Laparoscopic Nephron Sparing Surgery: Evolution in a Decade

Abukora, Firas; Nambirajan, Thiagarajan; Albqami, Nasser; Leeb, Karl; Jeschke, Stephan; Gschwendtner, Manfred; Janetschek, Günter

doi:10.1016/j.eururo.2004.12.021

Cited by 82 publications

(29 citation statements)

References 19 publications

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“…The traditional open approach to nephron-sparing surgery has established oncologic and functional outcomes with 10-year follow-up [8,9]. Several groups have published their results with the laparoscopic technique (Table 1) [3,4,[18][19][20][21][22][23][24][25]. Lane and Gill [4] recently published the results on 58 patients who had undergone an LPN with at least 5 years of follow-up (median of 5.7 years; range: 5-6.9 years).…”

Section: Laparoscopic Partial Nephrectomymentioning

confidence: 95%

Minimally Invasive Management of Upper Tract Malignancies: Renal Cell and Transitional Cell Carcinoma

Box

Lehman

Landman

et al. 2008

Urologic Clinics of North America

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Section: Laparoscopic Partial Nephrectomymentioning

confidence: 95%

Minimally Invasive Management of Upper Tract Malignancies: Renal Cell and Transitional Cell Carcinoma

Box

Lehman

Landman

et al. 2008

Urologic Clinics of North America

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“…13 Laparoscopic partial nephrectomy has further refined nephron-sparing surgery, by providing equivalent oncologic control to open procedures, with the additional advantage of faster recovery times, owing to the avoidance of a morbid subcostal incision. [14][15][16] One potential drawback to minimally invasive approaches for partial nephrectomy is the exposure of the kidney to the potentially deleterious effects of warm ischemia. Unlike open procedures, where the renal bed may be packed with ice, or local control can be exerted with manual compression, traditional laparoscopic approaches require arterial occlusion without the benefit of cooling.…”

Section: Discussionmentioning

confidence: 99%

Selective Versus Nonselective Arterial Clamping During Laparoscopic Partial Nephrectomy: Impact upon Renal Function in the Setting of a Solitary Kidney in a Porcine Model

Benway

Baca

Bhayani

et al. 2009

Journal of Endourology

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Diaz, Dilmer L.; Maxwell, Keegan L.; Badwan, Khalid H.; Talcott, Michael R.; Liapis, Helen; Cabello, Jose M.; Venkatesh, Ramakrishna; and Figenshau, Robert S., ,"Selective versus nonselective arterial clamping during laparoscopic partial nephrectomy: Impact upon renal function in the setting of a solitary kidney in a porcine model." Journal of Endourology.23,7. 1127Endourology.23,7. -1133Endourology.23,7. . (2009 Introduction: Laparoscopic partial nephrectomy has emerged as a standard of care for small renal masses. Nevertheless, there remains concern over the potential for irreversible insult to the kidney as a result of exposure to warm ischemia. We aim to investigate the utility of selective segmental arterial clamping as a means to reduce the potential for ischemic damage to a solitary kidney during laparoscopic partial nephrectomy utilizing a porcine model. Materials and Methods: A total of 20 domestic swine were randomized into four equal groups. Each subject underwent laparoscopic radical nephrectomy to create the condition of a solitary kidney. On the contralateral side, a laparoscopic lower pole partial nephrectomy was performed, employing either selective or nonselective vascular clamping for either 60 or 90 minutes. Postoperatively, clinical status and serial serum studies were closely monitored for 1 week.Results: There were no intraoperative complications. The 90-minute nonselective clamping produced devastating effects, resulting in rapid deterioration into florid renal failure within 72 hours. The 60-minute nonselective clamping group experienced modest but significant rises in both blood urea nitrogen and creatinine. Both 60-and 90-minute selective clamping groups performed well, with no significant rises in creatinine over a 7-day period, and no instances of renal failure. Conclusions: Selective arterial clamping is a safe and feasible means of vascular control during laparoscopic partial nephrectomy. In the porcine model, selective clamping appears to improve functional outcomes during prolonged periods of warm ischemic insult. Prospective evaluation of the technique in humans is necessary to determine if selective arterial control confers long-term functional benefits in patients with limited renal reserve.

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“…Das laparoskopische Knüpfen ist sehr zeitaufwendig. Ein entscheidender Schritt bestand deshalb darin, das Parenchym mit einer speziellen fortlaufenden Naht zu versorgen, und alle Knöpfe durch Klips zu ersetzen [5]. Eine weitere deutliche Verkürzung der Ischämiezeit gelang mit der Einführung der "Early-declamping-Technik" [6].…”

Section: Entwicklung Der Technikunclassified

Nierenteilresektion – pro Laparoskopie

Janetschek

2012

Urologe

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Partial nephrectomy has become the most frequently used surgical procedure in the treatment of renal cell cancer. The current role of laparoscopy for this indication has to be defined.The technique of laparoscopic partial nephrectomy has undergone a continuous development to become mature. Once the learning curve of the individual surgeon has been overcome the results are comparable to those of open surgery. This is true for ischemia time, complication rate and oncologic outcome. In addition there is the advantage of the minimally invasive approach in laparoscopy sparing a painful flank incision. Laparoscopic partial nephrectomy is not yet a standard of care but yields excellent results in the hands of experts. There are no conclusive studies comparing standard and da Vinci®-assisted laparoscopy. No clear advantages become obvious, but the costs of the robot are substantial.

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Laparoscopic Nephron Sparing Surgery: Evolution in a Decade

Cited by 82 publications

References 19 publications

Minimally Invasive Management of Upper Tract Malignancies: Renal Cell and Transitional Cell Carcinoma

Minimally Invasive Management of Upper Tract Malignancies: Renal Cell and Transitional Cell Carcinoma

Selective Versus Nonselective Arterial Clamping During Laparoscopic Partial Nephrectomy: Impact upon Renal Function in the Setting of a Solitary Kidney in a Porcine Model

Nierenteilresektion – pro Laparoskopie

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