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Martinez-Esteban A, Barron-Cervantes NM, Fuentes-Calvo KJ, Arechavala-Lopez SF, Ramos-Carpinteyro R, Cendejas-Gomez JJ, Méndez-Probst CE. Comparison of Intraoperative Results of Simple Open and Laparoscopic Nephrectomies in the Treatment of Benign Renal Pathologies in a First-Level Center in Mexico City. Cureus 2024; 16:e68142. [PMID: 39347242 PMCID: PMC11438502 DOI: 10.7759/cureus.68142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVES To assess the efficacy and safety of simple open versus laparoscopic nephrectomies for treating benign renal pathologies, with a focus on comparing the prevalence of surgical complications at a first-level center in Mexico City. METHODS A retrospective analysis spanning 2010-2020 was conducted where all patients undergoing simple nephrectomy for benign conditions were included and stratified into open and laparoscopic surgery groups. Variables analyzed included urological history, laboratory findings, surgical outcomes, complications, and histopathological results. Statistical comparisons employed Student's t-test for means and the chi-square test for frequencies. Additionally, binary logistic regression was utilized to identify predictors associated with conversion from laparoscopic to open surgery. RESULTS The laparoscopic approach showed significant advantages in intraoperative bleeding (p=0.008) and intensive care unit stay (p=0.04). The conversion rate from laparoscopic to open surgery was 19.23%, with no significant risk factors identified for conversion. CONCLUSIONS Laparoscopic simple nephrectomy proves to be a secure and effective method in specialized urological centers with skilled surgeons, offering superior intraoperative outcomes compared to open surgery. It effectively reduces intraoperative hemorrhage, minimizes blood transfusion needs, and shortens hospital stays. Nonetheless, challenges such as equipment availability, costs, and surgeon expertise must be addressed. Further research focused on postoperative complications is crucial to advocate for broader adoption of laparoscopic nephrectomy as the preferred standard for treating relevant urological conditions, emphasizing substantial advantages over traditional open approaches.
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Affiliation(s)
| | | | - Kevin J Fuentes-Calvo
- General and Gastrointestinal Surgery Service, Fundacion Clinica Medica Sur, Mexico City, MEX
| | - Sara F Arechavala-Lopez
- General and Gastrointestinal Surgery Service, Fundacion Clinica Medica Sur, Mexico City, MEX
| | | | - J Jesus Cendejas-Gomez
- Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MEX
| | - Carlos E Méndez-Probst
- Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MEX
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Kannan D, Penchala Reddy N, Paneerselvam A, Paul R, Thangarasu M, Rengan V, Jain N. Laparoscopic Retrograde Nephrectomy as a Troubleshooting Technique to Prevent Open Conversion: The Technique Description With a Review of 40 Cases. Cureus 2024; 16:e61482. [PMID: 38952611 PMCID: PMC11216113 DOI: 10.7759/cureus.61482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
Introduction Laparoscopic nephrectomies are safe, with low complication rates in skilled hands. However, traditional approaches may be unsuitable for conditions such as post-renal abscesses, long-standing urinomas, non-functioning kidneys post-pyeloplasty, pyelolithotomies, post-partial nephrectomy recurrences, tuberculous kidneys, pyelonephritis, and redo-renal surgeries. This study describes a modified retrograde nephrectomy technique and its outcomes in 40 cases. Methods We reviewed 40 cases where the retrograde nephrectomy technique was used. Surgeons opted for this method based on intraoperative findings and initial difficulties in accessing the lower pole area. Results Traditional dissection was challenging due to adhesions in the lower pole. The retrograde technique, starting from the renal hilum, allowed early ligation of renal arteries and veins, reducing bleeding risks and facilitating safer caudal dissection. Conclusions The retrograde nephrectomy technique offers a safer and more efficient alternative for complex nephrectomies. Early vascular control minimizes hemorrhage risk, making it a valuable method in challenging renal surgeries.
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Dung LT, Vu LN, Sy TV, Phuong TH, Khai NV, Hai DX, Nghia NQ. Right lumbar lymph trunk injury after right laparoscopic donor nephrectomy: a case report. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:124-128. [PMID: 37435143 PMCID: PMC10332277 DOI: 10.4285/kjt.23.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 07/13/2023] Open
Abstract
Laparoscopic donor nephrectomy (LDN) is increasingly popular because of its advantages over open surgery. Chyle leak after donor nephrectomy is a rare but potentially lethal complication if not treated appropriately. We describe a case of a 43-year-old female patient with no remarkable history who presented a chyle leak on day 2 after right transperitoneal LDN. Since conservative treatment failed, the patient underwent magnetic resonance imaging (MRI) and intranodal lipiodol lymphangiography, which confirmed the chyle leak from the right lumbar lymph trunk into the right renal fossa. The chyle leak was percutaneously embolized twice, on postoperative day (POD) 5 and POD 10, by a mixture of N-butyl-2-cyanoacrylate and lipiodol. The drainage fluid decreased significantly after the second embolization. The subhepatic drainage tube was withdrawn on POD 14, and the patient was discharged on POD 17. MRI lymphangiography and intranodal lipiodol lymphangiography effectively identified the chyle leak point. Percutaneous embolization seems to be a safe, effective method for treating high-output chyle leaks.
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Affiliation(s)
- Le Thanh Dung
- Department of Radiology, Viet Duc University Hospital, Hanoi, Vietnam
- Department of Radiology, University of Medicine and Pharmacy (VNU-UMP), Vietnam National University, Hanoi, Vietnam
| | - Le Nguyen Vu
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
- Department of Urology, University of Medicine and Pharmacy (VNU-UMP), Vietnam National University, Hanoi, Vietnam
| | - Than Van Sy
- Department of Radiology, Viet Duc University Hospital, Hanoi, Vietnam
| | - Tran Ha Phuong
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Ninh Viet Khai
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Dao Xuan Hai
- Department of Radiology, Viet Duc University Hospital, Hanoi, Vietnam
| | - Nguyen Quang Nghia
- Organ Transplantation Center, Viet Duc University Hospital, Hanoi, Vietnam
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Masoud M, Ibrahim A, Elemam A, Elatreisy A, Noureldin Y, Aubé M, Fahmy N. Learning curve of laparoscopic nephrectomy: a prospective pilot study. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00024-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Learning curve of laparoscopic nephrectomy (LN) is mainly affected by two main factors: plotting performance and experience. However, there is paucity in the literature addressing the number of cases required to adopt LN. Herein, we aimed to assess the learning curve of LN for various renal disorders and number of cases required to adopt the technique. Between September 2015 and December 2017, consecutive patients undergoing LN for various renal diseases were enrolled in this study. Patients were divided into two groups, the first 20 cases (group A) and subsequent 20 cases (group B). All procedures were performed by a single trainee urologist under supervision of an expert endourologist. Learning curve was assessed using operative time and incidence of complications.
Results
A total of 40 patients were included in this pilot clinical study. Mean age was 38.2 ± 16.3 years. The mean operative time for patients in group B was significantly lower than the mean operative time for patients in group A (108.5 vs. 139.3 min, p < 0.05). However, there were no significant differences between both groups in terms of intraoperative blood loss (86 vs. 104 ml; p = 0.081), conversion to open surgery (5% vs. 10%; p = 0.256) and postoperative complications (5% vs. 15%; p = 0.09) for group B and group A, respectively. Similarly, there was no significant difference between both groups in terms of hospital stay (42 ± 8 vs. 46 ± 11 h p = 0.01). The trainee surgeon reached a plateau after 22 cases.
Conclusions
Our study suggests that a minimum of 22 LN procedures are needed in order to adopt the technique of laparoscopic nephrectomy. Learning curve of LN is mainly affected by number of performed procedures within a short period of time.
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Walker A, Slim N, Nicholson M, Brassett C. Configuration of the extra-renal venous system in relation to the left renal vein: A cadaveric study and new proposed classification. Surgeon 2020; 18:349-353. [PMID: 32089372 DOI: 10.1016/j.surge.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/14/2020] [Indexed: 11/18/2022]
Abstract
The advent of laparoscopic live-donor nephrectomy for renal transplantation has prompted the need to define the precise anatomical relations of the left renal vein (LRV) and its tributaries. The left kidney is preferred as the greater length of the LRV facilitates implantation in the recipient. While previous studies have described variations in the LRV system, the connections between the left ascending lumbar vein (LALV) and LRV tributaries have been less well-defined. This study aims to further characterise the LALV and proposes a novel classification for its relation to other veins. Dissection of the LRV system, including the left suprarenal vein (LSV), left gonadal vein (LGV) and LALV, was performed in 38 cadavers. Their drainage points into the LRV were recorded, and measurements taken of the distances from these points to the junction of the LRV and inferior vena cava (IVC). The position of the LRV in relation to the aorta was anterior in 35 cases (92%), entirely posterior in 1 case (3%), and circumaortic in 2 cases (5%). Duplication of the LSV and LGV occurred in 6 (16%) and 10 (27%) cases respectively. A direct posterior connection between the LALV and LRV was identified in 32 (86%) cases. The drainage point of the LALV into the LRV lay between the IVC and LGV in 8 (25%) cases. In 20 cases (63%), the drainage points of the LALV and LGV were equidistant from the IVC; and in 5 cases (16%), those of the LALV and posterior branch of the LRV were equidistant from the IVC. In these two groups, the vessels shared a confluent trunk in 10 and 4 cases respectively. In 3 cases, connections were observed between all three vessels (LALV, LGV and posterior branch of LRV). No confluence trunk was shared by the LALV and LSV. These results confirm the high incidence of communicating LALVs, which represent a potentially troublesome source of operative bleeding if unrecognised. Confluent venous trunks may also present difficulties during vessel ligation prior to nephrectomy. It is suggested that a novel classification of the relation of the LALV based on these findings may assist in surgical planning and reduce complications.
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Affiliation(s)
- Alexander Walker
- Department of Surgery, University of Cambridge, Cambridge, UK; Human Anatomy Teaching Group, Department of Physiology, Development and Neurosciences, University of Cambridge, Cambridge, UK.
| | - Naim Slim
- Human Anatomy Teaching Group, Department of Physiology, Development and Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Cecilia Brassett
- Human Anatomy Teaching Group, Department of Physiology, Development and Neurosciences, University of Cambridge, Cambridge, UK
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Wang B, Tian Y, Peng Y, Ban Y, Shan G, Tan X, Tang X, Luo G, Sun Z. Comparative Study of Retroperitoneal Laparoscopic Versus Open Ipsilateral Nephrectomy After Percutaneous Nephrostomy: A Multicenter Analysis. J Laparoendosc Adv Surg Tech A 2020; 30:520-524. [PMID: 32027216 DOI: 10.1089/lap.2019.0746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: To investigate the feasibility of retroperitoneal laparoscopic ipsilateral nephrectomy of a benign nonfunctional kidney after percutaneous nephrostomy, and to compare this method with open surgery. Materials and Methods: Data from 70 patients who underwent simple nephrectomy from January 2014 to October 2018 at three large centers were retrospectively analyzed. All patients underwent percutaneous nephrostomy because of renal or ureteral calculi with severe hydronephrosis or pyonephrosis. Simple nephrectomy was performed via retroperitoneal laparoscopic surgery (retroperitoneal laparoscopic group; n = 33) or open surgery (open group; n = 37). The retroperitoneal laparoscopic and open groups were compared regarding preoperative variables (age, sex, location of surgery, hypertension, diabetes, BMI, preoperative serum creatinine level, American Society of Anesthesiologists (ASA) grade, fistula duration, fistula size, number of fistulae, and urinary tract infection), and perioperative variables (operation time, intraoperative blood loss, postoperative drainage volume, catheter indwelling time, gastrointestinal function recovery time, duration of bedrest, duration of postoperative hospitalization, postoperative hemoglobin decline, perioperative transfusion, and postoperative complications). Results: The retroperitoneal laparoscopic group included more patients with hydronephrosis, while the open group included more patients with pyonephrosis. There were no significant differences between the two groups in age (P = .813), sex (P = .729), location of surgery (P = .345), hypertension (P = .271), diabetes (P = .394), BMI (P = .798), preoperative serum creatinine level (P = .826), ASA grade (P = .820), fistula duration (P = .108), fistula size (P = .958), number of fistulae (P = .925), urinary tract infection (P = .111), or operative time (P = .851). The retroperitoneal laparoscopic group had significantly lesser intraoperative blood loss (P = .007), postoperative drainage volume (P = .008), shorter catheter indwelling time (P = .002), gastrointestinal function recovery time (P < .001), duration of bedrest (P < .001), and duration of postoperative hospitalization (P < .001), and lesser postoperative hemoglobin decline (P = .035) compared with the open group. Conclusions: Retroperitoneal laparoscopic ipsilateral nephrectomy is feasible for a benign nonfunctional kidney after percutaneous nephrostomy. The surgical method should be selected based on the surgeon's experience and the specific situation of the patient.
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Affiliation(s)
- Bo Wang
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Ye Tian
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Yue Peng
- Department of Nephrology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, P.R. China
| | - Yong Ban
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Gang Shan
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Xianyu Tan
- Department of Orthopedics, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, P.R. China
| | - Xiaohu Tang
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Guangheng Luo
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Zhaolin Sun
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
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Demirdağ Ç, Çitgez S, Öbek C. Clavien System Classification of Complications Developed following Laparoscopic Urological Operations Applied in our Clinic. SISLI ETFAL HASTANESI TIP BULTENI 2019; 53:228-239. [PMID: 32377088 PMCID: PMC7192280 DOI: 10.14744/semb.2018.98700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/28/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We analyzed the complications of laparoscopic surgery using Clavien system classification on 396 urological procedures performed at our institution between 2005-2009. METHODS A retrospective analysis was performed, focusing on complications associated with 396 laparoscopic surgeries performed between 2005 and 2009, which included radical and simple nephrectomy (n=188), partial nephrectomy (n=29), pyeloplasty (n=78), sacrocolpopexy (n=16) and radical prostatectomy (n=85). Complication data were tabulated according to the case number, procedure type, patient age, the American Society of Anesthesiologists score (ASA), Clavien classification system and annual complication rate during this study. Statistical analysis was performed with Fisher's exact and chi-square tests. RESULTS A total of 75 patients had complications during the study period. Thus, the total postoperative complication rate was 18.9%. When sub-stratified to various surgical procedures, complication rates were: laparoscopic radical and simple nephrectomy (11.1%), laparoscopic partial nephrectomy (37.9%), laparoscopic pyeloplasty (15.3%), laparoscopic sacrocolpopexy (18.7%) and laparoscopic radical prostatectomy (32.9%). When the complications were classified according to Clavien Classification System stage 1, 2, 3, 4, 5, complication rate was observed in 11.6%, 13.8%, 1.2%, 1%, and 0% of patients, respectively. A correlation was not identified between ASA score and complication rate (p=0.02). CONCLUSION The data presented here would enable us to compare our complication rates objectively with world literature.
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Affiliation(s)
- Çetin Demirdağ
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Sinharib Çitgez
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Can Öbek
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Gunn AJ, Patel AR, Rais-Bahrami S. Role of Angio-Embolization for Renal Cell Carcinoma. Curr Urol Rep 2018; 19:76. [DOI: 10.1007/s11934-018-0827-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Al-Qudah HS, Rodriguez AR, Sexton WJ. Laparoscopic Management of Kidney Cancer: Updated Review. Cancer Control 2017; 14:218-30. [PMID: 17615527 DOI: 10.1177/107327480701400304] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Laparoscopy has emerged as the preferred option for the surgical management of kidney cancer. Although many reports have been published regarding the operative outcome of renal cell carcinoma (RCC) and upper-tract transitional cell carcinoma (TCCA) treated laparoscopically, few review the oncologic outcome of these pathologies treated with laparoscopic techniques. METHODS We review the literature regarding the laparoscopic approaches, the complications related to laparoscopic surgery, and the long-term oncologic results of laparoscopic radical nephrectomy, partial nephrectomy, and nephroureterectomy. RESULTS Laparoscopic radical nephrectomy has become the new standard of care for most patients with suspected RCCs that are not amenable to nephron-sparing procedures. Laparoscopic techniques for managing RCC and TCCA are safe, follow well-established guidelines for surgical dissection, and meet or exceed perioperative convalescence and oncologic outcomes compared to traditional open procedures. The surgical techniques and the long-term outcome data for laparoscopic partial nephrectomy continue to mature. CONCLUSIONS Laparoscopy is a minimally invasive option available to most patients with kidney cancer. The immediate benefits of laparoscopy are well established and include less estimated blood loss, decreased pain, shorter perioperative convalescence, and improved cosmesis. Long-term oncologic outcomes of patients treated laparoscopically for kidney tumors resemble those of the open surgical approach.
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Affiliation(s)
- Hosam S Al-Qudah
- Genitourinary Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Laparoscopic heminephroureterectomy for urothelial carcinoma in a horseshoe kidney. FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Transmesenteric small bowel herniation causing intestinal obstruction following laparoscopic transperitoneal nephrectomy. FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lai WS, Rais-Bahrami S. Safety and Efficacy of En Bloc Renal Hilar Vascular Staple Ligation: A Meta-Analysis. J Urol 2016; 197:175-181. [PMID: 27457261 DOI: 10.1016/j.juro.2016.07.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE We reviewed the literature on the safety of en bloc ligation. We also performed a meta-analysis of the effect of using this technique with vascular staplers on perioperative factors compared to conventional renal pedicle dissection and isolated staple ligation of the renal artery and vein. MATERIALS AND METHODS A literature search was performed to include all primary studies related to the safety of en bloc ligation of the renal hilum. After exclusion criteria were applied 9 studies were identified for review, of which 4 included a control group and were used in the meta-analysis. The primary end point was the incidence of arteriovenous fistula. Secondary end points were procedure duration, blood loss and the number of perioperative complications. RESULTS None of the total population of 595 patients in whom en bloc ligation was performed for nephrectomy were diagnosed with arteriovenous fistula formation at an average postoperative followup of 26.5 months. When comparing en bloc and isolated ligation of the renal artery and vein, the meta-analysis showed a significant improvement in procedure duration for en bloc nephrectomy. There was no difference in estimated blood loss or the number of complications. CONCLUSION En bloc ligation appears to be as safe as and potentially more beneficial in terms of perioperative factors than conventional renal pedicle dissection and isolated vascular ligation.
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Affiliation(s)
- Win Shun Lai
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
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Kim BS, Kwon TG. Chylous ascites in laparoscopic renal surgery: Where do we stand? World J Clin Urol 2016; 5:37-44. [DOI: 10.5410/wjcu.v5.i1.37] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/30/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023] Open
Abstract
Postoperative chylous ascites, which is caused by the disruption of lymphatic channels and persistent lymphatic leakage, was a rare complication in the urologic field before laparoscopic surgery was introduced. Now that laparoscopic urologic surgery, especially laparoscopic nephrectomy, is widely performed, chylous ascites as a complication of laparoscopic renal surgery has been reported more frequently. With these accumulated experiences and data comes knowledge about the proper diagnosis and management of chylous ascites, although there is still some debate regarding the correct protocol for diagnosis and management. Therefore, we performed a systematic review of the current literature regarding the etiology, incidence, diagnosis, management, and prognosis of chylous ascites after laparoscopic renal surgery, as well as strategies used to prevent it, and discuss current perspectives on overcoming this complication in the laparoscopic age.
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Mohtashami F, Thiele A, Karreman E, Thiel J. Comparing technical dexterity of sleep-deprived versus intoxicated surgeons. JSLS 2016; 18:JSLS-D-14-00142. [PMID: 25408601 PMCID: PMC4232403 DOI: 10.4293/jsls.2014.00142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The evidence on the effect of sleep deprivation on the cognitive and motor skills of physicians in training is sparse and conflicting, and the evidence is nonexistent on surgeons in practice. Work-hour limitations based on these data have contributed to challenges in the quality of surgical education under the apprentice model, and as a result there is an increasing focus on competency-based education. Whereas the effects of alcohol intoxication on psychometric performance are well studied in many professions, the effects on performance in surgery are not well documented. To study the effects of sleep deprivation on the surgical performance of surgeons, we compared simulated the laparoscopic skills of staff gynecologists “under 2 conditions”: sleep deprivation and ethanol intoxication. We hypothesized that the performance of unconsciously competent surgeons does not deteriorate postcall as it does under the influence of alcohol. Methods: Nine experienced staff gynecologists performed 3 laparoscopic tasks in increasing order of difficulty (cup drop, rope passing, pegboard exchange) on a box trainer while sleep deprived (<3 hours in 24 hours) and subsequently when legally intoxicated (>0.08 mg/mL blood alcohol concentration). Three expert laparoscopic surgeons scored the anonymous clips online using Global Objective Assessment of Laparoscopic Skills criteria: depth perception, bimanual dexterity, and efficiency. Data were analyzed by a mixed-design analysis of variance. Results: There were large differences in mean performance between the tasks. With increasing task difficulty, mean scores became significantly (P < .05) poorer. For the easy tasks, the scores for sleep-deprived and intoxicated participants were similar for all variables except time. Surprisingly, participants took less time to complete the easy tasks when intoxicated. However, the most difficult task took less time but was performed significantly worse compared with being sleep deprived. Notably, the evaluators did not recognize a lack of competence for the easier tasks when intoxicated; incompetence surfaced only in the most difficult task. Conclusions: Being intoxicated hinders the performance of more difficult simulated laparoscopic tasks than being sleep deprived, yet surgeons were faster and performed better on simple tasks when intoxicated.
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Affiliation(s)
- Fariba Mohtashami
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Saskatchewan, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
| | - Allison Thiele
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Saskatchewan, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
| | - Erwin Karreman
- Department of Academic Family Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - John Thiel
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Saskatchewan, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
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Abstract
Nephrectomy is, perhaps, one of the techniques in which laparoscopic approach has been widely used. It has quickly evolved since Clayman introduced it in 1990 with a renal tumor. Since then, its goodness has been extrapolated to most entities that require surgical removal of the kidney. We review the current most discussed aspects referred to the main laparoscopic nephrectomy techniques (simple nephrectomy, nephroureterectomy, radical, and nephron-sparing nephrectomy) and particularities of this approach.
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16
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Patton MW, Salevitz DA, Tyson MD, Andrews PE, Ferrigni EN, Nateras RN, Castle EP. Robot-assisted partial nephrectomy for complex renal masses. J Robot Surg 2015; 10:27-31. [DOI: 10.1007/s11701-015-0554-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/27/2015] [Indexed: 01/20/2023]
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Shah P, Ganpule A, Mishra S, Sabnis R, Desai MR. Prospective study of preoperative factors predicting intraoperative difficulty during laparoscopic transperitoneal simple nephrectomy. Urol Ann 2015; 7:448-53. [PMID: 26692663 PMCID: PMC4660694 DOI: 10.4103/0974-7796.152045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To prospectively study and identify, the preoperative factors which predict intraoperative difficulty in laparoscopic transperitoneal simple nephrectomy. PATIENTS AND METHOD Seventy seven patients (41 males and 36 females) with mean age of 43 ± 17 years, undergoing transperitoneal laparoscopic simple nephrectomy at our institute between February 2012 to May 2013 were included in this study. Preoperative patients' characteristics recorded were: Gender of patients, history of intervention, palpable lump, BMI, urine culture, side, size of kidney, fixity of kidney on USG, perinephric fat stranding on preoperative CT scan, periureteral fat stranding, perinephric collection, enlarged hilar lymph nodes, renal vascular anomalies, differential renal function on renogram. Preoperative factors of these patients were noted and intraoperative difficulty in the surgery was scored between 1 (easiest) to 10 (most difficult or open conversion) by a single surgeon (who was a part of all studies either as operating surgeon or assistant). Using SPSS 15.0 software, multivariate and univariate analysis was done. RESULTS In multivariate analysis presence of pyonephrosis on preoperative evaluation and BMI < 25kg/m(2) were found to be statistically significant factors predicting intraoperative difficulty during laparoscopic simple nephrectomy. On univariate analysis following factors were associated with increased surgeon's score: Lower BMI, palpable kidney, pyonephrosis, history of renal intervention, perinephric fat stranding, right side, fixity of kidney on USG with surrounding structures. CONCLUSION Our findings suggest that presence of pyonephrosis as identified on preoperative imaging and a BMI of less than 25 Kg/m(2) are the most significant factors predicting intraoperative difficulty during laparoscopic simple nephrectomy.
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Affiliation(s)
- Pratik Shah
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Shashikant Mishra
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Ravindra Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mahesh R Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Knight BA, Potretzke AM, Larson JA, Bhayani SB. Comparing Expert Reported Outcomes to National Surgical Quality Improvement Program Risk Calculator-Predicted Outcomes: Do Reporting Standards Differ? J Endourol 2015; 29:1091-9. [DOI: 10.1089/end.2015.0178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- B. Alexander Knight
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Aaron M. Potretzke
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey A. Larson
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sam B. Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Montes SFP, Rodríguez IG, Ugarteburu RG, Villamil LR, Mendez BD, Gil PS, Madera JM. Intraoperative laparoscopic complications for urological cancer procedures. World J Clin Cases 2015; 3:450-456. [PMID: 25984519 PMCID: PMC4419108 DOI: 10.12998/wjcc.v3.i5.450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/30/2015] [Accepted: 04/09/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution.
METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications.
RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery (radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery (radical prostatectomy and radical cystectomy).
CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications.
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Henderson JM, Fabricius MJ, Fowler S, Keeley FX, Dickinson A. The complications of laparoscopic renal surgery: A review of 10 years of audit data in the UK. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415815585211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To report the complications of laparoscopic renal surgery from the British Association of Urological Surgeons (BAUS) database over ten years. Patients and methods: All entries for laparoscopic renal surgery between 2002 and 2012 were included for analysis. Data was refined, collated and presented in graphical or tabular form. The primary outcome measures were intra-operative, post-operative and overall complications rates. Secondary outcome measures were length of stay, conversion to open surgery and operative time. Results: A total of 16,869 cases were included for analysis. The overall complication rate was 14.7%, with intra-operative complications reported for 3.5% of procedures and post-operative complications reported for 12.1% of procedures. The overall complication rate decreased throughout the audit period, from 16.6% in 2002 to 15.1% in 2012. The capture rate is estimated at 30% and the group of surgeons motivated to self-report may not be representative of the whole group. Comparison with other series is difficult due to a lack of a standardized reporting format. Conclusion: This is the largest surgeon-reported series of laparoscopic renal surgery to date. There is an inherent bias in self-reported data which limits the conclusions that can be drawn, although the safe introduction of this technique and the continuing improvement in complication rates are suggested.
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Ghonge NP, Gadanayak S, Rajakumari V. MDCT evaluation of potential living renal donor, prior to laparoscopic donor nephrectomy: What the transplant surgeon wants to know? Indian J Radiol Imaging 2014; 24:367-78. [PMID: 25489130 PMCID: PMC4247506 DOI: 10.4103/0971-3026.143899] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
As Laparoscopic Donor Nephrectomy (LDN) offers several advantages for the donor such as lesser post-operative pain, fewer cosmetic concerns and faster recovery time, there is growing global trend towards LDN as compared to open nephrectomy. Comprehensive pre-LDN donor evaluation includes assessment of renal morphology including pelvi-calyceal and vascular system. Apart from donor selection, evaluation of the regional anatomy allows precise surgical planning. Due to limited visualization during laparoscopic renal harvesting, detailed pre-transplant evaluation of regional anatomy, including the renal venous anatomy is of utmost importance. MDCT is the modality of choice for pre-LDN evaluation of potential renal donors. Apart from appropriate scan protocol and post-processing methods, detailed understanding of surgical techniques is essential for the Radiologist for accurate image interpretation during pre-LDN MDCT evaluation of potential renal donors. This review article describes MDCT evaluation of potential living renal donor, prior to LDN with emphasis on scan protocol, post-processing methods and image interpretation. The article laid special emphasis on surgical perspectives of pre-LDN MDCT evaluation and addresses important points which transplant surgeons want to know.
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Affiliation(s)
- Nitin P Ghonge
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | | | - Vijaya Rajakumari
- Department of Renal Transplantation, Indraprastha Apollo Hospital, New Delhi, India
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Xu H, Ding Q, Jiang HW. Fewer complications after laparoscopic nephrectomy as compared to the open procedure with the modified Clavien classification system--a retrospective analysis from southern China. World J Surg Oncol 2014; 12:242. [PMID: 25081928 PMCID: PMC4121009 DOI: 10.1186/1477-7819-12-242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 07/20/2014] [Indexed: 01/06/2023] Open
Abstract
Background The objective of the study is to compare complication rates of laparoscopic nephrectomy and open nephrectomy using a standardized classification method Methods We retrospectively included 843 patients from March 2006 to November 2012, of whom 88 had laparoscopic radical nephrectomy (LRN), 526 had open radical nephrectomy (ORN), 42 had laparoscopic partial nephrectomy (LPN), and 187 had open partial nephrectomy (OPN). A modified Clavien classification system was applied to quantify complications of nephrectomy. Fisher’s exact or chi-square test were used to compare complication rates between laparoscopic and open approaches. Results The overall complication rate was 19.31%, 30.04%, 35.71%, and 36.36% in LRN, ORN, LPN, and OPN, respectively. More Grade II complications (odds ratio = 2.593, 95% CI 1.172 to 5.737, P = 0.010) and longer postoperation hospital stay (9.2 days and 7.6 days, P < 0.001) were observed in ORN compared with LRN. In multivariable analysis, surgical approach (LRN/ORN) (P = 0.036), age (P = 0.044), height (P = 0.020), systolic pressure (P = 0.012), fasting blood glucose level (P = 0.032), and blood loss during operation (P = 0.011) were significant predictors for grade II complications in radical nephrectomy. LPN had similar complication rates compared with OPN. Conclusions In conclusion, LRN had the advantages of less grade II complications and shorter postoperation hospital stay than ORN. Older age and more blood loss during operation would also contribute to more grade II complications in radical nephrectomy.
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Affiliation(s)
| | | | - Hao-wen Jiang
- Department of Urology, Huashan Hospital, Fudan University, 12 WuLuMuQi Middle Road, 200040 Shanghai, PR China.
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Matsuda T, Fujita H, Kunimoto Y, Kimura T, Ogino K. Chylous ascites as a complication of laparoscopic colorectal surgery. Asian J Endosc Surg 2013; 6:279-84. [PMID: 23941730 DOI: 10.1111/ases.12057] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 07/09/2013] [Accepted: 07/22/2013] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Until now, no data have been available on the incidence of chylous ascites after laparoscopic colorectal surgery. METHODS From January 2007 to December 2011, 137 patients with colorectal cancer underwent laparoscopic surgery at our institution. The clinical data of the patients with postoperative chylous ascites were compared with those of the patients without chylous ascites. RESULTS Chylous ascites developed in 9 of the 137 patients (6.5%). Blood loss, operative time, tumor location, and extent of lymph node dissection were not associated with postoperative chylous ascites. Mean postoperative hospital stay for patients with chylous ascites was significantly longer than that for patients without any complications (14 days vs 10 days; P < 0.001). Recurrence was observed in two of the nine patients with chylous ascites; it developed locally and in the liver in one patient, and peritoneal dissemination was seen in the other. The recurrence rate in the chylous ascites group (22.2%) was significantly higher than that in the non-chylous ascites group (3.9%; P = 0.016). The 3-year disease-free survival in the chylous ascites group (76.2%) was significantly lower than that in the non-chylous ascites group (93.4%; P = 0.020); however, the 3-year overall survival rates did not differ between the groups (87.5% vs 94.4%, respectively; P = 0.332). CONCLUSION Chylous ascites are not a rare complication of laparoscopic colorectal surgery. It was managed conservatively in all cases but was associated with longer hospital stays. We recommend careful tissue dissection at a suitable plane and meticulous clipping during lymphadenectomy to prevent chyle leakage when lymphatic invasion is suspected.
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Affiliation(s)
- Takeru Matsuda
- Department of Surgery, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Tonolini M, Villa C, Campari A, Ravelli A, Bianco R, Cornalba G. Common and unusual urogenital Crohn's disease complications: spectrum of cross-sectional imaging findings. ACTA ACUST UNITED AC 2013; 37:118-39. [PMID: 22456714 DOI: 10.1007/s00261-011-9764-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Involvement of the urinary tract and genital organs is not uncommon in patients affected with Crohn's disease (CD). Occurring in both sexes, uro-gynecological complications are often clinically unsuspected because of the dominant intestinal or systemic symptoms. Knowledge of their manifestations and cross-sectional imaging appearances is necessary to recognize and report them, since correct medical or surgical treatment choice with appropriate specialist consultation allows to prevent further complications. Besides uncomplicated urinary tract infections that usually do not require imaging, urolithiasis and pyelonephritis represent the most commonly encountered urinary disorders: although very useful, use of computed tomography (CT) should be avoided whenever possible, to limit lifetime radiation exposure. Hydronephrosis due to ureteral inflammatory entrapment and enterovesical fistulization may result from penetrating CD, and require precise imaging assessment with contrast-enhanced CT to ensure correct surgical planning. Representing the majority of genital complication, ano- and rectovaginal fistulas and abscesses frequently complicate perianal inflammatory CD and are comprehensively investigated with high-resolution perianal MRI acquired with phased-array coils, high-resolution T2-weighted sequences and intravenous contrast. Finally, rare gynecological manifestations including internal genital fistulas, vulvar and male genital involvement are discussed.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, Luigi Sacco University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
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Boris RS, Gupta GN, Benson JS, Linehan WM, Pinto PA, Bratslavsky G. Feasibility and outcomes of laparoscopic renal intervention after prior open ipsilateral retroperitoneal surgery. J Endourol 2013; 27:196-201. [PMID: 22963658 DOI: 10.1089/end.2012.0483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND PURPOSE Treating patients with renal-cell carcinoma (RCC) after previous retroperitoneal surgery (renal or adrenal) is technically challenging. We present our initial experience with laparoscopic renal interventions (LRI) after previous open retroperitoneal surgery in patients needing ipsilateral renal intervention. We report on feasibility, functional and oncologic outcomes of LRI after previous open retroperitoneal surgery. PATIENTS AND METHODS We reviewed records of patients undergoing attempted laparoscopic or robot-assisted renal intervention after at least one previous open ipsilateral retroperitoneal surgery. We identified 34 patients who underwent 39 staged attempted LRI after 48 previous open ipsilateral renal or adrenal surgeries. The LRI included 20 minimally invasive partial nephrectomies (MIPN), 11 laparoscopic radiofrequency ablations (LRFA), and 8 laparoscopic nephrectomies (LTN). Demographic, perioperative, renal functional, and oncologic outcome data were collected. Statistical analyses were performed to identify risks for conversion to open surgery. RESULTS No attempted nephron-sparing procedure resulted in kidney loss. Overall conversion rate of the cohort was 28% and was highest in the MIPN group (40%). On univariate analysis, only multiple tumors that were treated significantly increased chances of open conversion (P<0.01). Subset analysis demonstrated similar rates of blood loss, operative times, and conversion rates in patients undergoing partial nephrectomy having previous open partial nephrectomy compared with previous open adrenal surgery only. There was no significant difference in preservation of renal function between MIPN and LRFA, with more than 85% of preoperative renal function preserved. Mean follow-up of 11.9 months (range 1-97.5 mos) metastasis-free survival and overall survival was 94.1% and 97%, respectively. CONCLUSIONS LRI after previous open ipsilateral retroperitoneal surgery is feasible. Repeated partial nephrectomy has the highest conversion risks among the laparoscopic renal interventions and appears to be independent of previous renal or adrenal procedure. Attempting repeated LRI for multiple tumors is a significant risk factor for open conversion. Renal functional and oncologic outcomes are encouraging at early follow-up.
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Affiliation(s)
- Ronald S Boris
- National Institutes of Health, National Cancer Institute, Urologic Oncology Branch, Bethesda, Maryand, USA
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Chick JFB, Bair RJ, Mullen KM, Jacobson FL. Splenic herniation after laparoscopic nephrectomy. Intern Emerg Med 2012; 7:483-4. [PMID: 22903539 DOI: 10.1007/s11739-012-0841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 08/04/2012] [Indexed: 11/27/2022]
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Mohtashami F, von Dadelszen P, Allaire C. A surgical virtual reality simulator distinguishes between expert gynecologic laparoscopic surgeons and perinatologists. JSLS 2011; 15:365-72. [PMID: 21985726 PMCID: PMC3183557 DOI: 10.4293/108680811x13125733356477] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Concern regarding the quality of surgical training in obstetrics and gynecology residency programs is focusing attention on competency based education. Because open surgical skills cannot necessarily be translated into laparoscopic skills and with minimally invasive surgery becoming standard in operative gynecology, the discrepancy in training between obstetrics and gynecology will widen. Training on surgical simulators with virtual reality may improve surgical skills. However, before incorporation into training programs for gynecology residents the validity of such instruments needs to first be established. We sought to prove the construct validity of a virtual reality laparoscopic simulator, the SurgicalSim(TM), by showing its ability to distinguish between surgeons with different laparoscopic experience. METHODS Eleven gynecologic surgeons (experts) and 11 perinatologists (controls) completed 3 tasks on the simulator, and 10 performance parameters were compared. RESULTS The experts performed faster, more efficiently, and with fewer errors, proving the construct validity of the SurgicalSim. CONCLUSIONS Laparoscopic virtual reality simulators can measure relevant surgical skills and so distinguish between subjects having different skill levels. Hence, these simulators could be integrated into gynecology resident endoscopic training and utilized for objective assessment. Second, the skills required for competency in obstetrics cannot necessarily be utilized for better performance in laparoscopic gynecology.
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Affiliation(s)
- Fariba Mohtashami
- University of British Columbia, Department of Obstetrics and Gynaecology, Faculty of Medicine, Saint Paul's Hospital, Vancouver, British Columbia, Canada.
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Van Poppel H, Becker F, Cadeddu JA, Gill IS, Janetschek G, Jewett MAS, Laguna MP, Marberger M, Montorsi F, Polascik TJ, Ukimura O, Zhu G. Treatment of localised renal cell carcinoma. Eur Urol 2011; 60:662-72. [PMID: 21726933 DOI: 10.1016/j.eururo.2011.06.040] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/20/2011] [Indexed: 02/08/2023]
Abstract
CONTEXT The increasing incidence of localised renal cell carcinoma (RCC) over the last 3 decades and controversy over mortality rates have prompted reassessment of current treatment. OBJECTIVE To critically review the recent data on the management of localised RCC to arrive at a general consensus. EVIDENCE ACQUISITION A Medline search was performed from January 1, 2004, to May 3, 2011, using renal cell carcinoma, nephrectomy (Medical Subject Heading [MeSH] major topic), surgical procedures, minimally invasive (MeSH major topic), nephron-sparing surgery, cryoablation, radiofrequency ablation, surveillance, and watchful waiting. EVIDENCE SYNTHESIS Initial active surveillance (AS) should be a first treatment option for small renal masses (SRMs) <4 cm in unfit patients or those with limited life expectancy. SRMs that show fast growth or reach 4 cm in diameter while on AS should be considered for treatment. Partial nephrectomy (PN) is the established treatment for T1a tumours (<4 cm) and an emerging standard treatment for T1b tumours (4-7 cm) provided that the operation is technically feasible and the tumour can be completely removed. Radical nephrectomy (RN) should be limited to those cases where the tumour is not amenable to nephron-sparing surgery (NSS). Laparoscopic radical nephrectomy (LRN) has benefits over open RN in terms of morbidity and should be the standard of care for T1 and T2 tumours, provided that it is performed in an advanced laparoscopic centre and NSS is not applicable. Open PN, not LRN, should be performed if minimally invasive expertise is not available. At this time, there is insufficient long-term data available to adequately compare ablative techniques with surgical options. Therefore ablative therapies should be reserved for carefully selected high surgical risk patients with SRMs <4 cm. CONCLUSIONS The choice of treatment for the patient with localised RCC needs to be individualised. Preservation of renal function without compromising the oncologic outcome should be the most important goal in the decision-making process.
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Affiliation(s)
- Hein Van Poppel
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
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Ivey BS, Lucas SM, Meyer CA, Emley TE, Bey A, Gardner TA, Sundaram CP. Conversions in laparoscopic renal surgery: causes and outcomes. J Endourol 2011; 25:1167-73. [PMID: 21671761 DOI: 10.1089/end.2010.0725] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We examined conversions in laparoscopic renal surgery, evaluating the causes and outcomes. PATIENTS AND METHODS A single institution review of all laparoscopic renal surgeries, excluding renal donors, over a nine-year period was performed. Cases were evaluated for intraoperative results, conversions, and complications. RESULTS 399 laparoscopic renal surgeries were identified (394 available for review) with 41 conversions (31 open, 8 hand-assisted, 2 retroperitoneal). Intraoperative and postoperative complications occurred in 3.0% and 12.2%, respectively. The most common reason for conversion was a lack of progress (20), followed by difficult anatomy (8), tumor thrombus (5), and bleeding (4). Open conversion rates for hand-assisted laparoscopic (HAL), transperitoneal laparoscopic, retroperitoneal laparoscopic (RPL), and robot-assisted were 17.1%, 6.9%, 13.2%, and 1.8%, respectively, although HAL and RPL were more often used for bilateral procedures, previous abdominal surgery, and large specimens (P<0.05). Surgical indication significantly impacted perioperative outcome, where autosomal dominant polycystic kidney disease and partial nephrectomy were associated with the highest rate of open conversion (13%), while nephroureterectomy had the highest rate of complications (40%). Cases in which there were large specimens weighing over 1500 g were converted in 40% of cases vs 8.2% for smaller specimens, P<0.001. Previous abdominal surgery did not impact conversion rate (11.9% without vs 9.3% with previous surgery, P=0.401). Cases that were converted had a significantly higher blood loss, operative time, transfusion rate, hospital stay, and complication rate (P<0.05). CONCLUSIONS Rate of conversion to an open procedure is significantly impacted by surgical indication, specimen size, and surgical technique. Any conversion is associated with an increased perioperative morbidity.
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Affiliation(s)
- Bert S Ivey
- Department of Urology, Indiana University, Indianapolis, Indiana 46202, USA
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McAllister MW, Hsi RS, Torrey RR, Simmons Z, Baldwin BD, Baldwin DD. In vitro comparison of changes in effective patient weight between purely laparoscopic and hand-assisted laparoscopic surgery. J Endourol 2011; 25:651-5. [PMID: 21438691 DOI: 10.1089/end.2010.0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Subclinical rhabdomyolysis (RM) has been reported to occur at a high frequency in patients who are undergoing hand-assisted laparoscopic (HAL) surgery. Compressive forces of the surgeon's hand pushing the patient down onto the operating table may increase the patient's effective weight, a factor that is correlated with risk of RM. The purpose of this study was to evaluate the changes in effective patient weight during pure laparoscopic (PL) and HAL surgery. MATERIALS AND METHODS Using an in vitro model, 10 subjects performed translocation and knot tying tasks with both PL and HAL techniques. Changes in weight were monitored using a dynamic industrial scale with real-time digital recording. The means of the average changes in effective weight during the different tasks were compared using the Wilcoxon signed rank test with a P value of <0.05 considered significant. RESULTS The mean of the average weight increases during translocation was 2.99 kg with HAL compared with 0.06 kg with PL (Z=4.3, P<0.05). The mean average weight increase during knot tying was 1.28 kg in HAL compared with 0.02 kg (Z=2.6, P<0.05) in PL. The mean maximum weight increase was 8.70 kg and 8.01 kg in HAL compared with 0.43 kg and 0.59 kg in PL during translocation and knot tying tasks, respectively (P<0.05 for each). CONCLUSIONS HAL surgery results in a significant increase in effective patient weight compared with PL surgery. This increased effective weight during HAL surgery may increase the risk for subsequent RM.
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Affiliation(s)
- Marc W McAllister
- Department of Urology, Loma Linda University, Loma Linda, California, USA
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Rowley MW, Wolf JS. Risk Factors for Conversion to Hand Assisted Laparoscopy or Open Surgery During Laparoscopic Renal Surgery. J Urol 2011; 185:940-4. [DOI: 10.1016/j.juro.2010.10.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Michael W. Rowley
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - J. Stuart Wolf
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
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Abstract
OBJECTIVE The objective of our study was to retrospectively define the incidence of adrenal hematoma on CT or MRI after nephrectomy. MATERIALS AND METHODS Between January 2008 and June 2009, 465 patients underwent nephrectomy at our institution. Of these, patients without both preoperative and postoperative abdominal CT or MR studies within 6 months of surgery (n = 83) and those with documented adrenalectomy at the time of radical nephrectomy (n = 33) were excluded. Thus, 349 patients (292 male, 57 female; mean age, 60.2 years; range, 2-88 years) were included in the study. Preoperative and postoperative CT or MR studies were reviewed by two radiologists in consensus for the presence or absence of adrenal hematoma. Diagnosis of adrenal hematoma was made by imaging findings and follow-up. The incidence of adrenal hematoma was calculated with a 95% CI. RESULTS Of the 349 patients (partial nephrectomy, n = 232; radical nephrectomy, n = 117), 19 patients developed adrenal hematoma after nephrectomy (partial nephrectomy, n = 12; radical nephrectomy, n = 7) with an incidence of 5.4% (95% CI, 3.1-7.8%). All adrenal hematomas were located on the side of nephrectomy (right adrenal gland, n = 8; left adrenal gland, n = 11). In nine patients, the adrenal hematoma appeared as a round or oval lesion on postoperative imaging with a mean size of 2.6 cm (range, 1.5-4.0 cm). In 10 patients, the adrenal hematoma appeared as diffuse enlargement of the adrenal gland on postoperative imaging with a mean thickness of 1.3 cm (range, 0.6-1.8 cm). CONCLUSION An adrenal hematoma was identified in 5.4% of patients on CT or MRI after nephrectomy. A new round or oval adrenal mass after nephrectomy should be differentiated from a metastasis.
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Vricella GJ, Young DB, Boncher NA, Madi R. Conversion from pure laparoscopy to hand-assisted laparoscopy for control of bleeding in renal surgery: an attractive alternative to open conversion. J Endourol 2010; 25:81-4. [PMID: 20929410 DOI: 10.1089/end.2010.0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of conversion from pure laparoscopy to hand-assisted laparoscopy to control mild-to-moderate bleeding during renal surgery. PATIENTS AND METHODS Between August 2006 and August 2008, we performed 94 laparoscopic nephrectomies (44 partial and 50 radical). A total of three radical nephrectomies were converted from pure to hand-assisted laparoscopy for control of bleeding. The first patient was a 44-year-old man with a 14-cm cystic renal mass. The second patient was a 52-year-old man with a 3.8-cm renal mass, and the third patient was an 86-year-old woman with a 7-cm renal mass. RESULTS In all three procedures, the indication for conversion was bleeding from the renal hilum or the kidney parenchyma during dissection. The bleeding was difficult to control using pure laparoscopy, and therefore a hand port was inserted. Time for conversion and placement of the hand port averaged less than 7 minutes. Total estimated blood loss for the three patients was 800 mL, 2000 mL, and 650 mL, respectively. One patient needed a transfusion with three units of packed red blood cells. The postoperative course was uneventful in all patients, except for one patient who had prolonged ileus and stayed in the hospital for 6 days. The remaining two patients were discharged on postoperative days 2 and 3. CONCLUSIONS Conversion from pure to hand-assisted laparoscopy for bleeding control is feasible and effective. It adds minimal morbidity while maximizing cosmesis, and it should be considered as an alternative to open conversion in cases of mild-to-moderate bleeding.
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Affiliation(s)
- Gino J Vricella
- Department of Urology, Case Western Reserve Medical Center, Cleveland, Ohio 44106-5046, USA
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Cutress ML, Ratan HL, Williams ST, O’Brien MF. Update on the management of T1 renal cortical tumours. BJU Int 2010; 106:1130-6. [DOI: 10.1111/j.1464-410x.2010.09506.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Schwartz MJ, Faiena I, Cinman N, Kucharczyk J, Meriggi JS, Waingankar N, Richstone L, Kavoussi LR. Laparoscopic Bowel Injury in Retroperitoneal Surgery: Current Incidence and Outcomes. J Urol 2010; 184:589-94. [DOI: 10.1016/j.juro.2010.03.133] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Michael J. Schwartz
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Izak Faiena
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Nadya Cinman
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - John Kucharczyk
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Jenna S. Meriggi
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Nikhil Waingankar
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Lee Richstone
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Louis R. Kavoussi
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
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Open and laparoscopic donor nephrectomy: activity and outcomes from all Australasian transplant centers. Transplantation 2010; 89:1482-8. [PMID: 20418804 DOI: 10.1097/tp.0b013e3181dd35a0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic donor nephrectomy (LapDN) has been widely adopted despite a lack of randomized trials comparing recipient outcomes with open surgery. Review of registry data now seems the most realistic mechanism to compare outcomes. The Australia and New Zealand Dialysis and Transplant Registry prospectively captures data on all renal transplants performed in Australia and New Zealand including long-term follow-up of recipients. AIM.: To compare graft outcomes among recipient of kidneys from donors undergoing nephrectomy using open and laparoscopic techniques, through analysis of the Australia and New Zealand Dialysis and Transplant Registry after the introduction of laparoscopic donor surgery in Australia and New Zealand in 1997. METHODS Operative technique data for live donor transplants were collected from all surgeons performing live kidney donation procedures from May 1997 to December 2003; the outcomes of all live donor transplants were examined with follow-up to December 2007. Donor and recipient demographic variables and graft outcomes were compared between the laparoscopic and the open donor groups. RESULTS One thousand four hundred seventy-four live donor transplants were performed in 27 transplant centers. Of these, 315 (21%) were performed laparoscopically in 11 centers. Nineteen laparoscopic cases (6%) were converted to open. Total ischemic time was longer in the LapDN group (3.16 hr) than in the open donor group (1.61 hr, P<0.0001). The LapDN group experienced a lower incidence of rejection episodes (29.2% vs. 38.6%, P=0.002). Delayed graft function and technical failure rates were statistically equal across the groups. There were a total of 242 graft failures (175 graft losses and 67 deaths with a functioning graft, NS). Among surviving grafts, there was no consistent difference in serum creatinine at any time point. Graft and patient survivals were similar in both groups during 10-year follow-up. CONCLUSION This study suggests that there is no difference in short- or long-term recipient outcomes for open and laparoscopic live donor nephrectomy.
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Lin YS, Chung HJ, Lin ATL, Huang WJS, Huang YH, Lin TP, Chen KK. Laparoscopic partial nephrectomy: Taipei veterans general hospital experience. J Chin Med Assoc 2010; 73:364-8. [PMID: 20688302 DOI: 10.1016/s1726-4901(10)70079-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 06/15/2010] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Laparoscopic partial nephrectomy (LPN) is a definitive therapy in patients with a small renal tumor. The aim of this study was to present our interim results of LPN with its complications and outcomes. METHODS We conducted a retrospective chart review of 46 LPNs in 45 patients at Taipei Veterans General Hospital from April 2004 to September 2008. The perioperative data were prospectively collected. The follow-up data, including local recurrence, distant metastasis, and renal function, were recorded. RESULTS The mean age of these 45 patients was 54.8 years (range, 26-85 years). Three (6.5%) LPNs were converted to laparoscopic radical nephrectomy. The mean tumor diameter was 3.81 cm (range, 2.0-7.5 cm). The mean operative time was 319 minutes (range, 180-660 minutes). The mean blood loss was 501 mL (range, 20-3,300 mL). Pedicle clamping was performed in 37 (80.4%) cases and the mean warm ischemic time was 56 minutes (range, 24-100 minutes). There were 17 (40.0%) benign cases and 26 (56.5%) renal cell carcinomas, which were stage pT1a in 19 (73.1%) cases, pT1b in 5 (19.2%) cases, pT2 in 1 (3.8%) case, and pT3a in 1 (3.8%) case. The major complication rate was 4.3% (delayed bleeding in 1 case and urine leakage in 1 case). All margins were free for the malignant cases. Neither distant metastasis nor mortality was found. Local recurrence was found in 1 patient. The mean preoperative creatinine was 1.04 mg/dL (range, 0.6-2.4 mg/dL) and the mean elevated creatinine level was 0.10 mg/dL at 3 months (p < 0.05) and 0.13 mg/dL at 6 months (p < 0.05) postoperatively. The function of the operated kidney was reduced by a mean of 21.9% at 3 months (p < 0.05) and 27.7% at 6 months (p < 0.05) postoperatively. CONCLUSION Although our warm ischemic time and operative time were longer than those of other LPN studies, the interim results of our oncologic and renal functional outcomes were encouraging. Further refinement of the procedure is needed to shorten the warm ischemic time and improve the hemostatic technique. In addition, based on postoperative renal function, LPN does not significantly influence long-term renal function.
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Affiliation(s)
- Yi-Shung Lin
- Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taiwan, R.O.C
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Kim BS, Yoo ES, Kim TH, Kwon TG. Chylous ascites as a complication of laparoscopic nephrectomy. J Urol 2010; 184:570-4. [PMID: 20639020 DOI: 10.1016/j.juro.2010.03.128] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Indexed: 01/02/2023]
Abstract
PURPOSE Chylous ascites is a rare complication after major retroperitoneal surgery. Recently chylous ascites has developed more often after laparoscopic nephrectomy since that is increasingly done for various indications at many centers. We reviewed our cases of chylous ascites after laparoscopic nephrectomy. MATERIALS AND METHODS Between January 2002 and December 2008 we performed 622 transperitoneal laparoscopic nephrectomies. We retrospectively analyzed factors related to chylous ascites as a complication of laparoscopic nephrectomy. RESULTS The overall incidence of chylous ascites was 5.1% (32 of 622 cases), including 4 severe refractory cases (0.6%). The difference in incidence by operation type was not statistically different (p = 0.251). Chylous ascites developed more often after left than right nephrectomy (7.3% or 25 of 343 cases vs 2.5% or 7 of 279, p = 0.010). In patients with radical nephrectomy and nephroureterectomy the incidence was higher in those who did vs did not undergo lymphadenectomy (13.9% or 10 of 72 vs 4.0% or 11 of 275, p = 0.027). Only 1 patient underwent explorative laparotomy due to persistent severe chylous ascites despite 8-week conservative management. The other cases were successfully managed conservatively by total parenteral nutrition and a low fat diet. CONCLUSIONS Chylous ascites is not a rare complication after laparoscopic nephrectomy and most cases can be managed conservatively. To prospectively prevent this complication we recommend meticulous clipping of all perihilar and retroperitoneal fibrous fatty tissue during major vessel dissection, especially for left nephrectomy or extensive lymphadenectomy.
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Affiliation(s)
- Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
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López Cubillana P, Prieto González A, Tornero Ruiz J, López López A, Cao Avellaneda E, Server Pastor G, Escudero J, López González P, Doñate G, Ruiz Morcillo J, Gómez Gómez G, Pérez Albacete M. Nefrectomía laparoscópica asistida por la mano en casos difíciles. Actas Urol Esp 2010. [DOI: 10.1016/s0210-4806(10)70038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jeon SH, Han KS, Yoo KH, Choe BK, Seo IY, Lim JS, Ono Y. How Many Cases Are Necessary to Develop Competence for Laparoscopic Radical Nephrectomy? J Endourol 2009; 23:1965-9. [DOI: 10.1089/end.2008.0636] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Seung Hyun Jeon
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyung-Sik Han
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Koo Han Yoo
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Bong-Keun Choe
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ill Young Seo
- Departments of Urology, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae Sung Lim
- Department of Urology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yoshinari Ono
- School of Medical Welfare, Aichi Shukutoku University, Aichi, Japan
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Hsi RS, Ojogho ON, Baldwin DD. Analysis of Techniques to Secure the Renal Hilum During Laparoscopic Donor Nephrectomy: Review of the FDA Database. Urology 2009; 74:142-7. [DOI: 10.1016/j.urology.2008.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 10/03/2008] [Accepted: 11/04/2008] [Indexed: 11/28/2022]
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Kim BS, Yoo ES, Kwon TG. Complications of transperitoneal laparoscopic nephrectomy: a single-center experience. Urology 2009; 73:1283-7. [PMID: 19362334 DOI: 10.1016/j.urology.2009.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 11/24/2008] [Accepted: 01/12/2009] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To present the incidence of complications of transperitoneal laparoscopic nephrectomy performed for various indications during a 6-year period. METHODS From 2002 to 2007, 505 transperitoneal laparoscopic nephrectomies were performed, consisting of 125 live donor, 212 radical, 80 simple, and 28 partial nephrectomies and 60 nephroureterectomies. We retrospectively analyzed the factors related to perioperative complications, including the type of operation, body mass index, history of abdominal surgery, and American Society of Anesthesiologists score. RESULTS The overall complication rate was 13.7% (69/505). Major complications requiring open conversion or reoperation occurred in 15 patients (3.0%). The remaining 54 patients experienced minor surgical or postoperative medical problems. The mortality rate in our series was 0%. The complication rates by the type of operation were not significantly different. Patients with a history of abdominal surgery demonstrated slightly greater complication rates (19.2% vs 12.6%, P = .069). When stratified by a body mass index of <25 kg/m(2) and <25 kg/m(2), no statistically significant difference was found in the complication rates (13.1% vs 15.6%, respectively, P = .067). Patients with greater American Society of Anesthesiologists scores had greater complication rates (P = .038). The intraoperative complication rates decreased as our experience with laparoscopic surgery increased (P = .042); however, the total complication rates remained constant throughout the study period. CONCLUSIONS In consideration of the contributing factors, the complication rates of transperitoneal laparoscopic nephrectomy were not related to the type of operation, body mass index, or history of abdominal operation but to the American Society for Anesthesiologists score. Complications unique to laparoscopic nephrectomy exist but they decrease with experience.
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Affiliation(s)
- Bum Soo Kim
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea
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Vela Navarrete R, Rodríguez Miñón Cifuentes J, Calahorra Fernández J, González Enguita C, Cabrera J, García Cardoso J, Castillon Vela I, Plaza J. [Renal transplantation with living donors. A critical analysis of surgical procedures based on 40 years of experience]. Actas Urol Esp 2009; 32:989-94. [PMID: 19143290 DOI: 10.1016/s0210-4806(08)73977-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Absolute priority in an LDKT programme are donnor safety and kidney optimal anatomical and functional preservation. Reduced donnor morbidities, both at short and long term, are important objectives. Excellent technical grafting is a must as are the strategies employed for facilitatig it. We revised the incidences of our whole LDKT programme (40 years 243 donors) to confirm if these exigences have been acomplished or a change to new surgical procedures is recommended. MATERIAL AND METHODS Between 1968-2008 243 nephrectomies and grafting has been performed, a reduced number per year (A cadaver programme has been running simultaneously since 1964). For the nephrectomies a Turner-Warrick apprach was inititialy used and since 1973 a miniincisional, anterior, extraperitoneal approach of approximately 10 cm in length. The right kidney was removed in 75% of the cases and the right iliac area for the implant in 85% In adjacent opperating rooms, one team performs the nephrectomy while the other prepares and dissects free the grafting vessels. Most of the time the same senior surgeon performed both operatios: the nephrectomy and the implant. Peroperative and postoperative complications were evaluated by urologists and nephrologists in charge. RESULTS No donors dead, organs lost or major complications in the donors have been documented. Minor complications such as intestinal paresia, wound infection, persistent incisional pain were common. Miniincisional abdominal approach reduced postoperative pain and hospital stay (4 days). At long term no incisional hernia or abdominal paresia have been documented. Simultaneous work reduces ischemia time (30-45 s warm: 30-45 min cold) and opperatig room occupation(patient preparation plus anesthesia plus operation) estimated in 90-120 min for the nephrectomy and 120-160 for the grafting. The responsibility of the senior surgeon in both procedures facilitates vessel selection for the grafting. CONCLUSIONS No reasons have been found to reconvert our current nephrectomy procedure to laparoscopic or modify current surgical strategy. Superior safety of open surgery for donors and organs is confirmed. Pain and recovery time are reduced in laparoscopic surgery but not as much when compared with miniincisional approach. Open surgery permits optimal anatomical and functional organ extration facilitatig the quality of the implant. As numbers matter in laparoscopic surgery open nephrectomy is recommended for reduced LDKT programmes.
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Laparoscopic Radical Prostatectomy: Reducing the Learning Curve. Urology 2008; 72:1347-50. [DOI: 10.1016/j.urology.2007.12.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 12/07/2007] [Accepted: 12/07/2007] [Indexed: 11/21/2022]
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Conversion During Laparoscopic Surgery: Frequency, Indications and Risk Factors. J Urol 2008; 180:855-9. [PMID: 18635228 DOI: 10.1016/j.juro.2008.05.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Indexed: 11/21/2022]
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Wong JFS, Ho HSS, Tan YH, Cheng CWS. Rare cause of intestinal obstruction after laparoscopic radical nephrectomy: internal herniation via a mesenteric defect. Urology 2008; 72:716.e13-4. [PMID: 18597821 DOI: 10.1016/j.urology.2007.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/07/2007] [Accepted: 12/10/2007] [Indexed: 12/11/2022]
Abstract
A 43-year-old man had painless macroscopic hematuria and was diagnosed with a 9-cm renal carcinoma in the lower pole of the left kidney. He underwent laparoscopic transperitoneal left radical nephrectomy (LRN) with an uneventful recovery. Eleven days later, he developed intestinal obstruction (IO). Abdominal computed tomography scan showed dilated small bowels occupying the left renal fossa. Laparotomy revealed closed-loop small bowel obstruction resulting from internal intestinal herniation via a 5-cm mesenteric defect. It was repaired after the herniated bowels were reduced. This case illustrates a rare cause of IO after LRN, in which mesenteric defect is necessary.
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Affiliation(s)
- Joelle F S Wong
- Department of Urology, Singapore General Hospital, Singapore
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Barone JE, Kardon S. An unusual complication of a laparoscopic nephrectomy: the "lost" kidney stone. Urology 2008; 73:1164.e1-3. [PMID: 18554697 DOI: 10.1016/j.urology.2008.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 03/11/2008] [Accepted: 03/21/2008] [Indexed: 11/26/2022]
Abstract
This is the first reported case of a complication resulting from a lost kidney stone after a laparoscopic nephrectomy. The patient presented with a calcified right adnexal mass 3 years after having had a laparoscopic left nephrectomy for a staghorn calculus and hydronephrotic kidney. The mass was thought to be a rapidly growing teratoma and was excised. It proved to be a calcium oxalate stone. No similar cases could be found in the literature. Complications of lost gallstones after laparoscopic cholecystectomy are discussed.
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Affiliation(s)
- James E Barone
- Department of Surgery, Lincoln Medical and Mental Health Center, Bronx, New York 10451, USA.
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Hyams ES, Kanofsky JA, Stifelman MD. Laparoscopic Doppler technology: applications in laparoscopic pyeloplasty and radical and partial nephrectomy. Urology 2008; 71:952-6. [PMID: 18455632 DOI: 10.1016/j.urology.2007.11.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 09/29/2007] [Accepted: 11/13/2007] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The identification and isolation of vascular structures are crucial and technically demanding aspects of laparoscopic renal surgery. Doppler technology has been used for this purpose in laparoscopic varicocele repair, renal cryoablation, and adrenalectomy. However, it has not been formally described for use in laparoscopic radical nephrectomy, partial nephrectomy, or pyeloplasty. We report our initial experience with Doppler technology in 20 patients undergoing these procedures. TECHNICAL CONSIDERATIONS A laparoscopic Doppler probe was used in laparoscopic radical nephrectomy (n = 6), partial nephrectomy (n = 8), nephroureterectomy (n = 3), and robotic-assisted pyeloplasty (n = 3). The Doppler system consisted of a disposable 8-MHz probe passed through a 5-mm port and a battery-powered transceiver. The probe was used to guide dissection/isolation of the renal hilum and aberrant vasculature in radical and partial nephrectomy, confirm parenchymal ischemia before resection in partial nephrectomy, and identify crossing vessels during pyeloplasty. Nine accessory vessels were detected in 6 (35%) of 17 patients undergoing radical/partial nephrectomy or nephroureterectomy. In 1 case of partial nephrectomy, persistent parenchymal flow despite renal artery clamping required clamp repositioning. In 1 case of pyeloplasty, the Doppler probe detected a crossing vessel despite negative preoperative imaging findings. Use of the probe altered management in 7 (35%) and saved time in 15 (75%) of 20 cases. No complications were associated with the use of the probe. CONCLUSIONS Doppler ultrasound technology might have extended applications in laparoscopic renal surgery by facilitating the dissection and evaluation of vasculature. A prospective study with objective endpoints would be helpful in confirming the utility of this technology in these settings.
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Affiliation(s)
- Elias S Hyams
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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Abou-Elela A, Ghonaimy M, Reyad I, Abdelrazak O, Bedair AS. Outcome and complications of laparoscopic nephrectomy in patients with previous renal surgery. J Laparoendosc Adv Surg Tech A 2008; 18:237-43. [PMID: 18373450 DOI: 10.1089/lap.2007.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the technical difficulties, limitations, outcome, and complications of laparoscopic nephrectomy in patients with previous ipsilateral renal surgery. MATERIALS AND METHODS Eighteen patients with a history of epsilateral renal surgery underwent laparoscopic simple nephrectomy for benign renal disease at our center between November 2001 and March 2005. All patients were informed about the details of the laparoscopic procedure, and an informed consent was obtained that included the possibility of an emergency laparotomy. All procedures performed were carried out through a transperitoneal approach. A separate table with a laparotomy set was available in the room and ready for open conversion. RESULTS The procedure was completed in 13 patients. Excluding the cases converted to open surgery, the operative time ranged from 120 to 210 minutes, with a mean of 170 +/- 32.9. The intraoperative blood loss ranged from 30 to 400 cc, with a mean blood loss of 100. Complications included minor visceral injury (liver) in 1 patient, minor bleeding in 2, major bleeding (open conversion) in 1, technical failure (open conversion) in 4, postoperative bleeding (reexploration) in 1, and postoperative renal bed collection in 1. CONCLUSIONS Laparoscopic nephrectomy is an alternative to the open nephrectomy for the removal of nonfunctioning kidneys in benign diseases and results in less morbidity and a shorter hospital stay. A higher conversion to open and complication rate should be expected in patients with previous open or endoscopic renal surgery and postinflammatory conditions.
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