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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

6 month postoperative image of surgical incision of LESS-PN.
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fig4: 6 month postoperative image of surgical incision of LESS-PN.

Mentions: Postoperatively the patients were started on Ketorolac and tramadol for pain. Narcotics were not given unless requested by the patient for breakthrough pain. Patients were given clear liquids on the same day of surgery and were then advanced as tolerated. CBC and SMA-7 were monitored postoperatively on daily basis. Patients were discharged on tramadol pro re- nata, and seen in the outpatient clinic within 1-2 weeks. Followup exam (Figure 4), laboratory and QoL determination, and imaging studies were obtained as per protocol depending on tumor pathology.


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)

6 month postoperative image of surgical incision of LESS-PN.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig4: 6 month postoperative image of surgical incision of LESS-PN.
Mentions: Postoperatively the patients were started on Ketorolac and tramadol for pain. Narcotics were not given unless requested by the patient for breakthrough pain. Patients were given clear liquids on the same day of surgery and were then advanced as tolerated. CBC and SMA-7 were monitored postoperatively on daily basis. Patients were discharged on tramadol pro re- nata, and seen in the outpatient clinic within 1-2 weeks. Followup exam (Figure 4), laboratory and QoL determination, and imaging studies were obtained as per protocol depending on tumor pathology.

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