Biomedical subjects

Inderbir S Gill

Publications and source records attributed to Inderbir S Gill.

At least 19 recordsLinked to original sources

PubMed2007

5-Year outcomes of laparoscopic partial nephrectomy.

PURPOSE: Laparoscopic partial nephrectomy is increasingly a definitive therapeutic option in patients with a small renal mass. Intermediate term oncological outcomes after laparoscopic partial nephrectomy are excellent up to a mean followup of 3 years. We present outcomes in 56 patients, each of whom has now completed a minimum of 5 years of followup after laparoscopic partial nephrectomy. MATERIALS AND METHODS: Of the 557 laparoscopic partial nephrectomies performed at our institution 58 patients with a localized tumor have completed more than 5 years since surgery. Clinical and renal functional data on 56 patients (97%) were obtained from medical records, radiographic reports and patient contact via telephone. RESULTS: Average patient age was 64 years and 9% were symptomatic at presentation. Average tumor size was 2.9 cm. On histopathology renal cell carcinoma was confirmed in 37 cases (66%) and pathological tumor stage was pT1a in 32 (86%). Final surgical margin was positive for cancer in 1 patient. Median serum creatinine preoperatively and postoperatively was 0.9 and 1.0 mg/dl, respectively. No patient with normal baseline serum creatinine undergoing elective laparoscopic partial nephrectomy had postoperative chronic renal insufficiency (serum creatinine more than 2 mg/dl). At a median followup of 5.7 years (range 5.0 to 6.9) no distant recurrence (0%) and a single local recurrence (2.7%) were detected. Overall and cancer specific survival was 86% and 100%, respectively, at 5 years. CONCLUSIONS: To our knowledge this is the initial report in the literature of oncological and renal functional outcomes 5 years after laparoscopic partial nephrectomy with excellent results comparable to those of open nephron sparing surgery. At our center laparoscopic partial nephrectomy is an established alternative to open partial nephrectomy.

Adult↗

PubMed2006

Ejaculatory urine incontinence after radical prostatectomy.

OBJECTIVES: Urinary incontinence and erectile dysfunction remain the long-term complications that affect most patients' lives after radical prostatectomy. Previous reports evaluating incontinence have focused on volumes of urine loss and daily pad use to assess these issues. We have observed that small volumes of urinary incontinence during sexual activity can be just as disconcerting to patients. We attempt to further describe and assess the phenomenon of urinary incontinence with ejaculation in a series of patients. METHODS: We reviewed the experience of one physician who received referrals for the treatment of erectile dysfunction after radical prostatectomy from July 2002 to March 2005 and identified 26 men experiencing urine leak predominantly during ejaculation. Questionnaires assessing urinary incontinence were sent to all these patients. RESULTS: The mean age was 62 years (range 54 to 73). Sixteen patients underwent bilateral nerve-sparing, five unilateral nerve-sparing, and five nonnerve-sparing radical retropubic prostatectomy. At a median follow-up of 42 months (range 15 to 118), all patients had experienced urine leakage (volume 0.5 teaspoon to 1 cup) during ejaculation. The incontinence questionnaire revealed that most patients had mild incontinence; however, they experienced ejaculatory urine incontinence "most, or all of the time" and considered it a "big problem." CONCLUSIONS: Although the prevalence of ejaculatory urine incontinence is unclear, in our experience it occurs often enough to be considered a part of the routine postprostatectomy evaluation. A better understanding of the pathophysiology of postprostatectomy incontinence will lead to targeted therapy and an improved quality of life for the patient.

Aged↗

PubMed2006

Laparoscopic partial nephrectomy for incidental stage pT2 or worse tumors.

OBJECTIVES: To present our experience with laparoscopic partial nephrectomy (LPN) in patients with an incidentally detected Stage pT2, pT3a, or pT3b renal mass. METHODS: Of 525 patients undergoing LPN, 21 (4%) had pT2 or worse disease. LPN routinely involved en bloc excision of the overlying perirenal fat, along with the tumor and a healthy parenchymal margin. The preoperative computed tomography scans of these 21 patients were reviewed again by an unblinded radiologist to determine whether any suspicious radiologic signs of clinical Stage T2 or worse disease were present. RESULTS: The tumors were Stage pT2 in 1 (0.2%), pT3a in 19 (3.6%), and pT3b in 1 (0.2%). The mean pathologic tumor size was 3.7 cm (range 1.8 to 7.4). In the patient with pT3b disease, a tumor thrombus invading a renal vein branch was detected laparoscopically. The renal parenchymal and perirenal fat surgical margins were negative for cancer in all 21 patients (100%). The repeated nonblinded review of the preoperative computed tomography scans suggested definitive evidence, equivocal evidence, and no evidence of pT3a disease in 0, 5 (26%), and 14 (74%) patients, respectively, and suspicion for pT3b disease in the 1 patient. One patient with a 2.5-cm pT3a sarcomatoid renal cell carcinoma with negative surgical margins developed distant metastasis and died. During a mean follow-up of 29 months (range 1 to 58), the cancer-specific survival rate was 95%. CONCLUSIONS: The results of our study have demonstrated that adherence to surgical principles allows LPN to be performed for occult Stage pT2 and pT3 tumors with negative surgical margins and good oncologic outcomes. We have highlighted the importance of routine en bloc laparoscopic excision of the overlying perirenal fat along with the tumor, and intact specimen extraction, mirroring open surgery.

Aged↗

PubMed2006

Minimally invasive nephron-sparing surgery (MINSS) for renal tumours. Part II: probe ablative therapy.

OBJECTIVES: To review the evolution and current status of probe ablative methods of minimally invasive nephron-sparing surgery (MINSS) for renal tumours. METHODS: The English language literature of the past 10 yr was reviewed by using the National Library of Medicine database and the following keywords: chemoablation, cryoablation, high-intensity focused ultrasound, kidney, laser interstitial thermotherapy, microwave thermotherapy, nephron-sparing surgery, radiofrequency ablation, radiosurgery, renal, and tumour. Over 300 papers were identified, 50 of which were selected for this review on the basis of their contribution in advancing the field with regards to (1) evolution of concepts, (2) development and refinement of techniques, and (3) intermediate- and long-term clinical outcomes. RESULTS: Open partial nephrectomy is the reference standard for nephron-sparing surgery against which all MINSS techniques should be measured. Although the initial outcomes of cryoablation and radiofrequency ablation (RFA) are encouraging, long-term studies are necessary to confirm lasting efficacy. The optimal modality for tumour targeting, monitoring therapy, and follow-up remains to be determined. These ablative techniques should be reserved for carefully selected patients, the data should be prospectively accrued, and the long-term cancer cure rates should be compared with the reference standard. CONCLUSIONS: Promising long-term data are available for cryoablation. RFA is still considered developmental, and instances of incomplete cell kill, despite nonenhancement, are concerning. Other modalities are still experimental.

Catheter Ablation↗

PubMed2006

Minimally invasive nephron-sparing surgery (MINSS) for renal tumours part I: laparoscopic partial nephrectomy.

OBJECTIVES: To review the evolution and current status of extirpative methods (laparoscopic partial nephrectomy [LPN]) of minimally invasive nephron-sparing surgery (MINSS) for renal tumors. METHODS: The English language literature of the past 10 yr was reviewed by using the National Library of Medicine database and the following keywords: kidney, laparoscopic partial nephrectomy, minimally invasive, nephron-sparing surgery, renal, and tumor. Over 275 papers were identified. Of these, 55 papers were selected for this review on the basis of their contribution in advancing the field with regards to (1) evolution of concepts, (2) development and refinement of techniques, and (3) intermediate- and long-term clinical outcomes of LPN. RESULTS: Open partial nephrectomy (OPN) is the reference standard for nephron-sparing surgery against which all MINSS techniques should be measured. With available skills for time-sensitive intracorporeal suturing, LPN provides perioperative results and long-term oncologic and functional outcomes comparable to the reference standard, with significantly decreased patient morbidity. The initial 5-yr data of 50 patients has just become available, and shows overall and cancer-specific survival of 84% and 100%, respectively. As global experience with this technique increases, data need to be prospectively accrued, and long-term cancer cure rates should be compared with the reference standard. CONCLUSIONS: As of this writing, the technique and global acceptance of LPN is evolving, although it remains restricted by the complexity of laparoscopic renal reconstruction. In expert hands, cancer cure and renal function outcomes are similar to OPN.

Humans↗

PubMed2006

The predictive value of helical computed tomography for collecting-system entry during nephron-sparing surgery.

OBJECTIVES: To assess the ability of helical computed tomography (CT) including multiplanar reformatting and volume rendering (3D CT) to predict collecting system entry at surgery, as helical CT can be used to delineate renal tumour and normal renal anatomy before nephron-sparing surgery (NSS). PATIENTS AND METHODS: Knowledge of the possibility of collecting system entry during surgery might either dissuade some surgeons from NSS in elective situations or influence the operative approach or ablative technology in cases where NSS is imperative, or prepare the surgeon for the possibility of collecting system repair. We reviewed all 3D CT (349 scans) obtained before NSS at our institution over three consecutive years. Tumour size, central tumour extension, and presence of calyceal involvement were prospectively recorded at the time of 3D rendering. Collecting system entry was analysed for these three CT variables, and for three clinical variables (tumour side, size and surgical approach) collected retrospectively from the medical records. Multivariate logistic regression was used to assess the sensitivity, specificity, and positive and negative predictive values. RESULTS: Of 344 patients, 170 had collecting system entry reported at surgery. There were statistically significant associations between collecting system entry and central tumour location by CT (sensitivity 58.8%, specificity 80.5%, P < 0.001), calyceal involvement at CT (sensitivity 53.5%, specificity 78.2%, P < 0.001), and tumour size on CT of > 4 cm (sensitivity 39.4%, specificity 74.7%, P = 0.005). There were no significant associations with side or type of surgery (P > 0.83). CONCLUSION: Helical CT is a reliable predictor of calyceal entry at surgery.

Adolescent↗

PubMed2006

Laparoscopic partial nephrectomy: contemporary technique and outcomes.

OBJECTIVES: Laparoscopic partial nephrectomy has emerged as a viable alternative to open partial nephrectomy while minimizing patient morbidity. In this article and accompanying video we describe our current technique of LPN and review our outcomes in specific patient sub-sets. METHODS: Since September 1999 more than 500 laparoscopic partial nephrectomies have been performed by the senior author. Data were collected prospectively. All patients underwent a three-dimensional CT scan prior to the operation. Our established technique involves preoperative ureteral catheterization, laparoscopic renal ultrasonography to delineate the tumor, en bloc clamping of the renal hilar vascular pedicle, tumor excision with cold endoshears, pelvicaliceal suture repair and parenchymal closure over Surgicel bolsters with biologic hemostatic agent. Renal hypothermia was achieved laparoscopically with ice slush in selected cases with anticipated long warm ischemia time. RESULTS: Mean tumor size was 2.9 cm (1-10.3 cm), 31% of the tumors were greater than 3 cm, 5% occurred in a solitary kidney, and tumor location was central in 40% and hilar in 6% of patients. Transperitoneal approach was employed in 65% of the cases. Mean warm ischemia time was 32 min. Intraoperative complications occurred in 5.5%. Pathology confirmed renal cell carcinoma in 75% of the tumors. In the initial 100 patients with a 3 years minimum follow-up, overall survival was 86% and cancer-specific survival was 100%. CONCLUSIONS: Laparoscopic partial nephrectomy is a technically challenging procedure. Adequate prior experience with laparoscopy is necessary. Long-term functional and oncological outcomes are being confirmed currently.

Carcinoma, Renal Cell↗

PubMed2006

Learning curve in human laparoscopic surgery.

Laparoscopic urology has gained considerable popularity since the first laparoscopic nephrectomy was performed. However, the rapid application of the technique in urologic practice has led to increased reports of complications, even in the hands of surgeons who are well experienced in open surgical techniques, often early in a surgeon's laparoscopic experience. The lack of translation of open surgical skills into laparoscopic results has led us to reappraise the learning curves relevant to open and laparoscopic surgery, to understand the differences, and enable us to make changes in the curriculum and the training to acquire laparoscopic skills.

Clinical Competence↗

PubMed2006

Residual and recurrent disease following renal energy ablative therapy: a multi-institutional study.

PURPOSE: In this study we detail the incidence and pattern of residual and recurrent disease after radio frequency ablation or cryoablation of a renal mass and, using this information, determine reasonable minimum recommendations for when to perform surveillance imaging during year 1 after treatment. To our knowledge no evidence based guidelines exist for determining how or when followup abdominal imaging should be performed after renal energy ablative therapy. MATERIALS AND METHODS: We reviewed treatment and followup information of patients who underwent radio frequency ablation or cryoablation for a renal mass at 7 institutions. Postoperative monitoring was performed using a variety of surveillance schedules. RESULTS: Of 616 patients 63 were found to have residual or recurrent disease after primary radio frequency ablation (13.4%) or cryoablation (3.9%) for a median of 8.7% in 7 institutions. Most incomplete treatments (70%) were detected within the first 3 months. After salvage ablative therapy was rendered, therapy failed in only 4.2%. At a mean followup of 2 years patients with residual or recurrent disease had an overall survival rate of 82.5% and a 2-year metastasis-free survival rate of 97.4% for those with localized, unilateral renal tumors. CONCLUSIONS: In most cases initial treatment failure was detected within the first 3 months after treatment. Our findings support a minimum of 3 to 4 imaging studies in year 1 after ablative therapy, and at months 1, 3, 6 (optional) and 12.

Catheter Ablation↗

PubMed2006

Survey of residency training in laparoscopic and robotic surgery.

PURPOSE: We determined the current status of residency training in laparoscopic and robotic surgery in the United States and Canada. MATERIALS AND METHODS: A total of 1,188 surveys were sent via the Internet to all 1,056 current urology residents and 132 program directors with an Internet address registered with the American Urological Association. RESULTS: Responses were received from 372 residents (35%) and 56 program directors (42%). Of respondents 47% reported greater than 100 laparoscopic procedures performed yearly by 1 (36%) or more (51%) faculty members. Robotic procedures were performed at 54% of the institutions, mainly consisting of prostatectomy and pyeloplasty. At all institutions laparoscopic radical nephrectomy was performed and those at 69% of the institutions believed that it is the gold standard for renal tumors today. Urologists were involved in 87% of adrenal surgeries and 54% of respondents believed that is the gold standard approach. However, only 35% of respondents had participated in laparoscopic adrenalectomy. Of respondents 36%, 42% and 17% reported that laparoscopic donor nephrectomy was performed by only urologists, only a nonurology transplant team and shared equally, respectively. Of respondents 41% planned on performing laparoscopic donor nephrectomy in the next year. Laparoscopic needle ablation renal surgery was done in 51% of the programs and percutaneous needle ablation was done in 63%. None of the respondents (0%) believed that it is the gold standard but 51% believed that ablative procedures look promising for renal tumors. Of respondents 39% had participated in robotic radical prostatectomy and 53% thought that it looked promising but was not the gold standard. Of respondents 31% believed that they will be performing robotic surgery after residency, 30% were unsure and 29% will not be using the robot. Overall 38% of residents thought that their laparoscopic experience was at least average or acceptable. CONCLUSIONS: A large number of laparoscopic urological procedures are being performed at training institutions with robotic procedures being performed at 54% of respondent facilities. Residents are participating in most cases but only 38% consider their laparoscopic experience to be satisfactory. A need still exists for increased laparoscopic training for residents, which can be accomplished by expanding training facilities and increasing the number of faculty members performing laparoscopic procedures.

Adult↗

PubMed2006

The evolving presentation of renal carcinoma in the United States: trends from the Surveillance, Epidemiology, and End Results program.

PURPOSE: The incidence of renal cancer is increasing, while cases series suggest that tumor size is decreasing. This has important implications for treatment planning. We evaluated national trends in renal cancer size and observed survival in patients diagnosed in the 3 periods 1988 to 1992, 1993 to 1997 and 1998 to 2002. MATERIALS AND METHODS: From the Surveillance, Epidemiology, and End Results database we identified 29,053 patients diagnosed with primary renal cancer. Patients were stratified into size categories and 5-year time cohorts. Size distribution was compared across cohorts. Kaplan-Meier survival curves and Cox proportional hazards modeling were used to examine trends in overall and stage specific survival. RESULTS: From 1988 through 2002 renal tumor size decreased from 66.8 to 58.6 mm, while the age adjusted incidence of renal cancer increased from 8.6 to 11.2 cases per 100,000 individuals. Kaplan-Meier analysis showed steadily deteriorating survival with increased cancer size above 4 cm with a median survival of 105 months for 4 to 7 cm vs 46 months for more than 7 cm. Cox modeling demonstrated significantly improved survival in patients diagnosed in the latter cohorts. With adjustment for size the latter cohorts remained significantly improved compared to the earliest cohort, although the 1998 to 2002 cohort was no longer significantly different than the 1993 to 1997 cohort. CONCLUSIONS: Nationally renal tumor size at presentation has steadily and consistently decreased. Patients more recently diagnosed had improved survival, which could be attributable to decreased tumor size in the latter cohorts. Patients more recently diagnosed also demonstrated a relative survival advantage independent of size compared to the earliest patients studied.

Female↗

PubMed2006

Positive surgical parenchymal margin after laparoscopic partial nephrectomy for renal cell carcinoma: oncological outcomes.

PURPOSE: The oncological efficacy of partial nephrectomy is related to obtaining a negative surgical margin intraoperatively. This study assesses the oncological outcomes of patients undergoing laparoscopic partial nephrectomy for a renal tumor who had positive surgical margin on final pathology. MATERIALS AND METHODS: The experiences of 2 surgeons with 511 patients with a pathological diagnosis of renal cell carcinoma treated with laparoscopic partial nephrectomy were reviewed. Patients with a positive surgical margin were identified retrospectively. Oncological outcomes were assessed by followup with chest x-ray and computerized tomography every 6 to 12 months for 5 years. RESULTS: There were 9 patients (1.8%) with a positive margin on final pathology. Mean tumor size was 2.8 cm (range 1.7 to 4.0). Two patients underwent secondary completion radical nephrectomy, one at 4 days and the other at 2 months following laparoscopic partial nephrectomy. No residual tumor was identified in the nephrectomy specimen in either patient. Of the remaining 7 patients who elected surveillance, 1 with von Hippel-Lindau disease died of metastatic renal cell carcinoma to pancreas 10 months after laparoscopic partial nephrectomy. The remaining patients were disease-free for a median followup of 32 months (range 6 to 76). No patient in the series had port site seeding. CONCLUSIONS: A positive margin following laparoscopic partial nephrectomy does not necessarily indicate residual disease. However, vigilant monitoring is mandatory. While midterm outcomes parallel those of patients with a negative margin, longer followup is necessary to determine the ultimate oncological outcomes in this subgroup of patients.

Adult↗

PubMed2006

Probe-ablative nephron-sparing surgery: cryoablation versus radiofrequency ablation.

Over the past decade, a number of probe ablative therapies have emerged for the treatment of patients with localized renal tumors. Cryoablation and radiofrequency ablation (RFA) have been studied in the greatest detail. We present the results of 164 laparoscopic cryoablations and 82 percutaneous RFAs performed in our institution and compare them retrospectively in terms of complications, impact on renal function, follow-up imaging, and oncologic outcomes. Comparison of cryotherapy versus RFA revealed that mean tumor size was similar (2.56 cm vs 2.51 cm); however, the cryoablation group had a greater number of anteriorly located tumors (39% vs 10%), as well as fewer central tumors (6% vs 37%) and fewer solitary kidneys (24% vs 49%). Mean thermal treatment time was 19.3 minutes versus 32.2 minutes in the cryoablation and RFA groups, respectively. Radiologic evidence of tumor recurrence or persistence of disease was noted in 3 patients (1.8%) who underwent cryoablation and in 9 (11.1%) who were treated with RFA. All of have been successfully treated with repeat ablation/nephrectomy, or they are currently under observation. Complication rates were minimal in both groups; no significant impact on mean serum creatinine levels was noted. Cancer-specific survival following cryotherapy was 98% at a median follow-up of 3 years and 100% for RFA at 1-year median follow-up. Cryoablation and RFA are developmental nephron-sparing options. Early results are encouraging for both forms of probe ablation in terms of early oncologic control, preservation of renal function, and low complication rates. Longer-term oncologic data are necessary so that the true value of these treatment modalities can be determined.

Adult↗

PubMed2006

Cryotherapy: clinical end points and their experimental foundations.

More renal tumors are now being found at an early stage. Similarly, the treatment of patients with such small tumors is shifting away from radical nephrectomy toward nephron-sparing extirpative surgery or nonextirpative renal tumor ablation. Of the various techniques used for renal tumor ablation, cryotherapy is the most extensively studied and has the longest reported outcomes. In this article, we examine the experimental and clinical evolution of cryotherapy for small renal masses. A literature search was performed with the following key words: cryobiology, cryotherapy, cryoablation, tissue-ice interaction, temperature, monitoring, cryoinjury, renal function, blood pressure, and treatment end point. Articles that dealt with the experimental and clinical bases of current cryoablation principles and techniques were selected for review. Some recent studies representative of current clinical outcomes were also examined. Cryotherapy for the small renal tumor can be performed during open surgery, laparoscopically, or even percutaneously with use of a variety of probes and high-resolution imaging techniques to monitor therapy. In the clinical scenario, the ice ball is usually extended 1 cm beyond the visible tumor margin. Cryotherapy per se does not adversely affect renal function and blood pressure. Inadvertent cryoinjury to the collecting system rarely leads to urinary leakage. To date, only 6-month follow-up biopsy data are available. Absence of contrast enhancement on follow-up computed tomography or magnetic resonance imaging is considered oncologic success. For a sporadic unilateral renal tumor, 98% cancer-specific survival at 3 years has been reported. Cryotherapy has moved beyond the "experimental" stage, and initial outcomes are encouraging. The major criticism of this and other ablative techniques is the associated lack of histologic confirmation of complete tumor ablation. Long-term, diligently performed studies that provide detailed, meticulous, sequential 5-year radiologic and histologic data are necessary to confirm lasting efficacy. In addition, these data must be compared with those related to partial nephrectomy, which remains the reference standard.

Cryosurgery↗

PubMed2006

Repair of adult ureteropelvic junction obstruction in the solitary kidney: effect on renal function.

OBJECTIVES: To evaluate the effect of pyeloplasty for the treatment of ureteropelvic junction (UPJ) obstruction on adult renal function in the setting of a solitary kidney. METHODS: Since 1989, 312 patients have undergone operative intervention for UPJ obstruction. Of these, 13 patients (5 men and 8 women), aged 17 to 76 years (median 44.5), had a solitary kidney and were available for postoperative surveillance. Treatment consisted of endopyelotomy (n = 3), laparoscopic dismembered pyeloplasty (n = 3), and open dismembered pyeloplasty (n = 9). Two patients underwent two separate interventions for UPJ obstruction repair. Success was defined as symptomatic relief and radiographic resolution at the latest follow-up visit. In all patients, serum creatinine, estimated glomerular filtration rate, and weight were measured preoperatively, postoperatively, and at all follow-up examinations. Statistical analysis was performed to analyze group differences using the Wilcoxon signed-rank test. RESULTS: The median follow-up was 22 months (range 2 to 96). Three patients experienced a treatment failure and were excluded from the analysis. At the latest follow-up visit, the postoperative serum creatinine had improved by a median of 0.6 mg/dL (range -0.2 to 6.3; P <0.0001), and postoperative estimated glomerular filtration rate had improved by a median of 24.4 mL/min (range -13.9 to 66; P <0.0001). No statistically significant difference in renal function was observed between the patients' first and last follow-up visits. CONCLUSIONS: Operative intervention for the treatment of adult UPJ obstruction may result in symptomatic relief and, perhaps more importantly, renal functional improvement. These findings are important for effectively counseling patients and considering indications for intervention.

Adolescent↗

PubMed2006

Nerve-sparing laparoscopic radical cystectomy: technique and initial outcomes.

OBJECTIVES: To report the technique and early outcomes of nerve-sparing laparoscopic radical cystectomy with continent orthotopic ileal neobladder in selected male and female patients with bladder cancer. METHODS: Since 2000, 52 patients have undergone laparoscopic radical cystectomy at our institution, with nerve-sparing laparoscopic radical cystectomy performed in 5 patients. In the nerve-sparing technique, transection of the lateral vascular pedicle and the posterior dissection proceeds closer to the bladder, at some distance from the rectum. Hem-o-lock clips were used for hemostasis, avoiding the need for any energy source near the neurovascular bundle (NVB). In the male, the identification and complete release of the NVB before division of the urethra minimizes damage to the NVB along the prostatic apex. In the female, preservation of the uterus, fallopian tubes, ovaries, and vagina, maintenance of the endopelvic fascia, and minimal mobilization distal to the urethra facilitates nerve sparing. RESULTS: The median operative time was 10 hours, blood loss was 400 mL, and the length of stay was 5 days. No patient required blood transfusion, and one had a postoperative complication. All patients were free of recurrence at a median follow-up of 30 months. At 12 months, nocturnal and daytime continence was preserved in 100% and 75% of patients, respectively. Sexual function was preserved in the female patient and 2 of the 4 male patients. CONCLUSIONS: With careful attention to the anatomic location of the NVBs and a precise operative technique, nerve-sparing laparoscopic radical cystectomy can be performed in appropriately selected male and female patients with organ-confined bladder cancer.

Adult↗

PubMed2006

Laparoscopic partial nephrectomy: 3-year followup.

PURPOSE: LPN is a viable alternative to open partial nephrectomy for select small renal tumors. However, published intermediate term oncological data are sparse. We present our experience with LPN for tumor in 100 patients with a minimum followup of 3 years. MATERIALS AND METHODS: Of the 480 LPNs performed at our institution a minimum followup of 3 years is available in 100 patients since 1999. Overall and cancer specific survival data were obtained from patient charts, radiographic reports and direct telephone calls to patient families. RESULTS: All 100 cases were completed laparoscopically without open conversion. Mean tumor size was 3.1 cm and mean warm ischemia was 27 minutes. Final histopathology revealed renal cell carcinoma in 68 patients, including 1 with positive surgical margins. A second patient with oncocytoma had a positive surgical margin. At a median followup of 42 months (mean 42.6, range 24.3 to 62.5) no patient had evidence of local or port site recurrence. Two patients with renal cell carcinoma had a contralateral renal mass. Overall survival was 86% and cancer specific survival was 100%. Mean preoperative and postoperative serum creatinine was 1.1 and 1.3 mg/dl, respectively. Two patients with preoperative chronic renal insufficiency were undergoing hemodialysis. CONCLUSIONS: At 3-year followup LPN provides oncological outcomes comparable to those in contemporary open partial nephrectomy series.

Aged↗

PubMed2006

Laparoscopic partial nephrectomy in solitary kidney.

PURPOSE: We report our experience with LPN for tumor in a solitary kidney. MATERIALS AND METHODS: Of 430 patients undergoing LPN since February 1999 at our institution 22 (5%) underwent LPN for tumor in a solitary kidney, as performed by a single surgeon. The laparoscopic technique that we used duplicated open principles, including hilar clamping, cold cut tumor excision and sutured renal reconstruction. RESULTS: Mean tumor size was 3.6 cm (range 1.4 to 8.3, median 3 cm), median blood loss was 200 cc (range 50 to 500), warm ischemia time was 29 minutes (range 14 to 55), total operative time was 3.3 hours (range 2.2 to 4.5) and hospital stay was 2.8 days (range 1.3 to 12). Two cases (9%) were electively converted to open surgery. Pathological findings confirmed renal cell carcinoma in 16 patients (73%) with negative surgical margins in all those with LPN. Major complications occurred in 3 patients (15%) and minor complications developed in 7 (32%). Median preoperative and postoperative serum creatinine (1.2 and 1.5 mg/dl) and estimated glomerular filtration rate (67.5 and 50 ml per minute per 1.73 m2) reflected a change of 33% and 27%, respectively, which appeared proportionate to the median amount of kidney parenchyma excised (23%). One patient (4.5%) required temporary hemodialysis. At a median followup of 2.5 years (range 0.5 to 4.5) cancer specific and overall survival was 100% and 91%, respectively. No patient with LPN had local or port site recurrence, or metastatic disease. CONCLUSIONS: LPN can be performed efficaciously and safely in select patients with tumor in a solitary kidney. To our knowledge we present the largest series in the literature. Advanced laparoscopic experience and expertise are necessary in this high risk population.

Adult↗