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At least 667 records · Page 37Linked to original sources

PubMed2004

Comparison of radiofrequency ablation, cryoablation, and nephrectomy in treating implanted VX-2 carcinoma in rabbit kidneys.

PURPOSE: To compare the efficacy of radiofrequency (RF) ablation, cryoablation, and radical nephrectomy in the treatment of implanted VX-2 carcinoma in rabbit kidneys. MATERIALS AND METHODS: Sixty-eight New Zealand White rabbits were implanted with 1-mm3 segments of VX-2 carcinoma in the left kidney. Seven days after implantation, the tumors were treated with one of the following: (1) RF ablation using a 12-gauge electrode (RITA Medical Systems, Mountain View, CA) at 90 degrees C for 8 minutes with a 5-mm tumor margin target temperature of 60 degrees C (N = 20); (2) cryoablation using a 15 minute double-freeze technique with 2.4-mm cryoprobes and the Cryocare system (Endocare Inc., Irvine, CA) with a 5-mm tumor margin target temperature of -20 degrees C (N = 20); (3) open radical nephrectomy (N = 20); or (4) no treatment (controls; N = 8). Rabbits were allowed to survive for a total of 22 days and sacrificed; and the kidneys, lungs, liver, spleen, urinary bladder, and ureter were removed and examined grossly and histologically for tumor. RESULTS: Findings in animals sacrificed at 15 days post-treatment showed significant differences between all treatment groups and untreated controls (P < 0.002) Using a 3 x 2 chi-square comparison, no differences in disease-free survival were observed between the RF ablation group, the cryoablation group, and the open nephrectomy group (P = 0.72) CONCLUSION: Radiofrequency ablation, cryoablation, and radical nephrectomy were all efficacious in the treatment of implanted VX-2 renal tumors compared with untreated controls (P = 0.002). No statistically significant difference was found between any of the three treatments.

Animals↗

PubMed2004

Bilateral purely laparoscopic nephrectomy for renal masses using five ports without repositioning: a case report.

BACKGROUND AND PURPOSE: Bilateral nephrectomy is an infrequently performed procedure. The indications include bilateral masses too large for nephron-sparing surgery, recalcitrant hypertension in dialysis patients, pain, infection, reflux, or large symptomatic polycystic kidneys. Bilateral pretransplant purely laparoscopic nephrectomy for bilateral renal masses has not been reported previously. We present our experience with this procedure using five transabdominal trocars without having to reposition the patient. METHODS: We employed a five-port technique in a middle-aged woman with end-stage renal disease who presented with an infected peritoneal dialysis catheter. On abdominal CT, she had bilateral enhancing renal masses. Six weeks after removal of the catheter, she underwent bilateral transperitoneal laparoscopic nephrectomy. The technique is described, and recommendations are made regarding potential obstacles. RESULTS: The procedure was performed in 185 minutes, and the total hospital time was 41 hours. The estimated blood loss was 50 mL. Final pathology examination revealed a 5.5-cm right renal-cell carcinoma stage T1N0M0 and left hydronephrosis, atrophy, nephrosclerosis, and thick-walled renal cysts without malignancy. On 3-month follow-up she is well, without complaints. CONCLUSION: Bilateral pretransplant purely laparoscopic nephrectomy can be performed without significant repositioning, redraping, and resterilization. In this case, operative time and cosmesis were acceptable, and surgical morbidity was low.

Carcinoma, Renal Cell↗

PubMed2004

Hand-assisted laparoscopic right donor nephrectomy: surgical technique.

Many centers have adopted laparoscopic and hand-assisted laparoscopic (HAL) techniques for live donor nephrectomy. Currently, the majority of laparoscopic living donor kidneys are procured from the left side because of the longer renal vein and improved transplantation. However, indications exist for right donor nephrectomy. We present our technique of HAL right-sided donor nephrectomy. A key feature of our dissection is wide mobilization of adjacent structures to achieve good exposure of the right kidney and inferior vena cava. In addition, the use of the hand permits optimal positioning of the kidney for division of the renal vessels with the vascular stapler. At the time of division of the renal vein, the stapler is placed on the wall of the inferior vena cava in order to gain maximal length. This technique has allowed HAL right-sided donor nephrectomy to be performed safely when indicated.

Humans↗

PubMed1994

Laparoscopic nephrectomy results in better postoperative pulmonary function.

The pulmonary response to nephrectomy was studied in 16 patients undergoing laparoscopic (n = 8) or open (n = 8) nephrectomy using a standardized anesthetic technique. Although there was no significant difference between the two groups at 24 hours, postoperative pulmonary function measures (P = 0.02-0.03) and oxygenation (P = 0.03) were significantly better in the laparoscopic surgery group at 48 hours. The median opiate analgesic requirement (P = 0.02) and the number of nights spent in the hospital (P = 0.003) also were significantly lower in this group. The results of this study suggest that laparoscopic nephrectomy offers a real biological advantage in terms of postoperative preservation of lung function and that this might therefore be the safest technique for nephrectomy in patients with limited respiratory reserves.

Adolescent↗

PubMed1996

Laparoscopic nephrectomy for benign disease: comparison of the transperitoneal and retroperitoneal approaches.

We report our experience with the transperitoneal (TP) and retroperitoneal (RP) approaches for performing laparoscopic nephrectomy for benign disease. Thirty-three patients with benign renal disease underwent laparoscopic nephrectomy, 23 by the TP and 10 by the RP approach. The average age of the patient, ASA score, and specimen weight were similar for the two groups. The average operating time for the TP approach was 5.6 hours v 5 hours for the RP approach. The average hospital stay was 2.8 and 3 days for TP and RP groups, respectively. The use of postoperative analgesics was similar in the two groups (37 mg of morphine sulfate equivalent v 39 mg of morphine sulfate equivalent for the TP and RP groups, respectively). However, the RP group required less time to resume normal oral intake than the TP group (0.3 v 0.6 days). When assessed according to specimen weight of 100 or less, there was a significant reduction in the postoperative analgesia requirements for the RP group of patients (11 mg of morphine sulfate equivalent v 28 mg of morphine sulfate equivalent for the TP group). In this subgroup of patients, the resumption of oral intake also occurred more quickly in the RP than the TP group (0.4 v 0.5 days). The hospital stay and total convalescence time were similar for the two groups. Four complications occurred in the 33 patients: 2 patients (1 TP and 1 RP), required conversion to open surgery, 1 asthenic patient developed a vastus lateralis bruise undergoing a TP approach, and a brachial nerve palsy occurred in a morbidly obese patient who failed a TP approach. The RP approach to laparoscopic nephrectomy reduces the time to resuming normal oral intake for patients postoperatively and, in those patients with a small specimen, may significantly reduce their postoperative analgesia requirements. However, the RP approach for laparoscopic nephrectomy for benign disease does not significantly improve the length of hospital stay or the patient's ultimate postoperative return to normal activity in comparison to the TP approach. There does appear to be a trend toward a shorter operative time for the RP approach. The RP laparoscopic approach is our method of choice for patients with benign renal disease.

Adolescent↗

PubMed1997

Recent advances in laparoscopic partial nephrectomy: comparative study of electrosurgical snare electrode and ultrasound dissection.

Although technically feasible, laparoscopic partial nephrectomy (LPN) using conventional instrumentation presents the intraoperative challenge of hemostasis, creating a flush (i.e., precise guillotine) incision, and closure of the collecting system. In an effort to resolve these technical problems, we used a unique electrosurgical snare electrode (ESE) in combination with an ERBE electrosurgical generator and compared its effectiveness with that of two ultrasonic dissectors (Cavitron Ultrasonic Surgical Aspirator [CUSA] and harmonic scalpel [HS]) in performing LPN. Twelve female minipigs underwent right lower-pole LPN using one of the aforementioned modalities. Six weeks later, in the same animals, a left lower-pole LPN was performed using the same device, thereby providing an acute and chronic renal remnant to examine. The animals were harvested, and transverse and perpendicular histologic sections were prepared of the cut surface of each specimen. The weights of the LPN specimens and the remaining kidney were also recorded. The time required for partial nephrectomy, degree of hemostasis (i.e., blood loss), ease of excising the targeted tissue, changes in renal function, tissue reactivity, and depth of damage to the surface of the remaining renal parenchyma were measured for each device. All 12 procedures were successful using the ultrasonic dissection, and 11 procedures were successful using the ESE. The ESE was significantly faster than the two forms of ultrasonic dissection (p < 0.0001) and produced less intraoperative bleeding (P = 0.002). Both forms of ultrasonic energy produced significantly deeper parenchymal injury in the acute surgical specimen (P = 0.03) and more parenchymal fibrosis and chronic inflammation in the chronic surgical specimens (P = 0.007) than the ESE. None of the animals exhibited any extravasation from the incised collecting system when studied by retrograde pyelography 6 weeks postoperatively at the time of left LPN and harvest. The function of the renal remnant was consistent with the size of the partial nephrectomy specimen. No hypertension developed in any of the study animals. Our results using a unique electrosurgical snare probe show it to have potential advantages as a rapid, hemostatic method for performing a partial nephrectomy. We believe that this instrument may represent an important tool for performing nephron-sparing surgery via an open or laparoscopic approach. Clinical trials are in progress.

Animals↗

PubMed1998

Laparoscopic subcapsular nephrectomy.

A 26-year-old patient with end-stage renal disease secondary to vesicoureteral reflux and recurrent pyelonephritis was referred for bilateral native nephrectomy. A transperitoneal laparoscopic approach was used. Extremely dense fibrosis was encountered around the left kidney during the dissection. A left laparoscopic subcapsular nephrectomy and a right extracapsular nephrectomy were performed. The indications and surgical technique for laparoscopic subcapsular nephrectomy are discussed.

Adult↗

PubMed1999

Hand-assisted laparoscopic nephrectomy.

The introduction of hand-assisted laparoscopy should benefit every laparoscopic urologist. Hand assistance will shorten the learning curve for many urologists interested in performing laparoscopic renal procedures, including nephrectomy and nephroureterectomy. Advanced laparoscopists will be able to undertake more challenging procedures, including nephrectomies for inflamed, infected kidneys and live-donor nephrectomies. A step-by-step approach is presented for hand-assisted laparoscopic nephrectomy.

Humans↗

PubMed2004

Hand-assisted laparoscopic partial nephrectomy without hilar vascular clamping using a saline-cooled, high-density monopolar radiofrequency device.

BACKGROUND AND PURPOSE: Nephron-sparing surgery is now accepted as an alternative treatment option for small renal tumors. However, hemostasis during laparoscopic partial nephrectomy can be technically challenging, especially without hilar vascular clamping. The aim of our study was to evaluate the technique of hand-assisted laparoscopic partial nephrectomy using the TissueLink (TissueLink Medical, Dover, NH), a saline-cooled monopolar radiofrequency device, without hilar vascular clamping. PATIENTS AND METHODS: Using the hand-assisted laparoscopic approach, the kidney is mobilized transperitoneally, and the renal tumor with overlying perinephric fat is exposed. The tumor is excised with a 1-cm margin using a combination of the TissueLink device and endoscopic scissors. The tumor and a biopsy of the base of the tumor bed are sent for frozen-section examination. The bleeding vessels are controlled with digital compression and the TissueLink device. At the end of procedure, the tumor bed is covered with a hemostatic agent. Three female and four male patients ages 52 to 76 years (mean 66 years) were treated with this new device for incidental tumors detected during imaging studies (N = 6) or during work-up for gross hematuria (N = 1). Preoperative imaging studies included CT in six patients and MRI in three. The average tumor size was 2.2 cm (range 1.3-3 cm). Only peripheral tumors that did not approach the hilum or the collecting system were selected. RESULTS: All of the patients underwent a hand-assisted laparoscopic partial nephrectomy using the TissueLink device without hilar vascular clamping. There were no intraoperative complications or conversions to open surgery. The mean operative time was 175 minutes, with an estimated blood loss of 186 mL (range 100-300 mL). Histologic examination demonstrated renal-cell carcinoma in five cases, oncocytoma in one, and an angiomyolipoma in one. The dimensions of the normal tissue around the tumor ranged from 1 to 4 mm, and frozen-section analysis showed tumor-free margins in all cases. Postoperatively, all patients recovered well except one patient who developed transient atrial fibrillation, which was treated medically in the immediate postoperative period. All patients were discharged in good condition at an average of 3 days (range 2-6 days). CONCLUSION: Hand-assisted laparoscopic partial nephrectomy without vascular clamping using the TissueLink device is a safe and feasible technique for exclusion of small exophytic renal tissues.

Aged↗

PubMed2005

Controlled survival study of the effects of Tisseel or a combination of FloSeal and Tisseel on major vascular injury and major collecting-system injury during partial nephrectomy in a porcine model.

PURPOSE: We report the results of a controlled survival study in a porcine model investigating Tisseel or a combination of FloSeal and Tisseel in dealing with vascular and collecting-system injury during partial nephrectomy. MATERIALS AND METHODS: We performed an open right lower-pole partial nephrectomy on 15 large female pigs. The defect was repaired using standard open techniques (N = 5; controls), Tisseel only (N = 6; group I), or FloSeal followed by Tisseel (N = 4; group II). A Jackson-Pratt drain was placed. Nephrectomy and retrograde pyelography were performed at 1 week. RESULTS: Operative times were shorter in both study groups, achieving statistical significance in group I (P = 0.008). Warm-ischemia times were significantly improved in both study groups (P = 0.029 and P = 0.00005 in groups I and II, respectively). Time to hemostasis was significantly shorter in group II only (P = 0.002) but approached significance in Group I as well (P = 0.09). Estimated blood loss was not significantly different from the controls in either group. When Tisseel was placed alone after hilar control, hematoma formation under the Tisseel was noted on release of the hilar clamp. After 1 week, there was one urinoma and three urine leaks in the control group. In group I, there was one urinoma and four urine leaks, and there was only one urine leak and no urinomas in group II. There were no hematomas in any of the groups. CONCLUSIONS: Tisseel alone is not adequate for either hemostasis or management of major collecting-system injury. FloSeal capped with Tisseel appears sufficient to control major vascular and collecting-system injuries without adjunctive surgical measures. A proposed technique for laparoscopic partial nephrectomy without reconstructive techniques is presented that warrants clinical study.

Animals↗

PubMed2005

The Boatman's knot: a single knot for renal-vein ligation during laparoscopic nephrectomy: description of technique and evaluation of feasibility and safety.

BACKGROUND AND PURPOSE: The endovascular stapler is the standard of care for renal-vein ligation during nephrectomy, but recently, some reports have addressed the need for lowering the costs in the operating room. The authors describe the first use of "boatman's knot" in renal-vein ligation during laparoscopic nephrectomy and tests of its safety and feasibility. MATERIALS AND METHODS: Sixteen bilateral laparoscopic nephrectomies were performed in female pigs. On the right side, the renal vein was ligated with the boatman's knot, and on the left side, the vein was ligated with conventional intracorporeal technique. The knots were performed by the same surgeon at initial laparoscopic training. The time required to tie the knots was measured. After bilateral nephrectomy, a midline incision was created, and the bursting pressure of the knots was measured with a manometer by saline infusion into the vena cava. RESULTS: The average knot-completion time was 45 seconds (range 30-50 seconds), and the average time needed to carry out the conventional suture was 202.5 seconds (range 186-228 seconds). After renal-vein transection, there was complete hemostasis in all cases. The mean bursting pressure was 179.9 mm Hg (range 126-304 mm Hg). In five cases, the rupture site was in a lumbar vein previously sutured, while in three cases, the rupture happened in the vena cava itself. CONCLUSION: The boatman's knot is feasible, safe, easy to learn, and faster than conventional intracorporeal suturing. This technique may replace the endovascular stapler. However, its clinical applicability remains to be determined.

Animals↗

PubMed2005

Ureteropelvic junction obstruction after partial nephrectomy.

BACKGROUND AND PURPOSE: As the experience with partial nephrectomy continues to grow and the procedure increasingly becomes the standard of care for properly selected patients, it is critical to understand the potential complications and how these complications are best managed. Presented herein is the presentation, work-up, and treatment of ureteropelvic junction (UPJ) obstruction after partial nephrectomy. PATIENTS AND METHODS: From 1993 to 2004, 1154 partial nephrectomies have been performed at our institution by one surgeon. From the database of these patients, four (0.35%) were identified with postoperative UPJ obstruction. The charts of these patients were reviewed to identify preoperative and intraoperative characteristics as they relate to the development and risk of UPJ obstruction. Additionally, the presentation of UPJ obstruction, its management, and long-term follow-up are reported. RESULTS: Tumor location in the lower pole appears to be a risk factor for the development of UPJ obstruction, which is likely a result of ischemic or mechanical injury. This complication was managed successfully by endoscopic approaches in three of four cases. At a mean follow-up of 43 months, all patients remain free of obstruction according to both the absence of symptoms and radiographic evidence. CONCLUSION: Obstruction of the UPJ is an uncommon complication of partial nephrectomy. Endoscopic treatment of this complication yields a durable outcome, as all patients with a mean follow-up of more than 3 years show resolution of their obstruction.

Adult↗

PubMed2005

Partial laparoscopic nephrectomy using monopolar saline-coupled radiofrequency device: animal model and tissue effect characterization.

BACKGROUND AND PURPOSE: The optimal surgical tool for laparoscopic partial nephrectomy (LPN) would permit resection of lesions that penetrate relatively deeply and achieve hemostasis while allowing accurate viewing of the margins of the lesion, identification of the collecting system, control of both arteries and veins, and sealing of the collecting system. We hypothesized that the TissueLink Floating Ball (TissueLink, Inc.) might provide a simple, "pure" method of LPN. MATERIALS AND METHODS: Ten adult female pigs (30-50 kg) underwent LPN of the left kidney with the TissueLink operating at 70 to 80 W as the sole means of hemostasis. Operative time, estimated blood loss (EBL), and specimen weight and characteristics, were recorded. On postoperative day 7, an intravenous urogram was carried out, and an open partial nephrectomy and surface treatment were performed on the other side with the TissueLink and intraparenchymal temperature monitoring. RESULTS: All LPNs were performed without complications with an average operating time of 148 minutes and a mean estimated blood loss of 49 mL. The urograms performed at postoperative day 7 demonstrated prompt excretion and no evidence of urinary extravasation or hydronephrosis. At harvest, all eight kidneys in which the collecting system had been entered showed evidence of localized urine leak. No evidence of retroperitoneal hematoma was noted, and all renal arteries and veins were patent and with good flow. The resected edge showed a gross 2 to 3 mm of flat, whitish discoloration and a well-demarcated edge. During the open partial nephrectomy, significant temperature variations were noted according to the distance from the point of application of the TissueLink. Pathologic examination of the acute specimens demonstrated altered cytoplasmic and nuclear staining in tubules extending approximately 6 to 8 mm from the treated surface. In contrast, the kidney that had been left in situ after LPN demonstrated overt cortical necrosis (coagulated necrosis), bordered by cortical scarring with apparent dystrophic calcifications at the resection edge from the previous partial nephrectomy. Tubular atrophy was obvious, with interstitial fibrosis and interstitial inflammation. A well-demarcated zone of several millimeters of tissue was evident on gross examination. CONCLUSIONS: The saline-cooled monopolar radiofrequency dissector (TissueLink) is a valuable adjunct for LPN. The device provided excellent hemostatic control with resection of as much as 40% of the renal parenchyma. Our initial observations of the device in the laboratory and in clinical use led us to develop a successful technique for its use for deep parenchymal resection, which is described in detail.

Animals↗

PubMed2005

Long-term outcome of hand-assisted laparoscopic radical nephrectomy for localized stage T1/T2 renal-cell carcinoma.

PURPOSE: To evaluate the efficacy of hand-assisted laparoscopic radical nephrectomy (HALRN) in patients with localized stage T(1)/T(2) renal-cell carcinoma, we analyzed the clinical results of our patients treated in this way. PATIENTS AND METHODS: From March 1999 to March 2003, a total of 96 patients aged 28 to 86 years (mean 61 years) with clinical stage T(1)/T(2)N(0)M(0), pathologically confirmed renal-cell carcinoma underwent HALRN. The outcomes were compared with those of open radical nephrectomy, which was performed in 86 patients from November 1991 to February 1999 in our institution. Kaplan-Meier analysis was used to analyze survival. RESULTS: Ten patients (10.4%) had perioperative complications. During a mean follow-up of 25 months (range 6-54 months), no patients died of the cancer, although three patients had metastatic disease. The 4-year disease- free and overall survival rates were 88% and 100%, respectively. Seventy-eight patients who underwent open radical nephrectomy were followed for 38 to 156 months (median 86 months). Seventy-three survived without any recurrent disease, five survived with metastasis, and no patient died of metastatic disease. The 4-year disease-free and overall survival rates were 93% and 100%, respectively. CONCLUSIONS: Hand-assisted laparoscopic surgical management of T(1)/T(2) renal-cell carcinoma is feasible and safe. At our institution, HALRN confers long-term oncologic effectiveness equivalent to that of open radical nephrectomy.

Adult↗

PubMed2005

Laparoscopic and open surgical nephrectomy for xanthogranulomatous pyelonephritis.

BACKGROUND AND PURPOSE: Xanthogranulomatous pyelonephritis (XGP) is a severe, chronic renal-parenchymal infection. Nephrectomy is the treatment of choice. Because of the renal and perirenal inflammatory changes that commonly accompany XGP, the laparoscopic approach is difficult. We compared our experience with laparoscopic and open surgical nephrectomy for XGP. PATIENTS AND METHODS: A retrospective chart review of all adult nephrectomy specimens with the pathologic diagnosis of XGP between January 1997 and May 2003 was performed. Preoperative presentation, operative details, and postoperative recovery and complications were included in the data collection. RESULTS: Three patients approached laparoscopically and eight patients approached with open surgery were found to have XGP on pathologic analysis. The disease was suspected preoperatively in all patients. Among the laparoscopically treated patients, there was 1 (33%) who suffered major complications; this was the only patient who required conversion to open surgery. Among the open-surgical group, there were 2 (22%) major and 3 (33%) minor complications. Postoperative hospitalization was longer in the open-surgical group (mean 13.7 v 4.7 days), and when the case of open conversion was excluded, narcotic use was less in the laparoscopy group. CONCLUSIONS: The treatment of some XGP cases with laparoscopic nephrectomy is a possible, albeit challenging, option. The incidences of intraoperative and postoperative complications were roughly equivalent in the laparoscopic and open-surgery patients in our study. If completed, laparoscopy appears to be associated with decreased postoperative morbidity. However, this may represent selection bias, and larger, prospective studies may better define the suspected benefit.

Adult↗

PubMed2005

Laparoscopic nephrectomy using Ligasure system: preliminary experience.

BACKGROUND AND PURPOSE: The advent of laparoscopic surgery has created new technical challenges and problems. Recently, a new commercially available vessel-sealing technology, the Ligasure system, was introduced. The aim of our study was to compare the effectiveness of this new system with earlier methods in a group of patients affected by renal-cell carcinoma. PATIENTS AND METHODS: A series of 30 patients underwent laparoscopic radical nephrectomy for clinically localized renal-cell carcinoma. We always used a transperitoneal approach with a three-trocar technique. Patients were randomly divided in two groups: 15 underwent conventional laparoscopic radical nephrectomy, while 15 underwent laparoscopic nephrectomy using the Ligasure system, which is a bipolar radiofrequency generator. Information analyzed included intraoperative blood loss, operative time, conversion rate, and postoperative course. Statistical analysis was performed with commercially available software. The two groups were compared in term of clinical and pathologic variables using Student's t-test. Differences were considered significant at p < 0.05. RESULTS: No statistically significant differences were observed between the two groups for baseline characteristics. No conversion occurred in either group. Statistically significant differences were observed between conventional and Ligasure nephrectomy regarding mean intraoperative blood loss (485 mL and 100 mL, respectively; p < 0.05) and mean operative time (164 minutes and 68 minutes, respectively p < 0.05). No statistically difference was observed in the postoperative discharge time. CONCLUSION: The Ligasure vessel-sealing system seems to produce a consistent, reliable, permanent seal of veins, arteries, and tissue bundles by fusing the collagen in vessel walls. By reducing sutures and the number of instrument exchanges in the operating theatre, the Ligasure decreases operating time and blood loss. This new energy-based vessel-ligation device appears to be effective in advanced laparoscopic procedures.

Blood Loss, Surgical↗

PubMed2006

Randomized trial of laparoscopic donor nephrectomy with and without hand assistance.

PURPOSE: To compare the early results of standard laparoscopic (SL) and hand-assisted laparoscopic (HAL) donor nephrectomy in a randomized study. PATIENTS AND METHODS: Forty donors were randomly assigned in equal numbers to either SL or HAL. Two donors in the SL group and three patients in the HAL group underwent right nephrectomy; the others underwent left nephrectomy. In the SL group, specimen extraction was performed via a Pfannenstiel incision and in HAL group through a periumbilical midline incision. Objective intraoperative, hospital stay, and postoperative data as well as pain analog scores were collected prospectively. Patients completed the quality-of-life (QoL) SF-36 questionnaire preoperatively and at 1 month and 3 months of follow-up. RESULTS: There was a statistically significant difference in the mean operative time in the two groups (200 +/- 20.8 minutes for SL v 219 +/- 28.3 minutes for HAL; P = 0.02). There was no difference in the mean estimated blood loss (141.5 +/- 221.8 mL v 97.4 +/- 73 mL, respectively; P = 0.41), warm ischemia time (157.5 +/- 76.3 seconds v 135.5 +/- 53.7 seconds; P = 0.32), length of postoperative hospital stay (1.9 +/- 0.5 days v 2.1 +/- 0.5 days; P = 0.61), intravenous analgesia (22.1 +/- 14.0 mg v 28.3 +/- 14.8 mg of morphine sulfate equivalent; P = 0.18), or pain score on postoperative day 1 (6.1 +/- 1.0 v 6.2 +/- 1.1) and 2 (3.3 +/- 1.2 and 3.4 +/- 1.3). There were five minor complications in the SL group and three in the HAL group. The mean preoperative (89.7 +/- 4.8 v 89.2 +/- 7.4; P = 0.84), 1-month (63.4 +/- 13.9 v 64.5 +/- 12.6; P = 0.82), and 3-month (82.7 +/- 7.4 v 80.2 +/- 8.4; P = 0.41) postoperative QoL scores did not differ significantly between the groups. None of the recipients required postoperative dialysis, and there was no statistical difference between the two groups in the serum creatinine concentration. CONCLUSION: Laparoscopic and hand-assisted donor nephrectomies have similar outcomes and postoperative pain. Both approaches are well tolerated with minimal complication rates and have similar impact on patients' quality of life.

Female↗

PubMed1998

Initial experiences with the retroperitoneal approach for endoscopic nephrectomy with the patient in the prone position.

Retroperitoneal endoscopic nephrectomy with the patient in the prone position was performed in 12 patients. Indications for this procedure were end-stage kidneys with ureteropelvic junction stenosis or distal ureteric obstruction, nonfunctional kidneys with drug resistant renin-mediated hypertension, and distal ureter malignancy. The retroperitoneal area was exposed using an open surgical technique in combination with the use of a liquid-filled dissection balloon. Removal of kidney tissue was performed with a morcellator through one of the ports. On average, the operating time was 210 min (range 160-480 min) to complete a one-sided nephrectomy. No major complications occurred. Mean hospital stay in this series was 6.6 days, and the follow-up period was uncomplicated in all cases. Retroperitoneal endoscopic nephrectomy with the patient in the prone position is an acceptable alternative to open nephrectomy in selected indications.

Adult↗