Endoscopic minilaparotomy radical nephrectomy for chronic dialysis patients

Kageyama, Yukio; Kihara, Kazunori; Ishizaka, Kazuhiro; Okuno, Tatsusada; Hayashi, Tetsuo; Kawakami, Satoru; Masuda, Hitoshi; Suzuki, Masahito; Hyochi, Nobuhiko; Arai, Gaku

doi:10.1046/j.1442-2042.2002.00422.x

Cited by 21 publications

(39 citation statements)

References 12 publications

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“…This method is likely to save the bag cost and avoid unnecessary bleeding associated with blind techniques. As previously reported, we believe that this operation would be especially suitable for chronic dialysis patients with renal cell carcinoma, who have a high risk of perioperative complications 9 …”

Section: Discussionmentioning

confidence: 52%

Portless endoscopic radical nephrectomy via a single minimum incision in 80 patients

et al. 2004

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Aim : To assess the feasibility of our portless endoscopic radical nephrectomy via a single minimum incision, which narrowly permitted extraction of the specimen in the initial 80 patients. Methods : Radical nephrectomy was carried out extraperitoneally in patients with T1-3aN0M0 renal tumors using an endoscope through a single minimum incision without trocar ports and gas. All the instruments used were reusable.Results : The average length of incision, operative time and estimated blood loss were 6.6 cm (range, 4-9 cm), 3. 1 h (range, 1.7-5.6 h) and 324 mL (range, 10-2288 mL), respectively. The complication rate was 2.5% (2/80); complications included injury of the pleura and hemorrhage from the vena cava, both of which were repaired by suture during operation. Transfusion was performed in three patients (3.8%). Average times to oral feeding and walking were both 1.4 days. Wound pain was minimal and analgesics were generally not required by the second postoperative day. In patients with larger incisions (7 cm or more), estimated blood loss increased (approximately 100 mL on average) and oral feeding resumed later (0.3 days on average), relative to patients with smaller incisions (6 cm or less). However, overall results were similar between the two patient groups. In patients with a large tumor (7 cm or greater), operative time did not increase and complications and transfusions were both avoided. Conclusion : Portless endoscopic radical nephrectomy via a single minimum incision is a safe, reproducible, cost-effective and minimally invasive treatment option for patients with T1-3aN0M0 renal tumors.

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Section: Discussionmentioning

confidence: 52%

Portless endoscopic radical nephrectomy via a single minimum incision in 80 patients

et al. 2004

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“…We demonstrated MIES nephrectomy was less invasive than conventional nephrectomy and appropriate to RCC in dialysis patients. Since MIES nephrectomy can decrease postoperative pain, decrease the risk of surgical site infection, preclude complication by gas and prevent complications in the peritoneal cavity, earlier postoperative recovery than can be expected compared with that following conventional open nephrectomy 3–6 . When compared with laparoscopic nephrectomy, the following advantages can be expected from MIES nephrectomy: Firstly, gasless MIES nephrectomy does not impose circulatory stress on dialysis RCC patients with surgical risk.…”

Section: Discussionmentioning

confidence: 99%

“…We have performed minimum incision endoscopic surgery (MIES), which is also referred to as the portless endoscopic urological surgery (PLES), since 1998 3 . We have reported our initial experience of MIES radical nephrectomy in dialysis patients 4 . Here we report the result of sequential bilateral MIES radical nephrectomies on seven patients on dialysis with bilateral RCCs.…”

Section: Introductionmentioning

confidence: 99%

Sequential bilateral minimum incision endoscopic radical nephrectomy in dialysis patients with bilateral renal cell carcinomas

Sakura¹,

Kawakami²,

Masuda³

et al. 2007

Int J of Urology

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Since 1998, we have performed minimum incision endoscopic surgery (MIES) for renal cell carcinoma (RCC). For seven dialysis patients with bilateral RCC, we have performed sequential bilateral MIES radical nephrectomy. It was carried out by retroperitoneal approach through a single minimum incision that narrowly permitted extraction of the specimen using endoscopy and direct stereovision, without trocar ports, without gas insufflation and without the insertion of the hands of operators into the operative field. Although six of the seven patients had multiple complications in addition to chronic renal failure (CRF), bilateral kidneys were successfully removed by sequential MIES radical nephrectomy without major operative complication. Postoperative recovery was prompt with all patients resuming oral feeding and walking by the second postoperative day. Sequential bilateral MIES radical nephrectomy, leaving the peritoneal cavity intact and without imposing circulatory stress caused by gas insufflation, is a feasible treatment for bilateral RCCs in dialysis patients.

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“…We performed radical nephrectomy by single MIES via the translumbar approach with the patient in the flank position over the break of the operating table according to Kihara's method [5-7]. The surgical team consisted of the chief operator (T.K*: 19 years of urological experience) and two or three assistants.…”

Section: Methodsmentioning

confidence: 99%

“…In 2006, MIES was recognized as a method of advanced surgery by the Japanese government and it has been covered by the Japanese universal health insurance system since 2008 [5]. Single MIES is based on both standard open surgery and modified hand-assisted laparoscopic surgery [5], so the instruments employed are the same as those used for open surgery or laparoscopic surgery and it only requires a short time to learn the technique [5-7]. Because MIES is performed via a small incision, the surgical field is very limited.…”

Section: Introductionmentioning

confidence: 99%

Single minimum incision endoscopic radical nephrectomy for renal tumors with preoperative virtual navigation using 3D-CT volume-rendering

et al. 2010

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BackgroundSingle minimum incision endoscopic surgery (MIES) involves the use of a flexible high-definition laparoscope to facilitate open surgery. We reviewed our method of radical nephrectomy for renal tumors, which is single MIES combined with preoperative virtual surgery employing three-dimensional CT images reconstructed by the volume rendering method (3D-CT images) in order to safely and appropriately approach the renal hilar vessels. We also assessed the usefulness of 3D-CT images.MethodsRadical nephrectomy was done by single MIES via the translumbar approach in 80 consecutive patients. We performed the initial 20 MIES nephrectomies without preoperative 3D-CT images and the subsequent 60 MIES nephrectomies with preoperative 3D-CT images for evaluation of the renal hilar vessels and the relation of each tumor to the surrounding structures. On the basis of the 3D information, preoperative virtual surgery was performed with a computer.ResultsSingle MIES nephrectomy was successful in all patients. In the 60 patients who underwent 3D-CT, the number of renal arteries and veins corresponded exactly with the preoperative 3D-CT data (100% sensitivity and 100% specificity). These 60 nephrectomies were completed with a shorter operating time and smaller blood loss than the initial 20 nephrectomies.ConclusionsSingle MIES radical nephrectomy combined with 3D-CT and virtual surgery achieved a shorter operating time and less blood loss, possibly due to safer and easier handling of the renal hilar vessels.

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Endoscopic minilaparotomy radical nephrectomy for chronic dialysis patients

Cited by 21 publications

References 12 publications

Portless endoscopic radical nephrectomy via a single minimum incision in 80 patients

Portless endoscopic radical nephrectomy via a single minimum incision in 80 patients

Sequential bilateral minimum incision endoscopic radical nephrectomy in dialysis patients with bilateral renal cell carcinomas

Single minimum incision endoscopic radical nephrectomy for renal tumors with preoperative virtual navigation using 3D-CT volume-rendering

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