Laparoscopic partial nephrectomy for multiple (four) tumors

Abstract

_______________________________________________________________________________________Background: Nephron sparing surgery (NSS) is well established as the standard of care for most surgical small renal tumors when technically feasible. While the majority of sporadic renal tumors are solitary, multifocal tumors have been reported in 5.4% to 25% of patients with tumors smaller than 5cm. We present a video where we approach, through laparoscopy, four tumors on the same kidney. Case study: Male, 58y, went through a routine abdominal ultrasound which showed a 5cm left kidney nodule. His MRI pointed a total of 4 nodules on his left kidney. The aspect suggested a papillary cancer due to high cellularity and low vascularization. The patient was submitted to partial nephrectomy under ischemia to remove the two largest tumors (inferior pole) and a resection without clamping of the other two ipsilateral tumors. Result: We performed the surgery in 2 stages. In the first one, we approached the 2 tumors located on the inferior pole inducing warm ischemia, whereas in the second stage we resected the 2 remaining tumors using the technique without clamping. The surgery lasted 220 minutes, with 800mL of blood loss, not requiring blood transfusion. Ischemia time was 35 minutes. The histopathological analysis confirmed that the 4 tumors were papillary cancer, with free margins. Conclusion: NSS can be performed and should be tried in patients with multiple kidney tumors, preferably through laparoscopy or assisted by robot. It can be made either using or not clamping of the pedicle, depending on the RENAL score.

Unilateral Synchronous Multiple Kidney Tumors Managed by Laparoscopic Partial Nephrectomy: Five-year Follow-up

“…The histopathological examination revealed that all tumors were papillary cancer with negative tumor margins. 7 In the present case report, we performed resection of the largest tumor, localised to the lower pole of the right kidney after segmental artery control. The remaining four tumors were resected by the non-ischemic technique.…”

Best videos of the year in 2017

“…The third prize goes to the video entitled “Laparoscopic partial nephrectomy for multiple (four) tumors” by Lessandro Curcio et al from the Hospital Federal Ipanema in Brazil, published in the May-June issue (43(3): 567) ( 1 ) of our Journal. The authors nicely depict in this video a two-stage approach to managing a patient with multifocal renal tumors using a minimally invasive laparoscopic approach in which the larger tumors were approached in an initial setting using a conventional clamp technique, followed by which the two smaller ones were approach in a non-clamped manner.…”

“…The first and top prize is awarded to Peter Caputo et al from the Cleveland Clinic in Ohio in their video entitled “Robotic assisted laparoscopic augmentation ileocystoplasty” which was published in the Sept-Oct issue of our Journal (43(5): 994) ( 1 ). This video is innovative in its approach, with a truly beautifully video depiction with excellent accompanying narration.…”