renal function, tumor characteristics, American Society of Anesthesiologists score, operative time, positive surgical margins, estimated blood loss, and surgical complications. The median RENAL score of patients was 4.7. Median tumor size was 2.7 cm. Conversion to open surgery and hilum vessels clamped were not necessary in any patient. There were no changes in postoperative creatinine values and estimated glomerular filtration rate. The median operation duration time was 78.2 minutes, and median estimated blood loss was 110.2 mL. The median hospital stay was 3.8 days. A total of 2.8% of the patients had positive surgical margins at pathologic examination. Of the 143 patients, 7% developed fever after surgery requiring an adequate antibiotic regimen, 1.4% developed postoperative bleeding requiring blood transfusions, and 0.7% had postoperative urinary leakage from the drainage requiring double-J stent position. The unclamped sutureless LSE is a rational and safe approach to renal tumors with a low nephrometry score. This surgical technique does not increase the complication rate despite the reduction in parenchymal mass excised and the absence of hilar control.

897 - Endoscopic robot-assisted simple enucleation vs laparoscopic simple enucleation with single layer renorrhaphy technique in localized renal tumors: A propensity score-matching analysis from a high-volume centre

897 - Endoscopic robot-assisted simple enucleation vs laparoscopic simple enucleation with single layer renorrhaphy technique in localized renal tumors: A propensity score-matching analysis from a high-volume centre

Localized chromophobe renal cell carcinoma: preoperative imaging judgment and laparoscopic simple enucleation for treatment.

ABSTRACTObjective:To evaluate the preoperative imaging manifestation and therapeutic effect of laparoscopic simple enucleation (SE) for localized chromophobe renal cell carcinoma (chRCC).Materials and Methods:Clinical data of 36 patients who underwent laparoscopic SE of localized chRCC at our institute were retrospectively analyzed. All patients underwent preoperative renal protocol CT (unenhanced, arterial, venous, and delayed images). CT scan characteristics were evaluated. After intraoperative occlusion of the renal artery, the tumor was free bluntly along the pseudocapsule and enucleated totally. The patients were followed up regularly after the operation.Results:Mean tumor diameter was 3.9±1.0 cm, 80% of tumors were homogeneous and all the tumors had complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and degree of enhancement of the tumors were significantly lower than normal renal cortex. Mean operation time was 104.3±18.2 min. Mean warm ischemia time (WIT) was 21.3±3.5 min. Mean blood loss was 78.6±25.4 mL. No positive surgical margin was identified. Mean postoperative hospital stay was 5.3±1.5 d. Hematuria occurred in 3 patients and all disappeared within 3 days. After a mean follow-up of 32.1±20.6 months, no patient had local recurrence or metastatic progression.Conclusion:Localized chRCCs have a great propensity for homogeneity and complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and small degree of enhancement. Laparoscopic SE is a safe and effective treatment for localized chRCC. The oncological results were satisfactory.

Outcomes of robot-assisted simple enucleation of renal masses: A single European center experience.

The aim of this study was to assess the ability of pre-and intraoperative parameters, to predict the risk of perioperative complications after robot-assisted laparoscopic simple enucleation (RASE) of renal masses, and to evaluate the rate of trifecta achievement of this approach stratifying the cohort according to the use of ischemia during the enucleation.From April 2009 to June 2016, 129 patients underwent RASE at our Institution. We stratified the procedures in 2 groups: clamping and clamp-less RASE. After RASE, all specimens were retrospectively reviewed to assess the surface–intermediate–base (SIB) scoring system. Patients were followed-up according to the European Association of Urology guidelines recommendations. All pre-, intra-, and postoperative outcomes were prospectively collected in a customized database and retrospectively analyzed.A total of 112 (86.8%) patients underwent a pure RASE and 17 (13.2%) had a hybrid according to SIB classification system. The mean age was 61.17 years. In 21 patients (16.3%), complications occurred, 13 (61.9%) were Clavien 1 and 2, while 8 were Clavien 3a and b complications. Statistical significant association with complications was found in patients with American Society of Anestesiology (ASA) score 3 (44.5%, P = .04), longer mean operative time (OT) 195 versus 161.36 minutes (P =.03), mean postoperative hemoglobin (Hb) 10.1 versus 11.8 (P <.001), and mean ΔHb 3.59 versus 2.18 (P <.001). In multivariate logistic regression, only longer OT and ΔHb were statistical significant predictive factors for complications. In sub-group analysis, clamp-less RASE was safe in terms of complications (14.1%), positive surgical margins (1.3%), and mid-term local recurrence (1.3%). Although in this approach there is higher EBL (P = .01), this had no impact on ΔHb (P = .28). A clamp-less approach was associated with a higher rate of SIB 0 (71.8% vs 51%, P = .02), higher trifecta achievement (84.6% vs 62.7%, P = .004), and better impact on serum creatinine (mean 0.83 vs 0.91, P = .01).RASE of renal tumors is a safe technique with very good postoperative outcomes. Complication rate is low and associated with ASA score >3, longer OT, and ΔHb. RASE is suitable for the clamp-less approach, which allows to perform easier the pure enucleation (SIB 0) and to obtain higher rates of trifecta outcomes.

Laparoscopic Retroperitoneal Enucleation-Separation Surgery for Renal Angiomyolipoma: Perioperative and Oncologic Outcomes Based on a Randomized Controlled Trial.

To report a novel technique of laparoscopic retroperitoneal enucleation-separation surgery for specifically located renal angiomyolipoma (RAML) treated in our institute. We prospectively analyzed 40 patients who were randomized and received laparoscopic simple enucleation (Group 1) or enucleation-separation (Group 2) from January 2011 to February 2013. Patient characteristics, perioperative outcomes, renal function, and oncologic outcomes were compared between the groups. Average age, body mass index, sex distribution, tumor location and size, and operative time showed no significant difference between the two groups (p > 0.05). Average warm ischemia time in Group 1 was longer than that in Group 2 (25.3 minutes vs 17.6 minutes, p = 0.001). No complications except for one postoperative hemorrhage that occurred in Group 1 were observed. An improved early affected renal function recovery was observed in the Group 2 (percentage of glomerular filtration rate reduction for Group 1 vs Group 2, 24.3% vs 18.3%; p = 0.001). No local recurrences were found during the follow-up period. Laparoscopic simple enucleation and enucleation-separation technique are safe, efficient, and minimally invasive therapies for selected patients with RAMLs. In addition, the enucleation-separation appears to significantly minimize the warm ischemia injury and results in superior short-term renal function preservation, which could be a nephron-sparing alternative for the treatments of RAMLs.

Endoscopic robot-assisted simple enucleation (ERASE) for clinical T1 renal masses: description of the technique and early postoperative results.

Simple enucleation (SE) has proven to be oncologically safe. We describe the surgical steps and report the results of the Endoscopic Robotic-Assisted Simple Enucleation (ERASE) technique. Data were gathered prospectively from 130 consecutive patients undergone ERASE for intracapsular kidney cancer, between 2010 and 2013. ERASE was performed using the 4S Da Vinci surgical system, (Intuitive Surgical, Sunnyvale, CA, USA) in a three-arm configuration. Patients' characteristics and surgical outcomes of ERASE in cT1 were analyzed and the results in cT1a tumors were compared to those of pure laparoscopic SE performed in the same institution in the same time period. The mean (range) preoperative tumor size was 3.2 cm (0.8-10.0 cm), and clinical stage was T1a for 101 patients, T1b for 28, and T2a for 1. Median PADUA score was 8 (IQR 7-9). In 33.9% of patients, ERASE was done without pedicle clamping. Mean (±SD) warm ischemia time (WIT) was 18 ± 6 min. According to Clavien system, 1 grade 1 (0.8%), 5 grade 2 (3.1%), 4 grade 3 (3.8%), and 1 grade 4 (0.8%) surgical complications occurred. Positive surgical margin (PSM) rate was 2.8%. ERASE in cT1a tumors was associated with a significantly lower need for pedicle clamping, shorter WIT, and lower estimated blood loss (EBL) along with similar operative time and intra and postoperative complication rates but with a significantly lower incidence of urinary fistulas requiring stent insertion compared to laparoscopic SE. Also mean time to drainage removal and length of hospital stay (LOS) were significantly lower in for ERASE. The two groups had comparable PSM rate. ERASE has proven to be a feasible technique for the minimal invasive treatment of clinical stage T1 renal masses. The robotic approach can achieve surgical results superior to those of pure laparoscopy by reducing the need for clamping, WIT, EBL, and LOS.

Laparoscopic partial nephrectomy of thyroid cancer metastasis: case report and review of the literature

BackgroundFollicular cell thyroid carcinoma is a quite aggressive form of thyroid cancer. About 10% of follicular thyroid carcinoma shows multiple metastases: lung and bone are the most common sites of metastasis. Renal involvement from thyroid primary cancer is very rare with incidence of 4.5%–5.9%.PurposeWe report the first laparoscopic conservative treatment of renal metastasis from thyroid cancer. This is a new and useful approach in order to delay malignant disease progression and to reduce the surgical discomfort of the patient.Patients and methodsWe present the case of a 67-year-old woman, undergoing total thyroidectomy for follicular thyroid cancer with bone and lung metastasis. During adjuvant radiometabolic treatment, renal metastasis was diagnosed. Renal metastasis showed high metabolic activity, reducing the effectiveness of radioiodine therapy for secondary lesions. For this reason, we performed a laparoscopic simple enucleation of the single renal metastasis using extraperitoneal access and a clampless procedure.ResultsThe excision of the renal lesion improved the effectiveness of adjuvant radioiodine therapy: two months after surgery, the patient underwent adjuvant radiometabolic treatment with iodine-131 (150 mCi) and the following whole body scan showed only a small uptaking area at the level of the vertebral metastasis. The lung micrometastases were not detectable. At 36 months follow-up, malignant disease was clinically stable and well controlled.ConclusionMinimally invasive renal surgery with preservation of renal function and rapid recovery contributed to the success of radioiodine therapy and delayed the progression of the disease.

Minimally invasive enucleation with zero ischemia for malignancies. The Cluj Napoca experience

We read, with great interest, the article “Laparoscopic enucleation of a giant submucosal esophageal lipoma. Case report and literature review”, published by Tsalis et al. [1]. The authors present an important surgical approach for the management of benign tumors of the esophagus, by performing a laparoscopic enucleation of a lower esophageal lipoma. By presenting the surgical experience of our university hospital, we wish to emphasize that minimally invasive enucleation is not only applicable for benign tumors, but also for malignant ones with comparable results regarding recovery of the patient, as well as long term survival.Minimally invasive enucleation is recommended for symptomatic benign tumors and for those greater than 5 cm, as presented by this surgical team, but lately this technique was applied also for malignancies because it has proven it’s usefulness regarding the delay in cancer progression and the reduction in surgical discomfort of the patient. Large clinical trails lack, but some reports have been published, as is the case of nephrectomy for the management of a secondary metastasis carried out by Cochetti et al. [2]. In their case, minimally invasive surgery allowed the preservation of renal function, as well as the possibility for the medical oncologists to continue adjuvant therapy. Consistent data from human clinical trails lacks, but these reports were preceded by animal studies,a s the one presented by Zhang et al. [3]. They approach small renal cell carcinomas by suggesting the use of a laparoscopic simple enucleation, followed by coagulation on the tumor bed using an argon beam coagulator, with excellent results regarding recovery and blood loss. Nephron sparing surgery is accompanied by adjuvant solutions such as the thallium laser assistance [4] or microwave ablation [5], with superior results in comparison with the radical nephrectomy for pT1a and pT1b carcinomas [6]. Apart from renal malignancies and rare benign tumors, as is the case of esophageal ones, laparoscopic enucleation with zero ischemia was also attempted by Makdissi et al. [7] in the case of four hepatocellular carcinoma cases and two benign liver tumors, with free pathology surgical margins and excellent post-surgical recovery. Our experience confirmed the usefulness of minimally invasive enucleation with minimal ischemia especially in the case of the patients where renal preservation is crucial because of pre-operative insufficiency or multiple renal lesions.The long-term survival is comparative with a standard partial nephrectomy, even if sometimes the histopathology results showed a pseudo capsule tumor invasion. Thus, minimally invasive enucleation should be performed not only for benign tumors, but also for aggressive cancers if the lesion is locally confined on preoperative imaging, easily delineated intraoperatively and does not seem to growly invade beyond the pseudocapsule.

Laparoscopic simple enucleation and coagulation on tumor bed using argon beam coagulator for treating small renal cell carcinomas: An animal study followed by clinical application

SummaryBackgroundThe aim of our study was to evaluate the feasibility and clinical effect of laparoscopic simple enucleation and coagulation on tumor bed using an argon beam coagulator for treating small renal cell carcinomas.Material/MethodsThe animal experiments of coagulation therapy on the wound tissue bed during partial nephrectomy with an argon beam coagulator were performed on 16 rabbits, which were randomly divided into 4 groups. Groups A and B had renal artery occlusion; the treatment time of coagulation was 4 seconds and 6 seconds, respectively. Groups C and D did not have renal artery occlusion; the treatment time of coagulation was 2 seconds and 4 seconds, respectively. Then 30 clinical operations of laparoscopic simple enucleation and coagulation on tumor bed using an argon beam coagulator were performed.ResultsAll 16 rabbits successfully underwent the operation. By the histological examination, the scab depth of the wound tissue bed in groups A, B, C, and D were 2.76±0.17 mm, 3.15±0.15 mm, 2.28±0.16 mm and 2.75±0.06 mm, respectively. Group A differed significantly from groups B and C (P=0.012, 0.007), and group D differed significantly from groups B and C (P=0.002, 0.002). In the clinical study, all 30 patients successfully underwent the operation. The mean operative time was 182 minutes, and the mean blood loss was 280 ml. With a median follow-up time of 37 months, neither local recurrence nor distant metastasis was found by computerized tomography scan.ConclusionsLaparoscopic simple enucleation and coagulation on tumor bed using an argon beam coagulator can be considered for treating small renal cell carcinomas. However, the indication of this procedure should be highly selected.