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At least 1,441 records · Page 80Linked to original sources

PubMed1984

Arteriovenous fistula after partial nephrectomy--successful surgical repair. Report of a case.

The postnephrectomy arteriovenous fistula is a very rare condition. There have been 49 cases reported in the world literature to date. Our case is the 50th of this series, and, to our knowledge, the first one following partial nephrectomy. Recurrence of the hypertension after nephrectomy, increasing heart failure, lumbar or upper abdominal bruit are the most characteristic clinical signs suggesting the presence of an arteriovenous communication. The basic diagnostic procedure is angiography. The proper surgical treatment is the separate ligature of the 2 vessels involved.

Adult↗

PubMed1998

Nephrectomy decreases amylin and pramlintide clearance in rats.

Amylin is a 37 amino acid hormone, co-secreted with insulin from the pancreatic beta-cell in response to nutrient stimuli. Because the human amylin analog, pramlintide, is being tested in patients with diabetes mellitus, a known risk factor for nephropathy, we examined the role of the kidney on amylin and pramlintide metabolism and action in functionally nephrectomized rats. Nephrectomy markedly altered amylin metabolism: it increased incremental area under the plasma amylin concentration curve 3.6-fold (P<0.001) and increased the elimination half-life from 17+/-1 to 26+/-2 minutes (P < 0.01) after subcutaneous injection of 100 microg amylin. Nephrectomy decreased plasma amylin clearance from 20.3+/-1.1 to 7.9+/-0.4 mL/min (P < 0.0001). Thus, at these doses in the rat, the kidney is important for metabolizing amylin and pramlintide.

Amyloid↗

PubMed1989

[Balloon catheter arterial occlusion before high-risk splenectomy and nephrectomy].

Balloon catheter occlusion of the splenic or renal artery was undertaken in 10 patients (7 men and 3 women, aged 20-76 years) 30 to 120 min before a splenectomy (n = 8) or nephrectomy (n = 2), for the purpose of preventing a high intra- and post-operative blood loss and facilitating the technical procedure of removing an often markedly enlarged spleen. The operation time after balloon catheter occlusion was only 60-140 min; intra- and post-operative complications did not occur, other than one instance of pneumonia and one of subcutaneous haematoma. This method would seem to be suitable for reducing the operative risk of splenectomy or nephrectomy in the presence of a giant spleen or reduced tolerance of operation.

Adult↗

PubMed1997

Compensatory renal growth post fetal nephrectomy in the rabbit.

Compensatory renal growth post-nephrectomy is well documented both clinically and experimentally. However, little is known about the capacity for compensatory growth in utero. We performed unilateral nephrectomy in fetal rabbits and studied the growth of the contralateral kidney. Thirty fetal rabbits underwent in utero uninephrectomies at day 25 of gestation. On gestational day 28, all the fetuses were delivered by cesarean section and the ratios kidney weight/body weight of the operated fetuses were compared to those of control littermates. The kidneys were then analysed by histology. A significant increase in renal weight was observed. The histological study of the remaining kidneys indicated a statistically significant increase of the glomerular area which confirmed the renal hypertrophy. This experiment demonstrates the capacity for the rabbit to develop in utero compensatory renal growth.

Animals↗

PubMed2001

Moyamoya disease complicated with renal artery stenosis and nephrotic syndrome: reversal of nephrotic syndrome after nephrectomy.

A 7-year-old boy with moyamoya disease developed sustained hypertension, nephrotic syndrome, hyperreninemia, and occlusion of the right renal artery. After right nephrectomy, hyperreninemia and hypertension improved. Proteinuria was resolved after nephrectomy, in parallel with the decrease in plasma renin activity. Moyamoya disease can cause nephrotic-range proteinuria, which is caused hemodynamically by hyperreninemia.

Child↗

PubMed1992

Living donor nephrectomy. Complication rates in 490 consecutive cases.

490 living donor nephrectomies were performed during a 25-year period, all through a retroperitoneal approach. In this report, short-term complications and donor renal function are analysed. There was no mortality. The major complication rate was 1.4%. There were 5 cases of postoperative haemorrhage requiring reoperation, one of which developed non-A-non-B hepatitis. There was one case each of septicemia and pulmonary embolism. All these patients recovered. Minor complications were noted in 13.6% of the cases, mostly bacteriuria or minor pulmonary infiltrates. There were 5 cases of reversible heart disorders and 6 cases of mental disorders. After 6-12 months, all donors had satisfactory function of the remaining kidney, which had increased its GFR by 32-38%. We conclude that the short-term consequences of donor nephrectomy are acceptable. From previous reports, from this unit and from others, it is evident that the procedure does not carry any definite long-term health risks. With a permanent shortage of cadaveric organs and with continued superiority in the outcome of living donor transplantations, this important resource should not be disregarded.

Adolescent↗

PubMed1992

Fatal outcome of bilateral nephrectomy in a patient with polycystic kidney disease. Case report.

A 49-year-old woman had polycystic kidneys and liver cysts first diagnosed in 1968. She presented with hepatic and renal failure in 1980 and by 1988 was undergoing regular haemodialysis. In February 1989 she had bilateral nephrectomy (before renal transplantation) but developed septic shock and died. The reported mortality of bilateral nephrectomy before kidney transplantation is about 5%, and patients should be carefully selected and assessed before operation.

Abscess↗

PubMed1991

Renal accumulation and intrarenal distribution of inorganic mercury in the rabbit: effect of unilateral nephrectomy and dose of mercuric chloride.

The effects of unilateral nephrectomy and dose of mercuric chloride on the short-term renal accumulation and intrarenal distribution of inorganic mercury were studied in the rabbit. The renal accumulation of inorganic mercury, on a per gram basis, was increased in uninephrectomized (NPX) rabbits compared with that in sham-operated (SO) rabbits 24 h after the animals received either a nontoxic 2.0 mumol/kg or nephrotoxic 4.0 mumol/kg dose of mercuric chloride. In the NPX rabbits given the 2.0 mumol/kg dose of mercuric chloride, the increased accumulation of inorganic mercury was due to increased accumulation of mercury in the outer stripe of the outer medulla. In the NPX rabbits given the 4.0 mumol/kg dose of mercuric chloride, the increased renal accumulation of mercury appeared to be due to increased accumulation of mercury in both the renal cortex and outer stripe of the outer medulla. Interestingly, no differences in the renal accumulation of inorganic mercury were found between NPX and SO rabbits given a low nontoxic 0.5 mumol/kg dose of mercuric chloride. As the dose of mercuric chloride was increased from 0.5 to 4.0 mumol/kg, the percent of the administered dose of mercury that accumulated in each gram of renal tissue decreased substantially. The findings in the present study indicate that the renal accumulation of inorganic mercury increases after unilateral nephrectomy when certain nontoxic and nephrotoxic doses of mercuric chloride are administered. In addition, they indicate that the percent of the administered dose of mercury that accumulates in the renal tissue of both NPX and SO rabbits decreases as the dose of mercuric chloride is increased.

Animals↗

PubMed2001

Retroperitoneoscopic radical nephrectomy by the posterior lumber approach for renal-cell carcinoma associated with chronic renal failure.

PURPOSE: To evaluate the efficacy and invasiveness of retroperitoneoscopic radical nephrectomy for renal-cell carcinoma (RCC) in patients with chronic renal failure (CRF), a group known to have relatively high surgical risk. PATIENTS AND METHODS: Between May 1996 and September 1999, six CRF patients maintained on hemodialysis underwent retroperitoneoscopic radical nephrectomy for clinically localized RCC by the posterior lumber approach. The excised kidneys were evacuated via a posterior skin incision (5 cm) between two port sites; the muscle layers were not incised. RESULTS: The procedure was completed in all patients with no major complications. The mean operative time was 162 (range 135-210) minutes, and the estimated blood loss was 58 (15-100) mL; none of the patients required a blood transfusion. Regular hemodialysis was restarted on postoperative day 2 or 3. CONCLUSIONS: This procedure seems to be minimally invasive and suitable for the treatment of small RCC in atrophic kidneys, especially in patients with CRF.

Atrophy↗

PubMed2002

Specimen morcellation after laparoscopic radical nephrectomy: confirmation of histologic diagnosis using needle biopsy.

BACKGROUND AND PURPOSE: Laparoscopic radical nephrectomy (LRN) is being increasingly offered for the management of renal-cell carcinoma (RCC). Specimen removal may be performed through a small or hand-port incision or by specimen morcellation. Limited studies exist addressing the accuracy of histopathologic diagnosis in morcellated renal tumors. Because of concerns about the lack of a diagnosis secondary to the morcellation process, we performed premorcellation needle biopsies to obtain nondisrupted tissue for pathologic analysis. Herein, we compare the histopathologic diagnosis achieved via needle biopsy prior to morcellation with that of the final specimen. PATIENTS AND METHODS: Following successful laparoscopic resection, specimens were entrapped in a Lapsac. Needle biopsies were performed manually through the mouth of the Lapsac, and morcellation was then done in some patients using manual and mechanical methods. The histopathologic diagnoses in the needle biopsy specimens and the morcellated material were compared. RESULTS: Laparoscopic radical nephrectomy with specimen morcellation was performed in 15 patients. Nine patients had premorcellation needle biopsies. Eight of these biopsies had sufficient tissue for diagnosis of RCC. This finding correlated with final diagnosis from the morcellated material. Perinephric fat invasion was identified in three morcellated specimens. CONCLUSIONS: Needle biopsy prior to specimen morcellation confirmed the histologic diagnosis of the morcellated specimen. This finding suggests that such histopathology material is adequate for diagnosis and may make premorcellation needle biopsy redundant.

Biopsy, Needle↗

PubMed2003

Feasibility of laparoscopic partial nephrectomy using pledgeted compression sutures for hemostasis.

PURPOSE: To develop a technique for laparoscopic partial nephrectomy (LPN) without the use of hilar occlusion that allows large renal resection and excellent hemostasis. MATERIALS AND METHODS: Five female domestic pigs underwent right laparoscopic transperitoneal lower-pole partial nephrectomy after placement of pledgeted parenchymal compression sutures tied intracorporeally to induce regional renal hypoperfusion. Postoperatively, serial serum creatinine measurements were obtained to monitor renal function. The pigs were allowed to recover and 2 weeks later underwent an identical procedure on the left side. The animals were sacrificed after the second procedure, and both renal units were removed for ex vivo retrograde urograms and histologic analysis. RESULTS: The median operative time was 154.5 minutes (range 110-305 minutes), and the median blood loss was 137.5 mL (range 100-300 mL). On average, 35% (range 31%-36.8%) of the kidney was resected. All cases required use of adjunctive hemostatic clips to control bleeding from central vessels. All animals survived 2 weeks and had no evidence of urinary extravasation clinically or on ex vivo retrograde urograms. CONCLUSIONS: In the porcine model, LPN with placement of pledgeted sutures allows resection of large renal segments, although technical refinements are required to improve hemostasis. Currently, the need for adjunctive hemostatic measures limits the initial clinical application of this technique to small, exophytic tumors.

Animals↗

PubMed2004

Hand-assisted laparoscopic partial nephrectomy.

The resurgence of nephron-sparing surgery for selected renal masses has fueled interest in minimally invasive approaches. Several authors have shown that laparoscopic partial nephrectomy is feasible if two goals are met: resection of the mass with negative margins and control of bleeding. The latter is a particular challenge, but numerous options are available. The authors describe the operative technique and the available results of hand-assisted laparoscopic partial nephrectomy.

Humans↗

PubMed2004

Donor nephrectomy in the era of hand-assisted laparoscopic urologic surgery.

Living-donor nephrectomy has traditionally been performed through a flank incision with or without rib resection or by an anterior extraperitoneal incision, both of which reduce the willingness of potential donors to undergo the procedure. The first successful human laparoscopic donor nephrectomy was reported in 1995. In order to reduce warm ischemia and operative time and to make the operation safer and easier, some laparoscopic surgeons have used hand assistance. The authors describe their technique for this operation and review the results.

Equipment Design↗

PubMed2004

Retroperitoneoscopic living-donor nephrectomy: first clinical experiences in 19 operations.

The wish for a minimally invasive procedure is one of the utmost demands by all persons undergoing living-donor nephrectomies. The retroperitoneoscopic access for this procedure has proven to be a safe, minimally invasive, and efficient approach accompanied by early mobilization and a fast return to general daily activities. The incidence of complications during and after this technically demanding operation is comparable to that of other approaches. Because of the direct anatomic approach, retroperitoneoscopic living-donor nephrectomy has become the preferred access at our institution for both donors and surgeons.

Adult↗

PubMed1993

Retroperitoneal laparoscopic nephrectomy: laboratory and clinical experience.

Laparoscopic nephrectomy using an entirely retroperitoneal approach was performed in six anesthetized female pigs. In each animal, the kidney was localized using fluoroscopy, following which the retroperitoneum was insufflated with CO2. Subsequently, a retroperitoneal laparoscopic nephrectomy was performed in a 48-year-old man with a chronically obstructed, nonfunctioning kidney. Although the retroperitoneal approach provides excellent exposure for the dissection of the renal hilum, anatomic factors in the human limit port placement and organ entrapment and increase the risk for development of a pneumothorax.

Animals↗

PubMed1995

Adhesion formation after transperitoneal nephrectomy: laparoscopic v open approach.

The risk of postoperative adhesion formation is a significant concern with transperitoneal laparoscopic surgery. To evaluate the incidence of adhesions after major interventional urologic laparoscopy, 16 pigs underwent either laparoscopic (N = 8) or transperitoneal open (N = 8) nephrectomy. Adhesions occurred at 12.5% of the operative sites in the laparoscopic group compared with 75% of the operative sites of the open group. Adhesions were present along the incision site in all the pigs in the open group compared with 5 of 40 (12.5%) trocar sites in the laparoscopic group. Adhesion number, grade, and extent were significantly greater in the open group than the laparoscopic group for both nephrectomy and access (incision/trocar) sites (p < 0.05). Transperitoneal laparoscopic urologic surgery in the porcine model results in a marked decrease in adhesion formation compared with incisional transabdominal surgery.

Abdominal Muscles↗

PubMed1997

Laparoscopic nephrectomy using the harmonic scalpel.

Laparoscopic nephrectomy is gaining popularity. Improved instrumentation is making surgery easier with fewer complications. Our first three laparoscopic nephrectomies using the Harmonic Scalpel were performed on two women and one man. The surgical indications were nonfunctioning kidneys (two left, one right) with hypertension in one patient and stone disease in two. The three patients had a mean age of 46.3 years. The average hospital stay was 4 days, the average operative time 3.7 hours, and the average blood loss 160 mL. No complications occurred. Patients resumed oral intake within 8 hours postoperatively. We found the Harmonic Scalpel easy and safe to use. It saved time, was cost effective, and was capable of easily controlling small-vessel bleeding. In conclusion, the Harmonic Scalpel could be used effectively for both dissection and bleeding control without suction or other instrumentation.

Equipment Design↗

PubMed1997

Gasless laparoscopy-assisted partial nephrectomy for a complicated cystic lesion: case report.

We performed laparoscopy-assisted partial nephrectomy for a calcified cystic lesion of the kidney. This new technique combines the merits of laparoscopic and conventional open surgery. Although our method leaves a slightly larger scar than laparoscopic surgery, suturing of the cut renal parenchymal margin is easy, and CO2 pneumoperitoneum is not needed. In addition, if the frozen section reveals malignancy, it is easy to change the procedure to radical nephrectomy without making another incision. This new method may be useful for various renal lesions, as well as for surgery on the abdominal organs.

Angiography↗