SEARCH · PubMed Health

Results for “Nephrectomy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 433 records · Page 24Linked to original sources

PubMed1988

Changes in glomerular filtration rate, lithium clearance and plasma protein clearances in the early phase after unilateral nephrectomy in living healthy renal transplant donors.

1. Glomerular and tubular function was studied before and 2 months after unilateral nephrectomy in 14 healthy kidney donors by measurement of the clearances of 51Cr-labelled ethylenediaminetetra-acetate, lithium, beta 2-microglobulin, albumin and immunoglobulin G. 2. The glomerular filtration rate (GFR) of the kidney that remained in the donor rose from 45 +/- 10 (mean +/- SD) to 59 +/- 10 ml/min (P less than 0.01) 5 days after contralateral nephrectomy and remained at this level through the observation period. 3. The lithium clearance (CLi) of the remaining kidney rose from 11.6 +/- 3.7 to 20.5 +/- 8.2 ml/min (P less than 0.01) and remained significantly elevated throughout the observation period. 4. Absolute proximal fluid reabsorption rate (APR), which was estimated as GFR minus CLi, was unchanged 5 days after contralateral nephrectomy, but then rose gradually to reach significantly elevated levels after 4 weeks. 5. Fractional proximal reabsorption (FPR; APR/GFR) fell from 0.75 +/- 0.06 to 0.66 +/- 0.11 (P less than 0.01) but subsequently rose to levels not significantly decreased from normal. 6. Twenty-four hour fractional clearances of beta 2-microglobulin, albumin and immunoglobulin G rose markedly on the day of nephrectomy, peaked at 2-3 days and subsequently fell to moderately elevated levels. 7. Both the CLi and the plasma protein clearance studies demonstrate that the early response of the remaining kidney to contralateral nephrectomy in man is an increase in GFR, an unchanged APR and a fall in FPR. The proximal tubules thus initially handle the increased filtrate load by passing it on to more distal nephron segments.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2003

Mini incision live donor nephrectomy: an optimal approach for the developing countries.

OBJECTIVE: Laparoscopic donor nephrectomy (LD) is rapidly gaining popularity, however, this may not be affordable by donors in many developing countries because of its high cost. We describe our mini flank incision (MD) donor nephrectomy technique and its outcome. METHODS: A 7-10-cm subcostal rib sparing transverse incision was given 2 cm lateral to the tip of the 12th rib, towards the lateral border of rectus muscle. All dissections were performed with help of long retractors and instruments, vessels were transfixed and cut. In last 45 cases, vessels were clipped with Liga or Weck clips. Donors and recipients outcome was analysed. RESULT: From January 2000 to December 2002 a total of 148 patients underwent donor nephrectomy by mini incision technique. Mean patient age was 44.8 +/- 7.3 yr (range 20-70 yr). Nephrectomies were performed in 115 patients on the left side and in 33 cases on the right side. The mean incision length was 9.1 +/- 1.8 cm (range 7-10 cm). Mean operative time was 105 +/- 10.5 min (70-130 min). Mean analgesic (Tramadol) requirement was 205 +/- 52 mg; postoperative hospital stay was 2.2 +/- 0.5 d. Twelve per cent patients developed fever and 4% had superficial wound infection in postoperative period. Three patients required blood transfusion. Mean convalescence period was 22 +/- 2.8 d. CONCLUSION: Extrapleural, extraperitoneal, subcostal mini incisions live donor nephrectomy is a relatively safe procedure with low morbidity. This technique has a shorter hospital stay, early convalescence and better cosmesis. It is cost-effective and is an ideal substitute for the developing country.

Adult↗

PubMed2001

Outcome of the distal ureteric stump after (hemi)nephrectomy and subtotal ureterectomy for reflux or obstruction.

OBJECTIVE: To assess the outcome of the distal ureteric stump (DUS) after (hemi)nephrectomy with subtotal ureterectomy. PATIENTS AND METHODS: The records of 89 patients (median age 2.7 years, range 0.25-12) who underwent nephrectomy (24) or heminephrectomy (65) with subtotal ureterectomy between 1982 and 1996 were reviewed retrospectively for symptoms caused by the DUS. The mean follow-up was 9.8 years. Nephrectomy was undertaken for a poorly functioning dysplastic (in nine), scarred (in 10) or hydronephrotic (in five) kidney, and heminephrectomy for a poorly functioning upper moiety associated with ectopic ureterocele (in 26) or stenotic hydroureter (in 15), or for a poorly functioning lower moiety associated with reflux (in 24). There were 38 refluxing and 51 non-refluxing ureteric stumps. Two additional patients primarily operated elsewhere were referred with DUS symptoms. RESULTS: Only one patient had a symptomatic DUS, with recurrent haematuria and bacteriuria. The two patients referred from elsewhere presented with febrile UTIs. The first had been left with a long refluxing stump opening ectopically into the urethra, and the second with a long stump which was converted from nonrefluxing to a refluxing stump when he developed dysfunctional voiding. Surgical excision of the distal stump was curative in each case. CONCLUSIONS: The risk of a symptomatic DUS in patients who undergo subtotal ureterectomy in conjunction with (hemi)nephrectomy is very low, with no difference between refluxing and nonrefluxing stumps. Long ureteric stumps and dysfunctional voiding may cause symptoms. Because of the low morbidity associated with a short ureteric stump, we recommend subtotal ureterectomy in children who undergo (hemi)nephrectomy for reflux, vesico-ureteric obstruction or ectopic ureterocele associated with a poorly functioning kidney or kidney moiety.

Child↗

PubMed1998

A review of our first 100 cases of laparoscopic nephrectomy: defining risk factors for complications.

OBJECTIVE: To present the complications from our first 100 cases of laparoscopic nephrectomy, a technically demanding procedure requiring lengthy experience, and to define the risk factors. PATIENTS AND METHODS: Indications for laparoscopic nephrectomy included patients requiring nephrectomy for benign pathology and those requiring nephroureterectomy for upper tract transitional cell carcinoma confined to the upper ureter and/or renal pelvis. All patients were operated on by one surgeon (D.A.T.) via a transperitoneal route and data on diagnosis, outcome and complications collected prospectively. RESULTS: The overall complication rate was 18%, of which 3% were major and 15% minor complications. Five cases were converted to open surgery electively. Complications and conversions were associated with a history of pyonephrosis, previous renal surgery, staghorn calculi, polycystic kidney disease, and xanthogranulomatous pyelonephritis. While there was no discernible decline in the decrease in complications with experience, operative duration decreased from a mean of 204 min for the first 20 cases to 108 min for the last 20. Complications and conversions were more closely associated with diagnosis than with the surgeon's experience. CONCLUSION: Laparoscopic nephrectomy and nephroureterectomy can be undertaken for a variety of indications with reasonable complication and conversion rates. Although inflammatory conditions increase the difficulty of these procedures, we feel that patients requiring nephrectomy for benign disease should be offered a trial of laparoscopic surgery.

Adolescent↗

PubMed2000

Radiographic vs surgical size of renal tumours after partial nephrectomy.

OBJECTIVE: To compare the radiographic with the surgical size of renal tumours selected for partial nephrectomy. PATIENTS AND METHODS: In 50 patients undergoing elective partial nephrectomy for renal carcinoma (31 men and 19 women, preoperative tumour size 1.5-5. 2 cm) the maximum size of the renal tumour, as assessed from computed tomography (CT) before surgery, was compared with the tumour size at surgery. All patients had their renal artery temporarily occluded before surgery to shrink the kidney. RESULTS: After partial nephrectomy, the renal tumours were a mean of 0.63 cm smaller than the estimate from CT; tumours of >/= 3.5 cm on CT were particularly reduced. CONCLUSION: Incidentally discovered tumours on CT that are < 3.5 cm and favourably located are often selected for partial nephrectomy. If temporary vascular occlusion and surface hypothermia of the kidney causes shrinkage of most tumours of >/= 3. 5 cm, then surgeons might attempt partial nephrectomy in borderline cases, with a better chance of complete resection.

Female↗

PubMed2002

The differences in health outcomes between Web-based and paper-based implementation of a clinical pathway for radical nephrectomy.

OBJECTIVE: To evaluate the effects of a web-based clinical pathway (WCP) for radical nephrectomy on patient care, and to compare the effects with those of a paper-based clinical pathway (PCP). PATIENTS AND METHODS: Patients with renal cell carcinoma and who underwent radical nephrectomy were enrolled into the study. The results of using the WCP for radical nephrectomy from July 2000 to August 2001 were compared with those using the PCP between May 1999 and June 2000. The mean hospital stay, average admission charges, six quality indicators, and the advantages of the WCP were determined. RESULTS: Using a WCP for radical nephrectomy reduced the hospital stay and admission charges by as much as the PCP. A similar number of patients had variances from the WCP as with the PCP (P = 0.407), but the number of undetected variances and the variance detection time in the WCP were significantly less (P = 0.0193 and 0.0162). Implementing a WCP also improved the quality of care by as much as a PCP. CONCLUSIONS: Using a WCP for radical nephrectomy can improve health outcomes by reducing the hospital stay and admission charges, and by improving the quality of care by as much as a PCP. Furthermore, the WCP was more accurate and faster than the PCP in detecting variances.

Adult↗

PubMed2002

The role of refluxing distal ureteral stumps after nephrectomy.

BACKGROUND/PURPOSE: Classically, the refluxing distal ureteral stump has been removed during the nephrectomy by the means of an incision on the flank and lower abdominal wall. There are little data in the literature about the natural history of these stumps. In the current work the authors evaluated possible complications affecting the ureteral stump after total or partial nephrectomy for vesicoureteral reflux. METHODS: Between June 1974 and May 1991, our institution performed 25 nephrectomies followed by partial ureterectomy to correct vesicoureteral reflux into a nonfunctional kidney. The authors performed, respectively, 16 total and 9 partial nephrectomies. The reflux to operated units was graded according to the International Grading System as grade 1 (n = 1), grade 2 (n = 4), grade 3 (n = 9), grade 4 (n = 8), and grade 5 (n = 1). RESULTS: Ureteral stump removal was performed in 3 patients (13%). No correlation between the need for ureteral stump removal and age, gender, grade of preoperative reflux, associated contralateral reflux, and ureteral histology, became apparent. CONCLUSION: The remainder of the ureteral stump, after a total or partial nephrectomy to correct vesicoureteral reflux, presents a low rate of complications even in the presence of a high grade of reflux.

Adolescent↗

PubMed2003

Hand-assisted laparoscopic nephrectomy.

PURPOSE: We report our experience in performing a hand-assisted laparoscopic radical nephrectomy (HALRN) for renal cell carcinoma (RCC) and a hand-assisted laparoscopic live donor nephrectomy (HALDN) for renal transplantation. PATIENTS AND METHODS: The clinical data on 21 patients with HALRN for stage T1N0M0 RCC and 5 living kidney donors with HALDN for renal transplantation were reviewed. We compared the results of 21 HALRNs with those of 15 conventional open radical nephrectomies for stage T1N0M0 RCC. RESULTS: The HALRN for RCC was successfully performed without any major complications in all 21 patients. The mean operation time for the HALRN group was significantly longer than that for the open surgery group (262 minutes versus 219 minutes). However, the mean estimated blood loss in the HALRN group was less than that in the open surgery group (250 ml versus 388 ml), although there was no statistically significant difference. The frequency in usage of analgesia postoperatively in the HALRN group was significantly less than that in the open surgery group (2.5 times versus 7.3 times). The HALDN was also successfully performed without any major complications in all 5 cases. The mean operation time, blood loss and warm ischemic time were 248 minutes, 322 ml and 9.8 minutes, respectively. All donors resumed oral intake of food within 48 hours after the surgery and returned to normal, non-strenuous activity by postoperative day 8. CONCLUSIONS: Our results indicate that a hand-assisted laparoscopic nephrectomy is an effective and safe surgical procedure, and it is less invasive than an open nephrectomy.

Adult↗

PubMed1981

The effect of unilateral nephrectomy and sham operation on tyrosine content and activity of tyrosine aminotransferase in the rat.

During the first four days after unilateral nephrectomy the free tyrosine content in plasma, liver and hypertrophic kidney was decreased by more than 50% as compared with the values observed in intact rat. After sham operation, the content of tyrosine was decreased to the same extent. The activity of tyrosine aminotransferase in liver was doubled two days after sham operation: no such increase was observed after unilateral nephrectomy. At the same time a decline of the enzyme activity in kidney was demonstrated after both types of surgery. Hydrocortisone in a single i.p. dose stimulated enzyme activity in the liver of intact rats three-fold, and more than four-fold after nephrectomy and sham operation. In kidney of intact rat, as a result of hydrocortisone treatment, the enzyme activity was doubled; it was, however, insensitive to this treatment after unilateral nephrectomy, and increased only by 20% after sham operation. It is suggested that the changes in tyrosine content and tyrosine aminotransferase activity observed after unilateral nephrectomy were not due to stress alone, but underwent regulation aimed at assuring a sufficient level of this amino acid for metabolism.

Animals↗

PubMed2001

Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer.

BACKGROUND: The value of nephrectomy in metastatic renal-cell cancer has long been debated. Several nonrandomized studies suggest a higher rate of response to systemic therapy and longer survival in patients who have undergone nephrectomy. METHODS: We randomly assigned patients with metastatic renal-cell cancer who were acceptable candidates for nephrectomy to undergo radical nephrectomy followed by therapy with interferon alfa-2b or to receive interferon alfa-2b therapy alone. The primary end point was survival, and the secondary end point was a response of the tumor to treatment. RESULTS: The median survival of 120 eligible patients assigned to surgery followed by interferon was 11.1 months, and among the 121 eligible patients assigned to interferon alone it was 8.1 months (P=0.05). The difference in median survival between the two groups was independent of performance status, metastatic site, and the presence or absence of a measurable metastatic lesion. CONCLUSIONS: Nephrectomy followed by interferon therapy results in longer survival among patients with metastatic renal-cell cancer than does interferon therapy alone.

Actuarial Analysis↗

PubMed2003

Functional evaluation of the remaining kidney in patients after unilateral nephrectomy.

BACKGROUND: Unilateral nephrectomy is quite often surgical procedure. The remaining kidney undergoes a sequel of adaptational processes. The aim of the study was to evaluate kidney function in patients subjected to unilateral nephrectomy. MATERIALS AND METHODS: The study was carried out in 28 subjects allocated into three groups: healthy controls (n = 8) and patients subjected to unilateral nephrectomy evaluated 1 month (n = 10) and 1 year (n = 10) from the surgery. Biochemical as well ultrasonographic and scintigraphic data were recorded. RESULTS: From all evaluated standard biochemical parameters (creatinine, creatinine clearance, urea, microalbuminuria) significant changes were observed in the case of creatinine and microalbuminuria levels at 1 month, which increased from 0.96 mg/ml to 1.05 mg/dl and from 5.14 mg/24 h to 20.0 mg/24 h, respectively. (99)Tc(m)-DTPA plasma clearance was significantly elevated in patients 1 month after unilateral nephrectomy, by 7.5%, with a decrease by 17% in patients 1 year after surgical procedure, in reference to the control subjects. A significant increase in (99)Tc(m)-EC plasma clearance of patients evaluated 1 year from the operation, by 13% (p < 0.05) in comparison to the control group was seen. RI index markedly increased in nephrectomised patients both after 1 month and 1 year from the operation as compared to the controls, from 0.59 to 0.64 (p < 0.05) and 0.63 (p < 0.05), respectively. CONCLUSION: Adaptational changes of the remaining kidney are observed in patients 1 month and 1 year after unilateral nephrectomy.

Adult↗

PubMed2003

Operative mortality after nephrectomy for renal cell carcinoma.

OBJECTIVE: To study the rate and causes of operative and treatment-related mortality after nephrectomy for renal cell carcinoma (RCC) in Iceland. MATERIAL AND METHODS: This retrospective population-based study included all patients who underwent nephrectomy for RCC in Iceland between 1971 and 2000. Patients who died <30 days after the operation were analyzed and compared to those who survived surgery. Disease stage, tumor size, patient age and preoperative American Society of Anesthesiologists classification were compared between the two groups. Autopsy records were examined to determine the causes of death. RESULTS: During the study period 880 patients were diagnosed with RCC and 575 (65%) of them underwent a nephrectomy, 116 (20%) with palliative intent. Operative mortality (OM) was 2.8% and did not change during the 30-year period. Patients with OM were significantly older than those without (73 vs 64 years, respectively) but disease stage, tumor size, ASA classification and gender were comparable between the groups. OM was comparable for patients operated on with palliative (3.4%) vs. curative (2.6%) intent (ns). Median time of death was 10 days postoperatively but no patient died intraoperatively. Causes of death were peri- and postoperative bleeding in five patients, infection/sepsis in four, arrhythmia in three, acute renal failure in two, pulmonary embolism in one and multiorgan failure in one. CONCLUSIONS: OM after nephrectomy for RCC has remained low during the past three decades in Iceland. It is most often caused by perioperative bleeding and infections. We find that the low OM in patients with metastases gives support to the use of palliative nephrectomy as a treatment option when other forms of treatment have failed.

Adult↗

PubMed2000

The heterogeneous and delayed course of blood pressure normalization in hypertensive patients after bilateral nephrectomy with and without subsequent renal transplantation.

BACKGROUND: Controversy exists about the time course of blood pressure normalization following bilateral nephrectomy. We sought to evaluate the time course of blood pressure normalization following bilateral nephrectomy and after subsequent kidney transplantation. METHODS AND RESULTS: Clinical data from 14 hypertensive patients were retrospectively assessed. Baseline blood pressure was 175 +/- 33/109 +/- 9 mmHg. Ten patients firstly underwent unilateral nephrectomy, which resulted in a slight increase of blood pressure (185 +/- 22/110 +/- 5 mmHg). One month following bilateral nephrectomy, blood pressure was 167 +/- 23/104 +/- 17 mmHg, at 3 months 159 +/- 42/104 +/- 25 mmHg, and at 6 months 149 +/- 41/96 +/- 30 mmHg. Antihypertensive medication was necessary in 9/14 patients at a 2 year follow-up. Eight patients remained anephric (group I), 6 patients had subsequent kidney transplantation (group II). In group I, blood pressure was 159 +/- 42/93 +/- 17 mmHg and 129 +/- 34/75 +/- 14 mmHg at 3 and 6 months, respectively (p< 0.05 vs. baseline). In group II, blood pressure decreased from 188 +/- 42/ 128 +/- 46 mmHg to 167 +/- 48/113 +/- 32 mmHg at 3 months, but increased after transplantation to 186 +/- 39/118 +/- 33 mmHg. Antihypertensive medication was still necessary in 5 transplanted patients (83%) and in 3 anephric patients (38%). CONCLUSION: Adaptation of the blood pressure response following bilateral nephrectomy is a time requiring process, and long-term antihypertensive medication may still be necessary.

Adolescent↗

PubMed2002

Bilateral nephrectomy delays gastric emptying of a liquid meal in awake rats.

AIMS: This study evaluates the effect of bilateral nephrectomy on the gastric emptying of a liquid meal. METHODS: Male rats were submitted under anesthesia to cervical vessels cannulation and bilateral lumbar incision, followed or not by nephrectomy. Next day, they were gavage fed (1.5 mL) with phenol red (0.5gmL(-1)) in 5% glucose solution and sacrificed 0,10, 20,30 or 45 min later. A blood sample was obtained for biochemical analysis while gastric dye retention was determined by spectrophotometry. Data (mean +/- SEM) were compared by ANOVA and Student-Newman-Keuls tests. RESULTS: Gastric emptying values from nephrectomy group at 10,20,30 and 45 min were lower (P < 0.05) than those of sham-operated animals (22.0 +/- 4.0 vs. 38.9 +/- 6.1%, 34.1 +/- 1.4 vs. 66.9 +/- 1.3%, 45.5 +/- 6.1 vs. 64.9 +/- 5.4% and 59.7 +/- 2.4 vs. 81.5 +/- 4.0%, respectively). Mean arterial pressure, blood volume, serum osmolarity, urea, creatinine and potassium values were higher (P < 0.05) in nephrectomy group than in sham-operated animals (143.3 +/- 2.7 vs. 100.5 +/- 4.1 mmHg, 15.7 +/- 0.9 vs. 8.9 +/- 1.1 mL 100 g(-1), 344.0 +/- 10.8 vs. 299.4 +/- 1.3 mOsm KgH2O(-1), 344.0 +/- 33.7 vs. 47.0 +/- 2.8mg dL(-1), 3.6 +/- 0.3 vs. 1.1 +/- 0.1 mg dL(-1), 6.4 +/- 0.7 vs. 3.7 +/- 0.2 mEq L(-1), respectively). The plasmatic Na+ values did not change (139.3 +/- 2.0 in sham-operation vs. 123.0 +/- 7.5 mEq L(-1) in nephrectomy). CONCLUSION: Acute loss of kidney function markedly delays the gastric emptying rates, which could be involved in gastrointestinal dysmotility complaints seen after renal failure.

Animals↗

PubMed2001

Results of retroperitoneal laparoscopic radical nephrectomy.

PURPOSE: To analyze the retroperitoneal approach to laparoscopic radical nephrectomy in terms of feasibility, safety, morbidity, and cancer control. PATIENTS AND METHODS: We reviewed the records of 50 consecutive patients with renal cancer underwent radical nephrectomy via the retroperitoneal laparoscopic approach from 1995 through 1999. RESULTS: The mean operative time was 139 minutes (range 60-330 minutes) with a mean of 149.78-mL operative blood loss (0-1500 mL). The mean renal size was 100 mm (70-150 mm) with a mean tumor size of 38.6 mm (20-90 mm). The postoperative hospital was 6 days (2-13 days). Three open conversions were necessary: one for laparoscopically uncontrolled bleeding and two because obesity interfered with surgery. We noted two major complication and two minor complications. Two disease progression have been noted to date. One patient with a pT3 grade 2 renal-cell carcinoma had a local recurrence with liver metastasis 9 months after the procedure and died 19.7 months after radical nephrectomy. Another patient with a pT3aN+M+ cancer died 23.1 months after the procedure. CONCLUSION: Retroperitoneal laparoscopic nephrectomy for kidney cancer requires further assessment. It seems to have several advantages over open radical nephrectomy and to be effective and safe for small (<50-mm) renal tumors.

Carcinoma, Renal Cell↗

PubMed2001

Laparoscopic partial nephrectomy in the pig: comparison of three hemostasis techniques.

BACKGROUND AND PURPOSE: Control of intraoperative bleeding is the main technical difficulty encountered during laparoscopic partial nephrectomy. The objective of this study was to compare the efficacy and morbidity of three renal parenchymal hemostasis techniques: high-frequency bipolar electrical current, high-frequency unipolar spray electrical current, and ultrasound during laparoscopic partial nephrectomy performed in pigs without vascular control. MATERIALS AND METHODS: A standardized laparoscopic transperitoneal right lower-pole partial nephrectomy was performed in 27 pigs with a mean weight of 65 +/- 5 kg. The pigs were divided into three groups according to the technology used: Group 1 = bipolar electrical current, Group 2 = unipolar spray electrical current, and Group 3 = ultrasound. Intravenous urography was performed on the 28th day. The kidneys were then removed for histologic examination, and the pigs were sacrificed. The criteria evaluated were intraoperative and postoperative complications, blood loss, renal function, and thickness of the parenchymal lesions induced. The Kruskal-Wallis nonparametric test for comparison of medians was used for statistical analysis of the data (P < 0.05). Data from pigs that died before the end of the study were excluded from the analysis. RESULTS: All partial nephrectomies were performed laparoscopically, and all pigs were alive at the end of the operation. The postoperative complication rate was 11% (N = 3): two pigs died before the end of the study, one from hemorrhage on Day 6 (Group 2), and the other from prolonged reflex ileus with sacrifice of the pig on Day 7 (Group 3). One pig developed an asymptomatic urinoma (Group 2). Blood loss was significantly lower when ultrasound was used (P = 0.026). Global renal function was not significantly altered in the various groups. The median thickness of tissue necrosis and fibrosis detected in the scar zone was 6 mm (range 4-10 mm) and was similar in the three groups. CONCLUSION: Partial nephrectomy can be performed by laparoscopy without vascular control in the pig. Coagulation by ultrasound appears to present an advantage in terms of limitation of blood loss compared with coagulation by bipolar or unipolar spray electrical currents without presenting any benefit in terms of preservation of the renal parenchyma.

Animals↗

PubMed2001

Laparoscopic nephrectomy: prediction of outcome in relation to the preoperative risk factors in two approaches.

PURPOSE: The data on laparoscopic nephrectomy in Mansoura Urology & Nephrology Center were reviewed to identify the preoperative findings that may predict the need for conversion to open surgery. PATIENTS AND METHODS: One hundred sixty-three patients were subjected to transperitoneal laparoscopic nephrectomy, while 82 underwent retroperitoneal laparoscopic nephrectomy for benign renal diseases. The preoperative demographic data and laboratory and radiologic findings of these patients were correlated with failure rate of the laparoscopic procedure. RESULTS: The overall failure rate was 10.4% and 11% for the transperitoneal and retroperitoneal approach, respectively. Positive urine culture, renographic clearance of the removed kidney (>10 ml/min), and learning curve were independently associated with a greater risk of failure in patients undergoing transperitoneal nephrectomy. For the retroperitoneal approach, a positive urine culture, renographic clearance (> or =10 ml/min), and large kidney showed statistical significance. CONCLUSION: Preoperative data could be used as a predictor of laparoscopic nephrectomy outcome in patients with benign renal diseases. A more experienced surgeon should be selected for risky cases, bearing in mind the greater potential for early conversion to open surgery.

Adult↗

PubMed2002

Posterior retroperitoneoscopic partial nephrectomy using microwave tissue coagulator for small renal tumors.

BACKGROUND AND PURPOSE: Laparoscopic partial nephrectomy remains surgically challenging because of the potential for excessive blood loss, infection, and the development of urinary fistulas. In addition, posterior retroperitoneoscopic partial nephrectomy is not popular because of the limited space for surgical manipulation. We evaluated the usefulness of a microwave tissue coagulator in posterior retroperitoneoscopic partial nephrectomy for small posterior renal tumor. PATIENTS AND METHODS: Posterior retroperitoneoscopic partial nephrectomy was performed without renal pedicle clamping using a microwave tissue coagulator in six patients with small posterior renal tumors. RESULTS: The mean operative time was 136 minutes (range 78-180 minutes), and the blood loss was <20 mL. No serious operative complications occurred, and there was no significant deterioration of renal function. CONCLUSION: Posterior retroperitoneoscopic partial nephrectomy using a microwave tissue coagulator can be a safe and less invasive method for the treatment of small posterior renal tumors.

Aged↗