Do we need a cosmetic effect for radical nephrectomy?  Laparoendoscopic single-site surgery would help to answer this question

IntroductionThe use of kidney warm ischaemia during laparoscopic partial nephrectomy (LPN) may lead to damage of renal vessels and kidney failure. Laparoscopic partial nephrectomy done without clamping the renal pedicle is feasible and may be beneficial for the postoperative course.AimTo compare intra- and postoperative course in patients undergoing LPN with and without kidney warm ischaemia.Material and methodsThe material comprises 38 consecutive patients, who underwent LPN in our department during the years 2008-2009. In all cases renal vessels were identified and dissected at first, then resection of the tumour was done. Warm ischaemia was used only in case of difficulties with identification of tumour margin or with the management of bleeding. Out of 38 operations 13 were done without clamping the renal pedicle (group 1) and in the remaining 25 warm ischaemia was applied (group 2).ResultsMean dimension of resected tumours in groups 1 and 2 was 31 mm and 33 mm respectively (p > 0.05), while parameters of intra- and postoperative course differed significantly between the groups: mean blood loss – 135 ml vs. 354 ml (p < 0.05), time of surgery – 72.6 min vs. 132.2 min (p < 0.05), postoperative drain leakage – 290 ml vs. 504 ml (p < 0.05), postoperative hospital stay – 3.1 days vs 5.3 days (p < 0.05). In all patients baseline creatinine levels were normal while after surgery creatinine elevation over the upper limit was found in groups 1 and 2 in one and in 6 patients respectively (p < 0.05).ConclusionsLaparoscopic resection of kidney tumour without warm ischaemia is feasible and beneficial in pre- and intraoperatively selected cases. Bleeding from renal parenchyma, which requires renal pedicle clamping, may seriously deteriorate intra- and postoperative course in patients undergoing laparoscopic partial nephrectomy.

Section: Introductionmentioning

confidence: 99%

Impact of "non-clamping technique" on intra- and postoperative course after laparoscopic partial nephrectomy.

Petrasz¹,

Słojewski²,

Sikorski³

2012

“…Benefits of SPS technique are still arguable even in grownups. A very good cosmetic result is believed to be the main advantage in comparison to classic laparoscopy [3, 4, 8, 11]. Numerous publications report other theoretical benefits such as decrease of postoperative pain, decrease of blood loss, shorter hospital stay, and also reduced risk of organ damage connected with the necessity of additional ports placement, which results in cost reduction [1, 4, 5, 9, 12].…”

Section: Discussionmentioning

confidence: 99%

“…In the pursuit of minimized tissue injury resulting in decreased postoperative pain and increased emphasis on the cosmetic effect, single port laparoscopic procedures (SPS) have gained in popularity, even though they are technically more challenging and require longer training in comparison to traditional laparoscopy [1–3]. Increasing interest in this branch of minimally invasive surgery is also fuelled by huge technological advancement.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic single port surgery nephrectomy in a child - initial experience.

Bryks-Laszkowska¹,

Gołębiewski²,

Czauderna³

2012

The aim of the stucdy was to present technical aspects and possible intraoperative complications based on the first single port surgery (SPS) laparoscopic nephrectomy performed in our center. The SPS laparoscopic nephrectomy of the right kidney was performed using a transperitoneal access in a 4-year-old child due to a small nonfunctional kidney complicated by hypertension. The intraoperative course was complicated by rupture of the gall bladder wall after grasper removal without leakage of its contents into the peritoneal cavity. No postoperative complications occurred. The SPS nephrectomy appears to be an advantageous method in children which offers a good cosmetic effect. Other benefits require confirmation in further studies. Fixation of the gall bladder is a very helpful but risky maneuver.

“…Therefore, it is necessary to close it with interrupted or running sutures, which requires skill in laparoscopic suturing. The excised specimen can be removed through a small lower midline [14, 22, 23], Pfannenstiel incision [17, 18] or transvaginally in female patients [4, 20]. In 2004 Deger et al .…”

Section: Discussionmentioning

confidence: 99%

Single-session laparoscopic cystectomy and nephroureterectomy.

Słojewski¹,

Chłosta²,

Myślak³

et al. 2012

Self Cite

Patients with high grade and/or muscle invasive bladder cancer and with concomitant diseases of the upper urinary tract, e.g. urothelial tumors (transitional cell carcinoma – TCC) or afunctional hydronephrotic kidneys, may be candidates for simultaneous cystectomy and nephroureterectomy. Although the progress in laparoscopic techniques made these procedures feasible and safe, they are still technically demanding so only experienced surgeons can perform them. The aim of the study is to report our experience with laparoscopic simultaneous en bloc resection of the urinary bladder together with unilateral or bilateral nephroureterectomy in patients with TCC. Our material consists of three cases operated on in three centers between 2002 and 2011. After having completed bilateral (1 case) or unilateral (2 cases) nephroureterectomy, we performed radical cystectomy with pelvic lymph node dissection. All the specimens, including the kidneys, ureters, bladder, and reproductive organs in the female, were collected in endobags and were retrieved en bloc using hypogastric incision in the male patient and the vaginal route in the female patients. The demographic and perioperative information was collected and analyzed. All procedures were completed laparoscopically without the need of conversion to open surgery. No major intra- or postoperative complications were observed. Only 1 patient suffered from prolonged lymphatic leakage. From our experience we can conclude that single-session laparoscopic cystectomy and nephroureterectomy are technically feasible and safe, and may be offered for the treatment of selected cases of TCC of the urinary tract.