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

Abstract

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.

Renal Cell Carcinoma in Dialysis Patients with End Stage Renal Disease: Focus on Surgery and Pathology

“…Operative time and blood loss are similar to those in open surgery and complications including blood transfusion are very rare 17 . Postoperative data, days to oral feeding and days to walking are reported to be equal or sooner compared with LRN 17 and surgical site infection is extreamly rare despite the lack of use of prophylactic antibacterial agents 46 . These findings hold true even in ESRD patients.…”

“…Bleeding and operation time were comparable to LRN, as shown in Table.2. We already reported that this operation has minimal invasiveness similar to that of LRN 17 and an oncological outcome similar to that of open surgery 22 . Operative time and blood loss are similar to those in open surgery and complications including blood transfusion are very rare 17 .…”

“…We already reported that this operation has minimal invasiveness similar to that of LRN 17 and an oncological outcome similar to that of open surgery 22 . Operative time and blood loss are similar to those in open surgery and complications including blood transfusion are very rare 17 . Postoperative data, days to oral feeding and days to walking are reported to be equal or sooner compared with LRN 17 and surgical site infection is extreamly rare despite the lack of use of prophylactic antibacterial agents 46 .…”

“…The surgical technique of MIES RN, was previously demonstrated [17][18][19] . Briefly, the minimum incision, around 4 to 6 cm depending on the size of the specimen that narrowly permits extraction of the kidney covered with perinephric fat is made obliquely forward following the line of the 12th rib ( fig.1).…”

Collecting duct carcinoma with acquired cystic disease of the kidney in a long‐term hemodialysis patient

“…The patient underwent minimum incision endoscopic radical nephrectomy, which is also referred to as the portless endoscopic urological surgery, 6 via a right flank incision. Gross examination of the resected kidney weighing 1050g revealed multifocal tumors sized at 0.2-1.5 cm in the wall of several cysts and a gray-white tumor without pseudocapsule, measuring 2.0 cm ¥ 2.0 cm in the renal medulla (Fig.…”