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Laparoscopic radical nephrectomy for large renal tumor - a case report and technical considerations.

Szydełko T, Tupikowski K, Dembowski J, Niezgoda T, Wojciechowski A, Zdrojowy R - Cent European J Urol (2011)

Bottom Line: In comparison to an open procedure, the laparoscopic radical nephrectomy has demonstrated advantages in regard to perioperative morbidity, postoperative pain, time of hospitalization, and convalescence.The authors present a case of a large-volume- T2 renal tumor treated laparoscopically.The aim of the study is to present the operative technique and to discuss several unique problems that arise during the laparoscopic procedure in patients with large renal masses.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Urological Oncology, Wrocław University of Medicine, Wrocław, Poland.

ABSTRACT
In comparison to an open procedure, the laparoscopic radical nephrectomy has demonstrated advantages in regard to perioperative morbidity, postoperative pain, time of hospitalization, and convalescence. However, most series of laparoscopic radical nephrectomy are confined to T1 tumors. The authors present a case of a large-volume- T2 renal tumor treated laparoscopically. The aim of the study is to present the operative technique and to discuss several unique problems that arise during the laparoscopic procedure in patients with large renal masses.

No MeSH data available.


Related in: MedlinePlus

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Figure 0002: Port placement.

Mentions: The patient was placed in a left 45° flank position. A Hasson 2-cm mini-laparotomy was used to create a pneumoperitoneum. The first 10-mm trocar was inserted above the umbilicus at the edge of the rectus muscle and the pneumoperitoneum was achieved in a standard manner. Three additional trocars (1 x 5 mm, 1 x 10 mm, 1 x 12 mm) were inserted under direct vision with a 5-mm trocar beneath the costal margin, 12-mm trocar below the umbilicus laterally to the rectus muscle and the fourth, 10-mm trocar in the midclavicular line below the costal margin. The left colonic flexure was fully mobilized to expose the upper pole of the kidney. Then medial mobilization of the left colon was performed and the aorta beneath the lower part of the kidney was localized. After the lower pole of the kidney with tumor was freed, the kidney was moved laterally and the renal vessels were identified. Because of the limited working space caused by the large tumor volume, an additional trocar for the fan retractor was introduced. The trocar was inserted between two of the trocars: the lower 12-mm and the upper 5-mm ones (Fig. 2). Using this trocar, the colon was moved medially and the anterior wall of the aorta was exposed. A second retractor introduced through a lateral 10- mm port moved the kidney laterally. Such a maneuver enabled the surgeon comfortable access to the renal vascular pedicle. Once freely dissected, the renal artery was clipped and transected using titanium clips (TFX Medical Ltd., High Wycombe, UK). The renal vein was secured by means of an Endo-GIA (Tyco Healthcare Group LP, Norwalk, Connecticut, USA) stapling device. In order to mobilize the upper pole of the kidney the working instruments were moved to two upper ports (medial and lateral). At this stage of the operation a Liga-Sure device (Tyco Healthcare UK Ltd., Gosport, UK) was used. The lateral attachments were dissected to completely free up the kidney. The ureter was clipped and dissected. The renal specimen was entrapped in an Endocatch bag (Tyco Healthcare UK Ltd., Gosport, UK). A 5-mm closed suction drain was inserted through the port left by the lateral 10-mm trocar and positioned in the left retroperitoneal space. The renal specimen was removed through the 10-cm lateral incision of the abdominal wall (Fig. 3, Fig. 4).


Laparoscopic radical nephrectomy for large renal tumor - a case report and technical considerations.

Szydełko T, Tupikowski K, Dembowski J, Niezgoda T, Wojciechowski A, Zdrojowy R - Cent European J Urol (2011)

Port placement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921705&req=5

Figure 0002: Port placement.
Mentions: The patient was placed in a left 45° flank position. A Hasson 2-cm mini-laparotomy was used to create a pneumoperitoneum. The first 10-mm trocar was inserted above the umbilicus at the edge of the rectus muscle and the pneumoperitoneum was achieved in a standard manner. Three additional trocars (1 x 5 mm, 1 x 10 mm, 1 x 12 mm) were inserted under direct vision with a 5-mm trocar beneath the costal margin, 12-mm trocar below the umbilicus laterally to the rectus muscle and the fourth, 10-mm trocar in the midclavicular line below the costal margin. The left colonic flexure was fully mobilized to expose the upper pole of the kidney. Then medial mobilization of the left colon was performed and the aorta beneath the lower part of the kidney was localized. After the lower pole of the kidney with tumor was freed, the kidney was moved laterally and the renal vessels were identified. Because of the limited working space caused by the large tumor volume, an additional trocar for the fan retractor was introduced. The trocar was inserted between two of the trocars: the lower 12-mm and the upper 5-mm ones (Fig. 2). Using this trocar, the colon was moved medially and the anterior wall of the aorta was exposed. A second retractor introduced through a lateral 10- mm port moved the kidney laterally. Such a maneuver enabled the surgeon comfortable access to the renal vascular pedicle. Once freely dissected, the renal artery was clipped and transected using titanium clips (TFX Medical Ltd., High Wycombe, UK). The renal vein was secured by means of an Endo-GIA (Tyco Healthcare Group LP, Norwalk, Connecticut, USA) stapling device. In order to mobilize the upper pole of the kidney the working instruments were moved to two upper ports (medial and lateral). At this stage of the operation a Liga-Sure device (Tyco Healthcare UK Ltd., Gosport, UK) was used. The lateral attachments were dissected to completely free up the kidney. The ureter was clipped and dissected. The renal specimen was entrapped in an Endocatch bag (Tyco Healthcare UK Ltd., Gosport, UK). A 5-mm closed suction drain was inserted through the port left by the lateral 10-mm trocar and positioned in the left retroperitoneal space. The renal specimen was removed through the 10-cm lateral incision of the abdominal wall (Fig. 3, Fig. 4).

Bottom Line: In comparison to an open procedure, the laparoscopic radical nephrectomy has demonstrated advantages in regard to perioperative morbidity, postoperative pain, time of hospitalization, and convalescence.The authors present a case of a large-volume- T2 renal tumor treated laparoscopically.The aim of the study is to present the operative technique and to discuss several unique problems that arise during the laparoscopic procedure in patients with large renal masses.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Urological Oncology, Wrocław University of Medicine, Wrocław, Poland.

ABSTRACT
In comparison to an open procedure, the laparoscopic radical nephrectomy has demonstrated advantages in regard to perioperative morbidity, postoperative pain, time of hospitalization, and convalescence. However, most series of laparoscopic radical nephrectomy are confined to T1 tumors. The authors present a case of a large-volume- T2 renal tumor treated laparoscopically. The aim of the study is to present the operative technique and to discuss several unique problems that arise during the laparoscopic procedure in patients with large renal masses.

No MeSH data available.


Related in: MedlinePlus