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Partial Nephrectomy for Renal Cell Carcinoma
Accepted 65
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PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA. Andrew c. Novick, Cleveland, OH Partial nephrectomy has become the treatment of choice for patients with bilateral renal cell carcinoma (RCC) or unilateral RCC and a functionally impaired contralateral kidney. In these patients, partial nephrectomy offers the opportUnity for complete excision of the primary tumor while preserving sufficient renal parenchyma to avoid the need for renal replacement therapy. This .approach is gaining acceptance and popularity due to surgical advances that have extended its technical feasibility to include patients with large complex tumors, and due to accumulating data showing long-term survival free of cancer in a high percentage of patients. A variety of surgical methOds are available for performing Partial nephrectomy in patients with RCC. In most (>90%) cases, partial nephrectomy can be done in situ employing the techniques of wedge resection, enucleation, or transverse renal resection. Extracorporeal partial nephrectomy and autotransplantation are indicated for the small number of patients who require excision of a large, hypervascular, centrally-located RCC. In this movie, several operative cases are presented to illustrate the step-bystep performance of each of these techniques for partial nephrectomy in patients with RCC.
TOTAL BODY EXSANGUINATION AND HYPOTHERMIA AS AN ADJUNCT TO SURGICAL MANAGEMENT OF RENAL CELL CARCINOMA EXTENDING INTO THE RIGHT ATRIUM Stevan B. Streem, Andrew C. Novick and *Delos Cosgrove, Cleveland, Ohio (Presentation to be made by Dr. Streem)
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PERCUTANEOUS SURGERY AND LOCAL RADIOTHERAPY FOR INTRARENAL T.C.C. C.R.J. Woodhouse, M.J. Kellett* and H.J.G. Bloom. The Institute of Urology and the Royal Marsden Hospital, London, UK. The tape shows a patient undergoing percutaneous treatment for a renal pelvic transitional cell carcinoma (T .C.C.). 1. External views of the preliminary cystoscopy and bladder biopsy. 2. X-ray image intensifier controlled positioning of a ureteric catheter and retrograde opacification of the pelvis. 3. External and image intensifier views of the percutaneous renal puncture and track dilatation. 4. Endoscopic views of the renal pelvis, the T.C.C.
BILATERAL RETROPERITONEAL L YMPHADENECTOMY FOR TESTICULAR CANCER WITH PRESERVATION OF THE LUMBAR SYMPATHETICS, William J. Catalana, St. Louis, MO Bilateral retroperitoneal lymphadenectomy for testicular carcinoma frequenty leads to infertility on the basis of failure of seminal emission caused by surgical injury to the lumbar sympathetics. This videotape demonstrates a technique of bilateral retroperitoneal lymphadenectomy in which the sympathetic chains are identified, dissected out and preserved during the course of the retroperitoneal lymphadenectomy. This procedure allows for a thorough bilateral retroperitoneal lymphadenectomy with preservation of ejaculatory function in the majority of patients.
The surgical management of renal cell carcinoma extending into the heart can be challenging. However, as surgical extirpation offers the only hope of cure for this problem, an aggressive operative approach is generally warranted. This movie graphically depicts the use of a thoracoabdominal approach combined with adjunctive total body exsanguination and hypothermia for two patients with left sided renal cell carcinoma extending into the right atrium. In one of these cases, coronary artery bypass grafting was accomplished simultaneously.
and resection.
5. External views of the positioning of an Iridium wire (192Ir) in the nephrostomy tube to irradiate the track.
120A
66
PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA. Andrew c. Novick, Cleveland, OH Partial nephrectomy has become the treatment of choice for patients with bilateral renal cell carcinoma (RCC) or unilateral RCC and a functionally impaired contralateral kidney. In these patients, partial nephrectomy offers the opportUnity for complete excision of the primary tumor while preserving sufficient renal parenchyma to avoid the need for renal replacement therapy. This .approach is gaining acceptance and popularity due to surgical advances that have extended its technical feasibility to include patients with large complex tumors, and due to accumulating data showing long-term survival free of cancer in a high percentage of patients. A variety of surgical methOds are available for performing Partial nephrectomy in patients with RCC. In most (>90%) cases, partial nephrectomy can be done in situ employing the techniques of wedge resection, enucleation, or transverse renal resection. Extracorporeal partial nephrectomy and autotransplantation are indicated for the small number of patients who require excision of a large, hypervascular, centrally-located RCC. In this movie, several operative cases are presented to illustrate the step-bystep performance of each of these techniques for partial nephrectomy in patients with RCC.
TOTAL BODY EXSANGUINATION AND HYPOTHERMIA AS AN ADJUNCT TO SURGICAL MANAGEMENT OF RENAL CELL CARCINOMA EXTENDING INTO THE RIGHT ATRIUM Stevan B. Streem, Andrew C. Novick and *Delos Cosgrove, Cleveland, Ohio (Presentation to be made by Dr. Streem)
67
68
PERCUTANEOUS SURGERY AND LOCAL RADIOTHERAPY FOR INTRARENAL T.C.C. C.R.J. Woodhouse, M.J. Kellett* and H.J.G. Bloom. The Institute of Urology and the Royal Marsden Hospital, London, UK. The tape shows a patient undergoing percutaneous treatment for a renal pelvic transitional cell carcinoma (T .C.C.). 1. External views of the preliminary cystoscopy and bladder biopsy. 2. X-ray image intensifier controlled positioning of a ureteric catheter and retrograde opacification of the pelvis. 3. External and image intensifier views of the percutaneous renal puncture and track dilatation. 4. Endoscopic views of the renal pelvis, the T.C.C.
BILATERAL RETROPERITONEAL L YMPHADENECTOMY FOR TESTICULAR CANCER WITH PRESERVATION OF THE LUMBAR SYMPATHETICS, William J. Catalana, St. Louis, MO Bilateral retroperitoneal lymphadenectomy for testicular carcinoma frequenty leads to infertility on the basis of failure of seminal emission caused by surgical injury to the lumbar sympathetics. This videotape demonstrates a technique of bilateral retroperitoneal lymphadenectomy in which the sympathetic chains are identified, dissected out and preserved during the course of the retroperitoneal lymphadenectomy. This procedure allows for a thorough bilateral retroperitoneal lymphadenectomy with preservation of ejaculatory function in the majority of patients.
The surgical management of renal cell carcinoma extending into the heart can be challenging. However, as surgical extirpation offers the only hope of cure for this problem, an aggressive operative approach is generally warranted. This movie graphically depicts the use of a thoracoabdominal approach combined with adjunctive total body exsanguination and hypothermia for two patients with left sided renal cell carcinoma extending into the right atrium. In one of these cases, coronary artery bypass grafting was accomplished simultaneously.
and resection.
5. External views of the positioning of an Iridium wire (192Ir) in the nephrostomy tube to irradiate the track.
120A