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PubMedDate not supplied

Renal venous renin ratio as a predictor of improvement in hypertension following nephrectomy for unilateral renal disease.

Renal venous renin ratio (RVRR) was measured in twenty hypertensive patients before removal of a kidney for unilateral, parenchymal renal disease. They were then followed for 1.3-9 y. Hypertension was cured or improved in six of eight patients with positive unstimulated and stimulated ratios, in none of five whose ratios became positive only on stimulation, and in one of seven with all ratios negative. Patients improved or cured by surgery had a significantly shorter duration of hypertension and a significantly lower serum creatinine after nephrectomy. Unstimulated RVRR was a reliable predictor of the effect of unilateral nephrectomy on blood pressure level.

Female↗
PubMed2006

Rhabdomyolysis following laparoscopic radical nephrectomy: a case to heighten awareness.

Rhabdomyolysis, myoglobinuria and acute renal failure are rare complication of surgery. Long operative time, increased body mass, lateral decubitus positioning and extracellular volume depletion may predispose to this condition. The authors describe the case of a 70-year-old man with renal cell carcinoma who underwent a laparoscopic right radical nephrectomy in the lateral decubitus position. His postoperative course was complicated by acute renal failure due to rhabdomyolysis. Heightened awareness, early recognition and treatment of this condition are important, particularly as laparoscopic nephrectomy is becoming a common procedure for living donor transplantation.

Aged↗
PubMed1982

Rapid restoration of injured kidney after immediate removal of opposite normal kidney. In comparison with delayed contralateral nephrectomy.

The difference in restoration of injured kidneys according to the time of contralateral nephrectomy was investigated in rats. When the opposite normal kidney was removed immediately or when both kidneys were rendered ischemic totally, the function of the injured kidney or kidneys was rapidly restored and showed almost normal level of blood urea nitrogen as well as normal histology one week after the ischemic damage. But delayed contralateral nephrectomy slowed down the speed of recovery, and the injured kidney did not function completely and showed severe inflammatory reaction in histology four weeks after the injury. It was discussed that retention of some factors like renal hypertrophy factor would cause rapid restoration of the damaged kidney.

Animals↗
PubMed1996

Acute thrombosis in a contralateral kidney after radical nephrectomy: successful treatment by thrombolytic therapy using a tissue-type plasminogen activator.

A 67-year-old male became anuric immediately after a right radical nephrectomy for renal cell carcinoma. The patient was diagnosed with an acute arterial thrombosis of the remaining kidney within 4 hours after surgery by both CT scan and angiography. Thrombolytic therapy was started by a transcatheteral infusion of tissue-type plasminogen activator (TPA) resulting in a complete recanalization. Hydration and systemic administration of heparin followed, and renal function recovered within 3 weeks. This is the first report of acute thrombosis in a contralateral renal artery immediately after a radical nephrectomy which was successfully treated with TPA. It is probable that compression of the contralateral renal artery by the retractor for an extended period of time during surgery led to this unfavorable condition.

Aged↗
PubMed1998

Laparoscopy-assisted radical nephrectomy for renal cell carcinoma in patients on long-term hemodialysis: report of 2 patients.

We successfully performed a laparoscopy-assisted radical nephrectomy for renal cell carcinoma in 2 patients on long-term hemodialysis. Both tumors were incidentally discovered on screening by abdominal CT scanning. There were no complications during the operation or in the postoperative period, and both patients resumed normal activities by the fifth postoperative day. A laparoscopic-assisted radical nephrectomy may be useful for the treatment of renal cell carcinoma in hemodialysis patients.

Adult↗
PubMed2004

Resection of local recurrence of renal cell carcinoma in a hemodialysis patient 6 years after radical nephrectomy.

Left radical nephrectomy was performed on a 39-year-old-man because of renal cell carcinoma (grade 1, clear cell and granular cell carcinoma: pT3b pN0 pM0), 6 years after the beginning of hemodialysis. The second surgical intervention for local recurrence was performed 6 years after the first operation (grade 2 > 3, clear cell and granular cell carcinoma). This is the second published case report of the resection of a local recurrence of renal cell carcinoma after nephrectomy in a hemodialysis patient. Even after the curative operation, follow up for local recurrence should be continued in hemodialysis patients, especially for high stage renal cell carcinoma.

Adult↗
PubMed2004

Early experience of laparoscopic radical nephrectomy for T3b renal cell carcinoma.

We report our experience with laparoscopic radical nephrectomy for a 79-year-old man who had renal cell carcinoma (RCC) with a renal vein thrombus. For the transaction of the renal vein with the thrombus, we used an endoscopic gastrointestinal anastomosis stapler. The operating time was 4 h and blood loss was 400 mL. The patient could walk and drink on the first postoperative day. He recovered normal activity 30 days postoperatively. There were no intraoperative and postoperative complications. The present report demonstrates the feasibility of laparoscopic radical nephrectomy in patients with T3b RCC who suffer from tumor thrombus in the renal vein.

Aged↗
PubMed2004

Solitary metastasis of renal cell carcinoma to the parotid gland 10 years after radical nephrectomy.

Renal cell carcinoma metastasis to the parotid gland after tumor nephrectomy is extremely rare. We report a case of solitary parotid metastasis from clear cell renal cell carcinoma in a 59-year-old woman, who presented 10 years after primary treatment. To our knowledge this is the first case in the published literature presenting with solitary parotid metastasis after such a long time. Superficial parotidectomy with preservation of the facial nerve was performed. One year after, the patient developed contralateral multiple kidney tumors and underwent left radical nephrectomy. She is currently on a dialysis program and no additional metastasis has been observed for 18 months.

Carcinoma, Renal Cell↗
PubMed2005

Hand-assisted laparoscopic and open living donor nephrectomy in Korea.

BACKGROUND: We compared the results of hand-assisted laparoscopic living donor nephrectomy (LLDN) and conventional open living donor nephrectomy (OLDN). METHODS: The clinical data on 49 hand-assisted LLDN and 21 OLDN on the left side performed at two institutions in Korea from January 2001 to February 2003 were reviewed. Demographic data of donors and recipients were similar in the two groups. RESULTS: There was one conversion to an open procedure due to bleeding in the LLDN group. The median operation times (180 min in LLDN versus 170 min in OLDN) and warm ischemic times (2.5 min in LLDN versus 2.0 min in OLDN) in the two groups were similar. The estimated mean blood loss, duration of hospital stay and complication rate was also similar in the two groups. The LLDN group reported less pain (visual analog scale) postoperatively (4.1 versus 5.3), but this was not significant (P=0.058). The time to oral intake in the LLDN group was significantly longer by an average of 1 day (P=0.001). Return to work was sooner in the LLDN group (4.0 weeks versus 6.0 weeks; P=0.026). The recipient graft function was equivalent between the two groups. Hand-assisted LLDN appears to be a safe and effective alternative to OLDN. CONCLUSION: Our findings suggest that this technique may give the ability provide grafts of similar quality to OLDN, while extending to the donors the advantages of a traditional LLDN procedure.

Adult↗
PubMed2005

Modified endoscopic live donor nephrectomy: retroperitoneoscopy followed by hand-assistance.

We have developed a novel modification of previous approaches to donor nephrectomy and herein review our original operative procedure. First, the posterior aspect of the kidney was dissected retroperitoneoscopically and dissection of the renal artery, ureter and gonadal vein was almost completed. Second, the anterior aspect of the kidney was dissected with transperitoneal hand-assistance, and dissection of the renal pedicle from the anterior surface was accomplished easily and safely. This operative procedure was successfully performed for two donors with no intraoperative or postoperative complications. Our modified endoscopic donor nephrectomy is feasible as a minimally invasive procedure because of its safety, and its ability to preserve renal function and establish an excellent operative field for both posterior and anterior aspects of the kidney.

Feasibility Studies↗
PubMed2006

Retroperitoneoscopic partial nephrectomy using radiofrequency ablation.

Two patients with renal tumors underwent retroperitoneoscopic partial nephrectomy. The renal tumors were initially treated with radiofrequency ablation. This method allowed tumor excision to be achieved without clamping the renal pedicle. Residual renal function was well maintained as determined by enhanced computed tomography scanning and measurement of the serum creatinine level. There were no complications such as vascular damage or collecting system injury. The pathological diagnosis was clear cell carcinoma (pT1) in Patient 1 and was not determined in Patient 2 because of entire ablation. No recurrence has been observed after 3 years and 2 years of follow up, respectively. Radiofrequency ablation was useful for control of local bleeding during retroperitonaoscopic partial nephrectomy.

Adenocarcinoma, Clear Cell↗
PubMed2006

Hand-assisted laparoscopic radical nephrectomy using intraoperative ultrasonography for left renal cell carcinoma involving a level I renal vein tumor thrombus.

This report concerns two male patients, 65 (case 1) and 72 (case 2) years old, with a left renal tumor involving a level I renal vein tumor thrombus, who underwent hand-assisted laparoscopic radical nephrectomy using intraoperative ultrasonography. With the patient in the flank position, a midline supraumbilical hand port and two other ports were placed. Intraoperative ultrasonography identified the extent of the tumor thrombus. After hilar control, complete resection with intact removal was performed. Surgery lasted 305 min for case 1 and 237 min for case 2, with respective estimated blood loss of 410 mL and 572 mL. No postoperative complications occurred. Pathological examination showed a clear cell carcinoma with a level I tumor thrombus and negative surgical margins. Because the ultrasound probe can be easily inserted and the specimen can be extracted safely and intact, hand-assisted laparoscopic radical nephrectomy is practicable and effective for left renal cell carcinoma involving a level I renal vein tumor thrombus.

Aged↗
PubMed1991

Do not catheterise your nephrectomies.

A retrospective study of 100 consecutive nephrectomy patients showed a 20% catheterisation rate. Of the 11 carried out post-operatively only 4 were for urinary retention. The post-operative catheterisation rate for males was 7.1% and for females 2%. The rate of post-operative retention was 4.4%, which is much lower than that reported from other units. This rate of post-operative catheterisation for retention is so low that in spite of the very mild increase in complications compared with intra-operative catheterisation, the practice of routine prophylactic catheterisation of nephrectomy patients is unnecessary and cannot be recommended.

Adolescent↗
PubMed1994

Laparoscopic nephrectomy for benign renal disease.

OBJECTIVE: To perform nephrectomies in patients with benign renal conditions using laparoscopic techniques. PATIENTS AND METHODS: A total of five patients with benign renal conditions were treated. Three of the patients were morbidly obese. The operative technique was similar to a transperitoneal nephrectomy and was performed through four to six abdominal ports. Initial dissection involved mobilization of the overlying right colon to expose the retroperitoneum. Early identification of the inferior vena cava and ureter was critical to subsequent dissection and particularly to the exposure of the renal vessels. These vessels were controlled by either Endo-GIA staples (Autosuture Co., USA) or vicryl ties and haemaclips prior to division. After control of the vascular pedicle the kidney was mobilized within Gerota's fascia and removed. RESULTS: In three patients the procedure was performed entirely laparoscopically with retrieval of the kidneys through dilated abdominal port sites. Small incisions were necessary in the remaining two patients--one with a grossly hydronephrotic kidney and the other, a morbidly obese woman with co-existing cholelithiasis, treated laparoscopically also had an epigastric hernia which was repaired using a 5 cm incision through which her kidney and gall-bladder were removed. Operative times ranged from 2 to 4 1/2 h. Narcotic analgesia was required in two cases and the median post-operative stay was 2 days. A superficial skin infection in one patient was the only post-operative complication. CONCLUSION: Laparoscopy appears to have a definite role in the selective removal of kidneys for benign renal disease. Based on our experience this technique is particularly useful in the obese patient--reducing post-operative pain and allowing early mobilization, discharge from hospital and resumption of normal activities.

Adult↗
PubMed2004

The use of a fibrin tissue sealant during laparoscopic partial nephrectomy.

OBJECTIVE: To assess the feasibility and efficacy of commercially available fibrin tissue sealant as a haemostatic agent and collecting-system sealant during hand-assisted laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODS: Fifteen consecutive patients underwent LPN for enhancing renal masses suspicious for renal cell carcinoma via a transperitoneal approach and with the use of a hand-assistance device. Monopolar electrocauterization and argon-beam coagulation were initially used to slow bleeding from the resection site. Through a laparoscopic applicator, Tisseel(TM) fibrin sealant (Baxter Inc., Deerfield, IL) was applied to the transected partial nephrectomy bed while the surgeon's hand maintained adequate compression and partial haemostasis. No further haemostatic measures were required in any patient; the patients were evaluated for acute and delayed bleeding or urinary extravasation. RESULTS: In all cases electrocauterization and argon-beam coagulation followed by the application of Tisseel was successful in obtaining strict haemostasis of the surgical bed, with no evidence of bleeding during or after surgery on immediate and extended follow-up. In addition, there was no evidence during or after surgery of any urinary leak. There were no immediate or delayed complications in any of the patients; a short-term outpatient follow-up (12-60 weeks) revealed no additional problems. CONCLUSIONS: Conventional haemostatic measures of electrocauteriztion and argon-beam coagulation combined with commercial fibrin sealant allows successful haemostasis during LPN. In addition to haemostatic properties, fibrin sealants appear to have sealing properties that may help to prevent complications of urinary leakage by helping to seal or close the small defects in the urinary collecting system. The use of this compound may facilitate the ability of the urological laparoscopist during LPN.

Adult↗
PubMed2004

Laparoscopic live-donor nephrectomy: modifications for developing nations.

OBJECTIVE: To describe modifications to laparoscopic live-donor nephrectomy (LLDN) to make it more cost-effective for developing countries; LLDN was developed as a better alternative to conventional donor nephrectomy, with advantages of an earlier return to normal activities and smaller scars, but is not popular in developing countries because of high cost of disposable items. PATIENTS AND METHODS: From January 2000 to January 2002, 148 LLDNs were performed, of which two used a hand-assisted technique, 17 the standard technique, 79 a modified laparoscopically assisted cost-saving approach and 50 by the modified technique. In the latter approach the kidney was delivered through a 6-8 cm anterior subcostal flank incision. In last 50 patients we further modified the technique, clipping the hilum using endoclips and delivering the kidney by holding the lateral pararenal fat through a 5 cm iliac fossa incision. RESULTS: The mean age, operative duration, warm ischaemia time, blood loss, analgesic requirements, pain score and hospital stay were comparable among the various techniques used. Re-exploration was required in four patients (bleeding in two, trocar-induced bowel injury in two). Immediate complications after surgery occurred in 20% of patients. Using endoclips, the cost was considerably reduced, from $400 to $290. The iliac fossa incision was aesthetically pleasing and more acceptable to patients. CONCLUSION: These modifications are relevant in the context of a developing nation, as they provide all the benefits of LLDN at reduced cost and with better cosmetic results.

Adult↗
PubMed2005

The impact of warm ischaemia on renal function after laparoscopic partial nephrectomy.

UNLABELLED: Authors from Cleveland assessed the impact of warm ischaemia on renal function, using their large database of laparoscopic partial nephrectomies for tumour. While agreeing that renal hilar clamping is essential for precise excision of the tumour, and other elements of the operation, the authors indicate that warm ischaemia may potentially damage the kidney. However, they found that there were virtually no clinical sequelae from warm ischaemic of up to 30 min. They also found that advancing age and pre-existing renal damage increased the risk of postoperative renal damage. OBJECTIVE: To assess the effect of warm ischaemia on renal function after laparoscopic partial nephrectomy (LPN) for tumour, and to evaluate the influence of various risk factors on renal function. PATIENTS AND METHODS: Data were analysed from 179 patients undergoing LPN for renal tumour under warm ischaemic conditions, with clamping of the renal artery and vein. Renal function was primarily evaluated in two groups of patients: 15 with tumour in a solitary kidney, who were evaluated by serial serum creatinine measurements; and 12 with two functioning kidneys undergoing unilateral LPN, and evaluated by renal scintigraphy before and 1 month after LPN to quantify differential renal function. Also, in all 179 patients, mean serum creatinine data at baseline, 1 day after LPN, at hospital discharge, and at the last follow-up were provided as supportive evidence. Logistic regression analyses were used to assess the effect of various risk factors on renal function after LPN, i.e. patient age, baseline serum creatinine, tumour size, solitary kidney status, duration of warm ischaemia, pelvicalyceal suture repair, urine output and intravenous fluids during LPN. RESULTS: In the group of patients with a solitary kidney the mean warm ischaemia time was 29 min, kidney parenchyma excised 29%, and serum creatinine at baseline, discharge, the peak after LPN and at the last follow-up (mean 4.8 months) 1.3, 2.3, 2.8, and 1.8 mg/dL, respectively. One patient (6.6%) required temporary dialysis. In the second group, assessed by renal scintigraphy, the function of the operated kidney was reduced by a mean of 29%, commensurate with the amount of parenchyma excised. For all 179 patients, a combination of age > or = 70 years and a serum creatinine level after LPN of > or = 1.5 mg/dL correlated with a higher serum creatinine after LPN. On logistic regression, baseline serum creatinine and solitary kidney status were the only variables significant for serum creatinine status after LPN. CONCLUSIONS: The bloodless field provided by renal hilar clamping is important for precise tumour excision, pelvicalyceal suture repair and securing parenchymal haemostasis during LPN. However, renal hilar clamping causes warm ischaemia. These data indicate that the clinical sequelae of warm ischaemic renal injury of approximately 30 min are minimal. Advancing age and pre-existing azotaemia increase the risk of renal dysfunction after LPN, especially when the warm ischaemia exceeds 30 min.

Adult↗