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LAPAROSCOPIC HEMINEPHRECTOMY IN HORSESHOE KIDNEY
V1
LAPAROSCOPIC RENAL SURGERY Wednesday, 26 March, 12.45-14.15, eURO Auditorium
V1
V2
LEFT LAPAROSCOPIC RADICAL NEPHRECTOMY WITH RENAL VEIN THROMBUS
LAPAROSCOPIC PARTIAL NEPHRECTOMY IN A TRANSPLANTED KIDNEY
Massoud W., Saheb N., Schlosser J., Dumonceau O., Fennouri M., Iliescu B., Baumert H.
Rosales A.6DOYDGRU-$]XHUR-&DᚎDUDWWL-0RQWOOHR03RQFH'H/HµQ-
Paris Saint-Joseph Hospital Trust, Dept. of Urology, Paris, France Introduction & Objectives: Venous involvement develops in 5% to 10% of patients with renal cell carcinoma and is generally considered a relative contraindication to laparoscopic radical nephrectomy. Herein we present a video demonstrating a left laparoscopic radical nephrectomy for renal cell carcinoma associated with level I renal vein thrombus. Material & Methods: $ \HDUV ROG PDOH SDWLHQW SUHVHQWHG ZLWK OHIW ᚐDQN pain. CT Scan showed a left renal mass of 10 cm in diameter with a renal vein WKURPEXV7KHUHZDVQRGLVWDQWPHWDVWDVLV:LWKWKHSDWLHQWLQDPRGLᚏHGᚐDQN position, a transperitoneal four-port approach was used to laparoscopically resect a 10 cm right renal mass with tumour thrombus extending to, but not into, the inferior vena cava (IVC). After early ligature of the renal artery using KHPRORNFOLSVDWWKHOHYHORIWKH7UHLW]DQJOHD6DWLQVN\YDVFXODUFODPSZDV introduced percutaneousely and placed on the IVC in such a way as to include all the caval thrombus. The tumour thrombus was removed en bloc with the NLGQH\7KHSURFHGXUDOVWHSVRIRXUWHFKQLTXHDUHRXWOLQHGLQWKHYLGHR$WWKH end of the procedure, the specimen was retrieved through a Gibson incision.
Fundacio Puigvert, Dept. of Urology, Barcelona, Spain Introduction & Objectives: Tumour formation in a transplanted patient is greater than the general population. With respect to solid tumours, renal cancer is more prevalent. The WUHDWPHQWRINLGQH\WXPRXUVLQWUDQVSODQWHGNLGQH\VLVWKHVDPHDVLQQRWUDQVSODQWHGDV ORQJDVWKHNLGQH\IXQFWLRQUHPDLQVXQGHUDFFHSWDEOHOHYHOV$IWHUNLGQH\WUDQVSODQWDWLRQ UHQDOGLVVHFWLRQLVPRUHGLᚑFXOWGXHWRLQᚐDPPDWRU\FKDQJHVGHYHORSHGE\WKHKRVW Material & Methods: We present a 56 year-old female with past medical history positive for chronic renal failure who underwent cadaveric renal transplant 8 years ago. Her creatinine level was 90 mgr/100. In her last follow-up visit, abdominal CT scan revealed a FPUHQDOWXPRXUORFDWHGDWWKHSRVWHULRUDVSHFWRIWKHWUDQVSODQWHGNLGQH\7KHSDWLHQW was on immunosuppression treatment with Tacrolimus and steroids at that moment. A ODSDURVFRSLFSDUWLDOQHSKUHFWRP\ZDVRᚎHUHG7KHSDWLHQWZDVSODFHGLQWKHOHIWODWHUDO SRVLWLRQ 7KURXJK D WUDQVSHULWRQHDO DSSURDFK DQG DIWHU KDYLQJ LGHQWLᚏHG DQG LQFLVHG DGKHVLRQVWKHSHULWRQHXPZDVRSHQHGDQGWKHXSSHUSROHRIWKHWUDQVSODQWHGNLGQH\ ureter, common iliac and right external iliac were dissected and exposed. Intraoperative XOWUDVRXQGDVVHVVPHQWFRQᚏUPHGF\VWLFDQGVROLGFRPSRQHQWVRIWKHWXPRXUWKDWGLGQRW involve the collecting system. 20mg Mannitol was given and then the renal hilum was FODPSHGXVLQJ6DWLQVN\FODPSDQGDSDUWLDOQHSKUHFWRP\ZDVSHUIRUPHGZLWKPRQRSRODU FDXWHU\ &RPSOHWH UHQDO LVFKHPLD ZDV QRW DFKLHYHG GXH WR UHWURJUDGH ᚐRZ IURP WKH femoral artery and bleeding was seen constantly. The collecting system was opened. Hemostasis was achieved using suture, FloSeal®, Bioglue® and Surgicel®. The tumour was extracted using a 10mm Endocath®. A drain was left in the perinephric space.
Results: The actual surgical time was 4 hours. Surgical resection was successfully performed laparoscopically. Blood loss was less than 400 cc. No postoperative complications or hospital readmission occurred. There was no need of blood transfusion and the patient was discharged on day 3. Pathologic H[DPLQDWLRQ FRQᚏUPHG KLJK JUDGH S7E UHQDO FHOO FDUFLQRPD ZLWK QHJDWLYH surgical margins. At six months follow-up, there was no local or distant recurrence.
Results: Total OR time was 160min. Blood loss was 400cc. Renal ischemia was 32min. 1R EORRG WUDQVIXVLRQ ZDV UHTXLUHG $ ORZᚐRZ XULQDU\ ᚏVWXOD ZDV VHHQ DQG UHVROYHG spontaneously. The perinephric drain was removed 5 days after surgery. Postoperative length of stay was 7 days. Creatinine was 98mg/100 at the time of discharge. Tacrolimus was changed for Rapamycin and continued on low dose steroids. Pathology showed pT1aG3 type 2 papillary renal cell carcinoma with extensive necrotic component. Margins were not involved by the tumour
Conclusions: &RQWLQXHG H[SHULHQFH ZLWK WKH ODSDURVFRSLF WHFKQLTXH KDV opened the way to further indications to treat renal tumours with renal-vein thrombus.
Conclusions: /DSDURVFRSLFSDUWLDOQHSKUHFWRP\FDQEHDQDOWHUQDWLYHLQVHOHFWHGFDVHV RI UHQDO WXPRXU LQ D WUDQVSODQWHG NLGQH\ 7KH WXPRXU ORFDWLRQ VL]H DQG DPRXQW RI SHULUUHQDOᚏEURVLVDUHWKHPRVWLPSRUWDQWVHOHFWLRQFULWHULD
V3 LAPAROSCOPIC HEMINEPHRECTOMY IN HORSESHOE KIDNEY Celia A., Zeccolini G., Breda G. San Bassiano Hospital, Dept. of Urology, Bassano del Grappa, Italy Introduction & Objectives: /DSDURVFRSLFVXUJHU\LQSDWLHQWVZLWKKRUVHVKRH NLGQH\LVDFKDOOHQJLQJSURFHGXUHEHFDXVHRIDEQRUPDODQDWRP\/LWHUDWXUH reports only 3 cases of laparoscopic conservative treatment for neoplasm’s in KRUVHVKRHNLGQH\V7KLVYLGHRGHVFULEHVPDLQVWHSVRIOHIWKHPLQHSKUHFWRP\ IRU7EWXPRULQDKRUVHVKRHNLGQH\SHUIRUPHGLQRXU'HSDUWPHQW Material & Methods: A 48 years old male was admitted to our clinic because of left lumbar pain. Ultrasound scan and CT scan showed a 7 cm large mass, FHQWUDOO\ ORFDWHG RQ WKH OHIW VLGH RI DQ KRUVHVKRH NLGQH\ /DSDURVFRSLF transperitoneal left heminephrectomy was performed. With the patient in right lateral decubitus a transperitoneal access is performed according to +DVVRQ WHFKQLTXH WURFDUV DUH SRVLWLRQHG DV XVXDO 7KH RSHUDWLRQ VWDUWV E\PHGLDOL]LQJWKHOHIWFRORQ/HIWXUHWHUDQGJRQDGLFYHLQDUHLGHQWLᚏHG7KH SHGLFOHYHVVHOVDUHLGHQWLᚏHGLVRODWHGWLHGXSE\FOLSVDQGGLYLGHG%HKLQG WKHLVWKPXVDQDGGLWLRQDODUWHU\JRLQJWRLQIHULRUSROHRIERWKKHPLNLGQH\VLV IRXQG7KHEUDQFKLUURUDWLQJWKHOHIWHPLNLGQH\LVOLJDWHGE\FOLSVDQGGLYLGHG 7KHZKROHNLGQH\LVLVRODWHGZLWK*HURWDಬVIDVFLD7KHLVWKPXVDIWHUEHLQJ tied by 2 snares of polyglicolic acid thread, is resected. Careful hemostasis is performed on the resected parenchyma upon the isthmus. The resected NLGQH\LVUHPRYHGE\HQGREDJ Results: Operation lasted 210 minutes. Blood loss was 100 cc. Post operative hospital stay was 5 days. Histologic exam proved clear cell renal carcinoma with sarcomatoids areas ( pT2 N0 Mx). After 12 months of followup, the patient is disease free.
V4 TRANSVAGINAL NOTES NEPHRECTOMY WITH TWO ADDITIONAL 5MM LAPAROSCOPIC PORTS Branco A.W. %UDQFR $- 1RGD 5: &DPDUJR $+/ 6WXQLWL] /& .RQGR:0LUDQGD00/ &UX] 9HUPHOKD +RVSLWDO 'HSW RI 0LQLPDOO\ ,QYDVLYH 6XUJHU\ &XULWLED %UD]LO Introduction & Objectives: In the last few years, many reports have GHVFULEHGWKHIHDVLELOLW\RIQDWXUDORULᚏFHWUDQVOXPLQDOHQGRVFRSLFVXUJHU\ (NOTES) for porcine models, and more recently for human beings. The aim of this manuscript is to report a case of transvaginal NOTES nephrectomy with laparoscopic assistance in humans. Material & Methods: $\HDUROGIHPDOHSUHVHQWHGZLWKULJKWᚐDQNSDLQ DQGUHFXUUHQWXULQDU\WUDFWLQIHFWLRQGXHWRDULJKWQRQIXQFWLRQDONLGQH\6KH underwent a transvaginal NOTES nephrectomy with a vaginal access for the endoscope and two additional 5mm trocars placed in the abdomen. Results: Operative time was 170 minutes and estimated blood loss was 350cc. Early outcome was uneventful and the patient was discharged only twelve hours after the procedure was completed. The patient returned to her regular activities on postoperative day seven. Conclusions: This report proves the feasibility of transvaginal NOTES nephrectomy with laparoscopic assistance in a human being, however, the VDIHW\LQGLFDWLRQVDQGDGYDQWDJHVRIWKLVWHFKQLTXHRYHURWKHUVFDQRQO\ be assessed by further prospective studies
Conclusions: /DUJHWXPRXUVLQKRUVHVKRHNLGQH\PD\EHODSDURVFRSLFDOO\ treated. Anatomical abnormalities (above all vascular anatomy variations) VXJJHVW WR SHUIRUP WKLV NLQG RI ODSDURVFRSLF VXUJHU\ LQ ODSDURVFRSLFDOO\ experienced centres.
Eur Urol Suppl 2008;7(3):329
LAPAROSCOPIC RENAL SURGERY Wednesday, 26 March, 12.45-14.15, eURO Auditorium
V1
V2
LEFT LAPAROSCOPIC RADICAL NEPHRECTOMY WITH RENAL VEIN THROMBUS
LAPAROSCOPIC PARTIAL NEPHRECTOMY IN A TRANSPLANTED KIDNEY
Massoud W., Saheb N., Schlosser J., Dumonceau O., Fennouri M., Iliescu B., Baumert H.
Rosales A.6DOYDGRU-$]XHUR-&DᚎDUDWWL-0RQWOOHR03RQFH'H/HµQ-
Paris Saint-Joseph Hospital Trust, Dept. of Urology, Paris, France Introduction & Objectives: Venous involvement develops in 5% to 10% of patients with renal cell carcinoma and is generally considered a relative contraindication to laparoscopic radical nephrectomy. Herein we present a video demonstrating a left laparoscopic radical nephrectomy for renal cell carcinoma associated with level I renal vein thrombus. Material & Methods: $ \HDUV ROG PDOH SDWLHQW SUHVHQWHG ZLWK OHIW ᚐDQN pain. CT Scan showed a left renal mass of 10 cm in diameter with a renal vein WKURPEXV7KHUHZDVQRGLVWDQWPHWDVWDVLV:LWKWKHSDWLHQWLQDPRGLᚏHGᚐDQN position, a transperitoneal four-port approach was used to laparoscopically resect a 10 cm right renal mass with tumour thrombus extending to, but not into, the inferior vena cava (IVC). After early ligature of the renal artery using KHPRORNFOLSVDWWKHOHYHORIWKH7UHLW]DQJOHD6DWLQVN\YDVFXODUFODPSZDV introduced percutaneousely and placed on the IVC in such a way as to include all the caval thrombus. The tumour thrombus was removed en bloc with the NLGQH\7KHSURFHGXUDOVWHSVRIRXUWHFKQLTXHDUHRXWOLQHGLQWKHYLGHR$WWKH end of the procedure, the specimen was retrieved through a Gibson incision.
Fundacio Puigvert, Dept. of Urology, Barcelona, Spain Introduction & Objectives: Tumour formation in a transplanted patient is greater than the general population. With respect to solid tumours, renal cancer is more prevalent. The WUHDWPHQWRINLGQH\WXPRXUVLQWUDQVSODQWHGNLGQH\VLVWKHVDPHDVLQQRWUDQVSODQWHGDV ORQJDVWKHNLGQH\IXQFWLRQUHPDLQVXQGHUDFFHSWDEOHOHYHOV$IWHUNLGQH\WUDQVSODQWDWLRQ UHQDOGLVVHFWLRQLVPRUHGLᚑFXOWGXHWRLQᚐDPPDWRU\FKDQJHVGHYHORSHGE\WKHKRVW Material & Methods: We present a 56 year-old female with past medical history positive for chronic renal failure who underwent cadaveric renal transplant 8 years ago. Her creatinine level was 90 mgr/100. In her last follow-up visit, abdominal CT scan revealed a FPUHQDOWXPRXUORFDWHGDWWKHSRVWHULRUDVSHFWRIWKHWUDQVSODQWHGNLGQH\7KHSDWLHQW was on immunosuppression treatment with Tacrolimus and steroids at that moment. A ODSDURVFRSLFSDUWLDOQHSKUHFWRP\ZDVRᚎHUHG7KHSDWLHQWZDVSODFHGLQWKHOHIWODWHUDO SRVLWLRQ 7KURXJK D WUDQVSHULWRQHDO DSSURDFK DQG DIWHU KDYLQJ LGHQWLᚏHG DQG LQFLVHG DGKHVLRQVWKHSHULWRQHXPZDVRSHQHGDQGWKHXSSHUSROHRIWKHWUDQVSODQWHGNLGQH\ ureter, common iliac and right external iliac were dissected and exposed. Intraoperative XOWUDVRXQGDVVHVVPHQWFRQᚏUPHGF\VWLFDQGVROLGFRPSRQHQWVRIWKHWXPRXUWKDWGLGQRW involve the collecting system. 20mg Mannitol was given and then the renal hilum was FODPSHGXVLQJ6DWLQVN\FODPSDQGDSDUWLDOQHSKUHFWRP\ZDVSHUIRUPHGZLWKPRQRSRODU FDXWHU\ &RPSOHWH UHQDO LVFKHPLD ZDV QRW DFKLHYHG GXH WR UHWURJUDGH ᚐRZ IURP WKH femoral artery and bleeding was seen constantly. The collecting system was opened. Hemostasis was achieved using suture, FloSeal®, Bioglue® and Surgicel®. The tumour was extracted using a 10mm Endocath®. A drain was left in the perinephric space.
Results: The actual surgical time was 4 hours. Surgical resection was successfully performed laparoscopically. Blood loss was less than 400 cc. No postoperative complications or hospital readmission occurred. There was no need of blood transfusion and the patient was discharged on day 3. Pathologic H[DPLQDWLRQ FRQᚏUPHG KLJK JUDGH S7E UHQDO FHOO FDUFLQRPD ZLWK QHJDWLYH surgical margins. At six months follow-up, there was no local or distant recurrence.
Results: Total OR time was 160min. Blood loss was 400cc. Renal ischemia was 32min. 1R EORRG WUDQVIXVLRQ ZDV UHTXLUHG $ ORZᚐRZ XULQDU\ ᚏVWXOD ZDV VHHQ DQG UHVROYHG spontaneously. The perinephric drain was removed 5 days after surgery. Postoperative length of stay was 7 days. Creatinine was 98mg/100 at the time of discharge. Tacrolimus was changed for Rapamycin and continued on low dose steroids. Pathology showed pT1aG3 type 2 papillary renal cell carcinoma with extensive necrotic component. Margins were not involved by the tumour
Conclusions: &RQWLQXHG H[SHULHQFH ZLWK WKH ODSDURVFRSLF WHFKQLTXH KDV opened the way to further indications to treat renal tumours with renal-vein thrombus.
Conclusions: /DSDURVFRSLFSDUWLDOQHSKUHFWRP\FDQEHDQDOWHUQDWLYHLQVHOHFWHGFDVHV RI UHQDO WXPRXU LQ D WUDQVSODQWHG NLGQH\ 7KH WXPRXU ORFDWLRQ VL]H DQG DPRXQW RI SHULUUHQDOᚏEURVLVDUHWKHPRVWLPSRUWDQWVHOHFWLRQFULWHULD
V3 LAPAROSCOPIC HEMINEPHRECTOMY IN HORSESHOE KIDNEY Celia A., Zeccolini G., Breda G. San Bassiano Hospital, Dept. of Urology, Bassano del Grappa, Italy Introduction & Objectives: /DSDURVFRSLFVXUJHU\LQSDWLHQWVZLWKKRUVHVKRH NLGQH\LVDFKDOOHQJLQJSURFHGXUHEHFDXVHRIDEQRUPDODQDWRP\/LWHUDWXUH reports only 3 cases of laparoscopic conservative treatment for neoplasm’s in KRUVHVKRHNLGQH\V7KLVYLGHRGHVFULEHVPDLQVWHSVRIOHIWKHPLQHSKUHFWRP\ IRU7EWXPRULQDKRUVHVKRHNLGQH\SHUIRUPHGLQRXU'HSDUWPHQW Material & Methods: A 48 years old male was admitted to our clinic because of left lumbar pain. Ultrasound scan and CT scan showed a 7 cm large mass, FHQWUDOO\ ORFDWHG RQ WKH OHIW VLGH RI DQ KRUVHVKRH NLGQH\ /DSDURVFRSLF transperitoneal left heminephrectomy was performed. With the patient in right lateral decubitus a transperitoneal access is performed according to +DVVRQ WHFKQLTXH WURFDUV DUH SRVLWLRQHG DV XVXDO 7KH RSHUDWLRQ VWDUWV E\PHGLDOL]LQJWKHOHIWFRORQ/HIWXUHWHUDQGJRQDGLFYHLQDUHLGHQWLᚏHG7KH SHGLFOHYHVVHOVDUHLGHQWLᚏHGLVRODWHGWLHGXSE\FOLSVDQGGLYLGHG%HKLQG WKHLVWKPXVDQDGGLWLRQDODUWHU\JRLQJWRLQIHULRUSROHRIERWKKHPLNLGQH\VLV IRXQG7KHEUDQFKLUURUDWLQJWKHOHIWHPLNLGQH\LVOLJDWHGE\FOLSVDQGGLYLGHG 7KHZKROHNLGQH\LVLVRODWHGZLWK*HURWDಬVIDVFLD7KHLVWKPXVDIWHUEHLQJ tied by 2 snares of polyglicolic acid thread, is resected. Careful hemostasis is performed on the resected parenchyma upon the isthmus. The resected NLGQH\LVUHPRYHGE\HQGREDJ Results: Operation lasted 210 minutes. Blood loss was 100 cc. Post operative hospital stay was 5 days. Histologic exam proved clear cell renal carcinoma with sarcomatoids areas ( pT2 N0 Mx). After 12 months of followup, the patient is disease free.
V4 TRANSVAGINAL NOTES NEPHRECTOMY WITH TWO ADDITIONAL 5MM LAPAROSCOPIC PORTS Branco A.W. %UDQFR $- 1RGD 5: &DPDUJR $+/ 6WXQLWL] /& .RQGR:0LUDQGD00/ &UX] 9HUPHOKD +RVSLWDO 'HSW RI 0LQLPDOO\ ,QYDVLYH 6XUJHU\ &XULWLED %UD]LO Introduction & Objectives: In the last few years, many reports have GHVFULEHGWKHIHDVLELOLW\RIQDWXUDORULᚏFHWUDQVOXPLQDOHQGRVFRSLFVXUJHU\ (NOTES) for porcine models, and more recently for human beings. The aim of this manuscript is to report a case of transvaginal NOTES nephrectomy with laparoscopic assistance in humans. Material & Methods: $\HDUROGIHPDOHSUHVHQWHGZLWKULJKWᚐDQNSDLQ DQGUHFXUUHQWXULQDU\WUDFWLQIHFWLRQGXHWRDULJKWQRQIXQFWLRQDONLGQH\6KH underwent a transvaginal NOTES nephrectomy with a vaginal access for the endoscope and two additional 5mm trocars placed in the abdomen. Results: Operative time was 170 minutes and estimated blood loss was 350cc. Early outcome was uneventful and the patient was discharged only twelve hours after the procedure was completed. The patient returned to her regular activities on postoperative day seven. Conclusions: This report proves the feasibility of transvaginal NOTES nephrectomy with laparoscopic assistance in a human being, however, the VDIHW\LQGLFDWLRQVDQGDGYDQWDJHVRIWKLVWHFKQLTXHRYHURWKHUVFDQRQO\ be assessed by further prospective studies
Conclusions: /DUJHWXPRXUVLQKRUVHVKRHNLGQH\PD\EHODSDURVFRSLFDOO\ treated. Anatomical abnormalities (above all vascular anatomy variations) VXJJHVW WR SHUIRUP WKLV NLQG RI ODSDURVFRSLF VXUJHU\ LQ ODSDURVFRSLFDOO\ experienced centres.
Eur Urol Suppl 2008;7(3):329