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At least 1,009 records · Page 56Linked to original sources

PubMed2002

Lipid peroxidation in vitamin E-deficient rats submitted to subtotal nephrectomy.

Clinical and experimental evidence has indicated that chronic renal failure (CRF) is related to increased free radical production. CRF patients show increased lipid peroxidation after a progressive reduction in vitamin E, one of the most important antioxidants. In the present study the role of vitamin E deficiency in lipid peroxidation was investigated in rats submitted to subtotal nephrectomy. Male Wistar rats were divided into groups receiving different diets for a period of 45 days: SND - sham rats submitted to a regular diet containing vitamin E; ERD nephrectomized rats submitted to a regular diet containing vitamin E; SDD - sham rats submitted to a vitamin E-deficient diet; EDD nephrectomized rats submitted to a vitamin E-deficient diet. After 30 days the Experimental animals were submitted to 5/6 nephrectomy and the Controls were submitted to sham operation. The vitamin E levels of the SDD and EDD groups were significantly reduced (p < 0.05) in plasma (4.92 +/- 1.22 and 8.37 +/- 2.09 mmol/L, respectively), liver (7.57 +/- 2.72 and 9.44 +/- 2.55mg/g tissue, respectively) and kidney (8.17 +/- 2.38 and 9.40 +/- 3.10 mg/g tissue, respectively) when compared to the SRD and ERD groups. In contrast, in the EDD group the levels of thiobarbituric acid-reactive substances, expressed as nmol/mg protein, were significantly increased (p < 0.05) in the liver (1.41 +/- 0.27) and kidney (1.67 +/- 0.47), and superoxide dismutase activity was significantly increased in the erythrocytes (4455.80 +/- 1322.63 Ug/Hb) compared to all other groups. The vitamin E-deficient diet associated with subtotal nephrectomy determined an increase in lipid peroxidation, suggesting an important role of free radicals in the development of chronic renal failure.

Animals↗

PubMed2001

Laparoscopic radical/total nephrectomy: a decade of progress.

The first laparoscopic radical/total nephrectomy for a renal tumor was performed in June 1990. Since that time, the procedure has evolved as numerous surgeons have contributed novel strategies and technical advances. The state of the art is reviewed, including transperitoneal laparoscopic and hand-assisted techniques, as well as the retroperitoneal approach. Operative and postoperative data are reviewed with the goal of determining four factors: the efficacy, efficiency, morbidity, and cost of the procedure. Within the limits of available follow-up for this novel procedure, it appears to be as effective as open surgery in rendering the patient tumor free. Although it clearly is a less painful and less disabling procedure than open surgery, our understanding of the efficiency of the laparoscopic procedure remains in flux. The operative times for laparoscopic radical/total nephrectomy are approaching those of traditional open radical nephrectomy, although intraoperative costs remain higher and thus must be balanced against decreased hospitalization and convalescence.

Humans↗

PubMed2002

Laparoscopic radical nephrectomy: prospective assessment of impact of intact versus fragmented specimen removal on postoperative quality of life.

PURPOSE: We prospectively compared postoperative recovery and quality of life for groups of patients undergoing laparoscopic radical nephrectomy with intact or fragmented specimen removal. PATIENTS AND METHODS: A prospective evaluation of 12 patients having a transperitoneal laparoscopic nephrectomy was completed. In each case, a radical dissection was performed regardless of the surgical indication. Fragmented specimens (N = 7) were extracted at the umbilical port, and intact specimens (N = 5) were extracted through an infraumbilical incision. Demographic and perioperative data including specimen removal incision, narcotic requirements, and recovery interval were recorded. Subjective pain and activity assessments were administered prospectively on postoperative days 1, 2, 7, and 14. RESULTS: The mean incision length for intact specimen removal was 7.6 cm and that for fragmented removal was 1.2 cm (P < 0.05). Pain and activity self-assessments improved over time in each group. No significant differences in pain or activity scores were noted between treatment groups at any queried interval. Time to return of normal activity was not significantly different in the two groups. CONCLUSIONS: In this pilot study, no subjective or objective advantage was demonstrated for kidney fragmentation during laparoscopic radical nephrectomy. A larger randomized study is required to better assess any clinical advantage to specimen morcellation.

Female↗

PubMed2002

Laparoscopic retroperitoneal nephrectomy for Aspergillus-infected polycystic kidney.

BACKGROUND AND PURPOSE: The management of polycystic kidney disease is mostly restricted to conservative measures. However, nephrectomy may be indicated in particular cases, especially when there are infective complications. To decrease the morbidity of the procedure, the laparoscopic approach has become appealing. We present a laparoscopic retroperitoneal approach to complicated polycystic kidney disease in a high-risk patient. CASERESPORT: We performed right retroperitoneal laparoscopic nephrectomy in a 39-year-old man who had autosomal polycystic kidney disease and had undergone heart transplantation. The immunosuppressed patient presented with severe flank pain, generalized signs of infection, and acute renal insufficiency. With the patient in the right lateral decubitus position, the retroperitoneal space was entered by the open technique, and the posterior pararenal space was developed with finger dissection. Five trocars were used. After the renal vessels had been secured and divided, the cysts were successively punctured, gradually shrinking the operative specimen. The kidney was placed in an Endo-catch and removed after morcellation, with no need to enlarge the 2-cm lumbotomy. The operating time was 80 minutes, and the hospital stay was 4 days. Histologic examination revealed a polycystic kidney with Aspergillus infection. CONCLUSION: The laparoscopic approach is a less-invasive option for removing a polycystic kidney when nephrectomy is indicated. The retroperitoneal route has the advantage of minimizing infection risks because of the absence of peritoneal opening.

Adult↗

PubMed2002

Local hemostasis during laparoscopic partial nephrectomy using biodegradable hydrogels: initial porcine results.

BACKGROUND AND PURPOSE: Despite the advance of laparoscopic partial nephrectomy, significant technical limitations remain with regard to control of bleeding and closure of the collecting system. An attractive approach on the horizon for local hemostatic and wound control is the use of local tissue sealants. To date, sealants remain largely derived from natural biologic products and are difficult to apply laparoscopically with precise local control. In this study, we examined the novel strategy of forming occlusive tissue-adherent hydrogels utilizing a synthetic biodegradable polyethylene glycol-lactide copolymer (PEG-lactide) as an in situ occlusive barrier for hemostasis and wound control. Specifically, the objects of this study were to determine if PEG-lactide hydrogels could be formed intraperitoneally on renal tissue, to test the adhesiveness of the hydrogels to injured renal parenchyma, and to evaluate the ability of adherent hydrogel barriers to limit renal parenchymal bleeding and collecting system leakage following renal pole amputation or wedge excision. MATERIALS AND METHODS: Five kidneys from three female pigs were used in a nonsurvival study. A standardized model for laparoscopic partial nephrectomy was created by performing wedge excision or polar amputation under vascular control using a laparoscopic Satinsky clamp. Bleeding briskness following injury was assessed utilizing a scoring system and free blood quantitated comparing a conventional "clamp and wait" strategy with an adherent hydrogel strategy. For the hydrogel group, PEG-lactide hydrogel primer and macromer were applied through laparoscopic ports. The hydrogel was polymerized using a xenon light source, and the pedicle clamp was released to observe for bleeding. A subsequent opposite polar injury was created to confirm renal perfusion and the sites were compared. The kidneys were removed, and the adhesion of the hydrogel to the renal parenchyma was examined. RESULTS: The PEG-lactide macromer was effectively applied to five kidneys following partial nephrectomy. In all cases, successful intraperitoneal in situ polymerization was achieved, with resultant hydrogel formation. Polymeric hydrogel adhesion to the cut renal parenchyma was assessed semiquantitatively following vigorous cyclic washing. In all cases, polymer gels remained adherent without any evidence of peeling, delamination, or separation from the underlying tissue surface. In the control group, the mean bleeding score was 2.63 +/- 0.48 v 0.00 +/- 0.00 in the gel-treated group (P < 0.001). Blood loss in the control group was 56 +/- 5 ml v 0.00 +/- 0.00 in the gel-treated group (P < 0.001). In an ex vivo retrograde ureteral perfusion, no leakage was observed at pressure as high as 100 mm Hg. CONCLUSIONS: In this feasibility study, a biodegradable PEG-lactide polymer system photopolymerized rapidly in situ on exposed renal parenchymal surfaces, forming adherent hydrogel barriers. When applied during vascular clamping, an adequate physical bond and patch-like cap was created to prevent bleeding at physiologic renal perfusion pressures. Use of locally applied occlusive hydrogels holds promise for hemostasis and local wound control during laparoscopic urologic procedures.

Absorbable Implants↗

PubMed2002

Laparoscopic v open donor nephrectomy: a cost-utility analysis of the initial experience at a tertiary-care center.

BACKGROUND AND PURPOSE: Laparoscopic donor nephrectomy (LapDN) offers donors more rapid postoperative recovery and recipients equivalent graft function when compared with open donor nephrectomy (OpenDN). Nonetheless, costs are less favorable for LapDN than for OpenDN. We compared LapDN and OpenDN with cost-utility analysis. METHODS: A decision analysis modeling approach was performed: utilities derived using time trade-off and quality-adjusted life year (QALY) techniques; probabilities derived from a systematic review of the literature. All costs were included from a societal perspective using actual cost data from OpenDN and LapDN patients performed contemporaneously between July 1, 2000 and December 31, 2000. Costs of lost employment were estimated using mean provincial annual earnings. Incremental cost-effectiveness ratio (ICER) was calculated with "best-case" and "worst-case" scenarios for confidence intervals; sensitivity analyses were used to assess robustness. RESULTS: LapDN costs are higher ($10,317.40 vs. $9,853.70), while quality of life (QOL) is superior (0.7683 vs. 0.7062). The ICER from a societal perspective was C$7,471.11/QALY. If all donor nephrectomies nationally were performed laparoscopically, there would be an additional annual cost of C$665,240 with a societal gain of 24.84 QALYs. CONCLUSIONS: LapDN offers improved QOL at marginally higher cost. A societal ICER of $7,471.11/QALY compares favorably to many accepted health-care interventions. By potentially increasing organ donor rates, LapDN may be cost saving by decreasing the number of patients on dialysis.

Aftercare↗

PubMed2003

Initial experience in laparoscopic partial nephrectomy for renal tumor with clamping of renal vessels.

PURPOSE: To describe our initial experience with laparoscopic partial nephrectomy (LPN) with clamping of the renal vessels before tumor excision and suturing of the renal parenchyma. PATIENTS AND METHODS: Between July 2001 and April 2002, 19 consecutive patients underwent transperitoneal LPN in our institution, 14 for tumors <4 cm with suspicion of renal-cell cancer and 5 for suspicion of angiomyolipoma at CT with one tumor confirmed histopathologically by percutaneous needle biopsy. We divided these patients into the first 10 cases (Group 1) and the last 9 cases (Group 2). One patient had end-stage renal disease but was not on dialysis; the remaining patients had elective partial nephrectomy. Initially, a ureteral catheter was placed. The partial nephrectomy was performed with clamping of the renal vessels, so that the tumor was excised with cold scissors. Intracorporeal cooling of the kidney was achieved by a ureteral catheter connected to a 4 degrees C solution flowing to the renal pelvis during the whole procedure until the clamps were released. Intracorporeal free-hand suturing was exclusively used to close the collecting system (when opened) and to approximate the renal parenchyma. RESULTS: All procedures were completed laparoscopically. The mean renal warm ischemia time was 28.5+/-7 minutes (range 15-47 minutes). The mean laparoscopic operating time was 125+/-37 minutes (range 90-390 minutes). The mean intraoperative blood loss was 290+/-276 mL (range 25-1200 mL). Two patients required blood transfusion, and four had complications. There was immediate deterioration in renal function (creatinine 1.42+/-0.56 mg/dL), but improvement was seen at 1 month (1.17+/-0.34 mg/dL). There were no statistically significant differences in operative features and outcomes in Groups 1 and 2, but there were improvements in the mean operating time by 30 minutes, the mean intraoperative blood loss by 113 mL without any transfusion, and the mean renal warm ischemia time by 6 minutes. There was only one patient in Group 2 with a complication. The surgical margin was negative for tumor for all patients. Postoperative pathology examination showed renal-cell cancer in 11 patients (pT1), oncocytoma in 3 patients, and angiomyolipoma in 5 patients. The mean tumor grade was 2. The mean tumor size was 25.8+/-11.6 mm with a mean tumor-free margin of 2.6+/-2.4 mm. The median follow-up is 3 months, so oncologic outcome cannot be assessed. CONCLUSION: The technique of LPN can be standardized and should be proposed for small tumors when they are not invading the hilum. Clamping the renal pedicle allows better vision for more accurate tumor excision with a safety margin and hemostatic suturing of the parenchymal defect, resulting in less blood loss and shorter operative time, parameters that improve with experience.

Adenoma, Oxyphilic↗

PubMed2003

Use of fibrin glue and gelfoam to repair collecting system injuries in a porcine model: implications for the technique of laparoscopic partial nephrectomy.

BACKGROUND AND PURPOSE: One of the challenges of laparoscopic partial nephrectomies is the repair of a collecting system injury. We hypothesized that fibrin glue plus Gelfoam could be sufficient to repair such injuries. MATERIALS AND METHODS: Four pigs (eight kidneys) underwent collecting system injuries of various lengths (3, 5, and 10 mm) (N = 8 each) during partial nephrectomy. Gelfoam soaked in the fibrin glue was applied to seal the collecting system and parenchymal defects. After 1 hour of passive filling, the renal pelvis was distended at supraphysiologic pressure to the point of leakage. Each repair site was examined for urinary extravasation during the physiologic and active phases of filling. RESULTS: Hemostasis was achieved, and all collecting system injuries, regardless of size, were free of urinary leakage at physiologic pressures. Moreover, all defects maintained a seal at supraphysiologic pressures of at least 50 cm H(2)O. CONCLUSION: The combined use of fibrin glue and Gelfoam is an effective means to obtain hemostasis and seal collecting system injuries up to 10 mm at physiologic pressures and up to 50 cm H(2)O in the acute setting. Our hope is that this technique can facilitate both laparoscopic and open partial nephrectomies. New technologies will be employed in an attempt to obtain better seating of the sealant plug in the future. Survival studies are in progress.

Animals↗

PubMed2003

Effect of retroperitoneoscopic donor nephrectomy on tissue oxidative stress markers in rabbit pneumoretroperitoneum model.

BACKGROUND AND PURPOSE: Laparoscopic donor nephrectomy causes increased renal oxidative stress. There are no data about the effects of the retroperitoneoscopic route. The aim of our study was to evaluate the oxidative stress occurring in renal tissues during retroperitoneoscopic donor nephrectomy in a rabbit model. MATERIALS AND METHODS: Eighteen adult rabbits were randomized to three groups, each consisting of six rabbits. Group I (control) underwent 50-mL balloon dissection of the left retroperitoneal space without CO(2) insufflation. Group II (pneumoretroperitoneum) received a 3-hour CO(2) insufflation at a pressure of 10 mm Hg in the retroperitoneal space after balloon dissection. Group III (pneumoretroperitoneum with warm ischemia), in addition to the procedure applied in Group II, underwent left renal artery clamping for 3 minutes and reperfusion for the next 5 minutes. Bilateral nephrectomy was performed in all animals for analysis of oxidative stress markers. Concentrations of malonyldialdehyde (MDA), protein carbonyl, and reduced glutathione (GSH) were measured in renal tissue samples. RESULTS: The MDA and protein carbonyl content were increased both in the donor (P = 0.004 and P = 0.004, respectively) and in the remaining kidneys (P = 0.009 and P = 0.028, respectively) in Group II compared with Group I. There were no statistically significant increases in oxidative stress markers between Group II and Group III in donor kidneys. However, there were statistically significant decreases in MDA in the remaining kidneys in Group III compared with Group II (P = 0.009). CONCLUSION: Pneumoretroperitoneum causes increased oxidative stress in both donor and remaining kidneys. Short-term warm ischemia and reperfusion do not exert an additive effect on pneumoretroperitoneum-associated oxidative stress in donor kidneys.

Analysis of Variance↗

PubMed2004

Which is the real gold standard for small-volume renal tumors? Radical nephrectomy versus nephron-sparing surgery.

BACKGROUND AND PURPOSE: Until recently, the gold standard for treatment of localized renal-cell carcinoma with a normal contralateral unit was deemed to be a formal radical nephrectomy. Advocates of nephron-sparing surgery have recently challenged this concept; we wished to evaluate the evidence to determine which treatment is objectively superior for patients with renal tumors up to 4 cm. MATERIALS AND METHODS: MEDLINE, CANCERLIT, and EMBASE computer literature searches were performed to identify peer-reviewed papers pertaining to radical nephrectomy (RN), nephron-sparing surgery (NSS), or comparisons of these methods for tumors as large as 4 cm in maximum diameter. Review of the bibliographies of recovered articles and data in recent textbooks were used to supplement the computerized searches. There were a total of 797 cases in the RN group and 1211 in the NSS group. The parameters specifically evaluated were evidence of local recurrence, disease progression, and death within 33 months, this period being chosen primarily because it was the shortest follow-up in the studies evaluated. The data were then subjected to rigorous statistical analysis. Laparoscopic radical nephrectomy (LRN) and laparoscopic nephron-sparing surgery (LNSS) articles were also reviewed; however, current follow-up periods were considered too short to draw a statistically significant conclusion. RESULTS: Disease-specific survival rates (P=0.001; Mann-Whitney test) as well as the incidence of metastases (P<0.05; Mann-Whitney test) were significantly better in the NSS group. The incidence of local recurrence (P=0.22; Mann-Whitney test) was not significantly different. It should be borne in mind that there are different follow-up periods for each study, and this may have had an impact on the results. CONCLUSION: Nephron-sparing surgery seems to be as effective as RN in patients with renal cell tumours up to 4 cm, although only a large randomized controlled trial with long follow-up periods would provide a definite answer.

Carcinoma, Renal Cell↗

PubMed2004

Hand-assisted laparoscopic approach to simple nephrectomy.

Laparoscopic nephrectomy is commonly employed today for both malignant and benign renal conditions, yet the learning curve for all but the simplest procedures remains quite steep. Hand-assisted laparoscopic nephrectomy (HALN) bridges the gap between standard laparoscopy and open surgery, allowing urologists to develop laparoscopic skills while offering the advantages of minimally invasive surgery. Simple laparoscopic nephrectomy, performed for benign disorders, can at times prove to be challenging because of inflammation around the renal hilum. Meticulous dissection during HALN utilizing the intra-abdominal hand for tactile feedback, retraction, and blunt dissection may improve one's capabilities compared with the standard laparoscopic approach.

Humans↗

PubMed2004

Retroperitoneoscopic nephrectomy v classic lumbotomy for pyonephrosis.

PURPOSE: To describe our experience and operative technique for retroperitoneoscopic nephrectomy for pyonephrosis and to compare the results with those of open surgery. PATIENTS AND METHODS: Since October 1998, 23 successful retroperitoneoscopic nephrectomies for pyonephrosis were performed in our institution (Group A). These patients were compared with 23 patients, matched by age, sex, and body weight, who underwent classic lumbotomy for pyonephrosis (Group B). The two groups were compared in terms of operative time, blood loss, hospital stay, wound complications, and time of return to previous occupation. RESULTS: All the features studied except operative time were significantly different in favor of laparoscopy. CONCLUSION: Although technically difficult, retroperitoneoscopic nephrectomy for pyonephrosis is feasible. The extraperitoneal approach allows direct access to the renal hilum and helps avoid spillage of pus into the peritoneum.

Adolescent↗

PubMed2004

Pure laparoscopic right donor nephrectomy: step-by-step approach.

BACKGROUND AND PURPOSE: Debate surrounds laparoscopic kidney procurement for right donor nephrectomy. We detail our pure laparoscopic technique of right kidney retrieval. TECHNIQUE: We use a four-port transperitoneal approach and extract the kidney through a low Pfannenstiel incision. Important elements include: (1) dividing the triangular ligament; (2) identifying the vena cava early; (3) minimizing ureteral dissection; (4) mobilizing the kidney within Gerota's fascia; (5) dissecting the renal artery behind the vena cava; (6) cutting the extraction incision to the peritoneum; (7) applying a Hem-o-Lok and single metal clip on the artery; (8) placing the Endo-TA stapler on the renal vein adjacent to the vena cava; (9) cutting the vessels without clips/staples on the kidney side; and (10) retrieving the kidney manually. RESULTS AND CONCLUSIONS: This is a reliable method of right pure laparoscopic donor nephrectomy that maximizes donor benefit and cost-effectiveness. Right laparoscopic nephrectomy is likely easier with this technique and should not be avoided if it is the preferred kidney for transplantation.

Humans↗

PubMed1993

Endourologist at work: laparoscopic placement of drains after nephrectomy.

The exact indications and ideal candidates for laparoscopic nephrectomy are yet to be identified. Occasionally, urologists might drain the renal fossa, depending on the pathogenesis of the renal disease prompting the nephrectomy, as with chronic infection. The authors describe a technique of placing a closed drainage system under full view with insufflation after laparoscopic nephrectomy. No additional stab wounds are necessary.

Drainage↗

PubMed1994

Laparoscopic nephrectomy: an established routine procedure.

Between August 1992 and April 1993, 60 patients underwent laparoscopic nephrectomy in our institution for benign disease (35 hydronephrosis, 20 chronic pyelonephritis, 4 end-stage kidney, 1 renal hypoplasia). Conversion to open surgery was needed in six cases to overcome intraoperative bleeding or perirenal adhesions. The mean operative time was 3.5 +/- 1.3 hours, and the mean hospital stay was 3.2 +/- 2.1 days. No deaths occurred, but significant complications were encountered in four cases in the form of pulmonary embolism, a large hematoma, postoperative bleeding, and colonic perforation. Laparoscopic nephrectomy is a safe and effective alternative to open nephrectomy for benign renal conditions.

Adolescent↗

PubMed1994

Laparoscopic radical nephrectomy for renal cell carcinoma: early experience.

We developed a laparoscopic radical nephrectomy for malignant disease of the kidney and successfully performed the operation in six patients between July 1992 and October 1993. This procedure is basically derived from that of Clayman and associates. A CO2 pneumoperitoneum is induced, and five trocars are introduced into the abdominal cavity through the lateral abdominal wall. The kidney is removed en bloc together with the adrenal gland, perirenal fatty tissue, and Gerota's fascia. The free kidney is put into a laparoscopy sack, and the sack is pulled out through a 5- to 6-cm incision in the abdominal wall without morcellation to allow complete pathologic examination. By this procedure, right nephrectomy was performed in four patients and left nephrectomy in two patients. The mean operative time was 6 hours and 13 minutes, and the mean blood loss was 430 mL. There were no severe complications. The average hospital stay was 11 days, and the average time to full convalescence was 21 days. Pathologic examination revealed renal cell carcinoma in five patients and nephroblastoma in one. Of the patients with renal cell carcinoma, the stage was pT1pN0pM0 in three patients and pT2pN0pM0 in two. There has been no recurrent disease in these six patients with a mean follow-up period of 9.5 months.

Adult↗

PubMed1998

Transperitoneal laparoscopic nephrectomy in children.

Over a 40-month period, 24 consecutive children (1-15 years) underwent laparoscopic nephrectomy. The indication for surgery was a poorly functioning kidney (<6% on DMSA isotope scanning) secondary to a variety of causes, with or without pain or infection. Four cannulas were used in each patient. The kidney was approached through a small incision in the upper paracolic gutter without mobilization of the colon. The procedure was successful in all but one child, who had conversion to open technique because of poor laparoscopic viewing. In 12 children who required nephroureterectomy, the distal ureter was approached by an open technique through either a small extension of the iliac fossa cannula site or a Pfannenstiel incision for combined bladder surgery. The average operating time for laparoscopy was 85 (range 40-160) minutes. The children undergoing nephrectomy or nephroureterectomy alone had an average hospital stay of 2 (range 1-4) days. There were no laparoscopic or surgical complications. Laparoscopy provides a safe and successful approach to pediatric nephrectomy. The technique combines well with an open approach to the distal ureter when nephroureterectomy is indicated.

Adolescent↗

PubMed1999

Retroperitoneoscopic approach to nephrectomy.

Laparoscopic management of a variety of renal diseases has assumed an increasingly important role as an alternative to open surgery. At many institutions, the transperitoneal approach has been the more commonly employed technique because it creates a larger working space and reveals easily recognized landmarks. At the Cleveland Clinic, however, laparoscopic simple nephrectomy for benign disease and laparoscopic radical nephrectomy for cancer are preferentially approached retroperitoneoscopically. Herein, we present our technique of retroperitoneal laparoscopic nephrectomy.

Humans↗