Tumor Enucleation Research Articles

291. A CASE OF LAPAROSCOPIC AND THORACOSCOPIC ENUCLEATION FOR GIANT CIRCUMFERENTIAL ESOPHAGEAL LEIOMYOMA

Abstract Enucleation is surgically or endoscopically performed for submucosal tumors of the esophagus, especially for esophageal leiomyoma. Enucleation for large and circumferential tumors is technically challenging given a higher risk of mucosal injury and/or tumor rupture during procedure. We present a case of giant leiomyoma with a maximal diameter of 8 cm successfully enucleated by laparoscopic and thoracoscopic approaches. A 24-year-old man was referred to our hospital with a mediastinal tumor suspected on chest X-ray. He suffered from heartburn for more than 10 years and recently dysphagia. Endoscopic examination revealed esophageal submucosal tumors located at 30 cm to 35 cm from the incisor, involving whole luminal circumference. Boring biopsies were endoscopically performed of which pathological diagnosis was esophageal leiomyoma. CT showed wall thickening in the lower esophagus with a maximal esophageal diameter of 8 cm. Giant esophageal tumor enucleation with antireflux fundoplication was performed using both laparoscopy and thoracoscopy. The tumor expanded circumferential shape with the longitudinal extent of approximately 8 cm. After tumor enucleation, the esophageal mucosa was circumferentially exposed from the level of the azygos vein to the esophagogastric junction without the muscle layer. The esophageal mucosal injury occurred in 3 places, which were repaired by primary closure using absorbable threads. The operation time was 827 minutes and the loss of blood was 230 mL. The specimen was 160 g, and the final pathological diagnosis was leiomyoma. Postoperative course was not eventful. We experienced a case of enucleation for a giant esophageal circumferential submucosal tumor. Enucleation may be considered a possible treatment strategy to avoid esophagectomy even for a giant circumferential tumor especially in young patients.

289. PRIMARY MONOPHASIC SYNOVIAL SARCOMA OF THE CERVICAL ESOPHAGUS CONFIRMED BY DETECTION OF THE SS18-SSX2 FUSION TRANSCRIPTS

Abstract Synovial sarcoma (SS) of the esophagus is extremely rare. Because of the microscopic features of SS, the monophasic type can easily be misdiagnosed as other spindle cell tumors. Here, we present the first case of a primary SS of the esophagus in the presence of SS18-SSX2 fusion transcripts. A 47-year-old Japanese woman was initially diagnosed with thyroid papillary carcinoma in the left lobe and leiomyoma of the cervical esophagus and subsequently underwent left thyroid lobectomy and enucleation of the esophageal tumor. Four years after the first surgery, the esophageal tumor recurred. Endoscopic biopsy of the tumor revealed atypical cell proliferation with spindle cell features and mitoses. Immunohistochemistry showed focal positivity for bcl-2 and HHF35. Furthermore, the presence of SS18-SSX2 fusion transcripts was confirmed by reverse transcription-polymerase chain reaction analysis, using a paraffin-embedded tumor specimen. Therefore, the tumor was diagnosed as monophasic SS of the cervical esophagus. We re evaluated the surgical specimen enucleated 3 years previously, which was initially diagnosed as leiomyoma, and the diagnosis of SS was confirmed. The patient underwent cervical esophagectomy with isolated jejunal interposition reconstruction. Three years after the second surgery, SS recurred in the distal anastomotic site between the jejunum and the esophagus, and the patient underwent thoracoscopic esophagectomy with gastric conduit reconstruction. The pathological grade of the lesion worsened with every recurrence. Monophasic SS can be difficult to discriminate from other spindle cell tumors based on microscopy alone, and molecular analysis could be useful for confirming the precise diagnosis of monophasic SS.

Diagnosis and treatment of solid pseudopapillary neoplasm of the pancreas in children: A report of 18 cases.

PurposeTo explore the incidence, imaging and treatment of solid pseudopapillary tumor of pancreas in children, and Summarize the experience of treatment.MethodsThe clinical data of 18 children with a solid pseudopapillary tumor of the pancreas treated in our hospital from January 2012 to June 2021 were analyzed retrospectively. The age range was 8–16 years old, the average age was 11.67 years old, and the median age was 11.5 years old, namely, three boys with an average age of 10 years old and 15 girls with an average age of 12 years old. In total, two cases were admitted to the hospital because of trauma, seven cases were found in physical examination, and nine cases were admitted with the abdominal pain as the main complaint. Enhanced CT examination was performed before operation, nuclear magnetic resonance examination and abdominal ultrasound examination were performed in some children, and plain CT scan was performed after operation.ResultsSolid pseudopapillary tumor of the pancreas can occur in all parts of the pancreas, especially in the body and tail of the pancreas. Among the 18 cases, SPN occurred in the head of pancreas in 5 cases (27.78%), the neck of pancreas in 2 cases (11.11%), and the body and tail of pancreas in 11 cases (61.11%). All the 18 children were treated by operation. among them, 4 cases underwent choledochal pancreatico duodenectomy (1 case), 4 cases underwent pancreaticoduodenectomy combined with splenectomy (3 cases), 6 cases underwent spleen-preserving pancreatectomy / tail pancreatectomy (1 case), 3 cases underwent enucleation of pancreatic tumor due to exogenous growth, 1 case underwent laparoscopic partial pancreatectomy and pancreaticoenterostomy. Laparotomy was performed in 12 cases and endoscopic surgery in 6 cases. Postoperative pathology confirmed solid pseudopapillary tumor of the pancreas. None of the patients received radiotherapy and chemotherapy after operation and were followed up for 6 months to 2 years. There was no recurrence, metastasis or pancreatic dysfunction.ConclusionSolid pseudopapillary tumor of pancreas in children is a rare, low-grade malignant solid tumor with no specific clinical manifestations and laboratory examinations. Preoperative diagnosis mainly depends on enhanced CT. Surgical resection of tumor is a reliable treatment, and the specific operation is mainly based on the experience of the chief surgeon, the location of the tumor and the invasion of surrounding tissue. At present, there is no evidence of the effectiveness of other treatment options, and surgical resection of the tumor has a good prognosis.

Robotic enucleation of a solid pseudopapillary tumor in a pediatric patient

Robotic enucleation of a solid pseudopapillary tumor in a pediatric patient

Axillary schwannoma mimicking lymph node metastasis-associated breast cancer: a case report

BackgroundAxillary schwannoma associated with breast cancer is an extremely rare disease, and previous reports have been limited. In this setting, there is great concern about whether a tumor in the axillary region is lymph node metastasis. Herein, we report a unique case of axillary schwannoma that mimicked lymph node metastasis associated with breast cancer.Case presentationA 68-year-old woman who underwent mastectomy and axillary lymph node dissection for right breast cancer over 20 years ago presented to our hospital with numbness and weakness in the right arm for 6 months. Ultrasonography, computed tomography, and magnetic resonance imaging showed a 20-mm well-circumscribed round tumor in the right axillary region. Initially, she was suspected of having lymph node metastasis-associated breast cancer, but the result of the core needle biopsy was a schwannoma. The patient underwent tumor enucleation. The patient has had no recurrence 1 year after the operation.ConclusionAxillary schwannomas often mimic lymph node metastasis in patients with a history of malignancy, particularly breast cancer. To select the optimal treatment, the clinicians should make as accurately as possible a diagnosis, with histopathological examinations, when examining patients with cancer who develop tumors in the axillary region.

Differences in Distance between Mandibular Premolars Root Apices and the Mental Foramen by CBCT Imaging according to Sex in Patients Referred to Dental School of Ahvaz Jundishapur University of Medical Science in 2020-2021

Background and Objectives Knowing the location of mental foramen during common dental procedures such as local anesthesia, periapical and endodontic surgeries, extraction of impacted teeth and enucleation of cysts and tumors is important. Due to the limitations of available information about this anatomical structure, the aim of this study was to evaluate the relationship between root of mandibular premolar teeth and mental foramen. Subjects and Methods In this retrospective study, CBCT images of 94 patients (47 men and 47 women) who referred to the radiologic department of Ahvaz Jundishapur Dental School in 2020-2021 were recorded and evaluated. Finally, the data were analyzed to evaluate the difference in distance between mandibular premolar teeth root apex and the mental foramen in men and women, using SPSS software version 24 and t- test. Results There was no statistically significant difference for any of the roots of the second right mandibular premolar, first and second left mandibular premolars regarding the distance between the root apex and the mental foramen in men and women. But this distance in the root of the first right mandibular premolar was significantly greater in men than women (p = 0.008). Conclusion This study showed that except for the root of the first right mandibular premolar, there is no significant difference in the distance between the apex of the mandibular premolars to the mental foramen between men and women.

Laparoscopic enucleation of renal masses

Introduction: Tumor Enucleation (TE) of renal masses as an alternative of nephron-sparing surgery has increased in the past years. Objectives: To describe the perioperative, oncological and functional outcomes of laparoscopic TE in a series of patients with renal masses. Material and method: A descriptive and retrospective study of 71 patients who underwent laparoscopic TE surgery for renal mass in La Habana, Cuba at the Centro Nacional de Cirugía de Mínimo Acceso, between 2010 and 2019. Clinical-epidemiological and perioperative variables, complications, Clavien-Dindo grade and oncological variables were considered. The SPSS program, version 23.0 was utilized. Frequencies, mean percentages, standard deviation and Student´s t- test (p<0.05) were estimated. Survival was appraised by using the Kaplan Meier curve. Results: Mean age was 58 years. Male patients prevailed (60.6%), with comorbidities (87.3%), incidental diagnosis (73.2%), low complexity tumors (64.8%). Mean tumor size and RENAL score was 33.6 mm and 6.1, respectively. Hand-assisted transperitoneal approach was performed (92.9%), mean bleeding was 335.9 ml and length of hospital stay 5.2 days. Postoperative renal function was preserved (p=0.082). Postoperative complications prevailed (14.1%), bleeding (8.4%) and grade II and IV (4.2%, respectively). Most masses were malignant (71.8%), ccRC prevailed (52.1%), pT1a (78.4%), overall survival and cancer specific survival was 100% and 96.0%, respectively. Mean follow-up time was 7.4 years. Conclusions: Laparoscopic TE is a feasible alternative for treating select renal masses, with satisfactory perioperative, oncological and functional outcomes.

Robotic-assisted tumor enucleation versus standard margin partial nephrectomy: Perioperative, renal functional, and oncologic outcomes for low and intermediate complexity renal masses.

Standard margin partial nephrectomy (SPN) with sharp incision across normal renal parenchyma carries perioperative morbidity and renal functional implications. Tumor enucleation (TE) is an alternative approach using a natural plane of dissection around the tumor pseudocapsule to maximize parenchymal preservation. We compared perioperative, functional, and oncologic outcomes for robotic-assisted TE to SPN. Patients ≥18 years of age undergoing robotic-assisted TE or SPN were included (2008-2020). Baseline demographics and tumor characteristics were compared. Perioperative, renal functional, and oncologic outcomes were assessed for comparative effectiveness. A total of 467 patients were included with 176 (37.7%) TE and 291 (62.3%) SPN. Baseline characteristics and final histology were comparable; 18% of patients had baseline stage 3 chronic kidney disease. TE had lower median blood loss, operative time, length of stay, and fewer complications compared to SPN. Positive margin rates were higher for TE vs. SPN (8.5% vs. 3.4%, P = 0.04) with similar recurrence rates (2.3% vs. 3.4%, P = 0.48) and no difference in cancer-specific or overall survival with median 4.0 years follow-up. Baseline estimated glomerular filtration rate was comparable (76.1 vs. 78.2, P = 0.63) while renal function in the first year was better preserved with TE (74.6 vs. 68.1, P < 0.001) showing an 8-point estimated glomerular filtration rate (P = 0.001) advantage after adjustment. The rate of stage ≥3 chronic kidney disease by 12 months was lower for TE compared to SPN (21.5% vs. 34.1%, P = 0.006). TE is an alternative approach to SPN associated with favorable perioperative and renal functional outcomes. While positive margin rates are higher, longer-term recurrence rates are no different suggesting pseudocapsule disruption during TE has limited impact on oncologic outcomes.

Minimally invasive enucleation for benign and low-grade malignant pancreatic tumors: an analysis of 60 cases

Objective: To investigate the safety and feasibility of minimally invasive pancreatic tumor enucleation. Methods: The clinicopathological data of 60 patients with minimally invasive pancreatic tumor enucleation admitted to the Department of Pancreatic Surgery of Fudan University Cancer Center from November 2019 to August 2021 were retrospectively analyzed. There were 17 males and 43 females,with age of (50.0±13.2)years(range: 23 to 73 years). Tumors were located in the head of pancreas in 40 cases(66.7%),neck and tail of pancreas in 20 cases(33.3%). Patients were divided into robotic group(n=25) and laparoscopic group(n=35) according to surgical methods. The measurement data were compared by t-test or Mann-Whitney U test, and the categorical data were compared by χ2 test or Fisher exact probability method. The influencing factors of postoperative pancreatic fistula were analyzed by univariate and multivariate Logistic regression. Results: All patients successfully completed tumor enucleation without conversion to laparotomy. The operation time was (183.5±67.3)minutes(range:90 to 410 minutes). Twelve patients(20.0%) underwent stent placement and pancreatic duct repair during operation. The removal time of abdominal drainage tube after operation was (24.7±22.9)days(range:2 to 113 days). The tumor diameter in the robotic group was larger than that in the laparoscopic group((3.5±0.9)cm vs. (2.9±0.7)cm,t=-2.825,P=0.006). The incidences of postoperative biochemical fistula and grade B pancreatic fistula were 20.0%,22.9% and 36.0%,51.4%,respectively(χ²=2.289,P=0.318). There were no grade C pancreatic fistula,lymphatic fistula,biliary fistula,delayed gastric emptying,secondary operation and perioperative death in both groups. Multivariate logistic regression analysis was performed on the occurrence of clinically related pancreatic fistula(above grade B). The results showed that the increase of body mass index(OR=1.285,95%CI:1.053 to 1.569,P=0.014),the larger diameter of the tumor(OR=3.703,95%CI:1.465 to 9.360,P=0.006) and intraoperative pancreatic duct repair(OR=7.889,95%CI:1.471 to 42.296,P=0.016) were independent risk factors,whereas robotic surgery(OR=0.168,95%CI:0.036 to 0.796,P=0.025) was a protective factor. No case of pancreatin dependent dyspepsia and new onset diabetes mellitus was observed. Conclusions: Minimally invasive tumor enucleation is feasible in the treatment of benign and low-grade pancreatic tumors. The incidence of pancreatic fistula is high in the short term after operation,but serious complications are rare. The robot assisted system can reduce the risk of postoperative pancreatic fistula and has more advantages in dealing with larger diameter tumors because of clearer surgical vision and more accurate operation.

Characteristics of peritumoral pseudocapsule in small renal cell carcinoma and its influencing factors.

The aim of this study was to investigate the peritumoral pseudocapsule (PC) status and identify the factors influencing PC status in small renal cell carcinoma (RCCs). A total of 147 patients with small RCC (≤4cm) who had undergone tumor enucleation (TE) were assigned into three groups according to PC status: complete PC, PC absence, and PC invasion. Computed tomography (CT) imaging and clinicopathological features were compared among the three groups. Univariate and multivariate analyses were performed to identify factors associated with incomplete PC. The number of patients with complete PC, PC absence, and PC invasion was 87 (59%), 20 (14%), and 40 (27%), respectively. Compared with the other two groups, tumors with complete PC were most common in clear cell RCC (CCRCC) and showed a hyperenhancement pattern (92%) and clear boundary (63%) on CT scanning images (p < 0.001). PC absence was most common in female patients (50%), whereas PC invasion was more common in male patients (85%) (p=0.017). The tumor diameter in the PC absence group (2.24 ± 0.93 cm) was shorter compared with that of the complete PC group (2.88 ± 0.76 cm) and PC invasion group (3.16 ± 0.64 cm) (p < 0.001). Univariate and multivariate analysis showed that hypoenhancement pattern, unclear boundary, and non-CCRCC subtype were independent risk factors of incomplete PC. Hypoenhancement pattern, unclear boundary, and non-CCRCC subtype were significant predictors of incomplete PC in small RCCs. It remains to be established whether TE is an appropriate procedure for patients with incomplete PC.

Parenchymal Mass Loss During Partial Nephrectomy: Role of Devascularized Parenchymal Mass and Excised Parenchymal Mass and Impact on Functional Preservation.

To evaluate the importance of devascularized parenchymal mass(DPM) and excised parenchymal mass(EPM) in functional preservation after standard partial nephrectomy(SPN). Forty-one patients who underwent pure tumor enucleation(TE) and 52 patients who underwent SPN with necessary data were included. As no EPM was lost in TE, the TE samples were used to estimate the degree of volume shrinkage that occurred when the measurements were performed in vivo with blood flow versus ex vivo without, and the shrinkage ratio was calculated as specimen volume divided by tumor volume in vivo. In SPN, the specimen volume comprised tumor volume plus EPM. The EPM was calculated as specimen volume divided by shrinkage ratio minus tumor volume in vivo. The DPM was defined as total ipsilateral parenchymal mass loss minus EPM. T tests, χ2 test, and Mann-Whitney U tests were employed to compare clinical characteristics. Multivariate analysis was used to identify variables that correlated with glomerular filtration rate(GFR) preservation. The mean sizes of devascularized and excised parenchymal masses were 13.6 cm3 and 5.2 cm3 (P=.01), which accounted for 7.8% and 3.4% of preoperative ipsilateral parenchymal mass (P=.03) in SPN, respectively. The shrinkage ratio was 0.71 and correlation coefficient was 0.965. After stepwise regression, DPM, and preoperative GFR were significantly associated with global GFR preservation. The DPM comprises most of parenchymal mass loss after SPN and plays a more important role than EPM on functional outcomes. Surgeons should pay more attention to reducing devascularization during partial nephrectomy.

Schwannoma of the Upper Limb: Retrospective Study of a Rare Tumor with Uncommon Locations.

Background: Although schwannoma (neurilemmoma) is the most common tumor of the peripheral nerve, its low incidence, slow growth and vague symptoms often lead to misdiagnosis or delayed diagnosis. The aim of the study is to present a series with a large number of schwannomas in the upper limbs, some with very rare occurrence. Methods: We report 17 patients with a mean age of 58.5 years and upper limb schwannomas, located on the median, ulnar and radial nerves, but also on the posterior interosseous nerve and digital collateral nerves. The diagnosis was made by clinical examination and imaging tests, and in no case was a preoperative biopsy performed. Surgical treatment was established based on symptoms or aesthetic concerns. In all cases, a diagnosis of schwannoma was confirmed through histopathological and immunohistochemical examinations. Results: For all patients, a complete tumor enucleation was performed under a surgical microscope. No recurrence was recorded at 2 years after surgery. Patient satisfaction was good, with complete socio-professional integration in all cases. Conclusions: Although more frequently present on the main nerve trunks, schwannoma may be present on the collateral digital nerves in rare cases. A correct technique with complete tumor excision offers excellent postoperative outcomes and avoids recurrences.

Current tendencies in diagnostics and treatment of peripheral benign lung tumors

The OBJECTIVE was to estimate clinical characteristics, diagnostic possibilities of computed tomography, minimally invasive methods of treatment of peripheral benign lung tumors.MATERIALS AND METHODS. Benign tumors were diagnosed in 311 (8.2 %) patients among 3789 people with bronchopulmonary neoplasms. A comparative assessment of the results of diagnostics and treatment of two groups of patients was carried out. The first group included 103 patients treated from 2003 to 2009, the second one – 128 patients treated from 2013–2020. 219 (94.8 %) patients were operated on. RESULTS. Benign lung tumors were more often detected at the age of 40-60 years – in 143 (61.9%) patients. The majority (184 patients, 79.6%) had no complaints. In 208 (90 %) patients, tumors were diagnosed during fluorography studies. In the second group, multispiral computed tomography revealed tumors less than 10 mm in size in 38 % of cases. The histological type of tumors was determined during intraoperative express histological test. In the second group, the number of thoracoscopies increased from 2.2 to 43 %, and – thoracotomies decreased from 94.5 to 52.3 %, the number of stapler resections of the lungs doubled, and the number of tumor enucleation decreased by half (p&lt;0.01). Thoracotomy was performed in case of deep tumor localization or large size of the tumor, it was impossible to find it endoscopically. Ten patients underwent lobectomy.CONCLUSION. Most peripheral benign lung tumors are asymptomatic. Computed tomography revealed tumors less than 1cm in size in 38 % of cases. To rule out malignancy, it is necessary to perform urgent surgery with an intraoperative express histological test. Thoracoscopy allows to remove surface peripheral tumors using the method of stapler resection.

Attitude thérapeutique des obstructions tumorales des voies aériennes : étude rétrospective, survie à long terme et complications

Interventional bronchoscopy is now the standard treatment for tracheobronchial narrowing due to tumor. The objective of our study was to analyze long-term survival and complications occurring in patients with malignant airway obstruction. We retrospectively studied the data from 93 patients treated between 2008 and 2019. One hundred and eleven therapeutic bronchoscopies were performed. Sixty-seven patients had primary lung cancer, in 17 had tumors of another origin and 9 patients had benign or local lung tumors. Thulium laser was frequently used prior to tumor enucleation and to restore hemostasis. Seventy-one silicone stents were inserted. The death rate at the time of the procedure was 1.8% and immediate complication occurred in 9.9% of the patients. Long-term survival was significantly better for patients with cancer from other origins than in those with primary lung cancer (615.5days versus 177.9days). On the other hand, there was no significant difference in long-term survival between patients with locally advanced and metastatic lung cancer with endobronchial lesions treated by stent and those who were not (234.2days versus 164.6days). All patients with benign or with locally malignant tumors were still alive. Therapeutic bronchoscopy increases the long-term survival of patients with malignant airway obstruction. The risk-benefit ratio was favorable.

MP24-09 RISK OF PSEUDOANEURYSM AND COMPLICATIONS AFTER PARTIAL NEPHRECTOMY: COMPARISON OF TUMOR ENUCLEATION TO STANDARD MARGIN TECHNIQUE

You have accessJournal of UrologyCME1 May 2022MP24-09 RISK OF PSEUDOANEURYSM AND COMPLICATIONS AFTER PARTIAL NEPHRECTOMY: COMPARISON OF TUMOR ENUCLEATION TO STANDARD MARGIN TECHNIQUE Nicholas Elliott, Jae Han Lee, Hiten Patel, Whitney Halgrimson, Keshava Gali, Nicholas Lanzotti, Goran Rac, Marcus Quek, and Gopal Gupta Nicholas ElliottNicholas Elliott More articles by this author , Jae Han LeeJae Han Lee More articles by this author , Hiten PatelHiten Patel More articles by this author , Whitney HalgrimsonWhitney Halgrimson More articles by this author , Keshava GaliKeshava Gali More articles by this author , Nicholas LanzottiNicholas Lanzotti More articles by this author , Goran RacGoran Rac More articles by this author , Marcus QuekMarcus Quek More articles by this author , and Gopal GuptaGopal Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002563.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is the gold standard for the resection of amenable small renal masses. Some surgeons have adopted tumor enucleation (TE) over the standard margin PN (SPN) technique based on preservation of healthy renal parenchyma by following the tumor pseudocapsule. However, TE may also confer additional advantages due to avoidance of sharp incision including reduction in perioperative and bleeding complications. Therefore, we evaluated the rate of pseudoaneurysms and other complications following TE vs SPN. METHODS: A retrospective cohort study of patients undergoing PN (TE and SPN) between 2008 and 2020 was conducted. Baseline characteristics, comorbidities including chronic kidney disease and Charlson Comorbidity Index (CCI), prior surgical history, tumor size, clinical stage, and RENAL nephrometry score were captured. Clavien-Dindo complications including pseudoaneurysm were compared between the TE and SPN cohorts with univariable and multivariable logistic regression models. RESULTS: A total of 467 patients were included, 176 (37.7%) receiving TE and 291 (62.3%) SPN. There were no differences in baseline characteristics such as comorbidity, tumor size, clinical stage, or nephrometry score between groups. Conversion rates were similar but Clavien-Dindo complication rates were significantly less likely for TE with 19 (10.8%) compared to SPN with 68 (23.4%) (multivariable OR 2.55 (95%CI 1.45-4.51), p=0.001). Major Clavien-Dindo grade ≥3 complications were infrequent, but with notably lower rates for TE vs. SPN (2 (1.1%) vs. 22 (7.6%), multivariable OR 8.83 (95%CI 1.84-42.46), p=0.01). Reduction in bleeding complications was a major driver (1.7% vs. 6.2%, p=0.02) with no pseudoaneurysm events following TE compared to 13 following SPN (0.0% vs 2.8%, p=0.004). Need for interventional radiology largely reflected pseudoaneurysm differences (0 (0.0%) TE vs 14 (3.0%) SPN, p=0.003). Readmission occurred less often after TE vs. SPN (3.4% vs. 8.6%, p=0.03). CONCLUSIONS: Patients receiving TE experienced no clinically significant pseudoaneurysm formation and were less likely to have any bleeding complication or major Clavien-Dindo complication postoperatively. TE is a safe option for PN with avoidance of sharp excision optimizing perioperative parameters along with known benefits in renal function. TE may be preferred when minimizing morbidity aligns with patient selection and preferences. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e396 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Elliott More articles by this author Jae Han Lee More articles by this author Hiten Patel More articles by this author Whitney Halgrimson More articles by this author Keshava Gali More articles by this author Nicholas Lanzotti More articles by this author Goran Rac More articles by this author Marcus Quek More articles by this author Gopal Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...

V10-04 MINIMALLY-INVASIVE PARTIAL NEPHRECTOMY EMPLOYING 4K VISUALIZATION SYSTEM WITH OPAL 1 NEAR-INFRARED AND INDOCYANINE GREEN TECHNOLOGY

You have accessJournal of UrologyCME1 May 2022V10-04 MINIMALLY-INVASIVE PARTIAL NEPHRECTOMY EMPLOYING 4K VISUALIZATION SYSTEM WITH OPAL 1 NEAR-INFRARED AND INDOCYANINE GREEN TECHNOLOGY Pietro Diana, Andrea Gallioli, Alberto Piana, Angelo Territo, Julia Aumatell, Alejandra Bravo, Josep Maria Gaya, Jordi Huguet, Antonio Rosales, Francesco Sanguedolce, Pavel Gavrilov, Joan Palou, and Alberto Breda Pietro DianaPietro Diana More articles by this author , Andrea GallioliAndrea Gallioli More articles by this author , Alberto PianaAlberto Piana More articles by this author , Angelo TerritoAngelo Territo More articles by this author , Julia AumatellJulia Aumatell More articles by this author , Alejandra BravoAlejandra Bravo More articles by this author , Josep Maria GayaJosep Maria Gaya More articles by this author , Jordi HuguetJordi Huguet More articles by this author , Antonio RosalesAntonio Rosales More articles by this author , Francesco SanguedolceFrancesco Sanguedolce More articles by this author , Pavel GavrilovPavel Gavrilov More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002623.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal function preservation is one of the objectives of partial nephrectomies. Minimally-invasive surgery has allowed to decrease post-operative morbidity maintaining curative results in cT1 masses. New technologies are continuously developing in order to precisely visualize the vascular supply of the tumor and spare healthy parenchyma. We propose a clinical case in which the new visualization system Image 1S Rubina with OPAL 1 NIR/ICG has been employed. METHODS: We present a case of a 65 year-old male with no previous medical history. In February 2021 after an episode of hematuria underwent an abdominal US that described a left renal mass that was confirmed at CT scan and laparoscopic partial nephrectomy was indicated. Before the surgery a 3D reconstruction was performed confirming a 34 mm hilar mass in relations with the superior renal calyxes. The Image 1S Rubina with OPAL 1 near infrared/indocyanine green (NIR/ICG) technology by Storz was employed for this procedure. RESULTS: This new visualization system combines the 4K high resolution with fluorescence imaging providing an overlay of NIR/ICG data onto the standard white light. This technology allows an ICG-assisted tumor enucleation as the ischemic tumor margins are in contrast with the very well vascularized parenchyma. Monochromatic visualization of the field can be performed displaying the ICG signal in white on a black background achieving the greatest contrast between elements. Additionally, an overlay intensity map visualization can be set highlighting in different color the parenchyma respecting the ICG density in the tissue reflecting the vitality of the parenchyma. The feeding arterial branch was detected and sectioned before the enucleation as it was entering the mass itself. The total operative time was 145 min and the estimated blood loss was 70cc. The post-operative stay was devoid of complications. The patient was discharged at post-operative day 3. Pathological analysis detected a clear cell renal carcinoma with negative margins. CONCLUSIONS: This kind of technology allows a 4K resolution image and the NIR/ICG image with different overlay modes. This strengthen the insight of the tissue vascularization and vitality guiding the enucleation of the renal mass guaranteeing a parenchymal-sparing technique and thus preserving renal function. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e849 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pietro Diana More articles by this author Andrea Gallioli More articles by this author Alberto Piana More articles by this author Angelo Territo More articles by this author Julia Aumatell More articles by this author Alejandra Bravo More articles by this author Josep Maria Gaya More articles by this author Jordi Huguet More articles by this author Antonio Rosales More articles by this author Francesco Sanguedolce More articles by this author Pavel Gavrilov More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Role of Intraoperative Ultrasonography Associated with Clampless Technique in Three-Dimensional Retroperitoneoscopic Laparoscopic Enucleation of Completely Endophytic Renal Tumors.

Objectives: To evaluate perioperative and functional outcomes of clampless laparoscopic tumor enucleation for completely endophytic renal tumors with the guide of intraoperative ultrasonography. Methods: We analyzed patients with clinically completely endophytic tumors, renal tumors, who underwent clampless three-dimensional (3D) retroperitoneoscopic laparoscopic tumor enucleation between January 2012 and January 2021. Patients with exophytic tumors were excluded. Intraoperative ultrasonography was used to map out the mass in all surgeries. Results: Overall, 57 patients underwent clampless 3D retroperitoneoscopic laparoscopic tumor enucleation. Mean surgical time was 131 minutes, and mean estimated blood loss was 202 mL. Mean hospital stay was 4.7 days. Major and minor postoperative complications occurred, respectively, in 3 and 10 cases. Only a patient had a positive surgical margin. One-year renal function did not differ from baseline. Conclusion: Our study showed that clampless laparoscopic enucleation guided by laparoscopic ultrasonography ensured satisfactory outcomes for completely intrarenal tumors, with excellent renal function preservation 1 year after surgery.

Insulinoma como causa rara de hipoglicemia na infância: relato de caso

INTRODUCTION: Insulinoma is a neuroendocrine tumor that originates in pancreatic beta cells, resulting in severe and frequent preprandial hypoglycemia. The diagnosis should be considered in the presence of the Whipple triad (present in 75% of cases) and confirmed through the demonstration of high insulin levels associated with low serum glucose levels. Treatment is surgical and, in most cases, curative. CASE REPORT: Girl, 10-years-old, hospitalized for the investigation of possible refractory epilepsy with predominant morning seizures, which started 6 months prior to her admission. A pediatric endocrinology evaluation was requested, as hypoglycemia was evidenced during the occurrence of seizures, which improved after intravenous glucose infusion. During the tests of the critical sample, hyperinsulinism associated with hypoglycemia was revealed. The diagnosis of insulinoma was therefore considered and then confirmed, after an intrapancreatic lesion showed up on the imaging tests. She was referred for surgical excision and had good evolution after tumor enucleation. COMMENTS: Insulinoma is a rare neuroendocrine tumor in the pediatric group. It may initially present itself as a hard-to-control convulsive condition, accompanied by behavioral changes and developmental delay, which often leads to misdiagnosis. Thus, early diagnosis and intervention are important since they reduce the morbidity and mortality of affected individuals. The patient did not present neurological sequelae and had a favorable post-surgical evolution, without recurrence of symptoms or further episodes of hyperglycemia.

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Pancreatic neuroendocrine tumors (PNETs) were formerly termed pancreatic islet tumors. These are rare tumors, comprising 2%–3% of all pancreatic tumors. They derive from pluripotent pancreatic stem cells. PNETs can be classified as functional and nonfunctional. Functional tumors secrete hormones that result in a specific clinical presentation. Insulinomas are the most common PNETs. They are usually benign. Glucagonomas and VIPoma are most commonly malignant. Surgical resection, surgical debulking ± systemic treatment may be used. The Zollinger-Ellison syndrome (ZES) is characterized by gastric acid hypersecretion leading to severe acid-related peptic ulcer disease with diarrhea, caused by a gastrinoma, also a neuroendocrine tumor. The gastrinoma triangle (sweep of duodenum/head of pancreas) is the location of 80% of these tumors. The majority of gastrinomas are located in the duodenum. Gastrinomas may be associated with MEN1 (hyperparathyroidism, pituitary tumors, and gastrinoma) in 20% of cases. Surgical resection is the primary treatment of choice for sporadic gastrinoma. Enucleation of small pancreatic tumors, duodenotomy, and enucleation of small duodenal tumors are the most common procedures performed. Liver resection, hepatic artery embolization and/or chemoembolization, microsphere embolization, radiofrequency or cryoablation, and liver transplantation all have been utilized for metastatic disease.

Clampless Laparoscopic Tumor Enucleation for Exophytic Masses Greater Than 4 cm: Is Renorrhaphy Necessary?

Objective: To demonstrate the safety of clampless 3D laparoscopic tumor enucleation (cLTE) for exophytic T1b kidney masses, avoiding suture to achieve hemostasis. Methods: Between January 2010 and January 2021, 241 consecutive patients with an exophytic renal tumor underwent sutureless cLTE. Patients with predominantly endophytic growth or tumors 4 mm closer to the collecting system less were excluded. In all cases, an attempt was made to accomplish surgery without suturing kidney parenchyma. Data were obtained from a retrospective review of history and physical examinations, operative and pathology reports, anesthesia records during the hospital stay, and follow-up visits. Results: Among 241 patients who underwent cLTE, 148 had cT1a and 93 had cT1b renal tumor. The median tumor size was 32 mm, and the median R.E.N.A.L. (radius exophytic/endophytic nearness anterior/posterior location) score was 6. Renorrhaphy was necessary in 5 cases. The median operative time (OT) was 100 minutes, and the estimated blood loss (EBL) was 150 mL. The median 24-hour decrease in hemoglobin was 1.8 g/dL. The median length of stay was 4 days. Nineteen patients had postoperative complications: 3 cases had Clavien-Dindo (CD) 3a or more, 6 had CD2, and 10 had CD1. Comparing the T1a and T1b groups, except for the median OT and the EBL, no significant differences were observed in all the other variables analyzed. In both groups, renal function was preserved after 1 year from surgery. Conclusion: Our experience showed that sutureless cLTE is safe and feasible for T1b tumors leading to radical oncological outcomes and preserving renal function.