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Laparo-endoscopic single-site surgery for radical and cytoreductive nephrectomy, renal vein thrombectomy, and partial nephrectomy: a prospective pilot evaluation.

Derweesh IH, Silberstein JL, Bazzi W, Kopp R, Downs TM, Kane CJ - Diagn Ther Endosc (2010)

Bottom Line: Conclusions.LESS-RN, renal vein thrombectomy, and PN are technically feasible and safe while maintaining adherence to oncologic principles, with excellent QoL preservation and low discharge pain scores.Further study is requisite.

View Article: PubMed Central - PubMed

Affiliation: Division of Urology, Department of Surgery, University of California, San Diego School of Medicine, San Diego, CA 92103, USA.

ABSTRACT
Introduction. Laparo-endoscopic single-site surgery (LESS) may diminish morbidity of laparoscopic surgery. We prospectively evaluated feasibility and outcomes of LESS-Radical Nephrectomy (LESS-RN) and Partial Nephrectomy (LESS-PN). Methods. 10 patients underwent LESS-RN (6) and LESS-PN (4) between 2/2009-5/2009. LESS-RN included 2 with renal vein thrombectomy, one of which was also cytoreductive. Transperitoneal LESS access was obtained by periumbilical incision. Patient/tumor characteristics, oncologic, and quality of life (QoL) outcomes were analyzed. Results. 3 Men/7 Women (mean age 58.7 years, median follow-up 9.8 months) underwent LESS. 9/10 cases were completed successfully. All had negative margins. Mean operative time was 161 minutes, estimated blood loss was 125 mL, and incision size was 4.4 cm. Median tumor size for LESS-RN and -PN was 5.0 and 1.7 cm (P = .045). Median LESS-PN ischemia time was 24 minutes; mean preoperative/postoperative creatinine were 0.7/0.8 mg/dL (P = .19). Mean pain score at discharge was 1.3. Mean preoperative, 3-, and 6-month postoperative SF-36 QoL Score was 73.8, 74.4 and 77.1 (P = .222). All patients are currently alive. Conclusions. LESS-RN, renal vein thrombectomy, and PN are technically feasible and safe while maintaining adherence to oncologic principles, with excellent QoL preservation and low discharge pain scores. Further study is requisite.

No MeSH data available.


Related in: MedlinePlus

Representative image of a large (7 × 8 cm right upper pole mass) which underwent LESS-RN.
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fig1: Representative image of a large (7 × 8 cm right upper pole mass) which underwent LESS-RN.

Mentions: Prospective single institutional evaluation of LESS is performed by a single surgeon (IHD). Patients were referred with renal masses with radiographic criteria for suspicious for malignancy (Figure 1). All patients underwent complete history and physical exam and staging workup (chest/abdominal/pelvic computed tomography, liver function tests, and bone scintigraphy if necessary). Exclusion criteria for LESS included patients with imperative criteria for partial nephrectomy (solitary kidney, bilateral tumors, and preexisting nondialysis-dependent renal insufficiency), and tumors which crossed the midline, or those with bulky lymphadenopathy. Patients are considered for LESS-PN if they had a renal mass that was deemed amenable to laparoscopic partial nephrectomy (LPN). Patients were considered for LESS-RN if they were not deemed to be amenable to LPN and were candidates for elective OPN, but stated an explicit preference for RN despite potential feasibility of OPN. All procedures were consecutively performed between 2/2009 and 6/2009. Patient demographic factors, tumor characteristics, perioperative variables, outcomes and complications, and quality of life (QoL) scores were recorded at time of enrollment and analyzed.


Laparo-endoscopic single-site surgery for radical and cytoreductive nephrectomy, renal vein thrombectomy, and partial nephrectomy: a prospective pilot evaluation.

Derweesh IH, Silberstein JL, Bazzi W, Kopp R, Downs TM, Kane CJ - Diagn Ther Endosc (2010)

Representative image of a large (7 × 8 cm right upper pole mass) which underwent LESS-RN.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2901611&req=5

fig1: Representative image of a large (7 × 8 cm right upper pole mass) which underwent LESS-RN.
Mentions: Prospective single institutional evaluation of LESS is performed by a single surgeon (IHD). Patients were referred with renal masses with radiographic criteria for suspicious for malignancy (Figure 1). All patients underwent complete history and physical exam and staging workup (chest/abdominal/pelvic computed tomography, liver function tests, and bone scintigraphy if necessary). Exclusion criteria for LESS included patients with imperative criteria for partial nephrectomy (solitary kidney, bilateral tumors, and preexisting nondialysis-dependent renal insufficiency), and tumors which crossed the midline, or those with bulky lymphadenopathy. Patients are considered for LESS-PN if they had a renal mass that was deemed amenable to laparoscopic partial nephrectomy (LPN). Patients were considered for LESS-RN if they were not deemed to be amenable to LPN and were candidates for elective OPN, but stated an explicit preference for RN despite potential feasibility of OPN. All procedures were consecutively performed between 2/2009 and 6/2009. Patient demographic factors, tumor characteristics, perioperative variables, outcomes and complications, and quality of life (QoL) scores were recorded at time of enrollment and analyzed.

Bottom Line: Conclusions.LESS-RN, renal vein thrombectomy, and PN are technically feasible and safe while maintaining adherence to oncologic principles, with excellent QoL preservation and low discharge pain scores.Further study is requisite.

View Article: PubMed Central - PubMed

Affiliation: Division of Urology, Department of Surgery, University of California, San Diego School of Medicine, San Diego, CA 92103, USA.

ABSTRACT
Introduction. Laparo-endoscopic single-site surgery (LESS) may diminish morbidity of laparoscopic surgery. We prospectively evaluated feasibility and outcomes of LESS-Radical Nephrectomy (LESS-RN) and Partial Nephrectomy (LESS-PN). Methods. 10 patients underwent LESS-RN (6) and LESS-PN (4) between 2/2009-5/2009. LESS-RN included 2 with renal vein thrombectomy, one of which was also cytoreductive. Transperitoneal LESS access was obtained by periumbilical incision. Patient/tumor characteristics, oncologic, and quality of life (QoL) outcomes were analyzed. Results. 3 Men/7 Women (mean age 58.7 years, median follow-up 9.8 months) underwent LESS. 9/10 cases were completed successfully. All had negative margins. Mean operative time was 161 minutes, estimated blood loss was 125 mL, and incision size was 4.4 cm. Median tumor size for LESS-RN and -PN was 5.0 and 1.7 cm (P = .045). Median LESS-PN ischemia time was 24 minutes; mean preoperative/postoperative creatinine were 0.7/0.8 mg/dL (P = .19). Mean pain score at discharge was 1.3. Mean preoperative, 3-, and 6-month postoperative SF-36 QoL Score was 73.8, 74.4 and 77.1 (P = .222). All patients are currently alive. Conclusions. LESS-RN, renal vein thrombectomy, and PN are technically feasible and safe while maintaining adherence to oncologic principles, with excellent QoL preservation and low discharge pain scores. Further study is requisite.

No MeSH data available.


Related in: MedlinePlus