Perinephric Hematoma Research Articles

Is the Use of Pan-Computed Tomography for Blunt Trauma Justified? A Prospective Evaluation

Many trauma centers use the pan-computed tomography (CT) scan (head, neck, chest, and abdomen/pelvis) for the evaluation of blunt trauma. This prospective observational study was undertaken to determine whether a more selective approach could be justified. We evaluated injuries in blunt trauma victims receiving a pan-CT scan at a level I trauma center. The primary outcome was injury needing immediate intervention. Secondary outcome was any injury. The perceived need for each scan was independently recorded by the emergency medicine and trauma surgery service before patients went to CT. A scan was unsupported if at least one of the physicians deemed it unnecessary. Between July, 1, 2007, and December, 28, 2007, 284 blunt trauma patients (average Injury Severity Score = 11) underwent a pan-CT after the survey form was completed. A total of 311 CT scans were judged to be unnecessary in 143 patients (27%), including scans of the head (62), neck (50), chest (116), and abdomen/pelvis (83). Of the 284 patients, 48 (17%) had injuries on 52 unsupported CT scans. An immediate intervention was required in 2 of the 48 patients (4%). Injuries that would have been missed included 5 of 62 unsupported head scans (8%), 2 of 50 neck scans (4%), 33 of 116 chest scans (28%), and 12 of 83 abdominal scans (14%). These missed injuries represent 5 of the 61 patients with closed head injuries (8%) in the series, 2 of the 23 with C-spine injuries (9%), 33 of the 112 with chest injuries (29%), and 12 of the 86 with abdominal injuries (14%). In 19 patients, none of the four CT scans was supported; nine of these had an injury identified, and six were admitted to the hospital (1 to the intensive care unit). Injuries that would have been missed included intraventricular and intracerebral hemorrhage (4), subarachnoid hemorrhage (2), cerebral contusion (1), C1 fracture (1), spinous and transverse process fractures (3), vertebral fracture (6), lung lacerations (1), lung contusions (14), small pneumothoraces (7), grade II-III liver and splenic lacerations (6), and perinephric or mesenteric hematomas (2). In this small sample, physicians were willing to omit 27% of scans. If this was done, two injuries requiring immediate actions would have been missed initially, and other potentially important injuries would have been missed in 17% of patients.

Spontaneous Kidney Rupture With Incidental Renal Cell Cancer in Patient With Castleman's Disease

A 65-year-old man with a history of Castleman's disease presented with abdominal and right flank pain. He denied any recent trauma. On admission, his hemoglobin was 7.0 g/dL, and the blood urea nitrogen and serum creatinine concentration was 30 and 1.62 mg/dL, respectively. Computed tomography of the patient's abdomen revealed a large right perinephric hematoma. The patient underwent emergency nephrectomy. Microscopic examination of the specimen revealed an incidental renal cell carcinoma.

ASDIN: Percutaneous Renal Biopsy: Outpatient Observation without Hospitalization Is Safe

Percutaneous renal biopsy may be complicated by hemorrhage. Patients are frequently hospitalized for overnight observation. We evaluated prospectively the feasibility and safety of an outpatient renal biopsy protocol. During a 20-month period, 100 consecutive patients underwent outpatient renal biopsy using a standardized protocol. The biopsy was performed by Nephrology Fellows, under direct faculty supervision. All biopsies were carried out under real-time ultrasound guidance with a 16-gauge spring-loaded biopsy gun, and followed immediately by color Doppler ultrasound to exclude active bleeding. Blood pressure, heart rate, hemoglobin, and hematocrit were monitored for 8 hours postbiopsy. If there were no complications, the patients were discharged home after the observation period. A total of 91 patients required one or two needle passes, and nine needed three or four passes. A mean of 12.7 +/- 9.7 glomeruli were obtained per patient. No major complications were encountered. A small (<2 x 2 cm) perinephric hematoma was observed postbiopsy in 13 patients. Four patients were hospitalized for overnight observation due to a >4% decrease in their hematocrit, but none required a transfusion or intervention. No patient experienced a delayed biopsy-related complication. Outpatient, real-time, ultrasound-guided percutaneous renal biopsy is safe and effective, and minimizes the need for postbiopsy hospitalization. It can result in significant cost savings without exposing the patients to an increased risk of complications.

PREOPERATIVE ADMINISTRATION OF ETHAMSYLATE: REDUCES BLOOD LOSS ASSOCIATED WITH PERCUTANEOUS NEPHOLITHOTOMY? A PROSPECTIVE RANDOMIZED STUDY

To perform a multi-institutional study to characterize CT-detected complications after PNL. Computed tomography (CT) is commonly performed after percutaneous nephrolithotomy (PNL). One benefit of this imaging modality is the detection of procedure-related complications. Presently, the incidence of such complications is not well-defined.PNL procedures performed at 5 stone referral centers between July 2007 and June 2008 were reviewed. All patients undergoing CT within 24 hours after surgery were selected for further analysis. All CT studies were reviewed by a staff radiologist.One-hundred ninety-seven patients satisfied the study inclusion criteria. A body mass index >30 was present in 27.5% of patients. Treated stone burden was staghorn in 70 (35.5%), >2 cm in 72 (36.5%), and <2 cm in 55 (28%). Six treated renal units (3%) were ectopic; 45.4% of calculi were predominantly lower pole. Thoracic complications encountered were atelectasis in 88 (44.7%), pleural effusion in 17 (8.6%), pneumothorax in 3 (1.5%), hemothorax in 2 (1%), and hydrothorax in 1 (0.5%). Renal complications were perinephric hematoma in 15 (7.6%), collecting system perforation in 4 (2%), subcapsular hematoma in 3 (1.5%), urinoma in 2 (1%), and pseudoaneurysm in 1 (0.5%). There was 1 trans-splenic nephrostomy without splenic hematoma. No injuries to hollow viscera were detected. Two patients (1%) were found to have ascites.Major post-PNL complications detected by CT are uncommon, and when encountered, they are generally amenable to conservative management.

OUTCOMES OF PERCUTANEOUS NEPHROLITHOTOMY USING BALLOON DILATION IN A LARGE CONTEMPORARY SERIES

To perform a multi-institutional study to characterize CT-detected complications after PNL. Computed tomography (CT) is commonly performed after percutaneous nephrolithotomy (PNL). One benefit of this imaging modality is the detection of procedure-related complications. Presently, the incidence of such complications is not well-defined.PNL procedures performed at 5 stone referral centers between July 2007 and June 2008 were reviewed. All patients undergoing CT within 24 hours after surgery were selected for further analysis. All CT studies were reviewed by a staff radiologist.One-hundred ninety-seven patients satisfied the study inclusion criteria. A body mass index >30 was present in 27.5% of patients. Treated stone burden was staghorn in 70 (35.5%), >2 cm in 72 (36.5%), and <2 cm in 55 (28%). Six treated renal units (3%) were ectopic; 45.4% of calculi were predominantly lower pole. Thoracic complications encountered were atelectasis in 88 (44.7%), pleural effusion in 17 (8.6%), pneumothorax in 3 (1.5%), hemothorax in 2 (1%), and hydrothorax in 1 (0.5%). Renal complications were perinephric hematoma in 15 (7.6%), collecting system perforation in 4 (2%), subcapsular hematoma in 3 (1.5%), urinoma in 2 (1%), and pseudoaneurysm in 1 (0.5%). There was 1 trans-splenic nephrostomy without splenic hematoma. No injuries to hollow viscera were detected. Two patients (1%) were found to have ascites.Major post-PNL complications detected by CT are uncommon, and when encountered, they are generally amenable to conservative management.

LOSS OF EXPRESSION OF THE VITAMIN D RECEPTOR IN CLEAR CELL RENAL CELL CARCINOMA

biopsy yielding 91 specimens. Three patients had 2 masses and three more patients underwent rebiopsy. A definitive diagnosis was established in 76 patients (89%). Of the 91 specimens 22 (24%) were benign including 11 oncocytomas, 7 lipid poor angiomyolipomas, 2 abscess/ pyelitis, 1 metanephric adenoma, and 1 benign spindle cell neoplasm. 20 patients (24%) had minor complications including 14 small perinephric hematomas (none required transfusion or admission to the inpatient ward), 2 difficulty voiding, 1 small pneumothorax, 1 rash, 1 shoulder pain, and 1 generalized musculoskeletal pain. The biopsy changed management in 22 patients (26%) with benign lesions or metastatic disease from another primary. Of the remaining 63 patients 24 underwent partial or radical nephrectomy. In all these patients the final pathology of these tumors confirmed the malignant diagnosis derived from biopsy. The remainder of the patients elected needle ablation or observation. CONCLUSIONS: CT guided biopsy of a small solid renal mass is a safe procedure that provides diagnostic information about 90% of the time. Biopsy provides clinically useful information by identification of benign lesions and confirmation of type and grade of malignancy if either resection of needle ablative therapy is a consideration.

ROBOTIC‐ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY: SURGICAL TECHNIQUE AND CLINICAL OUTCOMES AT 1 YEAR

1 Ho H, Schwentner C, Neururer R, Steiner H, Bartsch G, Peschel R. Robotic-assisted laparoscopic partial nephrectomy: surgical technique and clinical outcomes at 1 year. BJU Int 2009; 103 : 663–8 2 Hyams E, Mufarrij P, Stifelman M. Robotic renal and upper tract reconstruction. Curr Opin Urol 2008; 18 : 557–63 3 Melfi F, Mussi A. Robotically assisted lobectomy: learning curve and complications. Thorac Surg Clin 2008; 18 : 289–95 4 Pareja R, Ramirez P. Robotic radical hysterectomy in the management of gynecologic malignancies. J Minim Invasive Gynecol 2008; 15 : 673–6 5 Ellis W, Lange P. Point: open radical prostatectomy should not be abandoned. J Natl Compr Canc Netw 2007; 5 : 685–8 6 Sawa Y, Monta O, Matsuda H. Use of the Zeus robotic surgical system for cardiac surgery. Nippon Geka Gakkai Zasshi 2004; 105 : 726–31 7 Lendvay T, Casale P, Sweet R, Peters C. VR robotic surgery: randomized blinded study of the dV-Trainer robotic simulator. Stud Health Technol Inform 2008; 132 : 242–4

The value of post-biopsy ultrasound in predicting complications after percutaneous renal biopsy of native kidneys

Clinically significant bleeding complications occur in >30% of patients undergoing percutaneous renal biopsy (PRB) of native kidneys and can be severe in up to 10% of patients. A noninvasive measure that would reliably predict which patients will do well with an uncomplicated post-biopsy course or which patients may be at risk of developing a clinically significant complication is in great demand. PRB of native kidneys was performed in 162 adult patients from February 2002 through February 2007 using real-time ultrasound and automated needle. Renal ultrasound (US) was performed at 1-h post-PRB to assess biopsy-related bleeding. Patients were observed for 24 h post-PRB to monitor clinically apparent biopsy-related complications. The value of the post-biopsy ultrasound in predicting complications was assessed. A clinically apparent complication was observed in 26 (16%) patients post-PRB (13 minor not requiring any intervention and 13 major requiring intervention). In patients with complicated courses, a haematoma at 1 h was seen in 77% (69% with minor and 87% with major complications). However, only 27 (20%) of 136 patients without complications (P < 0.0001) had a haematoma at 1 h. The presence of a haematoma 1-h post-PRB had a sensitivity of 77%, specificity of 80%, positive predictive value of 43% but a negative predictive value of 95% for predicting clinical complications. We find that with the use of renal ultrasound 1-h post-PRB, the absence of perinephric bleeding is predictive of an uncomplicated course while the presence of a perinephric haematoma is not reliably predictive of a clinically significant complication post-renal biopsy.

Robotic‐assisted laparoscopic partial nephrectomy: surgical technique and clinical outcomes at 1 year

To report our surgical technique of robotic-assisted laparoscopic partial nephrectomy (RLPN) for renal tumours of <7 cm and present their clinical outcomes, as minimally invasive PN is an increasingly viable option for small renal tumours. From July 2005 to December 2006, 20 consecutive patients (mean age 58.2 years, sd 7.9) had RLPN and a follow-up of > or =1 year, all surgery being undertaken by one surgeon. All cases were elective except in one patient with a solitary kidney. We used the three-arm da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA) in a four-port, transperitoneal approach. Transient vascular occlusion was applied in all cases using a tourniquet technique. The tumour was excised with a 5-mm margin using cold-cut scissors, and the margins were assessed by frozen sections. The specimen was placed in an impervious bag for subsequent removal via the camera port. Under direct vision, we repaired all pelvicalyceal system entries with absorbable sutures. After the entire tumour bed surface was lined with Floseal (Baxter Healthcare, Deerfield, IL, ISA) the capsule/parenchyma was closed with running suture, reinforced by haemostatic clips. The mean (sd) operative and warm ischaemia times were 82.7 (17.0) and 21.7 (2.4) min, respectively, and the mean estimated blood loss was 189 (32) mL. There were no intraoperative complications or conversion to open surgery. There was also no bleeding after surgery, perinephric haematoma or urinary leakage. The mean (sd) tumour size was 30.2 (2.4) mm, while margins were negative in all cases of malignancy. At the 1-year follow-up there was no local recurrence, renal functional deterioration or late surgical complications. Our RLPN technique is a safe and feasible option for small renal tumours. Reproducible technique and good team co-ordination are pivotal for obtaining good oncological and surgical outcomes.

Perinephric Hematoma Following Ureteroscopy and Holmium Laser Lithotripsy

We present a case of a ureteropyeloscopy with holmium laser lithotripsy for a 5mm distal ureteral calculus that was complicated by perinephric hemorrhage despite utilization of a ureteral access sheath and the absence of any bleeding disorders. Conservative management was elected and the patient did not require transfusion of blood products. We believe this is the first case of perinephric hemorrhage under these circumstances and suggest that surgeons inform their patients of the low risk of bleeding complications with ureteroscopy.

Kidney Rupture After Extracorporeal Shockwave Lithotripsy: Report of a Case

Background: Complications of extracorporeal shockwave lithotripsy (ESWL) occur in a small number of patients, although serious injury is rare. Objective: To report the serious complication of kidney rupture during ESWL. Case Report: A 65-year-old man was transferred to the Emergency Department (ED) with right flank pain. He had undergone ESWL for the right renal stone at a regional hospital 2 days earlier. Flank pain developed immediately after ESWL and was not spontaneously relieved. Computed tomography scan performed at the regional hospital showed an extensive right perinephric hematoma. When the patient arrived at the ED, his vital signs were unstable but were stabilized with fluid resuscitation and transfusion. Conservative care with no nephrectomy was chosen because there was no evidence of active bleeding on Doppler ultrasound examination. He was uneventfully discharged on the 31st hospital day without further complications. Conclusion: Although it is rare, patients may present with kidney rupture or hypotension after ESWL.

Embolization of Postbiopsy and Postnephrostomy Complications in Transplanted Kidney: A Case Report

Complications such as arteriovenous, arteriocalyceal fistula, pseudoaneurysm, or perinephric hematoma occur in allografted and native kidneys after interventional procedures. When these complications are not detected and treated immediately, they might be associated with a poor allograft prognosis. Reoperation may produce parenchymal injuries, therefore, endovascular embolization may be a preferred treatment modality. Herein we report an arteriocalyceal fistula and an arteriovenous fistula in a transplant kidney that were detected after biopsy and nephrostomy, respectively, they were treated with endovascular coil embolization. Percutaneous treatment is a safe and effective method for arteriocalyceal fistula and arteriovenous fistula following interventional procedures in renal allografts.

Is Hospital Admission and Observation Required after a Normal Abdominal Computed Tomography Scan in Children with Blunt Abdominal Trauma?

The objective was to determine if hospital admission of children with blunt abdominal trauma for observation of possible intraabdominal injury (IAI) is necessary after a normal abdominal computed tomography (CT) scan in the emergency department (ED). The authors conducted a prospective observational cohort study of children less than 18 years of age with blunt abdominal trauma who underwent an abdominal CT scan in the ED. Abdominal CT scans were obtained with intravenous contrast but no oral contrast. The decision to hospitalize the patient was made by the attending emergency physician (EP) with the trauma or pediatric surgery teams. An abnormal abdominal CT scan was defined by the presence of any visualized IAI or findings suggestive of possible IAI (e.g., intraperitoneal fluid without solid organ injury). Patients were followed to determine if IAI was later diagnosed and the need for acute therapeutic intervention if IAI was present. A total of 1,295 patients underwent abdominal CT, and 1,085 (84%) patients had normal abdominal CT scans in the ED and make up the study population. Seven-hundred thirty-seven (68%) were hospitalized, and 348 were discharged to home. None of the 348 patients discharged home and 2 of the 737 hospitalized patients were identified with an IAI after a normal initial abdominal CT. The IAIs in patients with normal initial CT scans included a 10-year-old with a mesenteric hematoma and serosal tear at laparotomy and a 10-year-old with a perinephric hematoma on repeat CT. Neither underwent specific therapy. The negative predictive value (NPV) of a normal abdominal CT scan for IAI was 99.8% (95% confidence interval [CI] = 99.3% to 100%). Children with blunt abdominal trauma and a normal abdominal CT scan in the ED are at very low risk of having a subsequently diagnosed IAI and are very unlikely to require a therapeutic intervention. Hospitalization of children for evaluation of possible undiagnosed IAI after a normal abdominal CT scan has a low yield and is generally unnecessary.

Visceral and Soft-Tissue Tumors: Radiofrequency and Alcohol Ablation for Pain Relief—Initial Experience

To determine retrospectively the effectiveness of percutaneous radiofrequency ablation (RFA) alone, alcohol ablation alone, or combined RFA and alcohol ablation (hereafter, combined ablation) to treat pain in patients with visceral and soft-tissue malignancies. This HIPAA-compliant study was institutional review board approved; the informed consent requirement was waived. Twenty patients, with 28 tumors, who underwent percutaneous computed tomography (CT) or magnetic resonance (MR)-guided RFA and/or alcohol ablation for pain relief over a 2-year period were retrospectively identified, and their medical and imaging data were studied: Nineteen patients were referred for ablation because of persistent pain despite use of analgesics, and one patient had refused analgesics. The 28 tumors were located in the liver, lung, adrenal gland, retroperitoneum, gluteal muscle, inguinal mass, and subcutaneous tissues on the back. Fifteen tumors were treated with RFA alone, 12 were treated with combined ablation (when lesions were > 4 cm in diameter, except in lung or renal tumors), and one was treated with alcohol ablation alone. Pain was quantified on a 0-10 scale before, 1 day after, and 1-6 weeks after ablation. On the basis of changes in pain score and pain medication use, pain was reported with a composite measure as complete, partial, or no pain response. Quantitative pain scale values were compared by using Friedman and Tukey post hoc tests to assess significant changes. At 1-6-week follow-up, pain relief was complete in nine patients (45%) and partial in six (30%); pain relief did not occur in five patients (25%). There was a significant (P < .05) decrease in pain at 1-day and 1-6-week follow-up compared with pain at baseline. Three adverse events were caused by therapy: Two were major complications (femoral neuropathy in one patient, perinephric hematoma and hemobilia in one patient), and one was a side effect of ablation (right shoulder pain) that resolved spontaneously. Percutaneous RFA alone or in combination with alcohol ablation provided pain relief from visceral tumors in most patients with intractable pain.

Case Report: Percutaneous Radiofrequency Ablation-Induced Perinephric Hematoma with Acute Renal Failure in a Solitary Kidney

Iatrogenic occurrences (including radiologically guided renal biopsy, shockwave lithotripsy, and minimally invasive ablative procedures) of subcapsular hematoma that lead to acute renal failure are rare but serious. The advancement of minimally invasive procedures has led to an increase in this complication, especially in patients with a solitary kidney. Fortunately, prompt surgical evacuation of the hematoma in these patients allows decompression of the renal parenchyma and recovery of renal function. We report a case of acute renal failure in a patient with a solitary kidney that resulted from a subcapsular hematoma as a complication of radiofrequency ablation.

Incidence of Perinephric Hematoma after Percutaneous Nephrolithotomy

To identify the incidence of, risk factors for, and subsequent complications of perinephric hematomas after percutaneous nephrolithotomy. We retrospectively analyzed patients who had undergone CT within 5 days of surgery for evidence of perinephric hematomas. Hematoma severity was graded on a 4-point system in which 0 = no blood, 1 = subcapsular blood, 2 = perinephric blood that does not or minimally displaces the kidney, 3 = blood that displaces the kidney > 2 cm, and 4 = blood that extends into the retroperitoneum. Univariate analysis was performed to identify significant preoperative, intraoperative, or postoperative risk factors. A total of 202 patients underwent percutaneous nephrolithotomy and were imaged with CT within 5 days of surgery. Of these, 140 (69%) were grade 0, 55 (27.2%) had localized bleeding (grades 1 or 2), and 7 (3.5%) had extensive bleeding (grades 3 or 4). Complications developed postoperatively in 13 of the patients in groups 1 to 4, including persistent fever longer than 12 hours after surgery in 8 patients, ileus in 2 patients, transfusion of packed red blood cells in 2 patients, and hydrothorax necessitating a chest tube in 1 patient. No patient had surgical or percutaneous intervention. At 3-month follow-up, no patients had symptoms or needed further imaging. Placement of a ureteral stent at the conclusion of the procedure occurred in a significantly higher number of patients in groups 1 to 4 (P = 0.009). The remaining factors were not significantly different. Subset analysis revealed a significantly greater hemoglobin decline in patients with extensive hematomas, groups 3 and 4, compared with groups 0 to 2 (P = 0.001). Perinephric hematomas occur in nearly one-third of patients undergoing percutaneous nephrolithotomies but are extensive only 11% of the time. Hematomas are not associated with an increased incidence of clinically relevant complications. There does not appear to be any indication for serial imaging during hospitalization or at 3-month follow-up.

Functional and Morphological Effects of Postpercutaneous Nephrolithotomy Superselective Renal Angiographic Embolization

To evaluate the functional and morphological effects of postpercutaneous nephrolithotomy (PCNL) superselective renal angiographic embolization. Between January 1995 and March 2006, superselective renal angiography was needed to control severe bleeding after 41 of 4095 PCNL procedures (1%). We evaluated the short-term effects of embolization after 3 months with renal ultrasonography (RUS), dimercaptosuccinic acid (DMSA) renal scan, and estimation of serum creatinine. We evaluated long-term morphological and functional effects with RUS, DMSA renal scan, and excretory urography (IVU). Bleeding was controllable with superselective embolization in 38 patients (93%). Six of them developed early postembolization complications, in the form of perinephric hematoma in 4 and urinary leakage in 2 patients. At 3 months, serum creatinine levels increased in 3 of 9 patients with a solitary kidney, but none required renal replacement therapy. Long-term follow-up was completed for 30 patients for a mean period of 3.9 +/- 2.3 years. We performed IVU for 27 patients. Among them, 2 renal units (7%) showed no dye excretion. DMSA scans showed homogeneous distribution of radiotracer with no evidence of photopenic areas in 6 renal units (20%). The mean percentage of DMSA uptake by the corresponding kidney improved from 25 +/- 9% at the 3-month scans to 34 +/- 11% at the last follow-up scans (P <0.001). The short-term deleterious effects of superselective renal embolization for post-PCNL renal vascular injuries were more pronounced in patients with a solitary kidney. However, the long-term follow-up showed functional and morphological improvements.

CT scanning for diagnosing blunt ureteral and ureteropelvic junction injuries

BackgroundBlunt ureteral and ureteropelvic (UPJ) injuries are extremely rare and very difficult to diagnose. Many of these injuries are missed by the initial trauma evaluation.MethodsTrauma registry data was used to identify all blunt trauma patients with ureteral or UPJ injuries, from 1 April 2001 to 30 November 2006. Demographics, injury information and outcomes were determined. Chart review was then performed to record initial clinical and all CT findings.ResultsEight patients had ureteral or UPJ injuries. Subtle findings such as perinephric stranding and hematomas, and low density retroperitoneal fluid were evident on all initial scans, and prompted delayed excretory scans in 7/8 cases. As a result, ureteral and UPJ injuries were diagnosed immediately for these seven patients. These findings were initially missed in the eighth patient because significant associated visceral findings mandated emergency laparotomy. All ureteral and UPJ injuries have completely healed except for the case with the delay in diagnosis.ConclusionMost blunt ureteral and UPJ injuries can be identified if delayed excretory CT scans are performed based on initial CT findings of perinephric stranding and hematomas, or the finding of low density retroperitoneal fluid.

Single-Port Laparoscopic Surgery in Urology: Initial Experience

To present our initial experience with single-port laparoscopic urologic surgery using the Uni-X Single Port Access Laparoscopic System, a single port, multichannel cannula, with specially designed curved laparoscopic instrumentation. We performed single-port laparoscopic surgery in 10 patients, including renal cryotherapy in 4, wedge kidney biopsy in 1, radical nephrectomy in 1, and abdominal sacrocolpopexy in 4. For the transperitoneal approach, the multichannel port was inserted transumbilically, and for retroperitoneoscopy, the port was inserted at the tip of the 12th rib. Data were collected prospectively into our institutional review board-approved data registry. Since September 25, 2007, a total of 10 patients have undergone single-port laparoscopic surgery for various upper abdominal and pelvic pathologic findings. All cases were completed successfully, without conversion to a standard laparoscopic approach. The total operative time for the various kidney procedures was 2.5 hours (range 2 to 3.2) and was 2.5 hours (range 2 to 3) for sacrocolpopexy. The mean blood loss was 100 mL for the renal procedures and 90 mL for sacrocolpopexy. The hospital stay was 2.8 days (range 1 to 8) for the kidney procedures and 2 days for sacrocolpopexy. One complication occurred in a patient with baseline congestive heart failure who underwent cryoablation and required oxygen mask ventilation postoperatively that delayed her hospital discharge for 1 week. The same patient, who was anemic preoperatively, was transfused with 3 U of packed red blood cells, although the postoperative computed tomography scan revealed a small perinephric hematoma. Single-port laparoscopic renal cryotherapy, wedge kidney biopsy, radical nephrectomy, and abdominal sacrocolpopexy are safe and feasible. Additional experience and continued investigation are warranted.

Efficacy of Laparoscopic and Percutaneous Radiofrequency Ablation of Renal Tumor

Purpose: We report here on the safety and efficacy of nephron-sparing radiofrequency ablation (RFA) for treating renal tumor. Materials and Methods: Starting June 2004, a total of 14 patients underwent RFA for renal tumor during the following 3 years. Of these, 12 cases were followed up for at least 6 months postoperatively. Eight cases of combined computed tomography (CT) and ultrasonogram-guided percutaneous RFA, and four cases of intraoperative ultrasonography-guided laparoscopic RFA were performed with mean follow-up of 18.2 months (range: 4-27 months). The treatment indications were a localized, small (<4cm), solid renal mass in the elderly patients and those patients with co-morbid conditions. Physical examination, CBC, determining the serum creatinine levels and urine analysis were performed for the follow-up laboratory study and kidney CT was performed at day 1, 1 week, 1 month, 3 months, 6 months and 1 year after ablation and thereafter semi-annually. The mean follow-up duration was 18.2 months (range: 4-27 months). Results: All the patients underwent successful RFA without any serious events. Four patients had mild perinephric hematoma on the follow-up CT scan and there was one case of mild gross hematuria postoperatively. With a mean follow-up of 18.2 months, two patients showed residual tumor at 3 months & 22 months, respectively, on the follow-up contrastenhanced CT after the first tumor ablation. One patient underwent a second RFA and another patient underwent laparoscopic radical nephrectomy, and no residual tumor was seen on the follow-up CT. Distant metastasis was not found in any cases and all the patients are alive on serial follow-up. Conclusions: Percutaneous or laparoscopic RFA is considered a useful treatment for selected patients who have a small renal mass, and to spare the nephrons. The ultimate role of this modality will continue to evolve and this warrants further studies. (Korean J Urol 2008;49:287-293) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏