Evolution of surgical technique of laparoscopic resection of kidney tumours
Authors:
Milan Hora 1; Viktor Eret 1; Petr Stránský 1; Tomáš Ürge 1; Jiří Klečka jr. 1; Ondřej Hes 2; Zdeněk Chudáček 3; Jiří Ferda 4
Authors place of work:
Urologická klinika LF UK a FN Plzeň
1; Šiklův patologicko-anatomický ústav LF
UK a FN Plzeň
2; Radiodiagnostické oddělení LF UK a FN
Plzeň
3; Radiodiagnostická klinika LF UK a FN Plzeň
4
Published in the journal:
Ces Urol 2010; 14(1): 24-31
Category:
Original article
Summary
Aim:
We document at our cohort of laparoscopic resections (LR) of kidney tumours progress in the technique of LR.
Material and methods:
The technique of LF was introduced at our institution in 9/2004. We have performed to 6/2009 together 73 LRs. The LR has been modified in time on basis of our opinion and new technical details published in recent literature.
Results:
We started first LRs in small extrarenal tumours with clamping renal vessels en bloc with small endoclamp and the resection defect was closed with time consuming intracorporeal suture. The methods have been continuously modified. We prefer in planning of operation multidetector CT including biphasic CT angiography. Here are the most substantial changes in technique: clamping renal artery only, clamping of complex renal hilum en bloc with extracorporeal clamp, possibility of application of argon beam coagulator to the bottom of resection, suturing with help of clips with lock (at the bottom absorbable PDS clips, for renorraphy non-absorbable bigger Hem-o-lok® clips), using of thrombin sealant in selected cases. With growing experience, we are able to solve some cases without clamping of renal vessels.
Conclusion:
The refining of the operation technique in LR enables to treat with this technique higher percentage of kidney tumours and results are improved as well. In spite of it, LR is indicated only in highly selected cases. Open resection remains gold standard.
Key words:
kidney tumour, laparoscopy, nephrectomy, resection of kidney.
Zdroje
1. Novotvary ČR. Praha: ÚZIS 2009; 256.
2. McDougall EM, Elbahnasy AM, Clayman RV. Laparoscopic wedge resection and partial nephrectomy – the Washington University experience and review of the literature. J Soc Laparoendosc Surg 1998; 2: 15–23.
3. Zorn KC, Gong EM, Mendiola FP, Mikhail AA, Orvieto MA, Gofrit ON, Steinberg GD, Shalhav AL. Operative Outcomes of Upper Pole Laparoscopic Partial Nephrectomy: Comparison of Lower Pole Laparoscopic and Upper Pole Open Partial Nephrectomy. Urology 2007; 70: 28–34.
4. Weight CJ, Lane BR, Gill IS. Laparoscopic partial nephrectomy for selected central tumours: omitting the bolster. BJU Int 2007; 100: 375–378.
5. Lattouf J-B, Beri A, D’Ambros OFJ, Grüll M, Leeb K, Janetschek G. Laparoscopic Partial Nephrectomy for Hilar Tumors: Technique and Results. Eur Urol 2008; 54: 409–418.
6. Richstone L, Montan S, Ost M, Reggio E, Permpongkosol S, Kavoussi LR. Laparoscopic Partial Nephrectomy for Hilar Tumors: Evaluation of Short-Term Oncologic Outcome. Urology 2008; 71: 36–40.
7. Simmons MN, Chung I, Gill IS. Perioperative efficacy of laparoscopic partial nephrectomy for tumors larger than 4 cm. Eur Urol 2009; 55: 199–208.
8. Ukimura O, Haber GP, Remer EM, et al. Laparoscopic partial nephrectomy for incidental stage pT2 or worse tumors. Urology 2006; 68: 976–982.
9. Turna B, Aron M, Gill IS. Expanding Indications for Laparoscopic Partial Nephrectomy. Urology 2008; 72: 481–487.
10. Hora M, Ürge T, Eret V, Stránský P, Klečka J jr, Hes O, Ferda J, Chudáček Z, Michal M. Laparoskopická resekce nádorů ledvin, Edukační sborník. XXXIII. brněnské onkologické dny 2009; 303–304.
11. Hora M, Eret V, Ürge T, Stránský P, Klečka J jr, Hes O, Michal M, Chudáček Z, Ferda J. Results of laparoscopic resection of kidney tumour in everyday clinical practice. Central European Journal of Urology 2009; 62(3): 160–166.
12. Ferda J, Hora M, Hes O, Ferdová E, Kreuzberg B. Assessment of the kidney tumor vascular supply by two-phase MDCT-angiography. Eur J Radiol 2007; 62: 295–301.
13. Hora M, Ferda J, Kreuzberg B, Klečka J, Hes O, Chudáček Z. Využití dvoufázové CT-angiografie při chirurgické léčbě nádorů ledvin. Čes Urol 2005; 9: 14–19.
14. Gong EM, Zorn KC, Orvieto MA, Lucioni A, Msezane LP, Shalhav AL. Artery- Only Occlusion May Provide Superior Renal Preservation During Laparoscopic Partial Nephrectomy. Urology 2008; 72: 843–846.
15. Verhoest G, Manunta A, Bensalah K, Vincendeau S, Rioux-Leclercq N, Guille F, Patard JJ. Laparoscopic Partial Nephrectomy with Clamping of the Renal Parenchyma: Initial Experience. Eur Urol 2007; 52: 1340–1346.
16. Hora M, Klečka J, Ürge T, Ferda J, Hes O, Eret V. Laparoskopická resekce tumorů ledvin. Čes Urol 2006; 10: 32–39.
17. Canales BK, Lunch AC, Fernandes E, Anderson JK, Ramani AP. Novel Technique of Knotless Hemostatic Renal Parenchymal Suture Repair During Laparoscopic Partial Nephrectomy. Urology 2007; 70: 358–359.
18. Benway BM, Wang AJ, Cabello JM, Bhayani SM. Robotic partial nephrectomy with sliding–clip renorrhaphy: Technique and outcomes. Eur Urol 2009; 55: 592– 599.
19. Hora M, Eret V, Ürge T, Klečka J. Možnosti využití tkáňových lepidel při ledvinu šetřících výkonech u tumorů ledvin. Čes Urol 2007; 11: 147–153.
20. Hora M, Eret V, Klečka J, Stránský P, Ürge T, Hes O, Chudáček Z, Ferda J. Využití tkáňových lepidel při resekcích ledvin. Praha: Galén 2008; DVD – 6 videí a článek 7 s.
21. Baumert H, Ballaro A, Shah N, Mansouri D, Zafar N, Molinie V, Neal D. Reducing Warm Ischaemia Time During Laparoscopic Partial Nephrectomy: A Prospective Comparison of Two Renal Closure Techniques. Eur Urol 2007; 52: 1164–1169.
22. Zeltser IS, Moonat S, Park S, Anderson JK, Cadeddu JA. Intermediate-term prospective results of radiofrequency-assisted laparoscopic partial nephrectomy: a non-ischaemic coagulative technique. BJU Int 2007; 101: 36–38.
23. Eret V, Hora M, Sýkora R, Hes O, Ürge T, Klečka J, Matějovič M. GreenLight (532 nm) laser partial nephrectomy followed by the suture of the collecting system without renal hilar clamping in a porcine model. Urology 2009; 73: 1115–1118.
24. Zeltser IS, Gusta A, Bensalah K, Kabbani W, Jenkins A, Part S, Perle MS, Cadeddu J. Focal radiofrequency coagulation-assisted laparoscopic partial nephrectomy: a novel nonischemic technique. J Endourol 2008; 22: 1269–1273.
25. Aron M, Canes D, Desai MM, Haber GP, Kaouk JH, Gill IS. Transumbilical single-port laparoscopic partial nephrectomy. BJU Int 2008; 103: 516–521.
26. Aron M, Kleniv P, Kaouk JH, Nguyen MM, Desai MM, Gill IS. Robotic and laparoscopic partial nephrectomy: a matched-pair comparison from a high-volume Centre. BJU Int 2008; 102: 86–92.
27. Deane LA, Lee HJ, Box GN, Melamud O, Yee DS, Abraham JB, Finley DS, Borin JFM, McDougall EM, Clayman RV, Ornstein DK. Robotic versus standard laparoscopic partial/wedge nephrectomy: a comparison of intraoperative and perioperative results from a single institution. J Endourol 2008; 22: 947–952.
28. Wang AJ, Bhyani SB. Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single-surgeon analysis of > 100 consecutive procedures. Urology 2009; 73: 306–310.
Štítky
Paediatric urologist Nephrology UrologyČlánok vyšiel v časopise
Czech Urology
2010 Číslo 1
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