scholarly journals Laparoscopic Nephrectomy,Ex VivoPartial Nephrectomy, and Autotransplantation for the Treatment of Complex Renal Masses

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Jasmir Gopal Nayak ◽  
Joshua Koulack ◽  
Thomas Brian McGregor
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Ex Vivo ◽  
Laparoscopic Nephrectomy ◽  
Cell Renal Cell Carcinoma ◽  
Renal Masses ◽  
Local Experience ◽  
Nephron Sparing ◽  
Stable Renal Function ◽  
Clinical Dilemma

In the contemporary era of minimally invasive surgery, very few T1/T2 renal lesions are not amenable to nephron-sparing surgery. However, centrally located lesions continue to pose a clinical dilemma. We sought to describe our local experience with three cases of laparoscopic nephrectomy,ex vivopartial nephrectomy, and autotransplantation. Laparoscopic donor nephrectomy was performed followed by immediate renal cooling and perfusion with isotonic solution. Back-table partial nephrectomy, renorrhaphy, and autotransplantation were then performed. Mean warm ischemia (WIT) and cold ischemic times (CIT) were 2 and 39 minutes, respectively. Average blood loss was 267 mL. All patients preserved their renal function postoperatively. Final pathology confirmed pT1, clear cell renal cell carcinoma with negative margins in all. All are disease free at up to 39 months follow-up with stable renal function. In conclusion, the described approach remains a viable option for the treatment of complex renal masses preserving oncological control and renal function.

scholarly journals Non-neoplastic pathologic findings in nephrectomy specimens; postoperative renal insufficiency and outcomes

2019 ◽  
Vol 9 (1) ◽  
pp. 01-01
Author(s):  
Nathan M Shaw ◽  
Frank C. Hill ◽  
Lauren Bakios ◽  
Jayashree Krishnan ◽  
Krishnan Venkatesan ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Insufficiency ◽  
Partial Nephrectomy ◽  
Univariate Analysis ◽  
Renal Parenchyma ◽  
Tubular Atrophy ◽  
Renal Masses ◽  
Vascular Abnormalities ◽  
Institutional Review ◽  
Nephron Sparing

Introduction: Incidence of renal masses has increased with increased abdominal imagings. The trend in treatment of renal masses has been toward renal preserving options, including surveillance, ablation and partial nephrectomy. Objectives: To determine the frequency of medical renal disease in patients undergoing surgical intervention for renal neoplasms and to establish whether these pathologic changes predict development of renal insufficiency in the immediate postoperative period. Patients and Methods: This was an Institutional Review Board (IRB)-approved retrospective review of all patients that underwent radical nephrectomy (RN), partial nephrectomy and nephroureterectomy from December 2009 to November 2013. Around 225 patients had complete pathologic and perioperative data for analysis. We compared preoperative and postoperative glomerular filtration rate (GFR), neoplastic findings, tumor characteristics (positive margins and extracapsular extension), and pathology information regarding non- neoplastic findings (tubular atrophy, chronic inflammation and fibrosis). Results: The presence of any pathologic abnormalities in the non-neoplastic renal parenchyma was significantly associated with increased serum creatinine levels postoperatively (P=0.01) and at last follow up visit (P=0.04). Univariate analysis showed that glomerular and vascular abnormalities were each significantly associated with worsening renal function. Conclusion: Our research suggests that abnormalities in non-neoplastic renal parenchyma found in renal specimens after RN should not be ignored as they may predict possible worse outcomes in renal function. This may help make a case for biopsy pre-operatively and a stronger case for nephron sparing surgery. This may also help determine which patients should be followed more closely postoperatively.

scholarly journals Oncological outcomes of partial nephrectomy for tumours larger than 4 cm: A systematic review

2014 ◽  
Vol 8 (1-2) ◽  
pp. 61 ◽  
Author(s):  
Tarek H El-Ghazaly ◽  
Ross J Mason ◽  
Ricardo A Rendon
Keyword(s):  
Systematic Review ◽  
Partial Nephrectomy ◽  
Survival Rates ◽  
Cancer Specific Survival ◽  
Renal Masses ◽  
Oncological Outcomes ◽  
Medical Associations ◽  
Nephron Sparing ◽  
Pubmed Search ◽  
Exact Size

Introduction: Many medical associations recommend nephron-sparing surgery (NSS) for tumours larger than 4 cm amenable to partial nephrectomy (PN). These recommendations are, however, mostly based on isolated reports. We systematically review the oncological outcomes of partial nephrectomy procedures performed for tumours larger than 4-cm.Methods: A PubMed search was carried out using keywords “partial nephrectomy” and “nephron sparing” for records dating back to 1995. In total, 2136 abstracts were analyzed; from these, 174 studies were scrutinized. We identified 32 manuscripts reporting size-specific cancer-specific survival rates for masses greater than 4 cm. From each of these studies, we recorded the number of PN, tumour diameter, follow-up duration, 5- and 10-year recurrence, overall and cancer-specific survival rates (OS, CSS). We also calculated weighted OS and CSS rates.Results: This systematic review includes 2445 patients with renal tumours larger than 4 cm who underwent PN: 1858 patients with tumours between 4 to 7 cm, 410 patients with tumours larger than 7 cm and 177 patients with tumours greater than 4 cm (exact size unknown). Our analysis revealed weighted 5-year CSS rates of 95.4%, 86.2% and 93.9% for tumours 4 to 7 cm, >7 cm, and all tumours >4 cm, respectively. The respective 5-year OS rates were 84.7%, 76.4%, and 84.7%.Conclusions: We found excellent 5-year CSS and OS rates for patients with tumours 4 to 7 cm treated with PN. These outcomes compare favourably to those reported in historical radical nephrectomy (RN) series for similarly sized tumours. Thus, PN is an acceptable and often preferred treatment for renal masses >4 cm which are amenable to nephron-sparing procedures.

scholarly journals Intraoperative ultrasound in robot-assisted partial nephrectomy: State of the art

2018 ◽  
Vol 90 (3) ◽  
pp. 195-198 ◽  
Author(s):  
Giacomo Di Cosmo ◽  
Enrica Verzotti ◽  
Tommaso Silvestri ◽  
Andrea Lissiani ◽  
Roberto Knez ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
State Of The Art ◽  
Short Review ◽  
Robot Assisted ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Ischemia Time ◽  
Oncological Safety ◽  
Nephron Sparing ◽  
Operative Ultrasound

Introduction: Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN). Material and methods: We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure. Results: Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy. Conclusions: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.

Renal function and oncologic outcomes in nephron sparing surgery for renal masses in solitary kidneys

2010 ◽  
Vol 29 (3) ◽  
pp. 343-348 ◽  
Author(s):  
Daniel J. Lee ◽  
Greg Hruby ◽  
Mitchell C. Benson ◽  
James M. McKiernan
Keyword(s):  
Renal Function ◽  
Nephron Sparing Surgery ◽  
Oncologic Outcomes ◽  
Renal Masses ◽  
Nephron Sparing

scholarly journals INVESTIGATING A NOVEL MODIFIABLE FACTOR AFFECTING RENAL FUNCTION AFTER PARTIAL NEPHRECTOMY: CORTICAL RENORRHAPHY

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Anna Fenner ◽  
Clint Bahler, MD
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumor Size ◽  
Controlled Trial ◽  
Tumor Resection ◽  
Volume Loss ◽  
Selective Embolization ◽  
Renal Masses ◽  
Urine Leak ◽  
Modifiable Factor

Background: Partial nephrectomy is a common treatment for the removal of renal masses. Typically, during the procedure, stitches are used to close two layers of the kidney—both deep and superficial. Renorrhaphy of the superficial layer, thought to reduce the risk of bleeding and urine leak, is routinely performed but has not been sufficiently studied. Hypothesis: Cortical renorrhaphy is a modifiable factor affecting renal function after partial nephrectomy. Omitting this step will preserve renal parenchyma without significantly increasing complications. Methods: A randomized, controlled trial is underway. Interim statistical analysis has been performed on the data being collected. Patients underwent partial nephrectomy with or without cortical renorrhaphy according to their randomized group assignment. Three-dimensional models were constructed using semi-automatic segmentation planimetry of the kidney prior to surgery and at 4-months after tumor resection to determine volume loss in the operated kidney. Results: The median (range) volume loss in the non-renorrhaphy group (n=8), 13% (0-24%), was trending lower than the renorrhaphy group (n=8), 22% (12-39). Using multiple linear regression, experimental group (p=0.0808) and warm-ischemia time (p=0.0995) were significant at the 0.1 level. Tumor size was not statistically significant (p=0.2644). There was one Clavien 3 complication in each group: The renorrhaphy group had one urine leak requiring a drain, and the non-renorrhaphy group had one postoperative bleed requiring selective embolization. Demographics were comparable among the two groups with both having 4 white males and 4 white females. The mean age (58 and 55 for renorrhaphy and non-renorrhaphy, respectively) and tumor size were also comparable. Conclusion and impact: A trend of increased volume loss from cortical renorrhaphy is seen as predicted by retrospective data. Completion of the trial is needed to conclude whether this is statistically significant.

Hook-wire assisted localization of a completely endophytic renal mass during three-dimensional laparoscopic partial nephrectomy: Presentation of our technique

2021 ◽  
pp. 039156032110318
Author(s):  
Nikolaos Ferakis ◽  
Spyridon Paparidis ◽  
Athanasios Papatheodorou ◽  
Evangelos N Symeonidis ◽  
Antonios Katsimantas
Keyword(s):  
Partial Nephrectomy ◽  
Renal Mass ◽  
Three Dimensional ◽  
Cost Effective ◽  
Surgical Excision ◽  
Laparoscopic Partial Nephrectomy ◽  
Cell Renal Cell Carcinoma ◽  
Renal Masses ◽  
Case Presentation ◽  
Hook Wire

Introduction: Totally endophytic renal masses may be invisible during laparoscopic partial nephrectomy, posing challenge to surgeons regarding tumor’s identification and resection. Case presentation: A 22-year-old male was incidentally diagnosed with a completely endophytic, cT1a renal mass. Percutaneous Computed Tomography-guided insertion of a hook-wire was performed prior to laparoscopic partial nephrectomy. The hook-wire anchored centrally into the tumor and its extra-renal part was easily identified intraoperatively, contributing to tumor’s identification and surgical excision. Total operative time was 185 min, warm ischemia time was 21.5 min, tumor excision time was 10 min, and total renorraphy time was 31 min. No complications were encountered perioperatively. The patient was discharged on the fourth postoperative day. Histology revealed a pT1a, clear-cell renal cell carcinoma, with negative surgical margins. Conclusions: Our first experience indicates that hook-wire guided excision of a completely endophytic renal mass during laparoscopic partial nephrectomy is feasible, safe, and cost-effective.

509 IS BASELINE RENAL FUNCTION A DECISION-MAKING CRITERION FOR CHOOSING AN ABLATIVE TECHNIQUE RATHER THAN A PARTIAL NEPHRECTOMY IN SMALL RENAL MASSES?

2010 ◽  
Vol 183 (4S) ◽  
Author(s):  
Pierre Bigot ◽  
Maxime Crepel ◽  
Gregory Verhoest ◽  
Karim Bensalah ◽  
Alexandre De La Taille ◽  
...  
Keyword(s):  
Decision Making ◽  
Renal Function ◽  
Partial Nephrectomy ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Baseline Renal Function

Safety and efficacy of transperitoneal laparoscopic nephron sparing surgery in patients with previous abdominal surgery

2020 ◽  
pp. 039156032092172
Author(s):  
Stefano Manno ◽  
Lucio Dell’Atti ◽  
Antonio Cicione ◽  
Angelo Spasari
Keyword(s):  
Length Of Stay ◽  
Abdominal Surgery ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Masses ◽  
Conversion To Open Surgery ◽  
Previous Abdominal Surgery ◽  
Estimated Blood Loss ◽  
Nephron Sparing

Objective: The aim of this study is to assess the safety and feasibility of the transperitoneal laparoscopic approach during nephron sparing surgery in patients with previous abdominal surgery. Patients and methods: We retrospectively analyzed patients undergoing transperitoneal laparoscopic partial nephrectomy for renal masses. All patients had received a diagnosis of cT1a renal exophytic mass (⩽5 cm). Patients were divided into two groups, those with and without previous abdominal surgery. Patients with solitary kidney or major previous abdominal surgery were excluded in this study. The operative time, estimated blood loss, length of stay, surgical complications, and positive surgical margins were recorded to compare outcomes among two groups. Results: Of the 157 patients who were included in our study, 71 (45.3%) had a history of abdominal surgery (Group 1), while the remaining 86 (54.7%) had not (Group 2). Cholecystectomy was the most common previous surgery performed near the renal fossa. Patients with previous abdominal surgery experienced increased operative time (111.5 vs 83.2 min; p = 0.001). However, no statistically significant difference was found in estimated blood loss (122.1 vs 114.4 mL; p = 0.363), length of stay (4.1 vs 3.8 days; p = 0.465), rate of conversion to open surgery (2.8% vs 2.3%; p = 0.234), and rate of complications ( p = 0.121). However, operative time ( p = 0.003) and length of stay ( p < 0.001) were greater in patients with versus those without previous open cholecystectomy. Conclusion: Our results suggest that laparoscopic partial nephrectomy after minor previous abdominal surgery is safe and feasible in selected patients affected by renal masses with low nephrometry score. However, previous cholecystectomy results in an increased risk of conversion to open surgery and longer hospital stay in patients undergoing right laparoscopic partial nephrectomy.

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