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PubMed2005

[Comparison of endoscopic versus open radical nephrectomy for stage T1 and T2 renal cancer].

The aim of this study was to compare the efficacy, efficiency and patient well-being of endoscopic radical nephrectomy (ERN) with those of open radical nephrectomy (ORN) in patients with stage T1 and stage T2 renal cell carcinoma during the period from 1995 to 2003. Eighty-four patients including 53 patients receiving ERN and 31 patients receiving ORN were evaluated. The two groups were analyzed for sex, side of tumor, clinical stage, age, tumor diameter, operative time, operative blood loss, postoperative time to oral intake and ambulation. There was no difference in patient background between the ERN and ORN groups. Although the mean operative times between the ORN and ERN group were not different (mean 240 versus 267 min. in ERN group, P N .S.), ERN patients had significantly less operative blood loss (mean 123 versus 469 ml. in ERN group, P < 0.01), significantly shorter time to start the oral intake of rice gruel (mean 1.4 versus 4.6 days. in ERN group, P < 0.01) and significantly shorter time to ambulation (mean 1.2 versus 3.1 days. in ERN group, P < 0.01). These findings revealed that endoscopic radical nephrectomy for the patients with stage T1 and T2 renal cell carcinoma appears to be associated with less morbidity and faster recovery rather than open radical nephrectomy.

Adolescent↗

PubMed2005

[Results of open radical nephrectomy in a series of 230 patients].

OBJECTIVE: To analyse the oncological results of open radical nephrectomy for renal cancer PATIENTS AND METHODS: Between December 1989 and June 2003, open radical nephrectomy for renal cancer was performed by the same operator in 230 patients. Cancers treated by partial nephrectomy were excluded from this study. The operation was performed via a lumbar incision in 95.7% of cases. Surveillance consisted of clinical examination and thoracic and abdominopelvic computed tomography twice a year for the first two years, then annually for 3 years, and then at 7 years and at 10 years in the absence of recurrence. RESULTS: With a median follow-up of 63.1 months, the 5-year and 10-year recurrence-free survival rates were 88.4% and 67.2%, respectively. Tumour size, tumour stage (TNM 1997), Fuhrman's nuclear grade, histological type of cancer, and the presence of suggestive signs were correlated with the recurrence-free survival rate. The 10-year recurrence-free survival rate was zero in patients with visceral or lymph node metastases at the time of diagnosis. The patient's age at the time of diagnosis and the presence of a paraneoplastic syndrome did not influence recurrence free survival in this series. CONCLUSIONS: This study confirms the data of the literature: tumour size, tumour stage, nuclear grade, histological type, and suggestive signs are prognostic factors of renal cancer. Radical nephrectomy ensures a global 5-year recurrence-free survival rate higher than 85%.

Adult↗

PubMed2004

Use of ETS-FLEX endoscopic linear vascular cutter in donor nephrectomy and transplantation surgery: a single institution's experience.

OBJECTIVES: We describe our experience with the use of ETS-FLEX endoscopic linear vascular cutter from January 2000 to October 2004 in live-donor nephrectomy and pancreatic bench work. MATERIALS AND METHODS: In live-donor nephrectomy, ETS-FLEX endoscopic linear vascular cutter (ELVC) is used for the stapling and division of renal vessels and ureter. When positioned on a vessel, the vascular cutter applies 3 staple lines proximally and 3 distally, and the vessel in between them is divided. In pancreatic graft bench work, ELVC is applied in 3 steps: the splenectomy, ligation of the mesenteric root, and the ligation of any peripancreatic lymphatic tissue or small vessels. RESULTS: From October 2000 to October 2004, we performed 80 living-donor nephrectomies in 56 men and 24 women (mean age, 39 years; range, 24-63 years). Thirty-one grafts were with multiple vessels. Mean warm ischemia time was 60+/-5 seconds. Mean operative time was 60+/-10 minutes. In all cases, there was no need for further hemostasis after removal of the kidney. There were no operative complications. All grafts were successfully revascularized with 100% graft survival (range of follow-up, 1-48 months). Patients' length of stay in hospital was 3+/-1 days. We have used the ETS-FLEX ELVC in 30 pancreatic graft preparations since January 2000. Mean time taken for the bench work preparation including Y-graft anastomosis was 45 +/- 10 minutes. Following revascularization, there was excellent perfusion with minimal and easily controllable bleeding that did not require blood transfusion. CONCLUSIONS: We believe that our use of the laparoscopic instrument, ETS-FLEX ELVC, with a mini-incision technique in live-donor nephrectomy and pancreatic graft preparation makes these complex and time-consuming procedures simple and fast, minimizing the chances of postoperative complications and resulting in excellent patient and graft survival.

Adult↗

PubMed2005

[Partial nephrectomy for renal cell carcinoma using a microwave tissue coagulator--postoperative recurrence and renal function].

Nowadays, partial nephrectomy is often selected for treatment of small renal cell carcinoma (RCC) because T1a RCC shows a favorable prognosis with a 5-year overall-survival rate exceeding 90%. To determine the methodological usefulness and treatment outcome of partial nephrectomy using microwave tissue coagulator (MTC), we evaluated our series of 121 patients (124 kidneys) with T1 RCC who underwent this procedure. Ninety-nine patients were elective and 22 patients were imperative cases. This procedure was indicated for asymptomatic solitary RCC; < or =4 cm in diameter in elective cases or < or =5 cm in imperative cases, expanding outward with a clear capsule, and showing neither renal pelvis nor renal sinus invasion. The median operation time was 150 minutes and the median blood loss was 217 ml. Eight patients needed transfusion, and conservative therapy cured 4 patients of postoperative urine leakage successfully. Three patients underwent early secondary nephrectomy due to multiple RCCs, invasive spindle cell carcinoma, or prolongation of urine leakage. No significant deterioration of renal function by creatinine clearance (Ccr) was observed, and postoperative Ccr could be precisely predicted from preoperative serum creatinine value and the renal parenchymal volume estimated with 3-dimensinal image reconstruction. Five-year overall-survival rate was 91% at the mean follow-up of up to 37.9 months and 107 patients were alive without disease. One patient showed local recurrence 2 years later and underwent radical nephrectomy. We believe that non-ischemic partial nephrectmy using MTC is a simple and reliable nephron-sparing surgery for small RCC in respect of postoperative recurrence and preservation of renal function.

Carcinoma↗

PubMed2005

[Haemostatic efficacy of a high intensity focused ultrasound applicator in lower pole partial nephrectomy in the pig].

OBJECTIVE: To evaluate the haemostatic property of a high intensity focused ultrasound (HIFU) applicator in lower pole partial nephrectomy in a porcine model. MATERIALS AND METHODS: An applicator with a flat HIFU transducer operating at a frequency of 3.78 MHz was designed. Nine female pigs weighing between 35 and 39 kg were used. The kidneys of 5 pigs were used to characterize basic lesions, study haemostatic efficacy and measure the temperature rise in treated tissues. The following 4 pigs were treated by HIFU prior to bilateral lower pole partial nephrectomy. Treatment consisted of circumferential juxtaposition of basic lesions in the lower pole with vascular clamping. Haemostatic efficacy was evaluated immediately and 30 minutes after lower pole resection. RESULTS: A 50-second ultrasound pulse with an intensity of 26 W/cm2 induced a full thickness lesion of the kidney, between 22 and 36 mm. Lesions were reproducible. The temperature rise observed in treated tissues was 62 +/- 12, 59 +/- 9 and 58 +/- 11 degrees C at distances of 15, 20 and 25 mm from the transducer, respectively. All lower pole partial nephrectomies were exsanguinated, except for one case (12.5%), in which a central renal artery was not controlled. CONCLUSIONS: Our HIFU applicator is an excellent haemostatic tool ensuring effective coagulation of the renal parenchyma, allowing dry lower pole partial nephrectomy. Improvement of the ergonomics of this applicator and adaptation to laparoscopy are currently under investigation.

Animals↗

PubMed2006

[The first 100 hand-assisted laparoscopic donor nephrectomies at the Academic Medical Center in Amsterdam].

OBJECTIVE: To evaluate the results of the first 100 hand-assisted donor nephrectomies in our hospital. DESIGN: Prospective, descriptive. METHOD: In the period January 2000-July 2004, 100 consecutive donors underwent laparoscopic nephrectomy as part of a living-related kidney transplantation at the Academic Medical Center in Amsterdam, the Netherlands. The operation was performed laparoscopically using a hand port (hand-assisted nephrectomy). The incision made for the hand port was also used for the removal of the kidney. RESULTS: Mean operating time was 168 min (range: 88-285). Median warm ischaemia time was 3 min (1.0-4.5) and median blood loss was 50 ml (20-1500). None of the operations required conversion to an open procedure and there were no deaths among donors or recipients. Postoperatively, 12 complications occurred in 10 donors. Median hospital stay for the donors was 5 days. In 3 recipients, the transplanted kidney had to be removed within 14 days. 1n 3 other recipients, surgical re-intervention was necessary due to urological complications. One-year graft survival was 94%. CONCLUSION: Hand-assisted laparoscopic donor nephrectomy was a safe and minimally invasive procedure for renal transplantation in this patient series.

Adult↗

PubMed2006

[Oncological results of renal cancer with inferior vena cava thrombosis after nephrectomy].

OBJECTIVE: The objective of this study was to evaluate survival and risk of recurrence in patients undergoing nephrectomy with resection of inferior vena cava tumour thrombus in our department. MATERIAL AND METHODS: From June 1991 to March 2003, 40 patients underwent radical nephrectomy with resection of inferior vena cava tumour thrombus. The upper limit of the tumour thrombus was below the hepatic veins in 21 cases (52.5%) and above the hepatic veins in 19 cases (47.5%), with thrombus in the right atrium in 6 cases (15%). Cardiopulmonary bypass (CPB) was used in 12 patients (30%) RESULTS: With a mean follow-up of 28.5 +/- 36.8 months (range: 0-150), 22 patients (55%) have died. The 2- and 5-year overall survival rates were 45.2% and 38. 7%, respectively. Local and/or metastatic recurrence was observed in 28 patients (70%) after a mean interval of 18 +/- 22.9 months (range: 1-104). Patients with tumour thrombus derived from the left kidney had a higher local recurrence rate than patients with thrombus derived from the right kidney (p = 0.0194). The 2- and 5-year recurrence-free survival rates were 28.3% and 8.9%, respectively. Only stage pN had a statistically significant prognostic value on overall survival, but not on recurrence-free survival. At the end of the study, only 1 patient (2.5%) can be considered to be cured with no disease progression with a sufficient follow-up (52 months) after nephrectomy. CONCLUSION: Nephrectomy with resection of tumour thrombus from the inferior vena cava provides a gain in terms of medium-term survival, but the majority of patients are not cured by this major surgery. Only lymph node status has a prognostic value.

Adult↗

PubMed2006

[Laparoscopic live donor nephrectomy: surgical technique and results].

OBJECTIVE: To report the results of laparoscopic live donor nephrectomy (LLDN) and to describe our technique. MATERIAL AND METHODS: We retrospectively reviewed 47 laparoscopic live donor nephrectomies performed between January 1999 and July 2005. Several parameters were studied: donor clinical characteristics, intraoperative and postoperative complications, operating time and warm ischaemia time. This series comprised 26 women (55.31%) and 21 men (44.68%) with a mean age of 48 +/- 20 years. Donor nephrectomy was mainly performed on the left kidney (85.37%). It was performed by lumbar endoscopy in the first 20 cases and by laparoscopy in 27 cases. Kidney extraction was performed via an incision between two trocar orifices for the first cases and via an iliac incision for the last 18 cases. RESULTS: The mean operating time was 189 min with a mean blood loss of 127 ml. Warm ischemia time was 6 minutes. Open conversion was required in two cases: renal vein injury in one case and an obese donor with difficulties of dissection in the other case. Surgical revision was required in only one case (haemoperitoneum secondary to genital vein injury). A trocar orifice abscess was observed in one case and prolonged ileus was reported in 2 cases. In the recipient, a urinary anastomotic fistula was observed secondary to ischaemic necrosis of the distal segment of the ureter. Late complications were essentially vascular (19.14%). A right renal graft was lost due to an error of compatibility. Mean serum creatinine was 132 +/- 6.5 micromol/l at 3 months for the other recipients. CONCLUSION: Our experience confirms the feasibility and efficacy of laparoscopic live donor nephrectomy. Intraoperative and postoperative complications and the conversion rate were low. Renal function was rapidly restored in the recipient. The morbidity of this technique is low, but there is a high risk of vascular complications at the beginning of the operator's experience.

Female↗

PubMed2006

Comparison of laparoscopic and open nephrectomy for adult polycystic kidney disease: operative challenges and technique.

OBJECTIVES: Autosomal dominant polycystic kidney disease an inherited systemic disorder is characterized by the development of multiple cysts in the kidneys and other organs. When nephrectomy is indicated, the laparoscopic approach is challenging due to the massive size of these kidneys. We present our technique and evaluate the surgical outcomes of laparoscopic versus open nephrectomy for patients with such condition. MATERIALS AND METHODS: A retrospective review was done for six laparoscopic and six open nephrectomies performed by two laparoscopic surgeons in two university hospitals between January 2004 and December 2004. Preoperative, intraoperative, and postoperative data are presented. A standard subcostal incision was used for the open cases while for the laparoscopic approach a 3-4-port transperitoneal laparoscopic approach was used to dissect the involved kidney, which is then removed intact or morcellated through pfannenstiel, midline, or expanded port site incision. RESULTS: The laparoscopic patients had a longer operative time with one major complication compared to the open group. On the other hand laparoscopic group achieved minimal blood loss, less narcotic requirement and a shorter hospital stay. No conversion to open required in the laparoscopy group. At a median follow up of 1 year no long-term complications reported in either groups. CONCLUSIONS: Laparoscopic nephrectomy for polycystic kidney disease is a feasible and safe alternative to open approach. In addition to low morbidity, other advantages of laparoscopic surgery also achieved in this subset of patients such as the ability to remove the dissected kidney through a small incision, reduced postoperative pain, short hospital stay, and excellent cosmesis.

Adult↗

PubMed1991

[Effect of partial nephrectomy on mercuric chloride-induced acute renal failure].

We investigated the effect of partial nephrectomy on mercuric chloride (HgCl2)-induced acute renal failure (ARF) in rats. HgCl2 (2 mg/kg) was subcutaneously injected to male Wistar rats 2 days or 2 weeks after either partial nephrectomy or sham surgery. Both deterioration of renal function (serum creatinine, creatinine clearance, and fractional excretion of sodium) and renal tubular damage due to HgCl2-induced ARF were inhibited by 5/6 nephrectomy. A moderate inhibitory effect was also noted by uninephrectomy. The levels of renal tissue ATP and total nucleotide did not increase 12 and 48 hours after uninephrectomy. These results suggest that partial nephrectomy is effective in suppressing the development of HgCl2-induced ARF. The mechanisms of the protection are not explained completely by a consequence of hypertrophy or an acceleration of intracellular energy metabolism. Intrarenal blood flow redistribution may be involved in one of the mechanisms.

Adenosine Triphosphate↗

PubMed1989

Prognosis in renal cell carcinoma: analysis of clinical course following nephrectomy.

The clinical courses and survivals of 159 patients who underwent nephrectomy for renal cell carcinoma are reviewed. A longer disease-free period after nephrectomy was correlated with significantly better survival. Among patients in whom metastases in the lungs or bones were detected after nephrectomy, those with between one and five pulmonary or solitary bone metastases, without definite increases in their number and size in the six months following their first appearance, survived significantly longer than patients with a similar number of metastases but which did increase in number and size in the following six months, or patients with six or more pulmonary or multiple bone metastases. Even when metastases detected after nephrectomy were confined to the lungs or bones throughout the observation period, the patients did not necessarily show significantly better survivals than patients with metastases detected in multiple sites.

Adult↗

PubMed1987

The failure of infarction and/or nephrectomy in stage IV renal cell cancer to influence survival or metastatic regression.

The success of cancer therapy depends on the destruction of all viable cancer cells in the primary site, as well as in metastatic areas. Surgery alone can do little for the patient whose tumor has produced distant involvement except in those situations where surgical excision, radiotherapy, chemotherapy, or immunotherapy can be relied on to eradicate metastatic disease. Because of the paucity of systemic therapy for renal cell carcinoma, an aggressive surgical approach to the primary tumor is justifiable when all metastatic lesions can be excised or otherwise definitively treated and in experimental protocols in which adjuvant therapy of possible benefit can be combined with palliative nephrectomy. There is no evidence, however, in reported studies to suggest that routine palliative nephrectomy in patients who will not be offered adjuvant systemic therapy or radiation is beneficial. Such practice is also associated with a higher incidence of complications and mortality than is expected for resection of localized renal cell carcinoma. For these reasons, it is reasonable to recommend adjunctive nephrectomy only in certain selected instances, which include (1) the control of a patient's current symptoms related to the primary disease, for example, flank pain, hematuria, fever and toxicity, anemia, erythrocytosis, and hypercalcemia; (2) nephrectomy with the excision of a solitary metastasis; and (3) the patient who is willing to undergo experimental therapy, part of which involves removal of the primary tumor.

Carcinoma, Renal Cell↗

PubMed1986

Repeat revascularization versus nephrectomy in the treatment of recurrent renovascular hypertension.

Between 1960 and 1983, 38 patients underwent multiple operations for treatment of recurrent renovascular hypertension. There were 23 women and 15 men who ranged in age from eight to 69 years old (a mean of 48.5 years). The cause of hypertension requiring repeat operation was determined roentgenographically, three patients had new disease of the contralateral nonoperated renal artery, 21 patients had a new lesion of the ipsilateral (previously operated) renal artery and 14 patients had new lesions of both the previously operated and nonoperated renal arteries. Thirty patients underwent a secondary unilateral operation and eight had a bilateral operation. Sixteen patients had unilateral renal artery revascularization, 14 had unilateral nephrectomy, three had bilateral revascularization and five had unilateral revascularization with contralateral nephrectomy. There were three operative deaths (an operative mortality of 7.9 per cent). At hospital dismissal, 30 of 35 patients were improved. Follow-up study ranged from seven months to 23 years (a mean of 7.2 years). There were eight (22.9 per cent) late deaths. Secondary revascularization alone produced improvement in 77 per cent. Nephrectomy alone produced improvement in 80 per cent. We conclude that secondary revascularization is the treatment of choice in patients with recurrent renal artery stenosis. Nephrectomy should be reserved for patients who cannot undergo a revascularization procedure for technical or medical reasons.

Adolescent↗

PubMed1983

Lack of effect of bilateral nephrectomy on the pharmacokinetics of 14C-indapamide (REV 2555) and its metabolites in the dog.

Renal impairment can affect the disposition of metabolites, as well as unchanged drug, especially when there is significant renal clearance of metabolites. The pharmacokinetics of indapamide, a highly metabolized drug, and total indapamide equivalents (as an indicator of metabolites plus unchanged drug) were determined in the anephric dog. An intravenous dose of 14C-indapamide was administered to dogs first after a sham-operation, and then following bilateral nephrectomy. The disposition of total indapamide equivalents, calculated from total radioactivity, was not substantially different after nephrectomy as compared to after sham-operation, with an increase after nephrectomy in the area under the blood level curve (+26.2%), and decreases in the elimination rate constant (-6.9%), volume of distribution (-12.7%) and total blood clearance (-21.9%). The only statistically significant change was the decrease in the volume of distribution. The elimination kinetics of unchanged drug were also qualitatively similar in both cases. After nephrectomy, a decrease was seen in the elimination rate constant (-10.9%) and the volume of distribution (-16.3%) while slight increases in the total blood clearance (+1.9%) and the area under the blood level curve (+4.8%) were noted. These findings could have important implications for advantageous use of indapamide in treatment of hypertensive patients with renal failure since these data suggest that metabolites as well as unchanged drug could still be effectively eliminated by an alternate, non-renal route, thus minimizing accumulation of these compounds.

Animals↗

PubMed1981

Indications of unilateral bovine nephrectomy: a report of four cases.

Unilateral nephrectomy was done on 4 cows with renal disease. The history and clinical signs varied and were not pathognomonic for disease of the urinary system. Serum creatinine and BUN concentrations were normal in each cow prior to nephrectomy, in spite of advanced renal disease. Results of urinalysis were abnormal in 3 cows. Cystoscopic examination aided in the diagnosis, by revealing unilateral hematuria in 1 cow. Palpation per rectum revealed a large abdominal mass adjacent to the kidney in 2 cows. Exploratory celiotomy was necessary in 3 cows to determine the exact nature of their disease. Nephrectomy was easily performed; however, ligature security was critical. A biopsy of the remaining kidney at the time of nephrectomy aided in determining medical therapy and prognosis. Three cows recovered from the effects of the disease and became productive members of the herd. One cow was euthanatized because of end-stage renal disease in the remaining kidney.

Animals↗

PubMed1996

Splenectomy complicating left nephrectomy.

PURPOSE: We attempted to clarify the details of incidental splenectomy complicating left nephrectomy. MATERIALS AND METHODS: We reviewed the literature and operations involving splenectomy performed during left nephrectomy between 1984 and 1994 at our university. Factors reviewed included patient characteristics, renal pathology, mechanisms of injury, blood transfusions and postoperative complications. RESULTS: Of the 418 left nephrectomies 18 (4.3%) resulted in splenectomy via a transperitoneal approach. Patients with a large or upper pole renal lesion, malignancy or advanced age are increasingly likely to undergo unanticipated splenectomy. CONCLUSIONS: Our results, combined with recommendations from the Centers for Disease Control and Prevention, suggest that all patients older than 65 years undergoing left transperitoneal nephrectomy or those at increased risk for splenic injury should receive preoperative pneumococcal vaccination.

Age Factors↗

PubMed1995

The incidence of multifocal renal cell carcinoma in patients who are candidates for partial nephrectomy.

PURPOSE: A prospective study was performed to determine the incidence of multifocal renal cell carcinoma in patients who are candidates for partial nephrectomy. MATERIALS AND METHODS: Preoperative imaging studies and surgical specimens in 44 patients suitable for partial nephrectomy but undergoing radical nephrectomy were prospectively reviewed. RESULTS: Of 44 renal cell cancers 11 (25%) demonstrated pathological multifocality, while 10 of 11 multifocal tumors (91%) occurred in the face of a primary tumor 5 cm. or smaller. Tumor multifocality was independent of the size of the primary renal tumor but occurred with a slightly higher frequency in tumors of stage T3A or greater even if the primary tumor was small. CONCLUSIONS: Partial nephrectomy in patients with unilateral renal cancer should be approached with caution and should not be performed simply because it is technically feasible.

Adult↗

PubMed1994

[Local recurrence following radical nephrectomy for renal adenocarcinoma].

PRESENTATION: If the rate of tumoral relapse after partial nephrectomy for hypernephroma is 8-10%, this element is rarely reported in the literature after radical nephrectomy. PATIENTS AND METHODS: 159 patients (pts) have undergone radical nephrectomy for kidney adenocarcinoma. Mean age is 61.3 years (26-85 years). The mean duration of follow-up is 50.8 months (12-183 months). The patients were regularly followed by abdominal CT scan at 6 months and than yearly by CT scan and chest X-ray. CONCLUSION: Considering the poor incidence of local relapse (1.3%) after nephrectomy and in a period where economical aspect weigh on our practice, a new policy of post-operative follow-up should be carried.

Adult↗