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PubMed2005

Predicting postoperative renal insufficiency in patients undergoing nephrectomy for renal malignancy: assessment by renal scintigraphy using 99mtechnetium-mercaptoacetyltriglycine.

PURPOSE: We performed Tc-mercaptoacetyltriglycine (MAG3) renal scintigraphy in patients with renal malignancy to evaluate the function of each renal unit before and after nephrectomy to see if postoperative functional deterioration could be predicted based on scintigraphy results and creatinine clearance. MATERIALS AND METHODS: A total of 22 men and 13 women with renal malignancy, including 32 with renal cell carcinoma and 3 with urothelial cancer, were prospectively enrolled in this study. Average patient age was 64.3 years (median 65, range 43 to 88). All patients underwent MAG3 renal scintigraphy before and after unilateral nephrectomy. At the same time serum creatinine and endogenous creatinine clearance were determined. RESULTS: Mean serum creatinine was 0.93 mg/dl before and 1.31 after nephrectomy (p <0.0001). Preoperative endogenous creatinine clearance was 70.8 ml per minute per 1.73 m, which decreased to 49.0 ml per minute per 1.73 m after nephrectomy (p <0.0001). Mean MAG3 clearance of the remaining kidney increased 35.1% above baseline from 156.5 to 211.5 ml per minute per 1.73 m following nephrectomy. Spearman rank core analysis revealed that preoperative MAG3 clearance of the remaining kidney significantly correlated with postoperative creatinine clearance (r = 0.596, p = 0.0005). Preoperative MAG3 clearance of the remaining kidney more than 130 ml per minute per 1.73 m coincided with postoperative creatinine clearance above 40 ml per minute per 1.73 m. CONCLUSIONS: MAG3 renal scintigraphy may be useful for predicting renal insufficiency after nephrectomy. The findings in this study suggest that preoperative MAG3 clearance of the remaining kidney less than 130 ml per minute per 1.73 m is a risk factor for postoperative renal insufficiency.

Adult↗

PubMed2005

End stage polycystic kidney disease: indications and timing of native nephrectomy relative to kidney transplantation.

PURPOSE: We evaluated the indications for and outcome of pre-transplant, concomitant and post-transplant native nephrectomy in patients with end stage polycystic kidney disease (PCKD). MATERIALS AND METHODS: The records of 32 patients were retrospectively reviewed using the electronic database at our institution. RESULTS: Between January 1992 and December 2002, 171 patients with end stage PCKD received a kidney transplant at University of California-San Francisco. A total of 32 patients (18.7%) underwent pre-transplant (7, group 1), concomitant (16, group 2) or post-transplant (9, group 3) native nephrectomy. Of these patients 25 underwent bilateral nephrectomy. Median followup was 18 months. Indications for nephrectomy were hematuria, a renal mass and chronic pain in group 1, lack of space in group 2 and urinary tract infection in group 3. Mean operative time +/- SEM was 231 +/- 14, 370 +/- 24 and 208 +/- 14 minutes in groups 1 to 3, respectively (p = 0.001). Mean intraoperative blood loss was 533 +/- 105, 573 +/- 155 and 522 +/- 181 ml in groups 1 to 3, respectively (p not significant). Two group 2 patients required blood transfusions. Postoperative complications requiring surgical intervention included wound dehiscence in group 1 and abdominal bleeding in group 3. Mean hospital stay was comparable among groups 1 to 3 at 7 +/- 0.7, 8.6 +/- 1.2 and 6.3 +/- 0.6 days, respectively (p not significant). At 3 months mean serum creatinine was not significantly different between groups 2 and 3 at 1.3 +/- 0.1 and 1.5 +/- 0.2 mg/dl, respectively. CONCLUSIONS: Unilateral or bilateral nephrectomy for PCKD at transplantation is safe in terms of postoperative patient morbidity and graft function. We perform concomitant native nephrectomy when indicated, preferably in recipients of living donor kidney transplants.

Adult↗

PubMed2006

Complications and the learning curve for a laparoscopic nephrectomy at a single institution.

BACKGROUND: We assessed our experiences in performing a laparoscopic nephrectomy, with regard to complications and the learning curve, during a 4-year period. METHODS: Between November 2000 and October 2004, a total of 78 laparoscopic nephrectomies were performed at our institution (37 radical nephrectomies, 30 nephroureterectomies and 11 simple nephrectomies). The patient charts were retrospectively reviewed to identify any operative and postoperative complications, and also to evaluate the operating time. RESULTS: A total of eleven complications (14.1%) occurred in our series (nine operative and two postoperative complications). All operative complications were due to vascular injuries (n=9), five (2.6%) of which required an open conversion. The operating time and the rates of complications decreased significantly as the surgeons' experiences increased. CONCLUSION: A laparoscopic nephrectomy could be performed as safely as previously reported. In addition, the learning curve for a laparoscopic nephrectomy appeared to be good over the initial 50 procedures at our institution.

Humans↗

PubMed2006

Retroperitoneoscopic pre-transplant native kidney nephrectomy.

AIMS: Laparoscopic nephrectomy has become a standardized procedure for removal of benign non-functioning kidneys. We present our experience of retroperitoneoscopic pre-transplant native kidneys nephrectomy. METHODS: Comparison of 40 patients who underwent retroperitoneoscopy with 40 open simple pre-transplant nephrectomy patients was done. RESULTS: Forty retroperitoneoscopic nephrectomies were done between June 2003 and April 2005. The mean operative time was similar in the two groups; however, the mean blood loss, postoperative analgesic requirement, complication rate, hospital stay and convalescence period were significantly less in the retroperitoneoscopic group. CONCLUSION: Retroperitoneoscopic nephrectomy should be offered as the primary treatment modality to patients requiring pre-transplant native kidney nephrectomy, except in patients where it is contraindicated.

Humans↗

PubMed2004

Comparison of cryotherapy and nephrectomy in treating implanted VX-2 carcinoma in rabbit kidneys.

OBJECTIVE: To compare the efficacy of cryoablation and radical nephrectomy for treating implanted VX-2 carcinoma in rabbit kidneys. MATERIALS AND METHODS: A pilot study was conducted using 27 New Zealand white rabbits to assess the natural history of VX-2 carcinoma in the kidney. VX-2 tumour segments (1 mm(3)) were excised from subcutaneous tumours in carrier rabbits and implanted in the left kidney of study rabbits. The tumours were allowed to grow for 6, 7, 8, 9, 10, 14, 18, 21 and 28 days after implantation. Tumour progression was analysed in the kidney and surrounding serosa, and metastatic tumour presence in the lung, liver, spleen and bladder determined. After this, 80 rabbits were implanted with VX-2 in the lower pole and randomized into one of three groups: group 1, 35 rabbits treated 7 days after VX-2 implantation with cryoablation using a 15-min double-freeze technique and a 5-mm tumour margin target temperature of - 20 degrees C; group 2, 35 rabbits treated with open radical nephrectomy; or group 3, 10 untreated controls. Rabbits were maintained for 22 days and then killed; the kidneys, lungs, liver, spleen, urinary bladder and ureter were removed, and examined grossly and histologically for tumour presence. RESULTS: In the pilot study there was a consistent 50-100 mm(3) tumour after 7 days of growth, with no evidence of metastatic disease. By day 10 the mean kidney tumour was 230 mm(3) and two of three rabbits had metastases in the lung. By day 18 the mean primary tumour was 5504 mm(3) and all rabbits had metastatic disease. In the comparison study, cryotherapy cured 66% of implanted rabbits while nephrectomy cured 64%. All untreated controls had significant local and metastatic tumours. Findings in animals killed at 15 days after treatment showed significant differences between both treatment groups and untreated controls (P < 0.002). There was no difference in disease-free survival between the cryotherapy and open nephrectomy groups (P = 0.78) CONCLUSION: Both cryoablation and radical nephrectomy were effective in treating implanted VX-2 renal tumours compared with untreated controls. There was no statistically significant difference between cryoablation and nephrectomy.

Animals↗

PubMed1998

Role of insulin-like growth factor binding proteins in human post-nephrectomy proximal tubule cells.

1. In order to determine the role of the insulin-like growth factor-I (IGF-I)/IGF binding protein (IGFBP) axis in the augmentation of tubule growth and function following reductions in nephron mass, primary cultures of human proximal tubule cells (PTCs) were generated from the histologically normal sections of ten surgically removed kidneys. 2. PTC hypertrophy (cellular protein content), DNA synthesis (thymidine incorporation) and apical sodium-hydrogen exchange (NHE) activity (ethylisopropylamiloride-sensitive apical 22Na+ uptake) were measured following 24 h incubation in media supplemented with 10 % pre- or post-nephrectomy sera obtained from these patients. The results were compared with the effects of pre- and post-operative control sera collected from seven patients undergoing retroperitoneal operations not involving removal of renal tissue. 3. Day 1 post-nephrectomy sera promoted a significant 73 % increase in apical NHE activity, which was accompanied by a significant increase in PTC binding of 125I-IGF-I (post- vs. pre-nephrectomy, 163 +/- 6 vs. 142 +/- 4 fmol (mg protein)-1; P < 0.05). Subsequent post-nephrectomy sera significantly stimulated PTC protein content and thymidine incorporation, peaking at day 7 (127.7 +/- 14.0 and 118.4 +/- 9.0 % of pre-nephrectomy values, respectively; P < 0.05). The growth effects were cell specific, as they were not observed with renal cortical fibroblasts. No change was detected in any of these measured variables following exposure to control sera. 4. Serum IGF-I and IGFBP-1 levels did not significantly change over time or between groups. IGFBP-3 levels progressively decreased in both control and nephrectomized sera from pre-operative values of 3580 +/- 305 and 3360 +/- 217 ng ml-1, respectively, to 2670 +/- 341 and 2600 +/- 347 ng ml-1 at 1 week post-operation. Serum IGFBP-2 levels increased to a comparable extent in both controls (day 0 vs. day 7, 2940 +/- 1024 vs. 7010 +/- 2520 ng ml-1; P < 0.01) and nephrectomized patients (day 0 vs. day 7, 3070 +/- 656 vs. 9130 +/- 2010 ng ml-1; P < 0.01). 5. The results indicate that nephrectomy engenders the elaboration of one or more humoral factor(s), which promotes increased binding of IGF-I to PTCs and which may in turn specifically stimulate PTC Na+ transport and growth.

Cell Size↗

PubMed2006

Time course of the renal functional response to partial nephrectomy: measurements in conscious rats.

Previous investigations into the functional responses of the surviving nephrons following reductions in renal mass have been performed largely in anaesthetized animals and have taken little account of how the compensatory changes develop with time. The present study has assessed a method for determining glomerular filtration rate (GFR) in unrestrained, uncatheterized, conscious rats (plasma disappearance of (99m)Tc-diethylenetriamene pentaacetic acid (DTPA)) and has used this method to document the time course of the changes in GFR over a 32 day period following uninephrectomy or 5/6 nephrectomy. Concurrent measurements of excretion rates and of the clearance of lithium (the latter being an index of end-proximal fluid delivery) provided information on changes in overall tubular function and segmental reabsorption. After uninephrectomy, the GFR of the remaining kidney (compared with that of a single kidney of sham-operated animals) increased maximally (by approximately 50%) within 8 days; after 5/6 nephrectomy, the increase in the GFR of the remnant kidney was maximal (at approximately 300%) within 16 days. Overall excretion rates of sodium and potassium were well maintained in partially nephrectomized animals throughout the period of study, while the excretion of water increased (by approximately 30% after uninephrectomy and by approximately 120% after 5/6 nephrectomy), partly as a result of the compensatory increases in GFR but mainly as a consequence of moderate (after uninephrectomy) or marked (after 5/6 nephrectomy) reductions in fractional reabsorption. During the early period after 5/6 nephrectomy, potassium excretion sometimes exceeded the filtered load, indicating net secretion. Lithium clearance data indicated that the changes in tubular function after 5/6 nephrectomy include a reduction in fractional reabsorption in the proximal tubule, whereas after uninephrectomy any such effect on the proximal tubule is minor and transient.

Adaptation, Physiological↗

PubMed1987

Compartmental vascular changes in dogs after nephrectomy, DOCA, and saline: effect of nifedipine.

Hypertension (mean arterial pressure, (MAP) 131 +/- 3 mmHg) developed in 18 dogs 4 weeks after left nephrectomy, deoxycorticosterone acetate (DOCA), 5 mg/kg sc twice weekly), and 0.5% NaCl drinking solution. This can be compared with MAP (95 +/- 7 mmHg) of 13 dogs with nephrectomy alone and MAP (86 +/- 4 mmHg) of dogs without nephrectomy. The two-compartment model of the circulation revealed no differences in systemic vascular compliance, compartmental compliance, or flow distribution to the compartments. However, the time constant for venous return for the compartment with the rapid time constant was increased from 0.05 +/- 0.004 min in control animals to 0.07 +/- 0.006 min in the nephrectomy alone group and 0.09 +/- 0.008 min in the hypertensive group (p less than 0.001), as a result of an increase in venous resistance. Arteriolar resistance in this compartment was also increased in the hypertensive animals, as was the mean circulatory filling pressure and overall resistance to venous return. Nifedipine (0.025-0.05 mg/kg) reduced MAP by 15% in the nephrectomy alone group and by 22% in the hypertensive group, with reduction in arteriolar resistance only in the fast time constant compartment. In the slow time constant compartment, arteriolar resistance was increased by more than 100% and flow decreased by more than 50% after nifedipine. Unilateral nephrectomy, DOCA, plus NaCl resulted in hypertension by increasing arteriolar resistance in a vascular compartment with a fast time constant for venous return. Nifedipine countered this effect by inducing arteriolar vasodilation in this compartment. In addition, nifedipine reduced the mean circulatory filling pressure and overall resistance to venous return.

Animals↗

PubMed1991

Tubuloglomerular feedback responses to acute contralateral nephrectomy.

After unilateral nephrectomy adaptive events must occur in the remaining kidney within the first 12-14 h in anticipation of an increase in glomerular filtration rate (GFR) and eventual renal hypertrophy. Utilizing micropuncture and microperfusion techniques in the rat, we have examined tubuloglomerular feedback (TGF) and single-nephron GFR (SNGFR) responses while the late proximal tubule was microperfused [late proximal tubule flow (VLP)] from 0 to 40 nl/min in 10 nl/min intervals at 2-4 and 12 h after contralateral nephrectomy. Urinary excretion increased, but SNGFR derived from distal collections was reduced, and early distal flow rate remained constant 2-4 h after nephrectomy. The operating point was shifted, suggesting activation of TGF. The turning point half-maximal activity (V1/2) and slope were not statistically different when all nephron data were submitted to a curve-fitting procedure, but group mean data suggested a quantitatively lower V1/2 and steeper slope of the TGF profile. Twelve to fourteen hours after contralateral nephrectomy, values for SNGFR at all microperfusion rates were increased, as were late proximal and early distal flow rates. The values for V1/2 and slope of TGF were not statistically different from control values. We conclude that TGF activity and sensitivity are not suppressed at 2 and 12 h after nephrectomy. Increased urinary excretion does not require TGF alterations. Changes in TGF may be adaptive to increases in SNGFR and may not be causal to the increase in filtration rate after nephrectomy.

Animals↗

PubMed1992

Gene expression of growth-related proteins and ECM constituents in response to unilateral nephrectomy.

To identify the specific regulatory mechanism associated with the events following unilateral nephrectomy, we measured the levels of mRNA encoding for extracellular matrix (ECM) constituents, for protooncogenes, and for proliferating cell nuclear antigen (PCNA) in renal cortex and glomeruli. One hour after left nephrectomy, c-jun and c-fos mRNA levels in renal cortex increased rapidly and then decreased rapidly to the control level, whereas c-myc and PCNA mRNA levels showed a slower and more sustained increase, with a peak at 6 h after nephrectomy, and then decreased to the control level after 7 days. mRNA levels for basement membrane components including alpha 1-chain of type IV collagen, laminin B1 and B2 chains, and heparan sulfate proteoglycan core protein were significantly increased in renal cortex at 12 h after nephrectomy, whereas those for interstitial collagens including alpha 1-chains of type I and type III collagen were unchanged following nephrectomy. On the other hand, the glomerular expression of all genes examined in this study showed little change during the experimental period. These results suggest that the time course of mRNA expression of ECM constituents is different from that of growth-related proteins in renal cortex and that glomerular mRNA levels for these components may not be associated with renal hypertrophy in the early stages following unilateral nephrectomy.

Animals↗

PubMed2005

[Assessment of long-term renal function after nephrectomy. Study of 53 patients].

BACKGROUND AND OBJECTIVE: Patients with unilateral nephrectomy maintain the remaining kidney function over time, as it has been described in healthy kidney donors. PATIENTS AND METHOD: We performed a cross-sectional study of 53 patients who were followed 5 or more years after nephrectomy. Serum creatinine, BUN, Glomerular Filtration Rate (GFR) (24 hours urine collection and Cockcroft formula), microalbuminuria, proteinuria, Body Mass Index and the annual loss rate of renal function were measured or calculated over the follow-up period. We retrospectively considered the presence of risk factors like diabetes, hypertension, microalbuminuria, dyslipemia, smoking habit, obesity and ACE inhibitors or angiotensin-receptor antagonists treatment. We divided our patients into two groups: group I (normal or mild renal failure: GFR > 50 cc/min and or serum creatinine < 1.4 mg/dL) and group II (moderate or severe renal failure). RESULTS: The main cause of nephrectomy was renal tuberculosis, followed by lithiasis and pyonephrosis. In addition, 7.5% of patients were kidney donors. At the time of study, 22.7% had diabetes, 60.4% hypertension and 39.6% were obese. The mean age was 60 years (37 years at the moment of nephrectomy). The GFR final mean was 53.6 cc/min (58.8 cc/min by Cockcroft formula). The mean renal function loss rate was 1 cc/min/year. 35% of the patients had moderate or severe kidney failure and were included in group II; 32% had proteinuria and 56.6% had abnormal microalbuminuria. The univariate risk factors analysis for the development of renal failure showed inter-group statistical significative differences in current age, nephrectomy age, microalbuminuria, proteinuria, and hypertension prevalence (p = 0.008). With regard to the progression rate, we found a significant correlation with final microalbuminuria (r = 0.358, p = 0.03). Current age and final proteinuria were found to be significant risk factors in the multivariate analysis. CONCLUSIONS: A high prevalence of renal insufficiency was found among patients with unilateral nephrectomy, which is mainly related to age and proteinuria. The renal function loss rate is slow and is influenced by microalbuminuria.

Aged↗

PubMed1994

Effect of an acute oral protein load on microalbuminuria in uninephrectomized patients in relation to the time since nephrectomy.

To evaluate the effect of an acute oral protein load (OPL) on urinary albumin excretion (UAE) in uninephrectomized subjects with a negative Albustix test, in relation to the time since nephrectomy, the UAE was determined by a double-antibody 125I radioimmunoassay in 3-hour urine collections before and after 150 g OPL under conditions of moderate physical activity in 18 subjects who underwent unilateral nephrectomy more than 10 years (346.5 +/- 178.60 months) before evaluation and had a mean basal creatinine clearance (CCr) of 45.3 +/- 14 ml/min (group 1), in 21 subjects who underwent unilateral nephrectomy less than 10 years (31.5 +/- 28 months) before evaluation and had a mean basal CCr of 76.0 +/- 22 ml/min (group 2), and in 16 normal volunteers (controls) with a mean basal CCr of 103.1 +/- 12 ml/min. The UAE was higher in group 1 as compared with either group 2 or controls at both basal state (90.8 +/- 65, 19.6 +/- 17, and 11.0 +/- 5 micrograms/min/100 CCr for groups 1 and 2 and controls, respectively; p < 0.001) and after OPL (92.0 +/- 65, 43.6 +/- 24, and 12.0 +/- 5 micrograms/min/100 CCr for groups 1 and 2 and controls, respectively; p < 0.001). However, the increase in UAE following OPL was significant (p < 0.001) only in group 2 patients. In all patients, the basal UAE was negatively correlated with basal CCr (r = 0.63; p < 0.001) and positively correlated with the time since nephrectomy (r = 0.73; p < 0.001) and with both systolic (r = 0.57; p < 0.001) and diastolic blood pressures (r = 0.69; p < 0.001). CCr calculated using 3-hour urine collections increased more in controls (11.2 +/- 44.2%) than in patient groups 1 (1.6 +/- 0.89) and 2 (7.7 +/- 3.7%; p < 0.001). Basal CCr calculated using 24-hour urine collections the day before the test was negatively correlated with the time since nephrectomy in group 1 (r = -0.69; p < 0.001) and positively correlated with the time since nephrectomy in group 2 (r = 0.89; p < 0.001). Multiple regression analysis revealed that the relationship between CCr and duration of uninephric state was independent of age or systolic and diastolic blood pressures in both patient groups. These results suggest that UAE increase significantly after an OPL in subjects who have been nephrectomized less than 10 years before the study and have basal CCr values higher than 50% of normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗

PubMed1998

Laparoscopic nephrectomy in children.

Using the techniques for laparoscopic nephrectomy developed in adults, pediatric nephrectomy results in equivalent surgical outcomes compared with open surgery. To date, both transperitoneal and retroperitoneal laparoscopic approaches to nephrectomy for benign renal disease have been described. Controversy exists among pediatric urologists, however, regarding the advantages of laparoscopic nephrectomy in children because convalescence from an open nephrectomy is also rapid. This article reviews the current indications and techniques for laparoscopic nephrectomy in children as well as other surgical applications of laparoscopy with respect to the pediatric patient.

Adolescent↗

PubMed2004

Laparoscopic partial nephrectomy using a microwave tissue coagulator for treating small peripheral renal tumors.

BACKGROUND: Laparoscopic partial nephrectomy has been recently applied as a minimally invasive procedure. Several non-ischemic operation devices in partial nephrectomy have been developed. However, the problem related to maintenance of renal homeostasis remains. We investigated the efficacy and safety of a microwave tissue coagulator in laparoscopic partial nephrectomy. METHODS: Between April 2001 and February 2003, eleven patients with small renal tumors underwent laparoscopic partial nephrectomy using a microwave tissue coagulator. Seven patients underwent hand-assisted laparoscopic procedure and 4 pure laparoscopic procedure. RESULTS: The mean tumor size on preoperative CT scan was 2.5 cm (range: 2.0 to 4.0 cm), the mean operative time was 307 minutes (range: 160 to 580 minutes), and the mean estimated blood loss was 154.4 ml (range: 50 to 1,140 ml). The microwave tissue coagulator well controlled the renal bleeding and maintained renal function. All patients safely underwent partial nephrectomy without inducing renal ischemia. A complication of urine leakage was recognized in only one patient with hypoproteinemia caused by nephrotic syndrome. CONCLUSIONS: Laparoscopic partial nephrectomy using a microwave tissue coagulator was a useful method for achieving homeostasis, and was less invasive for treating small renal tumors.

Aged↗

PubMed1999

Effect of renal denervation on the compensatory renal growth following nephrectomy in the cat.

The purpose of this study was to clarify the effect of denervation on the mass of the remaining kidney with or without unilateral nephrectomy using adult cats. The animals were divided into 4 groups: (1) control group, the weights of the right and left kidneys were measured intact in 5 cats; (2) nephrectomy group (Nx, n = 5 cats), the right kidney was removed and the left kidney was weighed 3-5 d after nephrectomy; (3) nephrectomy and denervation group (Nx+Dx, n = 7 cats), the left kidney was weighed on the 7th day after surgery in which the left kidney was denervated and the right kidney was removed; and (4) denervation group (Dx+Dx, n = 5 cats), both kidneys were weighed on the 7th day after denervation of the kidneys. In the control group, the left and right kidney weights per body weight (LKW and RKW) were the same (LKW, 0.74 +/- 0.06%; RKW, 0. 74 +/- 0.07%). In the Nx group, LKW increased to 0.90 +/- 0.03% 3-5 d after nephrectomy, although RKW of the removed kidney was 0.66 +/- 0.01%. In the Nx+Dx group, LKW increased to 0.97 +/- 0.15%, which was similar to that of the Nx group. In the Dx+Dx group, LKW (0.56 +/- 0.05%) and RKW (0.54 +/- 0.05%) were significantly less than those in the control group. We conclude that the renal nerves may contribute to maintaining the renal mass and that the neural effect on compensatory growth following nephrectomy may be covered by other growth factors.

Adaptation, Physiological↗

PubMed1991

[Clinical study of operative therapy for renal cell carcinoma. 1. Nephrectomy].

A study was made on treatment-related factors, notably prognosis, in 148 patients treated by surgical resection of the primary lesion among 170 consecutive patients who were admitted to the Department of Urology, Gunma University for the treatment of renal cell carcinoma during the period from September 1961 through August 1989. Operative procedures used in this series were radical nephrectomy in 100 patients, simple nephrectomy in 46, partial nephrectomy in 1 and tumor enucleation in 1, lymph node dissection being performed in 53 of the 100 patients treated by radical nephrectomy. The patients receiving surgical resection of the primary lesion were stratified according to sex, PS, disease stage, surgical procedure, lymph node dissection and weight of renal substance resected and comparisons were made on survival rate and recurrence rate among patients in different strata in an effort to observe if these factors are determinant of postoperative prognosis. No significant difference in survival rate was observed between sexes. Patients displaying a PS value of 0 had a significantly higher survival rate than those having a PS value of 1 or above. Whereas a significant difference in survival rare was noted between stage IIIA + IIIB + C disease patients, no significant difference was observed among stage I, II and III patients, thus stages up to IIIA being considered low stage. Radical nephrectomy was associated with a significantly higher survival rate than simple nephrectomy in low stage (stage I-II) disease patients. However, there was no significant difference in survival rate between stage I-II disease patients with vs. without lymph node dissection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1999

[Laparoscopic radical nephrectomy for renal cell carcinoma--transperitoneal anterior approach].

PURPOSE: To evaluate the usefulness of transperitoneal anterior approach in laparoscopic radical nephrectomy for patients with renal cell carcinoma. MATERIAL: Ten patients (Eight males and two females) with small renal cell carcinoma less than 7 cm in diameter were treated with laparoscopic radical nephrectomy between June 1997 and May 1999. Clinical stage was T1aN0M0 in 6 cases and T1bN0M0 in 4 cases. METHOD: Of the 10 patients, the initial four received preoperative embolization of the renal artery. Under general anesthesia laparoscopic radical nephrectomy via transperitoneal anterior approach was performed in all patients. This procedure facilitates initiated early access to the renal vessels as does open radical nephrectomy. The kidney was dissected en bloc with Gerota's fascia and delivered from the small skin incision without morcellation. RESULT: Two patients needed conversion to open surgery. The mean operating time of eight patients except for conversion cases was 247 minutes and the mean blood loss was 258 ml. There was no major complication associated with laparoscopic procedure. CONCLUSION: Transperitoneal anterior approach in laparoscopic radical nephrectomy is a suitable and useful procedure for the treatment of small renal cell carcinoma because it enables us to avoid possible tumor manipulation by early access to the renal vessels as open radical nephrectomy.

Adult↗

PubMed2000

Hydro-jet assisted laparoscopic partial nephrectomy: initial experience in a porcine model.

PURPOSE: Hemostasis represents a challenge when performing laparoscopic partial nephrectomy. Hydro-Jet cutting is an advanced technology that has been used to create an ultra-coherent water force that functions like a sharp knife. In the surgical field, it has mainly been used for liver surgery and initial clinical experience with laparoscopic cholecystectomies has been favorable. This technique allowed selective parenchymal cutting with preservation of vessels and bile ducts. We describe a novel Hydro-Jet assisted dissection technique for laparoscopic partial nephrectomy in a porcine model. MATERIALS AND METHODS: Ten partial nephrectomies were performed in 5 pigs using a Muritz 1000 (Euromed Medizintechnik, A. Pein, Schwerin, Germany) Hydro-Jet generator. A thin stream of ultra coherent fluid is forced at a high velocity through a small nozzle. A modified probe allows both blunt dissection concomitantly with high-pressure water application. Coagulation can be applied via a bipolar thermoapplicator as needed. RESULTS: Laparoscopic partial nephrectomy was successful in all animals. Water-jet cutting through the parenchyma was virtually bloodless and preserved the vasculature and the collecting system. The vessels were then ligated or coagulated under direct vision. The continuous water flow established a bloodless operating field and a clear view for the surgeon. The mean dissection time and warm ischemia time were 45+/-9 and 17+/-3 minutes, respectively. CONCLUSIONS: This preliminary study supports the suitability of this technique for laparoscopic partial nephrectomy to improve hemostasis. The improved anatomical dissection and hemostasis may further decrease morbidity and operative time. Further studies are underway to compare this technique with laser coagulation for laparoscopic partial nephrectomy.

Animals↗