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UP-1.028: Partial Nephrectomy: Comparison between Open vs. Laparoscopic Approach
UNMODERATED POSTER SESSIONS
UP-1.027 Optimized Laparoscopic Nephrectomy: Totally Transmesoic Shadpour P, Etemadian M, Magsudi R Hasheminejad Kidney Center, Iran University of Medical Science, Tehran, Iran Introduction and Objective: Following our encouraging experience with transmesoic pyeloplasty reported earlier, we now report our case series of laparoscopic transmesoic left nephrectomy, optimized for time conservation. Materials and Methods: Transmesoic simple nephrectomy follows the same general principles as described for pyeloplasty on the left side. Placing one umbilical, one epigastric, one pararectus trochars, and another midaxillary optional port whenever required for added exposure, the posterior peritoneum is incised medial to the inferior mesenteric vein at Treitz ligament. Developing this plane rapidly brings the renal vein into view proximal or distal to the gonadal insertion as chosen. Dissecting caudal and cephalad to this structure brings access to the renal artery(s) and followed by rapid and easy visualization of the proximal ureter and gonadal vein. These structures are clipped and severed first. Then by using the ureter for gripping and moving the specimen, blunt dissection and gradual delivery through the transmesoic aperture into the larger peritoneal cavity follows. After rechecking the fossa for hemostasis the specimen can be removed conventionally. Results: Between Oct. 2006 and Nov. 2008, 9 adults with the diagnosis of atrophic or severely hydronephotic non-functioning left kidney underwent laparoscopic nephrectomy by this method at our center. Mean (range) of time to access the renal vein, artery and total duration of laparoscopy were 4.8(3-7), 9.4(6-13) and 41(29-72) minutes respectively. Conclusion: Transmesoic laparoscopic nephrectomy is a rapid, time conserving approach to the atrophic left kidney. UP-1.028 Partial Nephrectomy: Comparison between Open vs. Laparoscopic Approach Dominguez Esteban M, Romero Otero J, Medina Polo J, Rodriguez Antolin A, Almonacid Grunet J, Passas Martinez J, Leiva Galvis O Urology Service, University Hospital 12th of October, Madrid, Spain Introduction and Objectives: Open partial nephrectomy (OPN) is recognized as the gold standard treatment for the small renal tumour (⬍7cm). The laparoscopy
approach is becoming to be recognized as a good alternative in this case. In our institution we performed both from 2003. We have evaluated our initial experience in the laparocoscopic partial nephrectomy (LPN), and compare it with our historical series about OPN. Materials and Methods: We present a retrospective study that included 115 partial nephrectomies by oncological reason (84 open and 31 laparoscopic), performed in our institution between 1989 and 2008. Both groups were similar in the following: Age, Hypertension, Mellitus Diabetes, Cardiopathy, BMI, ASA, Toumoral diameter and Glomerular Filtrate. We evaluated intraoperative and postoperative complications, surgical parameters, functional results (calculated by MDRD-4), oncological results and surveillance by Kaplan Meier method. Results: In this study, we demonstrate statistically significant differences between OPN and LPN for: 1. Surgical Time (161 vs. 236min. P⬍0,0001); 2. Ischemia Time (14 vs. 32min.p⬍0,0001); 3. Bleeding (817 vs. 485cc. P⫽0,043). In the case of hospital stay, 14 vs. 9 days, with a result next of statistically significant difference (p⫽0,057). In OPN was more frequent to open urinary via and the use of hemostat (p⬍0,05). About renal function, the difference between the value pre-surgery until 6, 12, 24 and 36 months, did not showed significant differences between both groups—the same with any complications, oncological results and surveillance. Conclusion: In our experience LPN, in comparison with OPN, is a safe and effective technique in terms of oncological and functional aspects in the case of small renal tumours, and it is becoming a good alternative in these cases. UP-1.029 Endoscopic Method of Treatment of Ureterocele Bakiev I, Alchinbaev M, Malikh M Scientific Center of Urology, Almaty, Kazakhstan Introduction and Objective: Evaluate efficiency of endoscopical method of treatment of ureterocele. Materials and Methods: In NTSU, from 1995 to 2006, 46 patients were inspected and treated by the method of endoscopical resection of ureterocele. For all patients, a diagnosis is set through the analysis of data of intravenous urography, ultrasonic research, KT, cistography and cistoscopy. A patient is make transvesical cruciform section. Results: Remote results were analyzed at
UROLOGY 74 (Supplment 4A), October 2009
22 patients. It is not exposed on the basis of having these signs of relapse of ureterocele. For 21 patients, PCS abbreviated, for one patient PCS extended, stent is set him catheter on 1 month. Conclusions: Endoscopical transvesical cruciform section of ureterocele is highly effective and a low injury method of treatment, with a low percentage of relapses. UP-1.030 Renal Ablation by Transcatheter Renal Arterial Embolization in the Treatment of Benign Renal Diseases at Binh Dan Hospital: Initial Results from 2 Cases of Complicated Nonfunctioning Kidney Do T, Nguyen Tuan V, Vu Le C, Vinh T, Nguyen Van A, Dang Dinh H Binh Dan Hospital, Ho Chi Minh City, Vietnam Introduction and Objective: We evaluate the efficacy of transcatheter ethanol renal ablation for a unilateral, poorly functioning kidney with long term JJ stent placement and persistent urinary leaks from a nephrostomy tube. Materials and Methods: From 3 to 15 March, 2009 we had two cases: the first female with a history of persistent indwell JJ stent due to complicated hydronephrosis, which was responsible for long term flank pain, and the other female with ureteral leaks through the nephrostomy tube were treated with transcatheter ethanol and gelform renal ablation. Function of the involved kidneys determined by diethylenetetraminepentaacetic acid scintigraphy and IVU in 2 cases was low. Drainage of the renal cavities and antibiotic therapy preceded renal ablation. After intravenous sedation, renal ablation was performed by catheterization of the renal artery and injection of 10 ml absolute ethanol, and completed by proximal occlusion with gelform. Results: Arterial flow was interrupted in 2 cases, determined by doppler ultrasound. In the patient had nephorostomy, urinary flow ceased in 5 days, and drain was removed in day 20 postoperatively. The other with JJ stent placement, no problem occurred after removal of JJ stent. No complication occurred till 2 months after procedure. Conclusions: Transcatheter ethanol and gelform renal ablation is safe and effective, and may permit an in situ nephrectomy that can replace surgical nephrectomy for treatment of benign hydronephrosis. However, to confirm this conclusion a bigger and longer study is needed.
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UP-1.027 Optimized Laparoscopic Nephrectomy: Totally Transmesoic Shadpour P, Etemadian M, Magsudi R Hasheminejad Kidney Center, Iran University of Medical Science, Tehran, Iran Introduction and Objective: Following our encouraging experience with transmesoic pyeloplasty reported earlier, we now report our case series of laparoscopic transmesoic left nephrectomy, optimized for time conservation. Materials and Methods: Transmesoic simple nephrectomy follows the same general principles as described for pyeloplasty on the left side. Placing one umbilical, one epigastric, one pararectus trochars, and another midaxillary optional port whenever required for added exposure, the posterior peritoneum is incised medial to the inferior mesenteric vein at Treitz ligament. Developing this plane rapidly brings the renal vein into view proximal or distal to the gonadal insertion as chosen. Dissecting caudal and cephalad to this structure brings access to the renal artery(s) and followed by rapid and easy visualization of the proximal ureter and gonadal vein. These structures are clipped and severed first. Then by using the ureter for gripping and moving the specimen, blunt dissection and gradual delivery through the transmesoic aperture into the larger peritoneal cavity follows. After rechecking the fossa for hemostasis the specimen can be removed conventionally. Results: Between Oct. 2006 and Nov. 2008, 9 adults with the diagnosis of atrophic or severely hydronephotic non-functioning left kidney underwent laparoscopic nephrectomy by this method at our center. Mean (range) of time to access the renal vein, artery and total duration of laparoscopy were 4.8(3-7), 9.4(6-13) and 41(29-72) minutes respectively. Conclusion: Transmesoic laparoscopic nephrectomy is a rapid, time conserving approach to the atrophic left kidney. UP-1.028 Partial Nephrectomy: Comparison between Open vs. Laparoscopic Approach Dominguez Esteban M, Romero Otero J, Medina Polo J, Rodriguez Antolin A, Almonacid Grunet J, Passas Martinez J, Leiva Galvis O Urology Service, University Hospital 12th of October, Madrid, Spain Introduction and Objectives: Open partial nephrectomy (OPN) is recognized as the gold standard treatment for the small renal tumour (⬍7cm). The laparoscopy
approach is becoming to be recognized as a good alternative in this case. In our institution we performed both from 2003. We have evaluated our initial experience in the laparocoscopic partial nephrectomy (LPN), and compare it with our historical series about OPN. Materials and Methods: We present a retrospective study that included 115 partial nephrectomies by oncological reason (84 open and 31 laparoscopic), performed in our institution between 1989 and 2008. Both groups were similar in the following: Age, Hypertension, Mellitus Diabetes, Cardiopathy, BMI, ASA, Toumoral diameter and Glomerular Filtrate. We evaluated intraoperative and postoperative complications, surgical parameters, functional results (calculated by MDRD-4), oncological results and surveillance by Kaplan Meier method. Results: In this study, we demonstrate statistically significant differences between OPN and LPN for: 1. Surgical Time (161 vs. 236min. P⬍0,0001); 2. Ischemia Time (14 vs. 32min.p⬍0,0001); 3. Bleeding (817 vs. 485cc. P⫽0,043). In the case of hospital stay, 14 vs. 9 days, with a result next of statistically significant difference (p⫽0,057). In OPN was more frequent to open urinary via and the use of hemostat (p⬍0,05). About renal function, the difference between the value pre-surgery until 6, 12, 24 and 36 months, did not showed significant differences between both groups—the same with any complications, oncological results and surveillance. Conclusion: In our experience LPN, in comparison with OPN, is a safe and effective technique in terms of oncological and functional aspects in the case of small renal tumours, and it is becoming a good alternative in these cases. UP-1.029 Endoscopic Method of Treatment of Ureterocele Bakiev I, Alchinbaev M, Malikh M Scientific Center of Urology, Almaty, Kazakhstan Introduction and Objective: Evaluate efficiency of endoscopical method of treatment of ureterocele. Materials and Methods: In NTSU, from 1995 to 2006, 46 patients were inspected and treated by the method of endoscopical resection of ureterocele. For all patients, a diagnosis is set through the analysis of data of intravenous urography, ultrasonic research, KT, cistography and cistoscopy. A patient is make transvesical cruciform section. Results: Remote results were analyzed at
UROLOGY 74 (Supplment 4A), October 2009
22 patients. It is not exposed on the basis of having these signs of relapse of ureterocele. For 21 patients, PCS abbreviated, for one patient PCS extended, stent is set him catheter on 1 month. Conclusions: Endoscopical transvesical cruciform section of ureterocele is highly effective and a low injury method of treatment, with a low percentage of relapses. UP-1.030 Renal Ablation by Transcatheter Renal Arterial Embolization in the Treatment of Benign Renal Diseases at Binh Dan Hospital: Initial Results from 2 Cases of Complicated Nonfunctioning Kidney Do T, Nguyen Tuan V, Vu Le C, Vinh T, Nguyen Van A, Dang Dinh H Binh Dan Hospital, Ho Chi Minh City, Vietnam Introduction and Objective: We evaluate the efficacy of transcatheter ethanol renal ablation for a unilateral, poorly functioning kidney with long term JJ stent placement and persistent urinary leaks from a nephrostomy tube. Materials and Methods: From 3 to 15 March, 2009 we had two cases: the first female with a history of persistent indwell JJ stent due to complicated hydronephrosis, which was responsible for long term flank pain, and the other female with ureteral leaks through the nephrostomy tube were treated with transcatheter ethanol and gelform renal ablation. Function of the involved kidneys determined by diethylenetetraminepentaacetic acid scintigraphy and IVU in 2 cases was low. Drainage of the renal cavities and antibiotic therapy preceded renal ablation. After intravenous sedation, renal ablation was performed by catheterization of the renal artery and injection of 10 ml absolute ethanol, and completed by proximal occlusion with gelform. Results: Arterial flow was interrupted in 2 cases, determined by doppler ultrasound. In the patient had nephorostomy, urinary flow ceased in 5 days, and drain was removed in day 20 postoperatively. The other with JJ stent placement, no problem occurred after removal of JJ stent. No complication occurred till 2 months after procedure. Conclusions: Transcatheter ethanol and gelform renal ablation is safe and effective, and may permit an in situ nephrectomy that can replace surgical nephrectomy for treatment of benign hydronephrosis. However, to confirm this conclusion a bigger and longer study is needed.
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