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PubMedDate not supplied

Pathologic findings at the time of nephrectomy for renal mass.

BACKGROUND: Ultrasound (US) and computed tomography (CT) have improved the diagnosis of solid renal masses. Nevertheless, some patients still undergo exploration for a presumptive diagnosis of renal cell carcinoma (RCC) and are found to have other pathology. We report a contemporary series of non-RCC renal masses (both incidental and symptomatic) among nephrectomies performed for suspected RCC. MATERIALS AND METHODS: All nephrectomies performed by the Urology Service at the Memorial Sloan-Kettering Cancer Center from July of 1989 through July of 1996 for a parenchymal renal mass were reviewed, and patients without a final diagnosis of RCC were identified. Cases were excluded if RCC was not suspected preoperatively. Presentation, preoperative radiographic evaluation, type of operation, and pathologic features were assessed. RESULTS: Of the 636 nephrectomies performed, 108 patients (16.9%) had a diagnosis other than RCC. CONCLUSIONS: Of patients undergoing nephrectomy for renal masses, 16.9% have other pathologic diagnoses. Sixty-six percent of these non-RCC masses are discovered incidentally, and the majority are treated with radical nephrectomy. Preoperative radiographic evaluation reflects both clinical presentation, with IVP used to evaluate symptomatic tumors, and diagnostic uncertainty, with multiple modalities used to evaluate cystic lesions. This information has important implications for preoperative counseling and surgical planning.

Adult↗

PubMed1988

Experience with 247 living related donor nephrectomy cases at a single institution in Japan.

There is currently much concern over the morbidity and mortality of donors undergoing nephrectomy for living related renal transplants. Between April, 1970 and July, 1986, 247 cases of living related renal transplants were performed at the Second Department of Surgery, Kyoto Prefectural University of Medicine. The average age of the donors was 50.3 +/- 9.7 years, 81 per cent of the donors being parents of the recipients. Minor abnormalities which did not affect the donors suitability were found in 71 cases. Nephrectomies were performed extraperitoneally in all cases. Peri-operative complications, including wound complications in 13 cases, urinary infection in 12 cases and pulmonary complications and arrhythmia in 4 cases, were considered to be minor in nature. A variety of renal function tests, carried out two weeks after nephrectomy revealed normal levels, although they had become slightly worse than those estimated pre-operatively. Long-term sequelae in the follow-up period from 18 months to 16 years and 2 months, was studied on 124 donors who answered questionnaires. Currently, there are 5 late deaths, none of which are directly related to the nephrectomy. Of the 124 donors, 85.5 per cent stated that there had been no change in their physical states following surgery. Pain or a feeling of discomfort at the wound site was reported by 10 donors (8.1 per cent) and hypertension was observed only in 3 (2.4 per cent). No major complication directly related to the donor nephrectomy was found, except for one case of incisional hernia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1998

Prognostic factors and the role of nephrectomy in metastatic renal cell carcinoma.

The objective of this study was to evaluate the prognostic factors and role of nephrectomy in metastatic renal cell carcinoma. We reviewed 62 cases of metastatic renal cell carcinoma (RCC) at presentation to document the factors influencing the survival and to evaluate the role of nephrectomy. Sex and age of the patients, size of the primary tumour, site and number of the metastases, nephrectomy, cell type and grade of the tumour and type of the medical treatment were analyzed as prognostic factors. The age and sex of the patients, cell type and type of the medical treatment did not appear to be significant predictors of prognosis. However, improved survival was correlated with tumours < or =7 cm in diameter, low grade tumours, metastasis limited to single organ and removal of the primary tumour. When these parameters were analyzed in a combined manner patients who had undergone nephrectomy showed consistently longer survival. We suggest that nephrectomy should be considered in all patients with metastatic RCC, as long as the morbidity of the operation is predicted to be acceptable.

Adult↗

PubMed2003

Unexpected surgical difficulties leading to hemorrhage and gas embolus during laparoscopic donor nephrectomy: a case report.

PURPOSE: To report the case of a laparoscopic donor nephrectomy in which the preoperative evaluation of the patient gave no indication of the surgical difficulties that were encountered intraoperatively, resulting in substantial bleeding, a suspected gas embolism, and emergency conversion of the procedure from laparoscopic to open donor nephrectomy. CLINICAL FEATURES: A 59-yr-old man - height: 175 cm, weight: 85.5 kg, American Society of Anesthesiologists physical status I - presented as kidney donor for laparoscopic donor nephrectomy. He was healthy, on no medication, and had no previous abdominal surgery or diseases of the urinary tract. The preoperative computed tomography (CT) scan evaluation of his kidneys confirmed this by reporting a normal bilateral renal and renal vascular anatomy. In contradiction to the preoperative CT scan findings, the surgeon discovered abnormalities in the operative field. This included extensive scarring surrounding the left kidney, adenopathy near the right hilum, and a large branch lumbar vein entering the renal vein. The large branch lumbar vein was clipped but the clips dislodged, causing significant blood loss, and a suspected gas embolus. The procedure was converted to an emergency open donor nephrectomy. Postoperatively the patient made a full recovery. CONCLUSION: Laparoscopic donor nephrectomies, though usually performed on healthy individuals, have their pitfalls, and complications during this procedure can be sudden and serious. As shown in this case, although CT scan results are regarded as reliable, they can be misleading. As an anesthetic precaution for possible gas emboli during laparoscopic procedures, nitrous oxide should be avoided and the patient be ventilated with 100% oxygen.

Blood Loss, Surgical↗

PubMed2006

Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques.

Four surgical techniques for living donor nephrectomy were analyzed retrospectively in terms of perioperative outcome and early complication rate. A total of 182 donor nephrectomies including 69 open (OLDN), 14 fully laparoscopic (LDN), 34 hand-assisted laparoscopic (HLDN) and 65 retroperitoneoscopic (RLDN) nephrectomies were analyzed. There was a significant difference in mean operating time (OPT) between the OLDN (160 min) and RLDN (150 min) as compared to the LDN (212 min) and HLDN group (192 min) (P < 0.001). Mean warm ischemia time (WIT) was significantly shorter with OLDN (114 s), RLDN (121 s) and HLDN (128 s) when compared to LDN (238 s) (P < 0.001). Major complication rate was comparable among the groups. Independent of the preferred technique, donor nephrectomy is associated with complication rates. RLDN is comparable to OLDN in terms of OPT, WIT. Learning endoscopic donor nephrectomy could be associated with a higher complication rate.

Adult↗

PubMed2001

Short-term impact of carbon dioxide, helium, and gasless laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient.

BACKGROUND: Laparoscopic donor nephrectomy has the potential to increase the number of living kidney donations by reducing donor morbidity. However, studies have shown that raised intraabdominal pressure can result in transient renal dysfunction. Therefore, laparoscopically procured kidneys might be at higher risk for suffering a period of ischemia during pneumoperitoneum. The objective of this study was to investigate the short-term impact of pneumoperitoneum used for laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient. METHODS: EXPERIMENT 1: KIDNEY DONOR: Initially, 36 brown Norway (BN) rats were randomized for three procedures: 2 h of carbon dioxide (CO2) insufflation (8 mmHg), 2 h of helium insufflation (8 mmHg), and 2 h of gasless technique (0 mmHg). After this, a unilateral nephrectomy was performed in all the animals. EXPERIMENT 2: RECIPIENT: Subsequently, 36 donor BN rats were subjected to a similar insufflation protocol, but after nephrectomy, a syngeneic kidney transplantation (BN-BN) was performed. Urine and blood samples were collected on postoperative days 1, 3, 7, and 14 for determination of renal function. Subsequently, donor and recipient kidneys were removed for histomorphologic and immunohistochemical analysis. RESULTS: In both donors and recipients, no significant changes in serum creatinine, proteinuria, or glomular filtration were detected between the CO2, the helium, and the gasless control groups. In both experiments, histologic analysis of Kidney specimens did not show any deleterious effects from abdominal gas insufflation. Although kidney grafts exposed to CO2 showed significantly higher numbers of CD45+ leukocytes 3 days after transplantation, immunohistochemical analysis did not show significant differences in number of infiltrating cells (CD4, CD8, ED1, OX6, OX62) between the two insufflation groups and the gasless control subjects. CONCLUSIONS: Abdominal gas insufflation does not have an adverse effect on the renal function of the kidney donor 1 week after laparoscopic donor nephrectomy. No differences in renal function or histomorphology were detected between syngeneic kidney grafts exposed to pneumoperitoneum and gasless control subjects.

Animals↗

PubMed2004

Laparoscopic nephrectomy for autosomal dominant polycystic kidney disease.

BACKGROUND: The authors reviewed their experience with laparoscopic nephrectomy for autosomal dominant polycystic kidney disease to evaluate whether patient-related or surgery-related factors influence operative outcomes. METHODS: A retrospective review was carried out of 22 consecutive laparoscopic nephrectomies performed by one surgeon in a university setting between March 1998 and March 2003. The impact of patient factors (body mass index, preoperative hemoglobin level, preoperative blood urea nitrogen and creatinine, kidney size and side, prior abdominal surgery, dialysis) and surgical factors (surgeon experience and preoperative embolization) on short-term outcomes (estimated blood loss, transfusion requirements, operative time, conversion, intra- and postoperative complications and length of stay) was analyzed using the Student's t-test, Pearson correlation, and Mann-Whitney and Fisher tests. RESULTS: A total of 19 patients underwent 22 nephrectomies. The average patient age was 49 years (range, 36-65 years) and the average body mass index was 31.4 kg/m2 (range, 20.4-64.5 kg/m2). Fourteen patients (68%) were receiving dialysis. Fifteen right (68%) and 7 left (32%) nephrectomies were performed. The median kidney size was 22 cm (range, 8-50 cm). Five patients (23%) had preoperative embolization. The median operative time was 255 min (range, 95-415 min). There were no mortalities. The intraoperative complication rate was 18% (1 vena cava laceration, 1 cecal perforation, 1 dialysis fistula thrombosis, 1 intrarenal bleeding requiring conversion), and the postoperative complication rate was 32% (1 myocardial infarction, 1 urgent laparotomy for clinical peritonitis, 1 minor bile fistula, 1 AV fistula thrombosis, 2 incisional hernias, 1 urinary retention). Four procedures (18%) were converted (1 for vena cava laceration, 1 for cecal perforation, 1 for intrarenal bleeding, 1 for adhesions). The median blood loss was 400 ml (range, 100-5000 ml). Eight patients (36%) received transfusions (median, 2 units). The median length of stay was 4 days. The patients who required blood transfusions had lower preoperative hemoglobin levels. Preoperative embolization did not affect surgical outcome. However, surgeon experience significantly reduced operative time. CONCLUSIONS: Laparoscopic nephrectomy for autosomal dominant polycystic kidney disease is a safe procedure, providing patients with a short hospital stay. Complication and conversion rates are relatively high.

Adult↗

PubMed2005

Tuberous sclerosis, associated with renal cell carcinoma and angiomyolipoma, in a patient who developed endstage renal failure after nephrectomy.

We report a case of tuberous sclerosis (TSC) associated with renal cell carcinoma and angiomyolipoma in a patient, who developed endstage renal failure that required hemodialysis after nephrectomy. A 37-year-old woman with TSC was admitted for further investigation of bilateral renal masses detected by computed tomography (CT). Angiography revealed a tumor stain (4 cm in diameter) in the medial portion of the right kidney. Because renal cell carcinoma (RCC) was strongly suspected, right nephrectomy was performed. Her serum creatinine level was already increased, moderately, at 2.4 mg/dl, before the right nephrectomy. Her renal function deteriorated quickly (in 1(1/2) years) after the right nephrectomy, and hemodialysis was introduced the next year. The histological findings of the resected right kidney revealed marked intimal thickening of the intralobular arteries. These findings suggested that the renal function loss was not only caused by the nephron mass reduction due to the nephrectomy but was also caused by nephrosclerosis. Though most patients with TSC die before developing endstage renal failure, this patient is currently receiving maintenance hemodialysis and has been followed for 3 years with no recurrence of RCC in the left kidney.

Adult↗

PubMed2005

Laparoscopic partial nephrectomy: technique, oncologic efficacy, and safety.

Laparoscopic partial nephrectomy is emerging as an attractive approach for selected renal masses, but has been performed with significant variability in technique. The procedure's evolution, a merger of proven open techniques with applicable laparoscopic techniques and limitations, is very much a work in progress. Just as long-term follow-up for open nephron-sparing surgery for selected renal masses has demonstrated recurrence-free survival equivalent to radical nephrectomy, a few large series of laparoscopic partial nephrectomy are beginning to surface that demonstrate its clinical efficacy, although duration of follow-up is still too short to make definitive statements. This article reviews the literature and the authors share their experience and preferences in technique, derived from 100 consecutive laparoscopic partial nephrectomies and from their assessment of the acute sealant effectiveness for partial nephrectomy in a large, hypertensive, porcine model that approximates clinical situations. This review aims to assist the urologic surgeon in determining which renal tumors to approach laparoscopically and which surgical approach best fits their laparoscopic expertise.

Female↗

PubMed2006

Open partial nephrectomy for the treatment of renal cell carcinoma.

Open partial nephrectomy, or nephron-sparing surgery (NSS), is now considered the standard of care for the treatment of small renal tumors. The oncologic efficacy and safety of NSS for the treatment of stage-T1a renal tumors has been repeatedly demonstrated to be equivalent to radical nephrectomy. NSS initially was reserved for patients with solitary kidneys, impaired renal function, hereditary tumor syndromes, bilateral renal tumors, and those with significant comorbidities predisposing to future renal failure. The indications have expanded recently to allow elective partial nephrectomy in the setting of a normal contralateral kidney. Furthermore, recent data demonstrate that partial nephrectomy for larger tumors (T1b), which have been historically treated with radical nephrectomy, is a viable option when surgical margins can safely be achieved. In the era of minimally invasive techniques, laparoscopic NSS is technically feasible, yet long-term studies are still needed to assess oncologic efficacy. New NSS ablative technologies, such as cryoablation and radiofrequency ablation, are on the horizon. In this article, we discuss the role of open NSS and surgical technique in the contemporary management of renal tumors.

Biopsy↗

PubMed1975

Clinical effects of bilateral nephrectomy.

The effects of removal of all renal tissue on hematopoiesis, osteodystrophy, blood pressure regulation and metabolic functions are reviewed; and, the indications for, and results of, bilateral nephrectomy are discussed. Nephrectomy results in a more severe anemia in dialysis patients which is poorly responsive to androgen therapy. No differences were detected in the severity of osteodystrophy between nephric and anephric patients. However, bilateral nephrectomy can occasionally result in the acute onset of hypocalcemia. Blood pressure regulation must be accomplished in the absence of a functioning renin-angiotensin system. This is largely on the basis of volume, but changes in vascular tone may also be significant. Little is known about the metabolic consequences of nephrectomies. The effect on substances metabolized by the kidney is an area for further investigation. Kidney tissue should be preserved, if at all possible, and nephrectomy performed only for specific indications.

Adult↗

PubMed1983

Angiotensin-induced drinking and the effect of bilateral nephrectomy.

The induction of drinking by the intraventricular administration of angiotensin II has been attributed to a specific interaction with receptors in the medial preoptic-anterior hypothalamic border. These studies have been pharmacological in nature, involving exogenous peptide. In experiments reported elsewhere the present authors have shown that nephrectomy resulted in a regionally selective increase in levels of brain angiotensinogen, the putative prohormone of any CNS angiotensin peptides. Nephrectomy also markedly perturbs fluid and ion homeostasis. A study was therefore made of the effect of bilateral nephrectomy on spontaneous and angiotensin-induced drinking behavior. A deficit in spontaneous drinking following nephrectomy was observed, but it was noted that this related directly to diminished food intake. Angiotensin II-induced drinking was markedly potentiated following nephrectomy, indicative of possible up-regulation of angiotensin receptors in selected regions of the rat brain. The results are consistent with a physiological role for angiotensin in regulating fluid intake and volume homeostasis.

Angiotensin II↗

PubMed1987

Enhanced accumulation of injected inorganic mercury in renal outer medulla after unilateral nephrectomy.

The effects of unilateral nephrectomy on renal accumulation and intrarenal distribution of mercury following a single injection of mercuric chloride (HgCl2, 0.5 mumol Hg/kg body wt, ip) were evaluated in the rat. In rats injected with HgCl2 immediately after nephrectomy or 10, 28, or 43 days after nephrectomy, the accumulation of mercury in the renal outer medulla was significantly greater than in respective sham-operated control rats. The increased accumulation of mercury in renal outer medulla was evident at 24 hr after injection of HgCl2 and persisted for at least 72 hr. The effect appeared to be a phenomenon associated specifically with the renal outer medulla in that elevated concentrations of mercury in the outer medulla were observed in the absence of similar elevations in the renal cortex, inner medulla, liver, and blood or in the whole body mercury content. Urinary excretion of mercury was unaffected by nephrectomy. Thus, associated with unilateral nephrectomy are changes in the renal accumulation and intrarenal distribution of systemically administered inorganic mercury that persist long after the rapid phase of compensatory renal growth (0-7 days) is completed.

Animals↗

PubMed1980

Partial nephrectomy: Mayo Clinic experience 1957--1977.

Three hundred and six partial nephrectomies were performed at Mayo Clinic between 1957 and 1977. Operative and postoperative risks were analyzed according to the indication for surgery, type of partial nephrectomy performed, and other factors. The results demonstrate that partial nephrectomy performed by modern techniques is safe, with acceptable operative time, operative blood loss, and postoperative hospital stay. Complications encountered also were investigated. One death occurred, 8 delayed nephrectomies were required, in 2 patients delayed renal hemorrhage developed, 10 had urinary fistulas or urinomas, and in 16 patients wound infections developed. Study of the techniques used in those cases with postoperative complications suggests several approaches to reduce still further the morbidity of partial nephrectomy.

Adolescent↗

PubMed1985

Effect of indomethacin on the adrenal renin response to nephrectomy in the rat.

The role of prostaglandins in the control of adrenal renin in vivo was evaluated in nephrectomized rats. Nephrectomy increased adrenal renin from 13.2 +/- 1.37 ng angiotensin I/mg protein/hr to 166.5 +/- 17.3 ng angiotensin I/mg protein/hr. Indomethacin treatment significantly suppressed the adrenal renin response to nephrectomy. (47.8 +/- 5.22 ng angiotensin I/mg protein/hr). Adrenal aldosterone was also suppressed by indomethacin. Adrenal prostaglandin E2 increased after nephrectomy and decreased after indomethacin. Plasma corticosterone and serum potassium did not change after indomethacin. These data indicate that inhibition of prostaglandin synthesis by indomethacin partially blocks the adrenal renin response to nephrectomy, suggesting that prostaglandins may play a role in the adrenal response to nephrectomy.

Adrenal Glands↗

PubMed2006

Total laparoscopic live donor nephrectomy: a 6-year experience.

BACKGROUND: Since the introduction of the laparoscopic live donor nephrectomy in 1995, attempts have been made to depart from the total laparoscopic approach to the hand-assisted approach to decrease surgical time and complications. We present our 6-year experience with the total laparoscopic approach. METHODS: Between December 1998 and November 2004 there were 168 total laparoscopic live donor nephrectomies performed at our institution. There were 163 left nephrectomies and 5 right nephrectomies. RESULTS: The procedure was performed in a systematic approach. The surgical time deceased from an average of 2:27 hours in the first year to 1:34 hours in the last year of the study. The overall average warm ischemia time was 3.5 minutes. Major bleeding requiring conversion to an open procedure occurred in 2 (1.2%) donors. Minor bleeding that was controlled laparoscopically occurred in 9 (5.4%) donors. Degloving of the renal capsule occurred in 2 (1.2%) donors with no consequences. Minor mesenteric rent occurred in 7 (4.2%) donors. All mesenteric complications were recognized and repaired laparoscopically. No ureteral or bowel injuries occurred. There were no mortalities. Eighty-three percent of donors were discharged the next day. CONCLUSIONS: Total laparoscopic live donor nephrectomy is safe. It was performed successfully in 98.8% of donors with a short surgical time, low morbidity, and 0% mortality.

Adult↗

PubMed2005

Retroperitoneoscopic donor nephrectomy: a retrospective, non-randomized comparison of early complications, donor and recipient outcome with the standard open approach.

OBJECTIVES: We retrospectively performed a comparative analysis of retroperitoneoscopic and open donor nephrectomy in terms of donor complications, as well as recipient complications and functional graft outcome. METHODS: A total of 134 donor nephrectomies including 69 open (ODN) and 65 retroperitoneoscopic (RDN) nephrectomies was analyzed retrospectively. Both groups were comparable in terms of age, body mass index (BMI), operating time (OPT), warm ischemia time (WIT) and blood loss. RESULTS: There were no statistically significant differences with respect to recipient outcome, mean values for age, BMI, OPT and cold ischemia time (CIT). The overall donor complication rate did not differ. Early functional graft follow-up showed significant differences in 24 h-urine output between the two groups (p<0.001), but serum creatinine was comparable after 7, 30, 180 and 365 days. The early rejection rate in the recipients was similar in the two groups. CONCLUSION: Retroperitoneoscopic donor nephrectomy (RDN) provides comparable perioperative features, such as operating time, warm ischemia time (WIT) and overall complication rate to the open donor nephrectomy (ODN). Additionally, it has no negative impact on recipients' operating time, graft ischemia and early graft function.

Adult↗

PubMed2006

Controlled study of Inline radiofrequency coagulation-assisted partial nephrectomy in sheep.

BACKGROUND: Primary or secondary tumors of kidney often are managed by partial nephrectomy. Intraoperative blood loss can be significant. Laparoscopic partial nephrectomy may be even more challenging. We developed the Inline radiofrequency coagulation (ILRFA) probe for liver surgery. It uses radiofrequency energy to make a linear coagulative plane and considerably reduces bleeding during parenchymal transection. In this stud,y we tested the efficiency of ILRFA in ovine kidney. METHOD: Seven sheep were used in this study. Under general anesthetic, a laparotomy was performed in each sheep. The first two sheep were used as pilot experiments. Five partial nephrectomies were made in the remaining five sheep using ILRFA. As a control, a matching partial nephrectomy was made in each sheep using diathermy and sutures. Blood loss was measured by determining the difference in the weights of dry sponges and blood stained sponges after resection. A paired t test was used to compare the bleeding between the control and the ILRFA technique. RESULTS: The mean blood loss using ILRFA was 33.14 g (SD 17) and 123.43 g (SD 72) in the control group. The bleeding was significantly reduced in the ILRFA group, with a P value of 0.0056. The time taken for applying the ILRFA was 3-4 min. CONCLUSION: We have achieved partial nephrectomy in ovine kidney using radiofrequency energy with significantly reduced blood loss.

Animals↗