Posterior retroperitoneoscopic partial nephrectomy using microwave tissue coagulator for small renal tumors

BACKGROUND AND PURPOSE: Laparoscopic partial nephrectomy remains surgically challenging because of the potential for excessive blood loss, infection, and the development of urinary fistulas. In addition, posterior retroperitoneoscopic partial nephrectomy is not popular because of the limited space for surgical manipulation. We evaluated the usefulness of a microwave tissue coagulator in posterior retroperitoneoscopic partial nephrectomy for small posterior renal tumor. PATIENTS AND METHODS: Posterior retroperitoneoscopic partial nephrectomy was performed without renal pedicle clamping using a microwave tissue coagulator in six patients with small posterior renal tumors. RESULTS: The mean operative time was 136 minutes (range 78-180 minutes), and the blood loss was <20 mL. No serious operative complications occurred, and there was no significant deterioration of renal function. CONCLUSION: Posterior retroperitoneoscopic partial nephrectomy using a microwave tissue coagulator can be a safe and less invasive method for the treatment of small posterior renal tumors.     

Laparoscopic partial nephrectomy using microwave tissue coagulator for small renal tumors: usefulness and complications

OBJECTIVES: We evaluated the usefulness and complications of laparoscopic partial nephrectomy for small renal tumors using a microwave tissue coagulator without renal pedicle clamping. METHODS: Between September 1999 and March 2003, 19 patients with small renal tumors 11 to 45 mm in diameter underwent laparoscopic partial nephrectomy without renal ischemia. RESULTS: Six and 13 patients were treated by the transperitoneal and retroperitoneal approaches, respectively. Excluding a case with open conversion due to dense perirenal adhesions, 18 patients successfully underwent laparoscopic procedures. The mean operative time was 240 minutes with minimal blood loss in 14 patients and 100 to 400 ml in 4. In a patient, frozen sections revealed a positive surgical margin and additional resection was performed. Postoperative complications included extended urine leakage for 14 days, arteriovenous fistula and almost total loss of renal function, respectively, in a patient. With the median follow-up of 19 months, no patients showed local recurrence or distant metastasis by CT scan. CONCLUSIONS: Laparoscopic non-ischemic partial nephrectomy using a microwave tissue coagulator may be useful for treating small renal tumors because it does not require advanced laparoscopic skill. However, the indication of this procedure should be highly selective in order to minimize serious complications secondary to unexpected collateral damage to surrounding structures.     

Retroperitoneoscopic partial nephrectomy using microwave coagulation for small renal tumors

OBJECTIVES: The outcome of laparoscopic partial nephrectomy using a microwave tissue coagulator for treatment of small renal tumors was studied.PATIENTS AND METHODS: From June 1999 to May 2001, eight patients with small renal tumors of less than 5.0cm in diameter (1.0-5.0cm, T1N0M0) underwent retroperitoneoscopic partial nephrectomy. To control bleeding during the partial nephrectomy, the renal parenchyma around the tumor was coagulated using a microwave tissue coagulator with a needle of 1.5cm length. The tumor was circumscribed within the coagulated area with 8-13 punctures of the coagulation needle, and partial nephrectomy was performed using scissors and bipolar forceps.RESULTS: All eight patients successfully underwent the procedure retroperitoneoscopically. The average operative time was 295 minutes and the average blood loss was 129ml. Three patients showed urine leakage from the renal calyces, which was controlled by suturing retroperitoneoscopically. In two patients, the surgical margin was revealed to be positive for renal cell carcinoma by frozen section pathology and additional resection was performed in these individuals. The patients were discharged from the hospital with almost full convalescence on day 10 on average. Within the mean follow-up period of 10.4 months, no recurrence was found when examined with computer tomography (CT) using contrast media. As a complication, one patient experienced a decrease in function of the operated kidney caused by unknown reason.CONCLUSION: Retroperitoneal partial nephrectomy using a microwave tissue coagulator is useful for treatment of small renal tumors located at the peripheral area of the kidney. Bleeding from the renal parenchymal incision site is well controlled without occlusion of the renal artery with additional use of a bipolar coagulator, when necessary. Further experience and long-term follow-up are mandatory however, to establish the usefulness of this technique.     

Retroperitoneoscopic partial nephrectomy by using microwave tissue coagulation

Partial nephrectomy is widely accepted as a treatment for small renal cell carcinoma. However, the laparoscopic approach has not yet been considered as a standard procedure. We reviewed our 13 retroperitoneoscopic partial nephrectomies and 11 conventional open partial nephrectomies. We have used microwave tissue coagulation for retroperitoneoscopic surgery without renal pedicle clamping between December 1999 and May 2003. The mean operating time for the retroperitoneoscopic group was not significantly longer than that for conventional open surgery group (183 minutes vs 194 minutes). However, the mean blood loss for the retroperitoneoscopic group was less than that for the open group (143 ml vs 512 ml). Histologic evaluation revealed renal cell carcinoma in 10 patients, angiomyolipoma in 2 patients, and lymphoangiomyomatosis in one patient for retroperitoneoscopic group and renal cell carcinoma in 11 patients for the conventional open surgery group. In addition, when compared with the historical control that had undergone conventional partial nephrectomy, laparoscopic cases had significantly shorter postoperative times to oral intake, ambulance, and discharge from hospital. Bowel injury, massive bleeding, urine leakage, and atelectasis occurred in one case each in retroperitoneoscopic surgery. Retroperitoneoscopic surgery in the case of massive bleeding was converted to open surgery. On the other hand, urine leakage and postoperative hemorrhage occurred in one case each in conventional open surgery. Retroperitoneoscopic partial nephrectomy by using microwave tissue coagulation is a useful and less invasive method, whereas this procedure is more challenging than open partial nephrectomy in terms of complications.     

Laparoscopic nephron-sparing surgery: preoperative assessment with three-dimensional computed tomography

OBJECTIVE: For retroperitoneal laparoscopic nephron-sparing surgery using a microwave tissue coagulator, it is helpful to know the relationship between the tumour, collecting system and vessels to prevent urinary leakage and vascular damage. We assessed the efficacy of multiplanar reformation and three-dimensional (3D) CT with the renal collecting system filled with contrast medium. METHODS: Fifteen patients with small renal tumours of less than 3 cm in diameter underwent dynamic CT examination ten minutes after injection of contrast medium of 30 ml. Multiplanar reformation, volume-rendered and maximum intensity projection images were created for determining operative approaches and for planning the operation. RESULTS: In all cases, the distance between the tumour and collecting system was measured on the multiplanar reformation. Accordingly, five cases were indicated for retroperitoneal laparoscopic nephron-sparing surgery using a microwave tissue coagulator. The remaining ten cases, due to the short distance (less than 10mm), were not considered good candidates for this procedure. The relationship between the tumour, collecting system and vessels was well shown on the volume-rendered and maximum intensity projection images. CONCLUSIONS: Multiplanar reformation and 3D-CT are able to give us an understanding of the surrounding structures. They are helpful in defining the indications for retroperitoneal laparoscopic nephron-sparing surgery using a microwave tissue coagulator and preoperative planning of nephron-sparing surgery.     

Retroperitoneoscopic partial nephrectomy for renal cell carcinoma: our initial experience and review of the literature

PURPOSE: We report our initial experiences of retroperitoneoscopic partial nephrectomy for renal cell carcinoma. MATERIALS AND METHODS: From April 2002 to October 2003, we performed 11 retroperitoneoscopic partial nephrectomy for renal cell carcinoma. Our indication was T1N0M0 renal tumors which sizes were about 4 cm or less and were exophytic and were not situated at the renal hilum. First we inserted single J catheter to the renal pelvis cystoscopically. under fluoroscopic guidance. Next 4 trocars were set at pneumoretroperitoneum and the renal artery and vein were clamped individually after cold saline was circulated from the single J catheter. Renal parenchyma was sharply cut with scissors and vessels were coagulated with bipolar coagulator. When renal collecting system was opened, cariceal suture repair was performed. We used the microwave tissue coagulator without clamping the renal pedicle when the tumor was 2 cm or less in diameter and the distance from the tumor edge to the renal collecting system was more than 1cm. RESULTS: In 9 cases renal pedicles were clamped and in 2 cases were not. Mean tumor size was 27.5 +/- 8.9 mm and mean operative time was 350 +/- 92 minutes and mean estimated blood loss was 743 +/- 998 ml, and mean warm ischemic time was 70 +/- 30 minutes. In one case bleeding from cut surface was uncontrollable, so open conversion was needed. In this case the renal artery and vein were clamed but another artery exited. The surgical margins were all negative, and no other complications were happened. Post operative serum creatinine raised soon after the operation but finally downed, and the mean up level was 0.07 ng/ml only. But RI examination revealed the residual renal damages were in proportioned to the warm ischemic times. During a mean followup of 8 months no patients has had local recurrence or metastatic disease. CONCLUSIONS: Retroperitoneoscopic partial nephrectomy for renal cell carcinoma is effective for select patients. But better cooling method and earlier suture technique and more long follow-up periods will be necessary for establishment.     

后腹腔镜肾部分切除术中免打结分层缝合法修补肾脏组织缺损的临床应用研究

目的:探讨后腹腔镜肾部分切除术中免打结分层缝合法修补肾脏组织缺损的临床可行性和安全性。方法:2008年12月～2010年12月,对167例肿瘤直径<4cm的肾肿瘤患者行后腹腔镜肾部分切除术。术中采用免打结技术分别缝合肾脏髓质和全层的分层缝合法修补肾脏组织缺损。观察肾脏热缺血时间、手术时间、术中出血量、术后住院天数、围手术期和近期并发症以及手术效果。结果:167例手术全部获得成功,无中转开放手术;术中平均肾脏热缺血时间(20.5±3.5)min,平均手术时间(62.1±10.6)min,术中出血量中位数30ml(10～220ml),无术中输血病例,术中肾脏组织冷冻病例检查3例,均为阴性,术后病理检查肾细胞癌肿瘤切缘均为阴性。术后住院时间中位数7d(5～13d),2例患者住院期间肾脏创面出血,予高选择性肾动脉栓塞后出血停止;术后无尿瘘病例。围手术期无死亡病例及二次手术切除肾脏病例。158例患者随访12～36个月,肾细胞癌患者均未见局部复发及远处转移,9例失访。结论:对于肿瘤直径<4cm的选择性肾肿瘤病例,后腹腔镜肾部分切除术中肾脏组织免打结缺损分层缝合法安全、有效,具有较好的临床可行性。     

Impact of microwave tissue coagulation during laparoscopic partial nephrectomy on postoperative renal function

Laparoscopic partial nephrectomy for small renal tumors has been performed with increasing frequency over the past few years. We prospectively evaluated preoperative and postoperative differential renal function in patients with functioning contralateral kidneys who underwent laparoscopic partial nephrectomy using a microwave tissue coagulator without hilar clamping. Seven patients (five men and two women) in this prospective protocol underwent laparoscopic partial nephrectomy for exophytic tumors using a microwave tissue coagulator when the tumor was 2 cm or less in diameter. Renal scanning with ⁹⁹technetium-labeled diethylenetetraminepentaacetic-acid scan was performed preoperatively and postoperatively at 7 days and 6 months after surgery in all patients. The mean tumor size and surgical duration were 17.0 ± 2.3 mm and 161.1 ± 20.5 min, respectively. Intraoperative blood loss was 35.6 ± 40.7 ml. The preoperative glomerular filtration rate (GFR) and differential split renal function (SF) in the affected kidney were 45.7 ± 12.8 ml/min and 50.5 ± 3.3%, respectively. On postoperative day 7 and at 6 months, GFR and SF in the affected kidney were 36.2 ± 9.0 and 36.8 ± 10.9 ml/min and 44.3 ± 4.1 and 45.0 ± 5.1%, respectively. No postoperative complications occurred. Laparoscopic nonischemic partial nephrectomy using a microwave tissue coagulator has the advantage of technical ease and adequate hemostasis. However, its indication should be restricted to small exophytic renal tumors due to the expected collateral damage causing renal impairment.     

Non-ischemic tumor enucleation for renal angiomyolipoma: a case report

A case of renal angiomyolipoma, successfully treated with non-ischemic tumor enucleation, is reported. A 16-year-old Japanese female visited another hospital with a chief complaint of general fatigue. She was diagnosed with angiomyolipoma of the right kidney, 7 cm in the long axis, which developed exteriorly at the lower pole. A nephrectomy was recommended. The patient visited us for a second opinion. We judged that nephron-sparing surgery was applicable to this case. The patient underwent non-ischemic tumor enucleation using a microwave tissue coagulator via retroperitoneal approach. The patient was discharged from our hospital 9 days after the surgery. Since a preoperative diagnosis with renal angiomyolipoma can be obtained relatively easily, maximum efforts for nephron-sparing surgery should be made.     

Partial nephrectomy for renal cell carcinoma using a microwave tissue coagulator--postoperative recurrence and renal function

Nowadays, partial nephrectomy is often selected for treatment of small renal cell carcinoma (RCC) because T1a RCC shows a favorable prognosis with a 5-year overall-survival rate exceeding 90%. To determine the methodological usefulness and treatment outcome of partial nephrectomy using microwave tissue coagulator (MTC), we evaluated our series of 121 patients (124 kidneys) with T1 RCC who underwent this procedure. Ninety-nine patients were elective and 22 patients were imperative cases. This procedure was indicated for asymptomatic solitary RCC; < or =4 cm in diameter in elective cases or < or =5 cm in imperative cases, expanding outward with a clear capsule, and showing neither renal pelvis nor renal sinus invasion. The median operation time was 150 minutes and the median blood loss was 217 ml. Eight patients needed transfusion, and conservative therapy cured 4 patients of postoperative urine leakage successfully. Three patients underwent early secondary nephrectomy due to multiple RCCs, invasive spindle cell carcinoma, or prolongation of urine leakage. No significant deterioration of renal function by creatinine clearance (Ccr) was observed, and postoperative Ccr could be precisely predicted from preoperative serum creatinine value and the renal parenchymal volume estimated with 3-dimensinal image reconstruction. Five-year overall-survival rate was 91% at the mean follow-up of up to 37.9 months and 107 patients were alive without disease. One patient showed local recurrence 2 years later and underwent radical nephrectomy. We believe that non-ischemic partial nephrectmy using MTC is a simple and reliable nephron-sparing surgery for small RCC in respect of postoperative recurrence and preservation of renal function.     

Laparoscopic partial nephrectomy

BACKGROUND AND PURPOSE: The technique of laparoscopic partial nephrectomy has matured significantly over the past decade and is emerging as an oncologically sound procedure for the management of small renal tumors. Methods of tumor excision as well as parenchymal reconstruction in a hemostatically controlled field have evolved to make this procedure safer. Improved techniques to minimize warm renal ischemia are being developed. Finally, methods to prevent positive surgical margins during laparoscopic surgery are crucial to a satisfactory oncologic outcome. These important technical issues, as well as the current results of laparoscopic partial nephrectomy, are discussed. MATERIALS AND METHODS: The urologic peer-review literature related to nephron-sparing surgery was reviewed. Controversial issues with respect to the surgical approach, methods of hemostatic control, acceptable time of warm ischemia, and cooling techniques were reviewed and collated. Perioperative results from larger series of laparoscopic and open partial nephrectomy were evaluated. RESULTS: Open nephron-sparing surgery for renal tumors < or =4 cm has cancer control equivalent to that of open radical nephrectomy. Evidence is now emerging that laparoscopic partial nephrectomy will provide similar oncologic results, although clinical follow-up is still early. Blood loss, postoperative pain, and convalescence seem to be favor the laparoscopic approach. Complication rates, primarily postoperative bleeding and urine leak, may be higher than for open nephron-sparing surgery. Methods of laparoscopic hemostatic control favor soft vascular clamping for larger tumors that are more endophytic and central. Smaller exophytic lesions may be managed without renal vascular control using a variety of coagulative and hemostatic tools. Data related to warm renal ischemia suggest that the time used for tumor excision and renal reconstruction should be 30 minutes or less. Techniques for laparoscopic renal cooling are being developed. CONCLUSIONS: Laparoscopic nephron-sparing surgery is a technique in evolution but with a promising outlook. The urologic peer-review literature reflects an exponential growth in interest, which suggests that this minimally invasive approach is practical and may benefit our patient population so as to allow them to return to normal healthy living more quickly.     

后腹腔镜肾部分切除术在治疗肾肿瘤的临床应用

目的探讨后腹腔镜保留肾单位的肾部分切除术治疗肾肿瘤的临床应用价值。方法 11例患者施行后腹腔镜保留肾单位的肾部分切除术的临床资料,其中男8例,女3例,年龄平均51.2岁,肿瘤直径3～4cm回顾性分析。结果所有手术均获成功,手术时间70～120min,血管阻断时间20～40min,术中失血100～300ml,术后无出血、尿漏等并发症。术后病理9例肾脏透明细胞癌(T1N0M0),2例肾血管平滑肌脂肪瘤,随访3～15个月无局部复发。结论后腹腔镜下保留肾单位的肾部分切除术治疗早期肾脏肿瘤,安全、有效,兼有创伤小,康复快等优点,近期疗效满意,远期疗效有待进一步观察。     

Retroperitoneal laparoscopic wedge resection for small renal tumor using microwave tissue coagulator

A patient with a small renal tumor underwent a successful retroperitoneal laparoscopic wedge resection using a microwave tissue coagulator without renal pedicle clamping or surface cooling. There were no postoperative complications, and renal function was well preserved. This minimally invasive procedure may be useful for treating small renal tumors.     

Enucleation of renal cell carcinoma in von Hippel-Lindau disease using a microwave tissue coagulator

The patient was a 37-year-old man who had undergone left nephrectomy under the diagnosis of left renal cell carcinoma associated with von Hippel-Lindau (VHL) disease 4 years ago. Computed tomography (CT) revealed 3 individual tumors 20 mm, 13 mm and 9 mm in maximum diameter in the right kidney. All three renal tumors were enucleated with a microwave tissue coagulator (MTC) without renal pedicle clamping. There were no major complications related to nephron-sparing surgery such as postoperative bleeding, persistent urine leakage and deterioration of renal function. Our findings suggest that renal tumors with VHL disease can be enucleated using a MTC safely and successfully without damaging renal function.     

后腹腔镜下节段性肾动脉阻断保留肾单位手术的初步结果和体会

目的:探讨后腹腔镜下节段性肾动脉阻断保留肾单位肾部分切除术治疗局限性小肾肿瘤的临床应用价值和初步结果。方法:回顾性总结贵阳医学院附属医院2011年9月~2013年6月采取后腹腔镜下节段性肾动脉阻断保留肾单位肾部分切除术治疗局限性小肾肿瘤患者44例。男26例,女18例,平均年龄50.2岁;平均肿瘤直径(2.8±0.9)cm;肿瘤位于下极25例,中极10例,上极9例;T1a期36例,良性肿瘤8例;肾透明细胞癌23例,乳头状癌7例,嫌色细胞癌6例,肾错构瘤8例。统计患者手术时间(min)、术中出血量(ml)、术后胃肠功能恢复时间(h)、手术并发症发生率(%)、切缘阳性率(%)、总住院时间(d)以及术后6个月术侧肾的肾小球滤过率(eGFR)下降(%)等参数,所有患者随访6~12个月,监测肿瘤复发情况。结果:44例患者手术时间110~192min,平均132min;术中出血40~120ml,平均74ml,无一例输血,无中转;术后胃肠功能恢复时间16.2~23.5h,平均19.3h;手术并发症发生率9.1%(4/44);住院时间4~9d,平均4.6d;切缘阳性率2.3%(1/44)。患者随访期内无肿瘤复发,术后6个月44例患肾eGFR较术前无明显变化。术后6~12个月7例(7/44,15.9%)患肾eGFR较术前下降13.4~18.5ml/min,平均下降15.2ml/min(P0.05)。结论:后腹腔镜下节段性肾动脉阻断保留肾单位肾部分切除术具有创伤小、术中失血量少、胃肠功能恢复快、手术并发症少、住院时间短等优点。少部分患者术后远期患肾肾功能有一定影响,需要进一步观察。该术式是治疗局限性小肾肿瘤的一种安全有效的手术方法。     

Non-ischemic partial nephrectomy using microwave tissue coagulator

PURPOSE: The indications and the safety of non-ischemic partial nephrectomy using a microwave tissue coagulator were studied. MATERIALS AND METHODS: Non-ischemic partial nephrectomy was performed on 17 kidneys of 16 patients using a microwave tissue coagulator. The diagnosis was renal tumor and renal stones in eleven and five patients, respectively. Renal tumors were less than 4 centimeters in diameter, while the stones were associated with a caliceal diverticulum or secondary cortical atrophy. Excision of the tumors was done via the retroperitoneal approach through an oblique lumbar incision. The needle of the microwave tissue coagulator was inserted around the tumor (stone) 10 to 20 times, and the coagulator was activated. Then the tumor (stone) was excised with a sharp knife or scissors. Patients were encouraged to walk on the first postoperative day. RESULTS: Vascular clamping was necessary in one patient to reduce bleeding. Nephrectomy was done after partial nephrectomy in one patient because it was difficult to close the urinary collecting system after it was widely exposed. Although urine leakage was seen postoperatively in two patients, it ceased spontaneously at 14 and 23 days after surgery. Postoperative complications developed in one of seven patients (14%) with protruding renal tumor, in three of five patients (60%) with non-protruding renal tumor and in two patients with renal stone. Allogenic or autologous blood transfusion was not necessary, nor was any bleeding noticed post-operatively. In one patient, atrophy of the renal parenchyma occurred gradually after surgery and function was eventually lost. However, renal function was well preserved and recurrence of the problem was not observed in the other 15 patients, excluding one who died of esophageal cancer. CONCLUSIONS: The microwave tissue coagulator is a useful surgical instrument for non-ischemic partial nephrectomy, not only in patients with renal tumors but also in patients with complicated kidney stones. However, non-protruding renal tumor in a patient with solitary kidney should be avoided for this surgery. Thermal injury to the renal parenchyma or large vessels should be avoided and urine leakage from the collecting system should be meticulously treated during the operation.     

Renal-tissue damage induced by laparoscopic partial nephrectomy using microwave tissue coagulator

BACKGROUND AND PURPOSE: The microwave coagulator is a useful instrument that enables surgeons to perform partial nephrectomy without vascular clamping. The extent of postoperative thermal damage in surgically spared renal tissue has not been well examined. The present study was conducted to evaluate the tissue damage caused by microwave coagulation in laparoscopic partial nephrectomy (LPN) for small renal tumors. MATERIALS AND METHODS: Seven cases of LPN with a microwave tissue coagulator were entered in the present study. The median tumor diameter was 1.5 cm, and the median size of the resected specimen was 2.2 cm. Postoperative tissue damage was evaluated by contrast-enhanced CT 1 month after surgery. Surgically spared renal-tissue volume and functioning renal-tissue volume were estimated from the images by NIH Image 1.62 software. RESULTS: Postoperative CT revealed unenhanced renal tissue adjacent to the surgical margin. The median estimated volumes of surgically spared and functioning renal tissue were 96.1% (range 74.3%-99.8%) and 88.4% (range 68.0%-92.7%) of preoperative normal renal tissue, respectively. The percentile volume of functioning to surgically spared renal tissue ranged from 89.9% to 96.0% (median 92.8%). CONCLUSIONS: The microwave coagulator enables us to carry out partial nephrectomy without vascular clamping. Although 96% of normal renal tissue was surgically spared, 4% to 10% of this tissue was nonfunctioning as a result of microwave-induced thermal damage.     

后腹腔镜下保留肾单位手术治疗肾肿瘤

目的探讨后腹腔镜保留肾单位手术治疗肾肿瘤的可行性及临床效果。方法 2009年6月至2011年5月,共施行后腹腔镜保留肾单位手术21例,男13例,女8例,平均年龄43(21～58)岁。肿瘤均为单发,左侧12例,右侧9例,其中含孤立肾2例。肿瘤平均直径2.5(1.8～4.0)cm。7例良性肿瘤行剜除术,14例恶性肿瘤行楔形切除术。结果 21例手术均获成功。手术时间85～185min,中位数115min;肾脏热缺血时间17～29min,中位数25min。术中失血约55～450ml,中位数105ml。术中腹膜破裂2例,肾蒂周围小血管损伤出血3例,肾静脉破裂1例,术中即时缝合。术后病理示所有切缘均阴性。术后平均随访10(2～23)个月,全部无瘤生存,无1例局部复发或穿刺通道处发生种植转移。结论后腹腔镜保留肾单位术能安全、有效地治疗直径≤4.0cm的肾脏单发肿瘤。     

Robotic partial nephrectomy for complex renal tumors: surgical technique

OBJECTIVES: Laparoscopic partial nephrectomy requires advanced training to accomplish tumor resection and renal reconstruction while minimizing warm ischemia times. Complex renal tumors add an additional challenge to a minimally invasive approach to nephron-sparing surgery. We describe our technique, illustrated with video, of robotic partial nephrectomy for complex renal tumors, including hilar, endophytic, and multiple tumors. METHODS: Robotic assistance was used to resect 14 tumors in eight patients (mean age: 50.3 yr; range: 30-68 yr). Three patients had hereditary kidney cancer. All patients had complex tumor features, including hilar tumors (n=5), endophytic tumors (n=4), and/or multiple tumors (n=3). RESULTS: Robotic partial nephrectomy procedures were performed successfully without complications. Hilar clamping was used with a mean warm ischemia time of 31 min (range: 24-45 min). Mean blood loss was 230 ml (range: 100-450 ml). Histopathology confirmed clear-cell renal cell carcinoma (n=3), hybrid oncocytic tumor (n=2), chromophobe renal cell carcinoma (n=2), and oncocytoma (n=1). All patients had negative surgical margins. Mean index tumor size was 3.6 cm (range: 2.6-6.4 cm). Mean hospital stay was 2.6 d. At 3-mo follow-up, no patients experienced a statistically significant change in serum creatinine or estimated glomerular filtration rate and there was no evidence of tumor recurrence. CONCLUSIONS: Robotic partial nephrectomy is safe and feasible for select patients with complex renal tumors, including hilar, endophytic, and multiple tumors. Robotic assistance may facilitate a minimally invasive, nephron-sparing approach for select patients with complex renal tumors who might otherwise require open surgery or total nephrectomy.     

Retroperitoneoscopic nephrectomy for pyonephrotic kidneys

PURPOSE: To assess the feasibility and efficacy of retroperitoneoscopic nephrectomy for pyonephrotic kidneys. PATIENTS AND METHODS: From July 2003 to December 2005, 67 patients underwent retroperitoneoscopic nephrectomy for nonfunctioning pyonephrotic kidneys. The patients were assessed for operative time, blood loss, analgesic requirement, conversion rate, and hospital stay. RESULTS: Retroperitoneoscopic nephrectomy could be accomplished in 58 patients (86.5%). The mean operative time and blood loss were 168 minutes and 101 mL, respectively. The mean postoperative analgesic requirement was 100 mg of diclofenac sodium. The mean hospital stay was 3.4 days. CONCLUSION: Retroperitoneoscopic nephrectomy can be accomplished successfully and safely in the majority of patients with pyonephrosis and may be considered as the primary treatment. However, this is a difficult procedure, and experience in routine retroperitoneal nephrectomy is recommended prior to doing a case.