Laparoscopic Partial Nephrectomy: Initial Experience and Comparison to the Open Surgical Approach

Winfield, Howard N.; Donovan, James F.; Lund, Greg O.; Kreder, Karl J.; Stanley, Kenneth; Brown, Bruce P.; Loening, Stefan A.; Clayman, Ralph V.

doi:10.1016/s0022-5347(01)67415-9

Cited by 138 publications

(55 citation statements)

References 18 publications

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“…Overall, postoperative haemorrhage after LPN has been reported to be 4.2-6% [8,9]. Delayed postoperative haemorrhage has not been well defined separately but appears to occur in 1.2% of small tumour cases and in up to 7.5% of more complex cases involving centrally located tumours [4,6,11,12].…”

Section: Discussionmentioning

confidence: 99%

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Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings

et al. 2010

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Study Type – Therapy (case series)  Level of Evidence 4 What’s known on the subject? and What does the study add? Delayed haemorrhage has not been well defined in the literature, clinical presentation has not been well described and treatment algorithms are lacking. From our experience we have shown that patients presenting with delayed bleeding after laparoscopic partial nephrectomy will need definitive rather than conservative treatment and angiographic findings demonstrate definitive lesions in all cases. Potential benefits include faster diagnosis and initiation of definitive treatment (angiography with embolization), avoiding repeat computed tomography imaging as it adds little in such patients and reducing need for prolonged hospitalization. OBJECTIVES • To determine the frequency of delayed postoperative haemorrhage requiring selective angioembolization (SAE) after laparoscopic partial nephrectomy (LPN). • To describe the clinical presentation and characterize the angiographic findings encountered in this setting. PATIENTS AND METHODS • Prospective data from 640 LPNs performed between August 1993 and May 2009 were retrospectively analyzed, from which patients with delayed postoperative haemorrhage (defined as ‘gross haematuria ≥7 days postoperatively that persists for more than 24 h’) and requiring SAE were identified. • Clinicopathological, preoperative and perioperative factors were reviewed. • Selective catheterization and angiography of the renal artery was performed for persistent gross haematuria and for haemodynamic instability associated with a significant drop in haematocrit level. • Arteries feeding the bleeding site were identified and embolized with endovascular coils. RESULTS • Patients presented with delayed haemorrhage between 7 and 30 days after surgery. SAE was required in 13 patients (2%) for delayed postoperative bleeding. • Of the 640 LPNs, 68 (10.6%) were performed without hilar occlusion (‘off‐clamp’) of whom one (1.5%) had a delayed haemorrhage, which was successfully embolized. • For patients with and without delayed haemorrhage after LPN, the mean tumour size was 2.7 cm and 3.3 cm (P= 0.31), the mean warm ischaemia time was 28.2 min and 14.3 min (P < 0.001), and the mean estimated blood loss 403.8 mL and 308.2 mL (P= 0.26), respectively. • Percutaneous angiography showed renal artery pseudoaneurysm in 10 patients and arterial contrast extravasation in three patients, two of whom also had an arteriovenous fistula. • Following embolization, creatinine levels remained stable in all patients. CONCLUSIONS • Clinically significant delayed postoperative bleeding after LPN occurs in a small percentage of patients. • Angiography will accurately make the diagnosis of RAP or AVF and SAE is safe and effective procedure that allows for preservation of renal function.

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Section: Discussionmentioning

confidence: 99%

“…The increased experience with laparoscopic renal surgery has meant that its use has now been extended to the treatment of larger and more complex lesions [1][2][3][4]. Oncological outcomes for laparoscopic partial nephrectomy (LPN) are comparable with radical nephrectomy as well as with open partial nephrectomy (OPN) [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings

et al. 2010

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“…7 Laparoscopy, however, has become the standard of care in various urologic oncology treatment regimens with demonstrated efficacy, decreased morbidity, and improved patient satisfaction. 8,9 L-RPLND has demonstrated improved convalescence and quality of life compared with open RPLND. 10,11 In similar fashion, a report on robot-assisted L-RPLND will continue to increase the minimally invasive nature of the procedure.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Retroperitoneal Lymph Node Dissection for Low-Stage Testicular Cancer

Skolarus

Bhayani

Chiang

et al. 2008

Journal of Endourology

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Skolarus, T. A.; Bhayani, S. B.; Chang, H. C.; Brandes, S. B.; Kibel, A. S.; Landman, J.; and Figenshau, R. S., ,"Laparoscopic retroperitoneal lymph node dissection for low-stage testicular cancer." Journal of Endourology.22,7. 1485Endourology.22,7. -1490Endourology.22,7. . (2008 Results: A total of 26 L-RPLND procedures were completed, 3 for paratesticular rhabdomyosarcoma. Mean operative time was 250 minutes (range 176-369 min); estimated blood loss was 145 mL (range 50-500 mL); lymph node count was 23.8 (range 8-48); and hospital stay was 1.5 days (range 1-3 d). Four patients underwent postchemotherapy L-RPLND for residual nodes (1.1-2.9 cm). There were no conversions to an open procedure, blood transfusions, or operative complications. Chemotherapy was instituted in five of six patients with pathologic stage II disease. Mean follow-up was 23.7 months without retroperitoneal disease recurrence. Conclusion: L-RPLND as a diagnostic and therapeutic tool provides the benefits of a minimally invasive approach to MMGCT. It is the procedure of choice at our institution for low-stage MMGCT and paratesticular rhabdomyosarcoma.

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“…For more substantial parenchyma, numerous other means are available, e.g. bipolar electrocautery, argon beam coagulator (ABC), Nd:YAG laser, holmium:YAG laser, electrosurgical snare electrode, microwave coagulator, and Gill renal tourniquet [6,[10][11][12][13][14][15]. A review of the literature shows that most surgeons prefer bipolar electrocautery with or without ABC [6,14,16].…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11][12][13][14]. Twelve underwent unilateral upper-pole LPN and one a simultaneous bilateral upper-pole LPN.…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic partial upper pole nephrectomy in infants and children

et al. 2001

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Objective To retrospectively review 5 years' experience of transperitoneal laparoscopic partial nephrectomy (LPN) in infants and children. Patients and methods Between January 1995 and December 1999, 14 upper‐pole partial nephrectomies (seven right and seven left) were undertaken in 13 children (mean age 3.8 years, range 0.4–14). One patient underwent bilateral upper‐pole LPN. No children required a lower‐pole partial nephrectomy during the study period. Evaluation included renal ultrasonography, voiding cystourethrography, renal scintigraphy and contrast‐enhanced computed tomography in some cases. Three ports (10, 5 and 5 mm) were used in all except two patients, who required an additional 2 mm port for liver retraction. The diseased parenchyma was transected with electrocautery or harmonic scalpel. The distal ureter was simply transected in the absence of reflux, but tied adjacent to the bladder if reflux was present. Results The mean operative duration for LPN was 100 min, with an estimated blood loss of < 30 mL. A liquid diet was tolerated on the first morning after surgery and age‐appropriate regular diet that evening in all except one patient. The mean hospital stay was 2.6 days. One patient had a significant decrease in haematocrit, which was managed conservatively, not requiring transfusion. Follow‐up telephone interviews with the patients' parents showed that all were satisfied with the medical and cosmetic outcome. Conclusion Transperitoneal LPN is preferable to open partial nephrectomy because: (i) The magnification provided by laparoscopy provides excellent vision for the precise dissection of the parenchyma and distal ureter, avoiding injury to the healthy tissue; (ii) There is minimal blood loss, fast recovery and less surgical scarring, and when upper‐pole partial nephrectomy is required, LPN is less damaging to the lower‐pole. Unlike total nephrectomy, where debate remains about open vs laparoscopic methods, the specific advantages of LPN make it clearly preferable.

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Laparoscopic Partial Nephrectomy: Initial Experience and Comparison to the Open Surgical Approach

Cited by 138 publications

References 18 publications

Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings

Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings

Laparoscopic Retroperitoneal Lymph Node Dissection for Low-Stage Testicular Cancer

Laparoscopic partial upper pole nephrectomy in infants and children

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