Nephrectomy In Management Research Articles

OPEN PARTIAL NEPHRECTOMY FOR SMALL RENAL TUMOURS: TECHNICAL AND ONCOLOGICAL OUTCOMES

Objective: To assess the safety and oncological outcomes of Open Partial Nephrectomy in management of small renal tumours.
 Study Design: Case series.
 Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Jan 2015 to Dec 2018.
 Methodology: We prospectively studied 61 patients with renal tumours either observed on computerized tomography (CT) scan or magnetic resonance imaging (MRI) having size ≤7cm and underwent open partial nephrectomy. The collected data included demographics, dimension of tumour, indication for surgery, cold ischemia time, hospital stay, complications and histopathological finding including involvement of margins. Patients were followed up for atleast 2 years.
 Results: Among 61, 39 patients were male and 22 females. The age of patients ranged from 20-72 years. Mean cold ischaemia time was 24.7 ± 6.37 minutes. Except for 2 patients with Von Hippel–Lindau (VHL) disease, all other patients had solitary renal growth. Nine (14.75%) patients had solitary kidney. The mean of maximum dimension of tumours was 3.84 ± 1.38 cm and mean hospital stay was 3.18 ± 2.19 days. Histopathological results showed 34 tumours to be conventional renal cell carcinoma (RCC) (55.73%) followed by 12 papillary renal cell carcinoma (19.67%). Two (3.27%) patients had positive surgical margin who were operated for >5 cm tumours and later managed expectantly. Twenty one patients had Grade I and II complications while 2 patients were stented post operatively for urine leak. At 2 years follow up there was no recurrence of tumour in any of the patient operated.
 Conclusion: Open ..........

AB062. Clinical analysis of retroperitoneal robotic-assisted laparoscopic partial nephrectomy in management of T1b renal carcinoma

BackgroundTo summarize our clinical experience and review our technique of retroperitoneal robotic-assisted laparoscopic partial nephrectomy (RALPN) in management of T1b renal carcinoma. Assess the clinical efficacy and safety of retroperitoneal RALPN.MethodsRetrospective review of 52 T1b renal carcinoma patients underwent retroperitoneal RALPN form January 2014 to October 2016. The patients included 30 males and 22 females, with an average age of (55.2±9.5) years old. There were 32 tumors in the left and 20 in the right. The mean lesion diameter was 4.5±0.7 cm.ResultsAll cases were performed successfully. The operation was completed in a mean of 80.5±12.3 min, the mean warm ischemia time was 17.4±5.1 min, the mean blood loss was 38.2±7.4 mL and the mean extubation time was 2.1±0.7 d. Postoperative pathology reported malignant tumor in all cases, including renal clear cell carcinoma in 45 cases, papillary renal cell carcinoma in 5 cases and chromophobe cell carcinoma in 2 cases. The surgical margin of all cases were negative.ConclusionsRetroperitoneal RALPN is an effective, safe and minimally invasive surgical management for T1b renal carcinoma.

Comparison of Retroperitoneal & Transperitoneal Laparoscopic Nephrectomy in Management of Pyonephrosis in Terms of Conversion to Open Surgery

Introduction: Since the mid-1990s, there has been an evolution in surgical practice from traditional open approaches to minimally invasive means of treating operative lesions. This study is carried out to study rate & indication of conversion to open surgery in pyonephrosis using retroperitonel and trans peritoneal laproscopic nephrectomy. Materials And Methods: This study was retrospective study done in Department of Urology Civil hospital & B J Medical College Ahmadabad .We performed a retrospective review of a maintained database of 219 consecutive laparoscopic simple nephrectomies done for pyonephrosis between July 2001 to February. 2013. Results: In study transperitoneal route using four ports was used in 165 (75.3%) while retroperitoneal access using three was used in 54(24.6%) patients. In our study total 163 (74.4%) had PCN (percutaneous nephrostomy) in situ, 79.3% in lap transperitoneal group and 59.2% in lap retro peritoneal group. 27(12.3%) patients required conversion to open surgery. Adhesion 13(5.9%) and bleeding 9(4.1%) were the main factors for conversion, while 2 (0.9%) patients required conversion due to bowel injury and limited space in 3(1.3%) patients. Conversion rate was 12.1 % (20/165) for transperitoneal procedures while 12.9 % (7/54) for retroperitoneal approach. Laparoscopic approach requires proper placement of ports for meticulous surgical dissection. Preoperative plain and CECT help in identifying renal hilar anatomy as well as the relationship with the surrounding structures. Conclusion: In our study, retroperitoneal laparoscopic nephrectomy has to be considered equal to transperitoneal laproscopic nephrectomy in terms of conversion to open surgery.

Use of Pure Laparoscopic Partial Nephrectomy in Management of Small Renal Tumors

Use of Pure Laparoscopic Partial Nephrectomy in Management of Small Renal Tumors