Association of RENAL nephrometry score with outcomes of minimally invasive partial nephrectomy

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98294/1/iju3222.pd

瑪麗醫院進行腹腔鏡腎臟切除術的早期經驗

OBJECTIVE: To report our early experience of laparoscopic nephrectomy. DESIGN: Prospective data collection. SETTING: Queen Mary Hospital, Hong Kong. PATIENTS: Transperitoneal laparoscopic nephrectomies were performed on 40 patients between July 1997 and December 2002. MAIN OUTCOME MEASURES: Demographic and perioperative data including operating time, blood loss, postoperative pain score, analgesic requirement, complications, time to resume oral intake, ambulatory state, and length of hospital stay. RESULTS: Laparoscopic nephrectomy was performed for 21 solid renal masses, five transitional cell carcinomas, and 14 non-functioning kidneys. Seven (17.5%) patients had previous abdominal surgery. The mean body mass index of the patients was 23.9 kg/m(2) and the mean operating time was 229 minutes. The mean estimated blood loss was 370 mL, and two patients required conversion to open surgery because of intra-operative bleeding. Other complications include diaphragmatic injury, port-site bleeding, chyle leakage, bleeding peptic ulcer, and myocardial ischaemia. The postoperative mean analgesic requirement was 26 mg of morphine sulphate equivalent. The mean time for patients to resume oral diet and full ambulation was 1.3 and 2.8 days, respectively, and the mean length of hospital stay was 6.7 days. The mean diameter of the solid renal tumour was 4.1 cm and the surgical margins of all resected specimen for malignant tumours were negative. CONCLUSION: Laparoscopic nephrectomy is a safe and efficacious approach for resection of benign non-functioning kidneys and malignant renal tumours.published_or_final_versio

Complications of retroperitoneoscopic living donor nephrectomy: single center experience after 164 cases

Objectives: Retroperitoneoscopic living donor nephrectomy (RLDN) is used by only a few centers worldwide. Similar to laparoscopic living donor nephrectomy it offers the donor rapid convalescence and excellent cosmetic results. However, concerns have been expressed over the safety of endoscopic living donor nephrectomy. Methods: We review the results of 164 consecutive RLDN from November 2001 to November 2007. Complications were classified into intra- and early postoperative. Results: Mean donor age was 53.4±10.7years (27-79). Left kidneys were harvested in 76% of cases. Mean operation time was 146±44min (55-270), and warm ischemia time 131±45s (50-280). In two patients (1.2%) conversion to open nephrectomy was necessary. The intraoperative complication rate was 3.0%. In the postoperative period we observed in 17.7% minor complications with no persisting impairments for the donor. The rate of major complications in the early postoperative period was 4.3%. Three patients (1.8%) necessitated revision, due to laceration of the external iliac artery in one patient and chyloretroperitoneum in two patients. Mean donor creatinine was 113.1±26.6mg/dl (63-201) on the first postoperative day, and 102.0±22.2mg/dl (68-159) on the fifth postoperative day. Conclusion: Retroperitoneoscopic living donor nephrectomy can be performed with acceptable intraoperative and early postoperative morbidity. Operation times and warm ischemia times are comparable to the open approac

Surgical management for upper urinary tract transitional cell carcinoma

Background Upper tract transitional cell carcinomas (TCC) are uncommon and aggressive tumours. There are a number of surgical approaches to manage this condition including open radical nephroureterectomy and laparoscopic procedures. Objectives To determine the best surgical management option for upper tract transitional cell carcinoma. Search strategy A sensitive search strategy was developed to identify relevant studies for inclusion in this review. The following databases were searched for randomised trials evaluating surgical approaches to the management of upper tract TCC: Medline EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, British Nursing Index, AMED, LILACS, Web of Science (R), Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, and ISI Proceedings. Selection criteria The following criteria that were considered for this review. Types of studies - All randomised or quasi-randomised controlled trials comparing the various surgical methods and approaches for the management of localised upper tract transitional cell carcinoma. Types of participants - All adult patients with localised transitional cell carcinoma. Localised disease was defined as limited to the kidney or ureter with no gross regional lymph nodal enlargement on imaging. Types of interventions - Any surgical method or approach for managing localised upper tract transitional cell carcinoma. Types of outcome measures - Overall and cancer-specific survival were primary outcomes. Surgery-related morbidity. Quality of life and health economics outcomes were secondary outcomes. Data collection and analysis Two review authors examined the search results independently to identify trials for inclusion. Main results We identified one randomised controlled trial that met our inclusion criteria. The trial showed that the laparoscopic approach had superior peri-operative outcomes compared to open approach. Laparoscopic was superior and statistically significant for blood loss (104 mL (millilitres) versus 430 mL, P &lt; 0.001) and mean time to discharge (2.3 days versus 3.7, P &lt; 0.001). Oncological outcomes (bladder tumour-free survival, metastasis-free survival, cancer-specific survival curves), at a median follow up of 44 months and in organ-confined disease, were comparable for both groups. Authors' conclusions There is no high quality evidence available from adequately controlled trials to determine the best surgical management of upper tract transitional cell carcinoma. However, one small randomised trial and observational data suggests that laparoscopic approach is associated with less blood loss and early recovery from surgery with similar cancer outcomes when compared to open approach. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2011, Issue 4. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.</p

Initial results of selective renal parenchymal clamping with an adjustable kidney clamp in nephron-sparing surgery: an easy way to minimise renal ischaemia

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Change in Nephrometry Scoring in Small Renal Masses (&lt;4cm) on Active Surveillance: Preliminary Observations from Tayside Active Surveillance Cohort (TASC) Study

Rationale and Objectives: - Prediction of growth, in particular knowing the possibility of aggressive cancer in small renal masses on active surveillance, remains poorly understood. The study was designed to determine whether serial nephrometry score measurements could predict possibility of aggressive malignancy (grade of cancer) in patients with small renal masses opting for active surveillance initially. Materials and Methods: - One hundred sixteen patients between January 2000 and December 2016 undergoing partial nephrectomy were recruited. Out of these, 97 were analyzed using different nephrometry scoring systems. Measurement of nephrometry scores (Radius of tumors, Exo/Endophytic; Nearness of tumors to the collecting system or sinus; Anterior/posterior; Location in relation to polar lines, Preoperative Aspects and Dimensions Used for Anatomical, Centrality Index) was performed by two researchers. Among the patients opting for partial nephrectomy, 40 were on active surveillance for at least 12 months (mean 32; 12-60 months) before partial nephrectomy. Computed tomography scan images of these patients were retrieved and analyzed including comparison to histopathology. Results: - Nephrometry scores measured on serial computed tomography scan images showed a significant correlation between change in score and grade of cancer on multivariate analysis (P value .001). Addition of multivariate analysis to nomogram based on change in size alone did not improve predictive value of area under the curve significantly. Conclusions: - Change in nephrometry scoring measurements correlates with grade of cancer in small renal masses but falls short of significantly predicting presence of malignancy or grade of cancer on nomogram in patients opting for active surveillance for small renal masses. At present, this approach may be inadequate for decision-making

Pathological study of elective nephrectomies for a two year period

Background: Nephrectomies whether partial, total or radical are common surgical procedures these days with trauma being the most common cause of an emergency nephrectomy. The indications of elective nephrectomies vary with different age groups- malignancies being common in the elderly age group and non-neoplastic indications of nephrectomy may present in any age group. The present study was undertaken in view of the increasing elective nephrectomies in our area thus analyzing the common causes requiring nephrectomy as a treatment. The present study also aimed at determining the age and sex distribution of various renal lesions requiring a nephrectomy.Methods: It was a prospective study for a period of 2 years - January 2013 to December 2014. A total of 45 nephrectomies were included in the study. Detailed clinical, biochemical and imaging findings were taken into consideration before analyzing each case. Results: There was a male predominance(64.4%) and 26.6% of the cases were in the age group of 40-50 years. 95.5% of the nephrectomies were performed for a non-neoplastic indication. Involvement of the right and left kidney was almost equal in the study. Chronic pyelonephritis was the most common histopathological diagnosis(68.8%).Conclusion: Inflammatory causes more commonly required a nephrectomy in the study population.  Chronic calculous pyelonephritis was the most common underlying pathophysiology leading to a nonfunctioning kidney thus highlighting the early treatment of renal calculi.

A study of the complications among the patients undergoing retroperitoneal and transperitoneal laparoscopic nephrectomy for pyonephrosis

Background: Nowadays laparoscopy have gained wider acceptance in urology that leads to more reports on the potential complications. This study was conducted to evaluate the complications among the patients undergoing retroperitoneal and transperitoneal laparoscopic nephrectomy.Methods: Analysis was done retrospectively through review of a maintained database of 219 consecutive laparoscopic simple nephrectomies done for pyonephrosis from July 2001 to February 2013 at the department of urology Civil Hospital and B J Medical College Ahmedabad.Results: Total 219 simple nephrectomies performed between July 2001 to February 2013 for pyonephrosis. In 165 (75.3%) of patient’s procedure was through trans peritoneal route while retroperitoneal access was used in 54(24.6%) patients. In our study there were major complications in 12 patients with laparoscopic transperitoneal group and in 4 patients in laparoscopic retro peritoneal group. The minor complication rate in present study was 13.3% (22/165) in laparoscopic transperitoneal group and 11.1% (6/54) in laparoscopic retroperitoneal group.Conclusions: There were major complications in patients with laparoscopic transperitoneal group and in few patients in laparoscopic retro peritoneal group. In most other series it was seen that retroperitoneoscopic surgery may be associated with more complications, the findings are unfounded. Minor complications can be managed easily if there is low threshold for conversion to open surgery

Comparison of Sufentanil- and Fentanyl-based Intravenous Patient-controlled Analgesia on Postoperative Nausea and Vomiting after Laparoscopic Nephrectomy: A Prospective, Double-blind, Randomized-controlled Trial

Background: The incidence of postoperative nausea and vomiting (PONV) remains high. The effects of sufentanil for PONV is not firmly confirmed. The aim of this study was to compare the effect of sufentanil- and fentanyl-based intravenous patient-controlled analgesia (IV-PCA) on the incidence of PONV after laparoscopic nephrectomy. Methods: Eighty-six patients were randomly allocated to receive either the sufentanil (n =43) or fentanyl (n =43). IV-PCA was prepared using either sufentanil 3 µg/kg or fentanyl 20 µg/kg, ramosetron 0.3 mg, and ketorolac 120 mg. The primary outcome of was the incidence of PONV during 24 h after post anesthesia care unit (PACU) discharge. The secondary outcomes were the modified Rhodes index and patient satisfaction scores at 24 h after PACU discharge, need for rescue antiemetics, pain score, need for additional analgesics, and cumulative consumption of IV-PCA Results: The incidence of PONV was comparable between the sufentanil and fentanyl groups (64.3% vs. 65%, p = 0.946; respectively). The number of patients who required antiemetics (p = 0.946) and the modified Rhodes index at 24 h after post-anesthesia care unit discharge (p = 0.668) were also comparable in both groups. No significant differences were found in the secondary outcomes, including the analgesic profiles and adverse events between the groups. Conclusions: In conclusion, sufentanil- and fentanyl-based IV-PCA showed similar incidence of PONV with comparable analgesic effects after laparoscopic nephrectomy. Based on these results, we suggest that sufentanil and fentanyl may provide comparable effects for IV-PCA after laparoscopic nephrectomy.ope

CT-Guided Microwave Ablation: A Safe and Effective Tool for Treatment of Small Renal Masses

Introduction: The increased utilization of abdominal imaging has resulted in higher rates of incidental detection and subsequent intervention for small renal masses. Though less research has been made available in comparison to other ablative methods, CT-guided microwave ablation has repeatedly proven to be a time efficient, less invasive treatment option for these incidentally found masses. Objective: Our research aimed to clarify the safety and efficacy of microwave ablation compared to the preferred treatment of nephrectomy. Methods: We performed a retrospective chart review of patients within the LSU Health Sciences network who presented with evidence of a renal mass on imaging and subsequently underwent same day renal mass biopsy and CT-guided microwave ablation or biopsy then nephrectomy between the years of 2015 and 2022. Chi-square test was used to compare groups. Results: Of the 184 patients included in this study, 8 of the 95 patients (8.42%) who underwent CT guided microwave ablation experienced complications compared to 16 of the 89 patients (17.89%) who underwent nephrectomy (p Conclusion: Our data supports CT-guided microwave ablation of small renal masses as a reasonable alternative to nephrectomy. Patients who underwent ablation had a significantly lower complication rate compared to those who underwent nephrectomy. As many of the small renal masses in this study were benign, microwave ablation served as a tool to spare patients from more invasive treatment of non-malignant masses. Additionally, recurrence rate was not statistically different between the two groups, further speaking to its utility in treatment. As AUA guidelines from 2021 currently lack solid evidence for encouraging usage of microwave ablation, additional research should be conducted to characterize its utility in treatment