Top

Published in:

01-03-2015 | Original Article

Retroperitoneal laparoscopic renal tumour enucleation with local hypotension on demand

Authors: Alberto Pansadoro, Giovanni Cochetti, Francesco D’amico, Francesco Barillaro, Michele Del Zingaro, Ettore Mearini

Published in: World Journal of Urology | Issue 3/2015

Abstract

Purpose

Laparoscopic partial nephrectomy is the standard treatment for peripheric cT1 renal tumours and is usually performed under warm ischaemia. However, it is important to reduce ischaemia time as much as possible to avoid renal damage. The aim of our study was to investigate the feasibility and safety of our technique and to evaluate short-term functional and oncological results.

Materials and methods

From June 2010 to December 2012, 54 consecutive patients with T1a–T1b renal tumour were enrolled in a high-volume tertiary institution. All patients underwent laparoscopic enucleation with controlled selective hypotension on demand. Karnofsky performance status scale, R.E.N.A.L. Nephrometry Score and Clavien–Dindo Classification were used to assess patients’ status, to stratify patients according to kidney disease and to evaluate complications, respectively. Renal function was evaluated with serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) preoperative and 3, 5, 7 and 90 days postoperatively.

Results

All the procedures were completed laparoscopically. Renal hypotension was necessary in 3/54 cases. Mean intraoperatively blood loss was 210 ± 98 ml. Renal carcinoma was found in 87 % patients. Margins revealed to be positive in 5.5 % cases. Mean hospital stay was 7.2 days. Grade IIIa and IIIb postoperative complications were 5.5 and 11 %, respectively. At 3 months, increase for sCr was 0.04 mg/dL; eGFR reduction was 1.2 ml/min. At a median follow-up of 20 months, there was one local recurrence that happened in a positive margin case.

Conclusions

Our preliminary results proved laparoscopic enucleation with controlled selective local hypotension on demand to be a feasible, safe and effective technique for T1 renal tumours.

Allaf ME, Bhayani SB, Rogers C et al (2004) Laparoscopic partial nephrectomy: evaluation of long-term oncological outcome. J Urol 172(3):871–873PubMedCrossRef

Herr HW (1999) Partial nephrectomy for unilateral renal carcinoma and a normal contralateral kidney: 10-year follow up. J Urol 161(1):33–34PubMedCrossRef

Guillonneau B, Bermúdez H, Gholami S et al (2003) Laparoscopic partial nephrectomy for renal tumor: single center experience comparing clamping and no clamping techniques of the renal vasculature. J Urol 169(2):483–486PubMedCrossRef

Mir MC, Campbell RA, Sharma N et al (2013) Parenchymal volume preservation and ischemia during partial nephrectomy: functional and volumetrical analysis. Urology 82(2):263–268PubMedCrossRef

Mor V, Laliberte L, Morris JN, Wiemann M (1984) The Karnofsky performance status scale, an examination of its reliability and validity in a research setting. Cancer 53(9):2002–2007PubMedCrossRef

Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853PubMedCrossRef

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedCentralPubMedCrossRef

Cochetti G, Puxeddu E, Del Zingaro M et al (2013) Laparoscopic partial nephrectomy of thyroid cancer metastasis: case report and review of the literature. Onco Targets Ther 6:355–360PubMedCentralPubMedCrossRef

Janetschek G (2007) Laparoscopic partial nephrectomy for RCC: how can we avoid ischemic damage of the renal parenchyma? Eur Urol 52(5):1303–1305PubMedCrossRef

10.

Simmons MN, Schreiber MJ, Gill IS (2008) Surgical renal ischemia: a contemporary overview. J Urol 180(1):19–30PubMedCrossRef

11.

Thompson RH, Lane BR, Lohse CM et al (2010) Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney. Eur Urol 58(3):331–336PubMedCrossRef

12.

Turna B, Frota R, Kamoi K et al (2008) Risk factor analysis of postoperative complications in laparoscopic partial nephrectomy. J Urol 179(4):1289–1294PubMedCrossRef

13.

Gill IS, Abreu SC, Desai MM et al (2003) Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience. J Urol 170(1):52–56PubMedCrossRef

14.

Collyer WC, Landman J, Olweny EO et al (2002) Laparoscopic partial nephrectomy with a novel electrosurgical snare in a porcine model. J Endourol 16(9):673–679PubMedCrossRef

15.

Janetschek G, Abdelmaksoud A, Bagheri F et al (2004) Laparoscopic partial nephrectomy in cold ischemia: renal artery perfusion. J Urol 171(1):68–71PubMedCrossRef

16.

Baumert H, Ballaro A, Shah N et al (2007) Reducing warm ischaemia time during laparoscopic partial nephrectomy: a prospective comparison of two renal closure techniques. Eur Urol 52(4):1164–1169PubMedCrossRef

17.

Verhoest G, Manunta A, Bensalah K et al (2007) Laparoscopic partial nephrectomy with clamping of the renal parenchyma: initial experience. Eur Urol 52(5):1340–1346PubMedCrossRef

18.

Shao P, Qin C, Yin C et al (2011) Laparoscopic partial nephrectomy with segmental artery clamping: technique and clinical outcomes. Eur Urol 59(5):849–855PubMedCrossRef

19.

Ng CK, Gill I, Patil MB et al (2012) Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy. Eur Urol 61(1):67–74PubMedCrossRef

20.

Carini M, Minervini A, Lapini A et al (2006) Simple enucleation for the treatment of renal cell carcinoma between 4 and 7 cm in greatest dimension: progression and long-term survival. J Urol 175(6):2022–2026PubMedCrossRef

21.

Lapini A, Serni S, Minervini A, Masieri L, Carini M (2005) Progression and long-term survival after simple enucleation for the elective treatment of renal cell carcinoma: experience in 107 patients. J Urol 174(1):57–60PubMedCrossRef

22.

Ficarra V, Galfano A, Cavalleri S (2009) Is simple enucleation a minimal partial nephrectomy responding to the EAU guidelines’ recommendations? Eur Urol 55(6):1315–1318PubMedCrossRef

23.

Link RE, Bhayani SB, Allaf ME et al (2005) Exploring the learning curve, pathological outcomes and perioperative morbidity of laparoscopic partial nephrectomy performed for renal mass. J Urol 173(5):1690–1694PubMedCrossRef

24.

Moinzadeh A, Gill IS, Finelli A et al (2006) Laparoscopic partial nephrectomy: 3-year followup. J Urol 175(2):459–462PubMedCrossRef

25.

Venkatesh R, Weld K, Ames CD et al (2006) Laparoscopic partial nephrectomy for renal masses: effect of tumor location. Urology 67(6):1169–1174PubMedCrossRef

26.

Porpiglia F, Fiori C, Terrone C et al (2005) Assessment of surgical margins in renal cell carcinoma after nephron sparing: a comparative study: laparoscopy vs open surgery. J Urol 173(4):1098–1101PubMedCrossRef

27.

Thompson RH, Leibovich BC, Lohse CM et al (2005) Complications of contemporary open nephron sparing surgery: a single institution experience. J Urol 174(3):855–858PubMedCrossRef

28.

Sutherland SE, Resnick MI, Maclennan GT, Goldman HB (2002) Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter? J Urol 167(1):61–64PubMedCrossRef

29.

Rais-Bahrami S, George AK, Herati AS et al (2012) Off-clamp versus complete hilar control laparoscopic partial nephrectomy: comparison by clinical stage. BJU Int 109(9):1376–1381PubMedCrossRef

30.

Porpiglia F, Fiori A, Bertolo R et al (2012) Long term functional evaluation of the treated kidney in a prospective series of patients who underwent laparoscopic partial nephrectomy for small renal tumors. Eur Urol 62(1):130–135PubMedCrossRef

Title: Retroperitoneal laparoscopic renal tumour enucleation with local hypotension on demand
Authors: Alberto Pansadoro
Giovanni Cochetti
Francesco D’amico
Francesco Barillaro
Michele Del Zingaro
Ettore Mearini
Publication date: 01-03-2015
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 3/2015
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-014-1325-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Retroperitoneal laparoscopic renal tumour enucleation with local hypotension on demand

Abstract

Purpose

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2015

Impact of warm versus cold ischemia on renal function following partial nephrectomy

Is retrograde intrarenal surgery a viable treatment option for renal stones in patients with solitary kidney?

SIU Newsletter – March 2015

Significance of prostate-specific antigen-related factors in incidental prostate cancer treated by holmium laser enucleation of the prostate

Efficacy and safety of dutasteride for the treatment of symptomatic benign prostatic hyperplasia (BPH): a systematic review and meta-analysis

Is there a peripheral site of action contributing to the voiding effects of α2-adrenoceptor agonists and antagonists?