Contemporary Open Surgery of the Kidney

Kenney, Patrick A.; Wotkowicz, Chad; Libertino, John A.

doi:10.1016/b978-1-4160-6911-9.00054-2

Cited by 12 publications

(16 citation statements)

References 198 publications

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“…The thoracoabdominal approach involves incision of the eighth, ninth, or tenth rib, with transpleural, transdiaphragmatic, and transabdominal exposure of retroperitoneal structures and the pleural and peritoneal cavities [ 1 ]. This method is particularly useful in right-sided cases, where hepatic veins limit exposure and control of the renal vascular supply [ 2 ]. Mobilizing the colon medially and kocherizing the duodenum allow a straightforward approach to the right kidney and early vascular control of the great vessels.…”

Section: Discussionmentioning

confidence: 99%

Thoracoabdominal Approach for Large Retroperitoneal Masses: Case Series and Review

Venkat

Matteliano

Drachenberg

2019

Case Reports in Urology

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The thoracoabdominal incision was first described in 1946 as an approach to concomitant abdominal, retroperitoneal, and thoracic injuries. In urology, this technique was popularized in 1949 for the resection of large renal tumours. Today, it is reserved for complex cases where optimal exposure of the renal hilum and adrenal and superior pole of the kidney is necessary. We present four consecutive cases in which this approach was taken by a single surgeon at our tertiary surgical centre. The outcomes, postoperative course, and pathology are described. We provide a comprehensive literature review and outline the indications, advantages, and disadvantages of this approach. Objectives. To present a case series outlining the efficacy and safety of the thoracoabdominal incision in complex oncologic procedures in urology. Methods. Four cases utilizing the thoracoabdominal incision, performed by a single surgeon at our tertiary care center, were reviewed. Case history, preoperative imaging, intraoperative experience, postoperative course, final pathology, and complications were examined. A thorough literature review was performed and comparison made with historical cohorts for estimated blood loss, length of stay, and complications encountered versus other common surgical approaches. The indications, advantages, and disadvantages of the thoracoabdominal approach were outlined. Results. All patients had large retroperitoneal masses of varying complexity, requiring maximal surgical exposure. Surgery was straightforward in all cases, without any significant perioperative or postoperative complications. Postoperative pain, length of hospital stay, estimated blood loss, and analgesia requirements were all similar to open and mini-flank approaches in review of historical case series cohorts. Laparoscopic approaches had lower estimated blood loss and length of stay. Conclusions. The thoracoabdominal approach is rarely utilized in urological surgery, due to the perceived morbidity in violating the thoracic cavity. These cases outline the benefit of the thoracoabdominal approach in select cases requiring maximal surgical exposure, and the generally benign postoperative course that appropriately selected patients may hope to endure. Postoperative pain, length of hospital stay, estimated blood loss, and analgesia requirements can be expected to be similar open and mini-flank approaches. As expected, laparoscopic approaches had lower estimated blood loss and length of stay.

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Section: Discussionmentioning

confidence: 99%

Thoracoabdominal Approach for Large Retroperitoneal Masses: Case Series and Review

Venkat

Matteliano

Drachenberg

2019

Case Reports in Urology

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“…NSS entails complete local resection of the renal tumor while leaving the largest possible amount of normal functioning parenchyma in the involved kidney [Kenney et al 2012]. The standard technique to close the renal defect following tumor resection is by approximating the transected margins with various suture techniques, sometimes together with hemostatic substances [Novick, 1993].…”

Section: Discussionmentioning

confidence: 99%

Bovine serum albumin–glutaraldehyde (BioGlue^®) tissue adhesiveversusstandard renorrhaphy following renal mass enucleation: a retrospective comparison

Bahouth

Moskovitz

Halachmi

et al. 2017

Therapeutic Advances in Urology

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Background: To present the operative and post-operative comparison between patients who underwent tumor-bed closure with sutures compared with bovine serum albuminglutaraldehyde (BioGlue ® ) tissue sealant only. Methods: We retrospectively analyzed data from our ongoing database of 507 eligible patients who underwent open NSS nephron-sparing surgery in our department between January 1995 and May 2014. Patients had tumor-bed closure with sealant adhesive (255 patients) or standard suture technique (252 patients). Demographic, clinical and perioperative data were compared between the two groups, by Chi-square test or by Fisher-Irwin exact test for categorical variables, and by t test for differences in means or by Wilcoxon rank sum test for continuous variables. A multivariate analysis was also done. Results: Patients' baseline characteristics showed similar distribution of the analyzed parameters among both groups, with few differences: younger age in the sealant group (65.4 versus 68.4 years, p = 0.01) and slightly larger mass size in the suture group (4.0 versus 3.9 cm, p = 0.03). Ischemia time was significantly shorter in the sealant group (21.8 versus 27.0 minutes, p = 0001). Blood loss and transfusion rate (0.8% versus 11.9%, p = 0.0001) were significantly less in the sealant group. A multivariate analysis showed date of surgery and blood loss as the major parameters affecting transfusion rate. Conclusions: Closing the tumor bed with BioGlue ® tissue adhesive is feasible, safe, can shorten ischemia time and potentially reduce transfusion rate.

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“…The current therapeutic approach to Wilms' tumors is based on performance of radical nephrectomy with possible adjunctive chemotherapy and/or radiotherapy. The contemporary oncological surgical principles still follow those popularized by Robson in the 1960s[ 1 2 3 ] for removal of renal tumors, in general, namely, early occlusion of the renal vessels, preferably the artery before the vein, and then removal of the kidney (with the Gerota and perinephric fat) as an intact mass. The recommended surgical approach for Wilms' tumor is through a transperitoneal transabdominal incision.…”

Section: Introductionmentioning

confidence: 99%

Nephrectomy in children with wilms' tumor: 15 years of experience with “Tumor Delivery Technique”

Mor

Zilberman

Morag

et al. 2018

Afr J Paediatr Surg

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Background:The contemporary surgical approach to Wilms' tumors follows that used in adults with renal cell carcinomas, namely, early occlusion of the renal vessels and then removal of the kidney as an intact mass. For years, the surgical approach at our institution has been different, starting with blunt separation of the kidney from the surrounding tissues, followed by its delivery outside the abdominal cavity while it is only attached to the major blood vessels which are subsequently ligated. We aimed to present this “tumor delivery technique” and evaluate its outcomes.Materials and Methods:We retrospectively reviewed medical records of children who underwent nephrectomy for Wilms' tumor using “tumor delivery technique.” All procedures were performed by the same team, according to the same surgical principles.Results:Between 2000 and 2015, 36 children were operated. Median age was 31 months (interquartile range [IQR]: 6–45 mo), and median maximal tumor diameter was 10 cm (IQR: 8–13.9 cm). Tumors were located to the right side in 47%, left side in 42%, and bilateral in 11%. Twelve children have received preoperative neoadjuvant chemotherapy. Capsular disruption and tumor spillage were documented in 4 cases (11%).Conclusions:“Tumor delivery technique” is an easy and safe approach which might reduce the overall complication rates and the incidence of intraoperative tumor spillage.

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Contemporary Open Surgery of the Kidney

Cited by 12 publications

References 198 publications

Thoracoabdominal Approach for Large Retroperitoneal Masses: Case Series and Review

Thoracoabdominal Approach for Large Retroperitoneal Masses: Case Series and Review

Bovine serum albumin–glutaraldehyde (BioGlue^®) tissue adhesiveversusstandard renorrhaphy following renal mass enucleation: a retrospective comparison

Nephrectomy in children with wilms' tumor: 15 years of experience with “Tumor Delivery Technique”

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Contemporary Open Surgery of the Kidney

Cited by 12 publications

References 198 publications

Thoracoabdominal Approach for Large Retroperitoneal Masses: Case Series and Review

Thoracoabdominal Approach for Large Retroperitoneal Masses: Case Series and Review

Bovine serum albumin–glutaraldehyde (BioGlue®) tissue adhesiveversusstandard renorrhaphy following renal mass enucleation: a retrospective comparison

Nephrectomy in children with wilms' tumor: 15 years of experience with “Tumor Delivery Technique”

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Bovine serum albumin–glutaraldehyde (BioGlue^®) tissue adhesiveversusstandard renorrhaphy following renal mass enucleation: a retrospective comparison