Outcomes of hand-assisted laparoscopic nephrectomy in technically challenging cases

Kalra, Pankaj; Glassman, Deborah T.; Gomella, Leonard G.; McGinnis, David E.; Simón, Daniel; Chang, Mark; Byrne, Dolores; Kuo, Ramsay L.

doi:10.1016/j.urology.2005.07.043

Cited by 14 publications

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“…Median operative time was 3.3 hours (IQR = 1.5 h), with median blood loss of 60 mL (IQR = 150 mL). Thirty-one (7.9%) patients needed transfusion, with a median of two units transfused (range [1][2][3][4][5][6][7][8][9][10][11][12]. Intraoperative and postoperative complications occurred in 3.0% and 12.2%, respectively.…”

Section: Resultsmentioning

confidence: 99%

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Conversions in Laparoscopic Renal Surgery: Causes and Outcomes

Ivey

Lucas

Meyer

et al. 2011

Journal of Endourology

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Section: Resultsmentioning

confidence: 99%

“…A total conversion rate for these simple nephrectomies was 12.8% (15), with 10.3% (12) necessitating open conversion. For each approach, conversion occurred in 12% to 13% of cases, although only 4/7 conversions were to an open procedure for TPL, whereas all four conversions for both HAL and RPL were to an open procedure.…”

Section: Surgical Indicationsmentioning

confidence: 99%

Conversions in Laparoscopic Renal Surgery: Causes and Outcomes

Ivey

Lucas

Meyer

et al. 2011

Journal of Endourology

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“…Nevertheless, disadvantages of open surgery are well known, including wider incision, more analgesics requirement, greater post-operative discomfort and pain, prolonged hospital stay, as well as longer convalescence period. Some urologists proposed that hand-assisted laparoscopic nephrectomy could help dissection of kidney and control of renal hilum, so as to reduce complications and shorten operative time ( 4 - 6 ). However, the incision is similarly longer and the injury is greater in this technique.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic nephrectomy outside gerota fascia and en bloc ligation of the renal hilum for management of inflammatory renal diseases

2018

Int. braz j urol.

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ObjectivesThis study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications.Materials and MethodsThirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined.ResultsAmong 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery.ConclusionsIn laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.

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“…La duración de la cirugía y la pérdida sanguínea estimadas fueron de 210 minutos y 310 ml, respectivamente, con una estancia hospitalaria media de tres días. Estos datos son similares a los de otros grupos que trataron casos técnicamente complejos 6 : masas renales mayores de 7 cm 7 y de 10 cm 8 , o cuadros con intensa inflamación perirrenal 9 . Ningún paciente requirió conversión a cirugía abierta.…”

Section: Discussionunclassified

Nefrectomía laparoscópica asistida por la mano en casos difíciles

et al. 2010

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evaluar los resultados de nefrectomía laparoscópica asistida por la mano en pacientes con masas renales técnicamente complejas. Métodos: se ha realizado una evaluación retrospectiva de 100 nefrectomías laparoscópicas realizadas en un solo hospital entre 2001 y 2005. Se ha seleccionado a los pacientes con antecedentes de cirugía abdominal previa, procedimientos previos en el riñón afectado, evidencia de inflamación perirrenal, lesiones renales de más de 10 cm de diámetro o trombosis venosa renal tipo I. Resultados: se ha incluido un total de 12 pacientes; 5 de ellos presentaban una lesión de al menos 10 cm de diámetro, dos trombosis venosa renal y 5 referían cirugía abdominal mayor. La mayoría de los pacientes tenía más de uno de estos hallazgos. Tres pacientes presentaban procesos inflamatorios (cálculos coraliformes) y un tumor renal T4 fue tratado con éxito, sin necesidad de reconversión. El tiempo operatorio y la pérdida sanguínea medias fueron de 210 minutos y 310 ml, respectivamente, con una estancia media de tres días. Ningún paciente requirió reconversión a cirugía abierta. Conclusiones: la nefrectomía laparoscópica asistida por la mano es una opción mínimamente invasiva, atractiva en el contexto de masas técnicamente complejas, con un tiempo operatorio, una pérdida sanguínea y una tasa de complicaciones razonables.

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Outcomes of hand-assisted laparoscopic nephrectomy in technically challenging cases

Cited by 14 publications

References 14 publications

Conversions in Laparoscopic Renal Surgery: Causes and Outcomes

Conversions in Laparoscopic Renal Surgery: Causes and Outcomes

Laparoscopic nephrectomy outside gerota fascia and en bloc ligation of the renal hilum for management of inflammatory renal diseases

Nefrectomía laparoscópica asistida por la mano en casos difíciles

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