Partial Nephrectomy For Renal Tumors Research Articles

V15Laparoscopic partial nephrectomy for renal tumours after renalartery clamping: The Quebec City experience

V15Laparoscopic partial nephrectomy for renal tumours after renalartery clamping: The Quebec City experience

Open partial nephrectomy for renal tumours: current status

BJU InternationalVolume 95, Issue s2 p. 35-40 Open partial nephrectomy for renal tumours: current status Andrew C. Novick, Corresponding Author Andrew C. Novick Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USAGlickman Urological Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. e-mail: NOVICKA@ccf.orgSearch for more papers by this authorIthaar Derweesh, Ithaar Derweesh Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USASearch for more papers by this author Andrew C. Novick, Corresponding Author Andrew C. Novick Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USAGlickman Urological Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. e-mail: NOVICKA@ccf.orgSearch for more papers by this authorIthaar Derweesh, Ithaar Derweesh Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USASearch for more papers by this author First published: 17 February 2005 https://doi.org/10.1111/j.1464-410X.2005.05197.xCitations: 61Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume95, Issues2March 2005Pages 35-40 RelatedInformation

COMPLICATIONS OF LAPAROSCOPIC PARTIAL NEPHRECTOMY IN 200 CASES

We analyzed complications of the initial 200 cases treated with laparoscopic partial nephrectomy for a suspected renal tumor. Since August 1999, 200 consecutive patients have undergone laparoscopic partial nephrectomy. Mean patient age was 61.6 years, mean body mass index was 29.9 and mean tumor size was 2.9 cm (range 1 to 10). There were 51 central tumors (25%) and 15 solitary kidneys (7.5%). A central tumor was defined as any tumor infiltrating up to the collecting system or renal sinus, during the excision of which entry into and repair of the collecting system was necessary. Mean estimated blood loss was 247 cc and mean operative time was 3.3 hours. Data on complications were obtained from a prospectively maintained computerized database and via telephone calls to patients and/or local referring physicians. A total of 66 patients (33%) had 1 or more complications, which were intraoperative in 11 (5.5%), postoperative in 24 (12%) and delayed in 31 (15.5%). Overall 30 patients (15%) had a non-urological complication and 36 (18%) had a urological complication, including hemorrhage in 19 (9.5%) and urine leakage in 9 (4.5%). Hemorrhage occurred intraoperatively in 7 cases (3.5%) and postoperatively in 4 (2%), while it was delayed in 8 (4%). Of patients with urine leakage none required reoperation, 6 (3%) required a Double-J stent (Medical Engineering Corp., New York, New York) only, 2 (1%) required a Double-J stent with computerized tomography guided drainage and 1 required no treatment. Open conversion was necessary in 2 patients (1%), reoperation was done in 4 (2%) and elective laparoscopic radical nephrectomy was performed in 1 (0.5%). Laparoscopic partial nephrectomy is an advanced procedure with potential for complications. It requires considerable experience with reconstructive laparoscopy.

1293: Laparoscopic Partial Nephrectomy for Renal Tumors with and without Ischemia - A Retrospective Comparison Including 130 Patients

1293: Laparoscopic Partial Nephrectomy for Renal Tumors with and without Ischemia - A Retrospective Comparison Including 130 Patients

765 Laparoscopic partial nephrectomy for renal tumours with and without ischemia - A retrospective comparison including 130 patients

765 Laparoscopic partial nephrectomy for renal tumours with and without ischemia - A retrospective comparison including 130 patients

Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients

Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients

Laparoscopic upper pole partial nephrectomy with concomitant en bloc adrenalectomy

Objectives To report our experience with laparoscopic partial nephrectomy for renal tumor with concomitant adrenalectomy. An upper pole renal tumor may contiguously involve the adrenal gland, requiring concomitant adrenalectomy. Although commonly performed in the setting of laparoscopic radical nephrectomy, concomitant adrenalectomy has not been described during laparoscopic partial nephrectomy. Methods Four patients with an upper pole renal tumor and suspected adrenal involvement underwent laparoscopic partial nephrectomy with concomitant ipsilateral adrenalectomy. Preoperative three-dimensional computed tomography revealed the renal tumor to be closely abutting the adrenal gland in 3 patients and a 4-cm adrenal mass in 1 patient. The mean renal tumor size was 3.2 cm (range 1.4 to 6.6). To maintain oncologic principles, our transperitoneal laparoscopic technique excises the adrenal gland en bloc with the renal tumor. As such, adrenalectomy is performed first, followed by partial nephrectomy, incorporating hilar control, tumor excision, and sutured renal reconstruction. Results All four procedures were performed without open conversion or intraoperative complications. The mean renal warm ischemia time was 36 minutes, estimated blood loss 169 mL, total operating time 3.9 hours, and hospital stay 3.2 days. One patient developed a transient urinary leak postoperatively. Pathologic examination of the renal tumor revealed renal cell carcinoma (n = 1), dystrophic calcification with ectopic bone formation (n = 1), adult mesoblastic nephroma (n = 1), and subcapsular heterotopic adrenal cortex with cyst (n = 1), all with negative surgical margins. Pathologic examination of the adrenal gland revealed adenoma in 1 case and a normal adrenal gland without malignant involvement in 3 cases. All patients were disease free at last follow-up (mean 6.2 months, range 2 to 12). Conclusions In patients with an upper pole renal tumor and radiologically suspected adrenal involvement, laparoscopic partial nephrectomy with concomitant adrenalectomy can be performed efficaciously respecting oncologic principles.

Therapeutic experience of partial nephrectomy for renal tumor using a microwave tissue coagulator

We have performed partial nephrectomy using a microwave tissue coagulator for renal tumor. From July 1992 to March 2003, 9 patients (9 renal units) were operated and evaluated. They were 7 men and 2 women aged 46-77 years. One patient was indicated as chronic renal failure and others were elected indications. Tumors were 1.7-3.0 cm in diameter. In 8 cases, renal vessels did not clamped. It seemed that bleeding was less when coagulation output was not too high. Postoperative complications occurred as urinary leakage in one patient with the tumor in the renal hilum. Another patient was diagnosed as local recurrence several months after partial nephrectomy, and radical nephrectomy was carried out. It is considered that this method for small tumors is useful and less invasive.

Partial nephrectomy: the rationale for expanding the indications.

We report preliminary results of partial nephrectomy for renal tumors of > or =4 cm in 39 patients with the intent of extending the indications for kidney-sparing surgery. From July 1989 to October 2001, 39 patients underwent a partial nephrectomy for renal cortical tumors >4 cm in maximum diameter. Fourteen (36%) had the procedure performed for essential reasons, and 25 (64%) had an elective kidney-sparing operation. We evaluated tumor location and histology, perioperative renal function, and postoperative complications. There were 20 conventional clear-cell (51%), 13 papillary (33%), 4 chromophobe (10%), and 3 oncocytomas (8%) with a median tumor size of 5 cm. After a median follow-up of 13 months, 36 patients had no evidence of disease, 1 patient had died as a result of other causes, and 2 patients who had essential operations were alive with disease. Twenty-three patients (70%) maintained normal postoperative renal function. Of six patients with moderate preoperative renal dysfunction, five (83%) had no change in postoperative renal function and only one patient required short-term dialysis. With careful patient selection, partial nephrectomy can be effectively used to treat patients with renal cortical tumors >4 cm in diameter. The benefits of this approach include the effective local tumor control while at the same time preserving maximum renal function.

LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR RENAL TUMOR: DUPLICATING OPEN SURGICAL TECHNIQUES

We describe our technique of and single institutional experience with purely laparoscopic partial nephrectomy for renal tumor, wherein the focus is to duplicate established open techniques of oncologic nephron sparing surgery. Since August 1999 laparoscopic partial nephrectomy for renal tumor has been performed in 50 patients. Of the patients 24 (48%) had either a compromised contralateral kidney (20) or a solitary kidney (4). Mean tumor size was 3.0 cm. (range 1.4 to 7). In 9 patients (18%) the inner margin of the tumor was in close proximity to the pelvicaliceal system. Our current laparoscopic technique involves preoperative ureteral catheterization, laparoscopic renal ultrasonography, transient atraumatic clamping of the renal artery and vein, tumor excision with an approximate 0.5 cm. margin using cold endoshears and/or J-hook electrocautery, pelvicaliceal suture repair (if necessary) and suture repair of the renal parenchymal defect over surgicel bolsters. In 1 case renal surface hypothermia was achieved laparoscopically with ice slush. All suturing and knot tying were performed with free hand intracorporeal laparoscopic techniques exclusively. All procedures were successfully completed without open conversion. Mean surgical time was 3.0 hours (range, 0.75 to 5.8) and mean blood loss was 270.4 cc (range 40 to 1,500). Mean warm ischemia time was 23 minutes (range, 9.8 to 40). Caliceal entry in 18 cases (36%) was suture repaired in a watertight manner. Following caliceal repair, none of these 18 patients had a postoperative urine leak. Hospital stay averaged 2.2 days (range 1 to 9). Major complications occurred in 3 patients (6%) including intraoperative hemorrhage in 1, delayed hemorrhage necessitating nephrectomy in 1 and urine leak in 1. Renal cell carcinoma was confirmed on pathological examination in 34 patients (68%), and all had negative inked surgical margins for cancer. During a mean followup of 7.2 months (range 1 to 17) no patient has had local or port site recurrence or metastatic disease. Laparoscopic partial nephrectomy is a viable alternative for select patients with a renal tumor. The largest single institutional experience to date is presented wherein the open techniques of nephron sparing surgery have been duplicated laparoscopically.

Study for partial nephrectomy using microwave tissue coagulator

From 1999, we have performed the partial nephrectomy for the size of ≤ 4cm in diameter of renal cell carcinoma using the microwave tissue coagulator in our institution. In this study, we examined the side effect and usefulness of the microwave tissue coagulator. Total 11 patients who had been treated the partial nephrectomy for renal tumor without the renal artery cramping at our institution between 1999 and June 2001 were enrolled in this study. We underwent the open surgery in 6 patients and laparoscopic surgery in 5 patients. There were no cases that shifted to the nephrectomy and trancefused due to bleeding from the tumor resection's side. We didn't have patients who were not pathologically diagnosed for using the microwave tissue coagulator. All patients didn't have serious side effect and renal disfunction post operation.

LAPAROSCOPIC PARTIAL NEPHRECTOMY WITH A MICROWAVE TISSUE COAGULATOR FOR SMALL RENAL TUMOR

LAPAROSCOPIC PARTIAL NEPHRECTOMY WITH A MICROWAVE TISSUE COAGULATOR FOR SMALL RENAL TUMOR

Carcinological Risks and Retroperitoneal Laparoscopy

Purpose: To determine the incidence of trocar site spillage, local recurrence, and metastatic disease associated with retroperitoneal laparoscopic tumor resection.Methods: From 1994 to 1999, 228 retroperitoneal laparoscopic procedures were performed at our institution. Fifty–six procedures (24.6%) were for malignancies and comprised 41 radical nephrectomies and 8 partial nephrectomies for renal tumors, and 7 nephro–ureterectomies for renal pelvis tumors. The pathological stage and the status of surgical margins were noted according to the 1997 TNM classification. Postoperative follow–up data were obtained by means of physical and radiological examinations after 1 and 3 months, and then half–yearly. Trocar site seeding, local recurrence and metastatic disease were recorded. Kaplan–Meier actuarial analysis was used to determine the disease–free survival likelyhood.Results: The mean follow–up was 24.9±13.85 months. All the patients had tumor–free surgical margins. No laparoscopic trocar site recurrences were identified. For laparoscopic radical nephrectomy: one patient had a local recurrence with hepatic metastasis of a pT₃G₂ tumor after 9 months and died 19.7 months after the procedure. One patient with a pT_3aG₃M+ tumor died 23.1 months after radical nephrectomy without any sign of local recurrence. For laparoscopic nephro–ureterectomy: one patient with a pT₃G₃ tumor had a local recurrence 12.1 months after the procedure and died 26.6 months after surgery. One patient with a pT₁G₂ renal pelvis tumor had bone metastasis at 9 months and died 29 months after the procedure. The Kaplan–Meier actuarial disease–free survival rate was 91% at 54 months for radical nephrectomy, 61% at 30 months for nephro–ureterectomy and 100% at 49 months for partial nephrectomy.Conclusion: Malignancies of the upper urinary tract can be managed by means of retroperitoneal laparoscopy. Short–term results suggest that this procedure is not associated with an increased risk of portsite or local recurrence, and that disease–free survival is equivalent to that obtained with open surgery.