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PubMed1989

[Partial nephrectomy for renal tumors].

We performed partial nephrectomy in 5 patients with renal tumors. In 1 patient with synchronous bilateral renal cell carcinoma, radical nephrectomy was conducted simultaneously for the contralateral kidney. The second patient had a transitional cell carcinoma of the renal pelvis of the contralateral side, for which the pelvis was resected simultaneously. In the remaining 3 patients the contralateral kidney was normal. In these patients the tumor was less than 3.0 cm in size and localized in either the upper pole or peripheral region, for which partial nephrectomy was performed. The weight of the resected kidney ranged 6 to 35 g with a mean of 18.2 g. The tumor size was 1.8 to 4.0 cm, the mean being 2.4 cm. Tumor grading was renal cell carcinoma grade 1 in 2 patients, grade 2 in 2 patients and oncocytoma in one patient. In all patients the tumor was encapsulated with a pseudocapsule with no involvement of the perinephric fat, venous or regional lymph nodes, and the tumor was diagnosed as pT2V0N0M0, stage I. In none of the patients intraoperative or postoperative complications developed with renal function of the operated kidney normal. The follow up interval after the operation was 5 years in 1 patients and 6 months to 1 year and 2 months in the remaining 4 patients. All patients have survived without metastasis or local recurrence in the operated kidney. We believe that partial nephrectomy is worth performing in selected patients with renal cell carcinoma not only in those having lesion in solitary kidney or bilateral kidneys but also in those whose function of the contralateral kidney is normal.

Adenoma↗

PubMed1992

[Laparoscopic nephrectomy. Animal experiment and clinical application].

Laparoscopic nephrectomy was carried out on 6 sows in order to develop the procedures of clinical laparoscopic nephrectomy and the equipment necessary for this operation. Based on the animal experiments, it was shown that (1) retroperitoneal approach was difficult due to narrow space. (2) there must be at least 5 cm distance between each trocar and 4 or 5 trocar 1 cm in diameter were basically required. (3) The procedure consisted of incision and dissection of the peritoneum around the kidney, cutting and ligation of the ureter, dissection along the medial side of the ureter to approach the renal pedicle and clipping and cutting of the renal vessels. (4) The equipment required for this surgery must be functionally equivalent to those used in the open surgery. (5) In addition, the specifically designed equipment, such as a morcellator and an instrument to ligate renal vessels are necessary. The first clinical case of laparoscopic nephrectomy was a 34 years old man with a right non-functioning hydronephrosis due to ureteropelvic junction stricture. The surgery was successfully performed with a 110 ml blood loss. It took 7 and half hours because of abundant peri-renal fatty tissue and large extra-renal pelvis. The convalescence was uneventful. Laparoscopic nephrectomy can be applied on selected cases and the development of equipment will make the surgery more popular.

Animals↗

PubMed1993

[Laparoscopic nephrectomy; results of initial 14 cases and procedure for renal cell carcinoma].

Since July 1991, we have performed laparoscopic nephrectomy for removal of damaged kidneys in thirteen patients. In addition, we recently developed a new procedure of laparoscopic nephrectomy for renal cell carcinoma and successfully removed the kidney with renal cell carcinoma. Patients' age ranged from 18 to 80 years with the average being 50 years. There were 8 male and 6 female patients. Original disease was calculous disease in 5 patients, vesicoureteral reflux in 4, renovascular disease in 2, ureteropelvic junction obstruction in 1, ectopic ureter in 1 and renal cell carcinoma in 1. The mean size of the diseased kidney was 9 x 5 x 4 cm in the initial 13 cases and 13 x 7 x 6 cm in the case with renal cell carcinoma. The size of the tumor was 2.5 x 2 x 2 cm. In the first 13 patients, nephrectomy was performed as described previously. In the patient with renal cell carcinoma, a new procedure was applied. In the new procedure, five trocars were introduced into the abdominal cavity through the lateral abdominal wall. The kidney was removed en bloc together with the adrenal gland, perirenal fat and Gerota's fascia in the same fashion as traditional radical nephrectomy. Thirteen kidneys were successfully removed, but one failed because of dense adhesion to the surrounding tissue. Three of the 13 patients required additional laparotomies to control bleeding or to remove missed stone.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

[Treatment results of radical nephrectomy for relatively confined small renal cell carcinoma--translumbar versus transabdominal approach].

We performed radical nephrectomy for 166 patients with renal cell carcinoma over 25 years period between 1967 and 1991. Among them, 49 patients had stage T1-3 NOMOVO tumors less than 6 cm in maximum diameter. Twenty-seven of them received radical nephrectomy by a modified translumbar approach whereas the conventional transabdominal approach was applied to the remaining 22 patients. We retrospectively studied treatment results of the 49 patients to evaluate the current translumbar approach. There was no significant difference in the age and sex distribution of the patients, and the size, stage, grade and histological subtype of the tumor between translumbar and transabdominal groups, although the incidence of venous invasion (pVla) was significantly greater in translumbar group. Statistical analysis revealed shortened operating time, decreased blood loss and quickened postoperative recovery (resuming oral intake or walking) in translumbar group as compared to those in transabdominal group. No major complication was observed in both groups. There was no significant difference in actuarial survival rate or disease-free survival period between the two groups. Actuarial three-year survival rate was 96% for translumbar and 89% for transabdominal group, respectively. Sites of metastasis were lung (2 patients) or bone (1 patient) in translumbar group and bone (1 patient) or unknown (1 patient) in transabdominal group. With the favorable prognosis comparable to that of transabdominal radical nephrectomy and the relatively small invasiveness, the current translumbar radical nephrectomy appears to be the choice for the patients with relatively confined small renal cell carcinoma.

Adult↗

PubMed1995

[Retroperitoneoscopic nephrectomy without pneumoperitoneum--experiments in pigs].

Laparoscopic nephrectomy has been performed widely for minimally invasive therapy. However, the procedure of insertion of needles and trocars can cause vascular and intestinal injuries. In addition, pneumoperitoneum using high pressure CO2 gas can cause circulatory and respiratory problems. In order to avoid these problems, we tried retroperitoneoscopic nephrectomy without CO2 gas in 8 kidneys of 4 pigs. A 1.5 cm skin incision was made just below the lowest rib and a small retroperitoneal space was made with the forefinger. The sheath of a 27 Fr rigid nephroscope was covered with a condom balloon and inserted into the retroperitoneal space. Under observing through the nephroscope, the condom was filled with 150-200 ml saline to make a space for the operation. After removing the nephroscope with condom, a scope and trocars were inserted into the space and retroperitoneoscopic nephrectomy was performed. Making the space with condom balloon in the retroperitoneal space was very efficient. The procedures succeeded in 8 and average procedure time was 3 hours. Retroperitoneoscopic nephrectomy without gas is a very attractive minimally invasive technique.

Animals↗

PubMed1997

[A trial of laparoscopic assisted radical nephrectomy].

BACKGROUND: We tried a new procedure of gas-less laparoscopy assisted radical nephrectomy. METHODS: Prior to insertion of laparoscope, pararectal incision approximately 7 cm in length was made to enter into the intraabdominal cavity. A 12 mm trocar was placed just below the umbilicus and a flexible electroscope was inserted through it. A 10 cm size disposable fan for lifting up the abdominal wall was indwelled through the under space of trocar port. After appropriately lifting up the abdominal wall, a 10 mm trocar for working channel was placed at mid-axillar line. Under laparoscopic and trans-laparotomic views, radical nephrectomy was performed using the combined technique of laparoscopic and open surgery. RESULTS: Seven patients have been successfully treated with this procedure. The mean operating time of this procedure was significantly shorter than that of totally laparoscopic nephrectomy. The recovery time from the operation was as short as usual laparoscopic nephrectomy. CONCLUSION: We thought that this procedure could open a new scope of laparoscopic surgery.

Adult↗

PubMed2002

[Retroperitoneoscopic hand-assisted nephrectomy for live donor: Akita University experience].

PURPOSE: Laparoscopic nephrectomy is being employed in renal transplantation because of its minimal invasiveness, and several modifications in surgical procedures have been proposed. We devised a new technique of retroperitoneoscopic hand-assisted nephrectomy (RHAN) for live donor. We report the early experiences with this technique in 5 cases of live renal graft donor. TECHNIQUES AND SUBJECTS: The donors are placed in a modified decubitus position under general anesthesia, and all the laparoscopic surgical procedures were performed retroperitoneally using 3 port sites and a sealing device (LAP DISC) under a pressure of 10 mmHg. The LAP DISC is placed through a para-rectus abdominal skin incision of approximately 8 cm in length into the retroperitoneal cavity and used as a rout for instrumental as well as hand-assisted manipulations during the surgery. The hand-assistance through the LAP DISC made the surgical manipulation considerably easier and allowed the immediate removal of the graft after the interruption of the renal blood flow. This procedure was applied to 5 subjects, 4 in the left and one in the right kidney. RESULTS: The operating data were 264-359 min for operating time, 0.9-3.9 min for warm ischemic time and 40-755 ml for intra-operative blood loss, respectively. The serum creatinine level of the recipients at day 7 was 0.9-2.7 mg/dl. These values, except for operating time, were at the same range as those of the open live donor nephrectomy in our clinic. The 5 donors discharged 7-9 days after RHAN without any surgical complications. CONCLUSION: Our technique of RHAN will be a minimal invasive one in terms of both for the donors and the grafts, and be widely acceptable for donor nephrectomy on either side.

Female↗

PubMed1999

Complete renal embolization as an alternative to nephrectomy.

PURPOSE: Simple nephrectomy is technically demanding in patients with recurrent inflammation or bleeding. It is also unwise to subject patients in poor health to the rigors of an extensive operative procedure. We report our experience with complete renal embolization as a safe and reliable alternative to surgical nephrectomy. MATERIALS AND METHODS: Eight patients underwent complete renal embolization as an alternative to nephrectomy. Patients were given antibiotics intravenously before and after embolization. Six patients with indwelling nephrostomy tubes received post-embolization instillation of 80 mg. gentamicin before tube removal. Narcotic analgesics were also given as needed for pain control. Post-embolization hospital course was noted. RESULTS: The indications for embolization included hydronephrotic, poorly functioning kidneys with pain in 5 cases, and recurrent bleeding from angiomyolipoma, bleeding after percutaneous resection of renal pelvic transitional cell carcinoma with metastases and spontaneous renal bleeding after hemodialysis in 1 each. Embolization was successful in 4 men and 4 women with a mean age of 58.8 years. In 6 patients severe flank pain required narcotic analgesics. One patient complained of nausea, 6 had fever and 6 had leukocytosis. In 1 case thrombosis of a limb of an aortobifemoral bypass graft required thrombectomy. Median hospital stay was 2.5 days. At a mean followup of 30.6 months presenting symptoms had resolved in all cases without hypertension, renal failure or abscess. CONCLUSIONS: Complete renal embolization is a viable alternative to nephrectomy in patients with poorly functioning kidneys who present with pain or bleeding and in those who are poor operative candidates. This procedure is safe, reliable and minimally invasive with few long-term sequelae, and it is well tolerated.

Adolescent↗

PubMed1999

A 3 trocar technique for transperitoneal laparoscopic nephrectomy.

PURPOSE: Additional trocars and retractor instruments may enhance the risk of iatrogenic injuries during laparoscopic nephrectomy. We describe a modified technique of laparoscopic nephrectomy requiring only 3 ports of entry and no extra instruments instead of the 5 ports, 2 of which are used for retractors, usually required. MATERIALS AND METHODS: With the patient in full flank position a 10 mm. trocar is inserted between the umbilicus and subcostal margin, a 5 mm. trocar is placed subcostal in the midclavicular line and a 12 mm. trocar is inserted over the iliac crest in the anterior axillary line. The first step is incision of the line of Toldt and medial reflection of the colon. During the second step of vascular controls the posterosuperior attachments of the kidney are left untouched, keeping the renal vessels stretched, with no need for an extra instrument. The third step consists of severing the remaining posterior and superior attachments of the kidney followed by specimen retrieval. A total of 14 consecutive patients underwent laparoscopic nephrectomy with this technique. RESULTS: All 14 procedures were completed without an additional port. There were no intraoperative or postoperative complications, except 1 abdominal wall hematoma. Mean operating time was 120 minutes (range 70 to 230) and mean hospital stay was 5 days (range 3 to 7). CONCLUSIONS: Transperitoneal laparoscopic nephrectomy with laparoscopic access limited to 3 trocars is a reliable and safe technique.

Adolescent↗

PubMed1999

[Retrospective study of laparoscopic peritoneal radical nephrectomy].

OBJECTIVE: To analyse the results of laparoscopic radical nephrectomy in terms of feasibility, safety, morbidity and tumour control. MATERIAL AND METHODS: Between August 1993 and July 1998, 29 laparoscopic retroperitoneal radical nephrectomies were performed in 17 men and 12 women for renal tumours less than or equal to 90 mm in diameter. The working space was created by finger dissection without using a dilatation balloon. Four additional trocars were inserted under digital control. The renal pedicle was dissected first: the renal artery was clipped and the renal vein was sectioned by EndoGIA. After sectioning the ureter, the kidney was dissected with the perirenal fat and Gerota's fascia. The operative specimen was extracted in an impermeable endoscopy bag, without division, by enlarging the first trocar incision to 50 mm in order to avoid any parietal contact. RESULTS: The mean age of the patients was 61.3 years (range: 40 to 78 years). Radical nephrectomy was performed on 13 right kidneys and 16 left kidneys, with mean dimensions of 112.9 mm (range: 85 to 150 mm). The mean tumour diameter was 40.2 mm (range: 20 to 90 mm). The mean operating time was 145 min (range: 80 to 330 min) with a mean blood loss of 100 cc (range: 0 to 1000 cc). A mean daily dose of 2.8 g (range: 1 to 5 g) of parenteral paracetamol and a mean daily dose of 1.8 mg (range: 0 to 10 mg) of morphine hydrochloride were necessary postoperatively. The mean hospital stay was 4.8 days (range: 1 to 11 days). One intraoperative haemorrhage required open conversion and one colon injury was treated by temporary colostomy. One local recurrence with hepatic metastasis occurred 9 months after the operation in a patient operated for a Furhman grade II stage pT3 tumour with negative resection margins. CONCLUSION: Laparoscopic radical nephrectomy is currently under evaluation. This technique is feasible, and respects the principles of cancer surgery: primary control of renal vessels, en bloc extraction of the kidney with Gerota's fascia.

Adenocarcinoma↗

PubMed1999

Pediatric retroperitoneoscopic nephrectomy using 2 mm. instrumentation.

PURPOSE: We describe several modifications of the retroperitoneoscopic approach to nephrectomy for benign renal disease, including the use of 2 mm. instrumentation and prone patient positioning. MATERIALS AND METHODS: A total of 14 children underwent retroperitoneoscopic nephrectomy in the prone position. An inflatable dissecting device was inserted into the retroperitoneum after a small muscle splitting incision was made at the lateral border of the sacrospinalis muscle approximately 1 cm. below the costovertebral angle. After inflation the dissecting device was replaced with a 5 mm. cannula and pneumoretroperitoneum was maintained with carbon dioxide insufflation. Two 2 mm. trocars were then placed under endoscopic guidance. Dissection was performed using 2 mm. instrumentation and the specimen was retrieved through the largest port site. RESULTS: Nephrectomy was performed in 9 girls and 5 boys 3 months to 9.8 years old. The preoperative diagnosis included chronic pyelonephritis with minimal renal function, reflux with a nonfunctioning kidney, multicystic dysplastic kidney, an upper pole dysplastic moiety with an associated ureterocele and a dysplastic kidney with a vaginal ectopic ureter. Mean operative time for retroperitoneoscopic nephrectomy was 142 minutes with an estimated blood loss of less than 15 ml. Contralateral ureteral reimplantation was performed after retroperitoneoscopic dissection in 5 patients. Overall average hospital stay was 2 days and there were no complications. CONCLUSIONS: Several modifications of the retroperitoneal approach, including the use of prone patient positioning and 2 mm. instrumentation for visualization and dissection, may improve the safety and efficacy of this technique in children.

Child↗

PubMed2000

Kidney function after radical nephrectomy: assessment by quantitative SPECT of 99mTc-DMSA uptake by the kidneys.

UNLABELLED: To determine the function of the remaining contralateral kidney after the removal of a functioning kidney, 30 consecutive patients (18 men, 12 women; average age, 67 y; age range, 34-87 y) who were undergoing unilateral radical nephrectomy were evaluated by sequential quantitative 99mTc-dimercaptosuccinic acid (DMSA) SPECT (QDMSA) studies. METHODS: The 30 patients were undergoing radical nephrectomy for renal tumors. The first study was done before surgery. Follow-up studies were performed 2-23 mo after surgery. Clinical evaluations and determinations of serum creatinine level were performed at the same time as the QDMSA studies. RESULTS: The relative contribution of the resected kidneys to the global renal function before surgery was 43.2% +/- 7.3%. After surgery the uptake of the remaining kidney increased from 13.4% +/- 4.0% to 18.3% +/- 5.8% (t = 5.7; P = 0.0000). The relative function of the remaining kidney increased from 56.8% +/- 7.1% to 79.1% +/- 23.6% (t = 4.9; P < 0.0001) of the global renal function before nephrectomy. Increases in the renal volume (from 211 +/- 62 cm3 to 229 +/- 68 cm3; t = 4.5; P = 0.0001) and in the percentage injected dose per cubic centimeter (%ID/cm3) of the remaining kidney (from 0.066 +/- 0.02 % ID/cm3 to 0.085 +/- 0.03 %ID/cm3; t = 4.6; P = 0.0001) were associated with this change. Nine patients had 2 follow-up studies performed 3-4 mo after surgery and 12-14 mo after surgery. The volume of the remaining kidney (209.22 +/- 46.20 cm3 versus 217.88 +/- 58.85 cm3; t = 0.962; P = 0.364), the %ID/cm3 (0.09 +/- 0.016 %ID/cm3 versus 0.093 +/- 0.025 %ID/cm3; t = 0.362; P = 0.726), and the percentage uptake (19.26% +/- 4.45% versus 20.11% +/- 7.01%) did not change significantly between these 2 QDMSA studies. CONCLUSION: The results of this study suggest that adaptive changes causing hyperfunction of the remaining kidney may occur after nephrectomy of a functioning kidney in adults. These changes occur soon after surgery, persist for at least 1 y, and are evident on QDMSA studies.

Adaptation, Physiological↗

PubMed2000

Robotic remote laparoscopic nephrectomy and adrenalectomy: the initial experience.

PURPOSE: We evaluated the feasibility of performing laparoscopic nephrectomy and adrenalectomy exclusively by using robotic telepresent technology from a remote workstation and compared outcomes with those of conventional laparoscopy in an acute porcine model. MATERIALS AND METHODS: Five pigs underwent bilateral laparoscopic nephrectomy (robotic in 5 and conventional in 4) and adrenalectomy (robotic in 4 and conventional in 3). In the 9 robotic laparoscopic procedures all intraoperative manipulations were completely performed telerobotically from a remote workstation without any conventional laparoscopic assistance on site. Animals were sacrificed acutely. RESULTS: Robotic laparoscopic nephrectomy required significantly longer total operative (85.2 versus 38.5 minutes, p = 0.0009) and actual surgical (73.4 versus 27.5 minutes, p = 0.0002) time than conventional laparoscopy. However, blood loss and adequacy of surgical dissection were comparable in the 2 groups. Robotic laparoscopic adrenalectomy required longer total operative (51 versus 32.3 minutes, p = 0.13) and actual surgical (38.5 versus 18.7 minutes, p = 0.14) time than conventional laparoscopy. The solitary complication in this study was an inferior vena caval tear during robotic right adrenalectomy, which was adequately repaired by sutures telerobotically in a remote manner. CONCLUSIONS: To our knowledge we present the initial experience with remote telerobotic laparoscopic nephrectomy and adrenalectomy. Telepresent laparoscopic surgery is feasible.

Adrenalectomy↗

PubMed2000

Feasibility of pathological evaluation of morcellated kidneys after radical nephrectomy.

PURPOSE: The indications for laparoscopic nephrectomy have grown to include renal malignancy. Although morcellation of these specimens has been described, to our knowledge we present the first systematic review of the feasibility and validity of pathological evaluation of these tumors with regard to grade and stage. MATERIALS AND METHODS: Nine formalin fixed and 5 fresh intact radical nephrectomy specimens were evaluated by 2 pathologists before and after high speed electrical tissue morcellation. The ability to distinguish tissue histology, and tumor size, stage and grade were compared. Impermeability of the laparoscopy sack after morcellation was also evaluated using indigo carmine stained normal saline placed in the used sack. RESULTS: The 9 preserved specimens included 7 renal cell carcinomas and 2 oncocytomas, while 4 of the 5 fresh specimens were renal cell carcinoma and 1 was oncocytoma. Overall tumor size was 2 to 7 cm. (mean 4.9). The 4 fresh renal cell carcinomas were of the clear cell type. Comparison of pathological evaluation after morcellation by another pathologist revealed identical histology, grade and stage for each tumor. Four cases of perinephric fat invasion (3 fixed and 1 fresh specimens) were identified after morcellation. Only tumor size was not assessed after morcellation. Laparoscopy sack integrity was confirmed in 13 of 14 cases. In 1 case involving a formalin fixed specimen a gross defect in the laparoscopy sack was demonstrated after morcellation. CONCLUSIONS: Morcellation of radical nephrectomy specimens in vitro did not alter the determination of histology, grade or local invasiveness of tumor. For all fresh tissue and remarkably for all but 1 formalin fixed tissue specimen the laparoscopy sack remained intact. Preliminary data from this in vitro model imply that limited in vivo morcellation of radical nephrectomy specimens may be performed without sacrificing staging information.

Adenoma, Oxyphilic↗

PubMed2000

Laparoscopic donor nephrectomy: impact on an established renal transplant program.

The current disparity of viable organs and patients in need of a transplant has been an impetus for innovative measures. Live donor renal transplantation offers significant advantages compared with cadaveric donor transplantation: increased graft and patient survival, diminution in incidence of delayed graft function, acute tubular necrosis (ATN), and reduction in waiting time. Notwithstanding these gains live donors continue to be underutilized and account for only approximately one quarter of all renal transplants performed in the United States. It has been felt that inherent disincentives to live donation have slowed its growth. These include degree and duration of postoperative pain and convalescence, child care concerns, cosmetic concerns, and time until return to full activities and employment. In an attempt to curtail the disincentives to live donation, laparoscopic live donation (laparoscopic donor nephrectomy; LDN) was developed. The purpose of this study was to compare the results of our first 25 laparoscopic nephrectomies (performed over a 10-month period from September 1998 through July 1999) with the previous 25 standard open donor nephrectomies (ODNs) completed over the past 3 years. We conducted a retrospective review of all donor nephrectomies and recipient pairs performed over the past 3 years. End points included sex, operative time, length of stay, immediate and long-term renal function, and willingness to donate. There were no differences in demographics of the ODN versus the LDN group. The average length of stay was 2.48+/-0.72 days for the LDN versus 4.08+/-0.28 days for the ODN. ODN and LDN have comparable short- and long-term function with no delayed graft function and no complications. Growth of living donor transplant has increased from 16 per cent of all kidney transplants performed in 1995 to 23 per cent in 1999. We conclude that LDN is a viable alternative to the standard donor operation. LDN has had a positive impact on the donor pool by minimizing disincentives to live donation. With the initiation of our laparoscopic program the number of LDNs has increased. Presently the live donor pool is the most viable alternative to significantly increase the number of kidneys for transplantation.

Adult↗

PubMed2001

Renal dysfunction associated with staged bilateral partial nephrectomy: the importance of operative positioning.

PURPOSE: Remnant kidneys may be susceptible to injury during positioning for a contralateral flank incision. We document renal dysfunction in a remnant kidney after staged partial nephrectomies. MATERIALS AND METHODS: We review a case of renal dysfunction associated with staged bilateral partial nephrectomy. Pertinent data and radiographic findings are presented. RESULTS: A man with multiple bilateral solid enhancing renal masses underwent left partial nephrectomy, resulting in sparing of 50% of the renal parenchyma. Postoperatively nuclear renography showed excellent flow and 33% function on that side. Right partial nephrectomy was then performed via the standard flank approach through the bed of the 11th rib, sparing 50% of the renal parenchyma. Cold ischemia time was 40 minutes. Serum creatinine increased to 4.9 mg./dl. within 48 hours. Nuclear renography immediately postoperatively showed poor flow and 13% function in the left kidney. CONCLUSIONS: Limited published data imply detrimental hemodynamic and myocutaneous consequences due to use of the kidney rest. Table flexion with elevation of the kidney rest may also cause ischemic damage in a previously operated contralateral kidney. Careful positioning is critical for preventing undue injury to the remnant kidney and in such cases elevation of the kidney rest should be avoided. Alternatively stage 2 may be approached via an anterior incision.

Humans↗

PubMed2001

Laparoscopic radical nephrectomy.

Most of the open renal procedures have been duplicated or approximated by laparoscopy. Past concerns about increased operative time, cost, resection completeness, and port site metastases are being overruled or put into perspective as experience with laparoscopic radical nephrectomy (LRN) is gained: necessary skills can be acquired, operative times are approaching those for open procedure, and a 14% difference in cost is counterbalanced by reduced postoperative expenditures. Moreover, LRN is acknowledged by its quality-of-life advantages-reduced morbidity and improved cosmetic outcome. Disease-free rate with LRN at last follow-up is 100% for TNM stage I and 89% +/- 6.6 for stage II (1997 classification). Complications are acceptable with an 8% to 35% incidence of minor complications and a 3% to 19% incidence of severe complications. Conversion to an open procedure occurs in 0% to 10% of cases. The procedure's limitations and the appropriate criteria for patient selection are evident. The learning process is believed to last for approximately 20 procedures and patient selection is based on both clinical criteria and one's insight on his location on the learning curve. Therefore, LRN is becoming the treatment of choice for most TNM stages I and II renal tumors. Moreover, recent data advocating pre-immunotherapy nephrectomy in metastatic patients may permit laparoscopic nephrectomy to further benefit selected metastatic patients by potentially shortening the time interval from nephrectomy to immunotherapy and improving immune responsiveness.

Carcinoma, Renal Cell↗

PubMed2001

[Comparison of laparoscopic and open nephrectomy in children].

Between August 1997 and October 2000 16 children aged 13 months to 15 years (mean 5.9 years) were subjected to laparoscopic nephrectomy on account of benign kidney disease, 10 by a transperitoneal approach, 6 by the retroperitoneal route. Retrospectively this group was compared with a group of 16 children aged 1 month to 15 years (mean 4.6 years) where in 1995-1998 nephrectomy was performed for the same reasons by the open route. The mean duration of the operation was 106.5 min. for the laparoscopic approach and 54.3 min. for open surgery (p = 0.00004), the postoperative drainage of the wound was 1.18 days in laparoscopic operations and 2.12 days in open operations (p = 0.025). The mean period of hospitalization was 5.12 and 6.68 days resp. (p = 0.003), analgetics were administered for 21.3 and 31.25 hours resp. after operation (p = 0.03). As to the beginning of oral food intake there was no significant difference, a blood transfusion was administered to one patient after the open operation. One patient developed a postoperative complication after open nephrectomy. The authors consider laparoscopic nephrectomy in children a safe and useful method.

Adolescent↗