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PubMed2004

A comparison of traditional open, minimal-incision donor nephrectomy and laparoscopic donor nephrectomy.

Laparoscopic donor nephrectomy (LDN) and minimal-incision donor nephrectomy (MILD) are less invasive procedures than the traditional open donor nephrectomy approach (ODN). This study compares donor and recipient outcome following those three different procedures. Sixty consecutive donor nephrectomies were studied (n = 20 in each group). Intra-operative variables, analgesic requirements, donor recovery, donor/recipient complications and allograft function were recorded prospectively. Operating and first warm ischaemia times were longer for LDN than for ODN and MILD (232+/-35 vs 121+/-24 vs 147+/-27 min, P < 0.001; 4+/-1 vs 2+/-2 vs 2+/-1 min, P < 0.01). Postoperative morphine requirements were significantly higher after ODN than after MILD and LDN (182+/-113 vs 86+/-48 vs 71+/-45 mg; P < 0.0001). There was no episode of delayed graft function in this study. Donors returned to work quicker after LDN than after ODN and MILD (6+/-2 vs 11+/-5 vs 10+/-7; P = 0.055). Donor and recipient complication rates and recipient allograft function were comparable. We concluded that MILD and LDN reduce postoperative pain and allow a faster recovery without compromising recipient outcome.

Adult↗
PubMed2005

Use of a minimally invasive donor nephrectomy program to select technique for live donor nephrectomy.

BACKGROUND: Live donor nephrectomy (LDN) is a major surgical procedure with an accepted low mortality and morbidity. Minimally invasive donor nephrectomy (MIDN) has been shown to decrease the wound morbidity associated with the lumbotomy of the classic open technique. Transplant programs face the challenge of initiating their MIDN programs without jeopardizing the safety of the donor and the graft quality. We present the experience at the University of Calgary after the initiation of a MIDN program, with a preoperative selective approach using the 3 major techniques for LDN. METHODS: From December 2001 to May 2004, 50 consecutive, accepted, live kidney donors were evaluated and chosen to undergo nephrectomy by an open, laparoscopic, or hand-assisted technique. Patients were chosen for a particular technique based on the criteria of vascular anatomy, size of abdominal cavity, previous surgery, and technical implications for the recipient. RESULTS: A total of 15 open, 11 laparoscopic, and 24 hand-assisted nephrectomies were performed. There were no statistically significant differences in sex, age, or body mass index between the groups. There were statistically significant differences in surgical times (P < .001) and in the number of days spent in the hospital (P < .001). All kidneys had primary function. There were 2 conversions in the hand-assisted group and 1 blood transfusion in the open group. Death-censored graft survival was 100% with an observation time of 20 months (SD +/- 9 months; range = 3-32 months). One graft from the hand-assisted group was lost from patient death with functioning graft 8 months after transplant. CONCLUSIONS: The learning curve for MIDN does not necessarily need to impact donor or recipient outcomes. The initiation of an MIDN program can be implemented safely if the cases are selected carefully and the use of the classic open technique is kept as an alternative.

Adult↗
PubMed1999

Modified minimal cost retroperitoneoscopic nephrectomy, nephrectomy with isthumusectomy and nephroureterectomy in children: a pilot study.

OBJECTIVE: To assess the feasibility of retroperitoneoscopic nephrectomy, nephrectomy with isthmusectomy and nephroureterectomy in children with nonfunctioning kidneys and renal anomalies, at minimal cost using a modified technique. PATIENTS AND METHODS: Eleven children (aged 4-16 years) underwent retroperitoneoscopic nephrectomy, nephroureterectomy, or nephrectomy with isthmusectomy for nonfunctioning kidneys. Three patients had previously undergone percutaneous nephrostomy to evaluate whether the kidney could be salvaged, but this did not alter the success of technique, although adhesions and fibrosis required careful and precise dissection. RESULTS: All procedures were completed successfully with minor complications (peritoneal transgression via the port in two patients, with no consequences). The mean operative duration, blood loss and hospital stay were 109 min, 82 mL and 2.25 days, respectively. CONCLUSION: Retroperitoneoscopic procedures can be conducted safely, successfully and at minimal cost without compromising any principles of technique. It is not essential to prepare the bowel or use ureteric catheterization and renal artery embolization. Expensive balloon dissectors, trocar-sealing balloons, endostaplers and endobags, lap sacs or morcellators are not required. The direct approach to the kidney via retroperitoneoscopy is also quicker.

Adolescent↗
PubMedDate not supplied

Retroperitoneoscopic nephrectomy for benign diseases of the kidney: prospective nonrandomized comparison with open surgical nephrectomy.

PURPOSE: To describe, define, and evaluate the efficacy of retroperitoneoscopic nephrectomy (RPN) for benign diseases of the kidney and to compare it with open surgical nephrectomy (OSN) via a flank approach. PATIENTS AND METHODS: From August 1995 to November 1997, 29 men and 14 women (mean age 33 years) with severely damaged kidneys underwent RPN. Among these, 11 patients had undergone prior surgery, 3 had chronic renal failure, and 8 patients had a percutaneous nephrostomy. The RPN was performed via three or four ports, with the kidneys being removed intact from the retroperitoneal working space. During the same period, 43 patients underwent OSN through a flank approach (extrapleural and extraperitoneal) for nonfunctioning or poorly functioning kidneys. RESULTS: In the RPN group, two patients required conversion to OSN. The operative time and estimated blood loss ranged from 40 to 210 minutes (mean 114 minutes) and 50 to 450 mL (mean 127 mL), respectively. In the OSN group, the corresponding values were 60 to 100 minutes (mean 104 minutes) and 70 to 600 mL (mean 266 mL), respectively. The mean length of hospitalization after RPN was considerably shorter--2 to 7 days (mean 3.4 days)--than after conventional open surgery--4 to 16 days (mean 8.6 days). The incidences of minor and major complications were 21% and 5%, respectively, in the RPN group and 33% and 2% in the OSN group. The postoperative analgesic requirement was significantly less (P < 0.001) in RPN group. The interval to return to normal activity ranged from 7 to 30 days (mean 20.3 days) and 20 to 60 days (mean 32.9 days) in the RPN and OSN group, respectively, with superior performance status, cosmesis, and quality of life observed in the former group. CONCLUSION: Retroperitoneoscopic nephrectomy is as effective as open nephrectomy for benign kidney diseases with less postoperative pain, a shorter hospital stay, earlier recuperation, and excellent cosmesis. This procedure can also be performed in patients who have undergone abdominal operations previously, in those with chronic renal failure, and in those with a percutaneous nephrostomy. The operation has become our first line of approach for benign diseases of the kidney.

Adult↗
PubMed2006

Cost containment in laparoscopic radical nephrectomy: feasibility and advantages over open radical nephrectomy.

PURPOSE: To highlight the impact of the laparoscopic experience of the surgical team on achievement of satisfactory results with cost containment in performing laparoscopic radical nephrectomy (LRN). PATIENTS AND METHODS: We compared the cost components of 15 consecutive uncomplicated LRNs performed in 2001 (LRN01) with 15 consecutive uncomplicated laparoscopic radical nephrectomies performed in 2003 (LRN03) and with 15 consecutive uncomplicated procedures performed at our institution by the same surgical team in the year 1999 matched for patient age, tumor size, and disease stage. The groups were comparable in demographics. RESULTS: The operative times were 250, 225, and 195 minutes in the LRN01, LRN03, and open-surgery groups, respectively, while the lengths of postoperative stay were 3.8, 3.1, and 6.5 days. Operating room costs, excluding the disposable instruments, were 11.00 /min for the open surgery and 10.00 /min for laparoscopic nephrectomy, and the cost of the postoperative stay was 300 to 310 per day. The cost of disposable instruments was 952.18 for LRN01 and 146.37 for LRN03. The overall costs were 4155.00 for the open-surgery group, 4672.00 for LRN01, and 3336.37 for LRN03. CONCLUSIONS: Cost containment in laparoscopic nephrectomy is possible. A proper team learning curve and the employment of reliable reusable instruments is the key to reducing costs, making this procedure as economically advantageous as the equivalent open procedure.

Cost Control↗
PubMed2003

Cost comparison of hand assisted laparoscopic nephrectomy and open nephrectomy: analysis of individual parameters.

PURPOSE: Hand assisted laparoscopic nephrectomy (HAL) is an effective approach to nephrectomy that is less morbid than open nephrectomy (ON). In response to budgetary pressure at our large county hospital we reviewed the published experience and identified the cost components of HAL that could be targeted to decrease procedure cost. MATERIALS AND METHODS: A comprehensive literature review of HAL and ON was performed and certain parameters were abstracted, including operative (OR) time, operative equipment and hospital stay (LOS). Using these data the projected overall cost and individual cost centers at our institution for HAL and ON were compared. Decision tree analysis models were devised to estimate the cost of each treatment using computer software. One and 2-way sensitivity analyses were performed to evaluate the effect of individual treatment variables on overall cost. RESULTS: The literature showed 6 and 9 reports on 127 and 419 patients for ON and HAL, respectively. LOS was 5 and 3 days for ON and HAL, respectively. OR time was 169 and 204 minutes for ON and HAL, respectively. Based on a review of the costs at our institution ON was a less costly procedure by $205 ($6,882 vs $7,087 US dollars). The slight cost superiority of the open approach was due to significantly lower costs associated with operating room time and equipment. On the other hand, HAL demonstrated a cost advantage for LOS. One-way sensitivity analyses showed that HAL was less costly if HAL OR time was less than 184 minutes, LOS following HAL was less than 2.5 days or HAL OR supply costs were less than $718 US dollars. Two-way sensitivity analysis demonstrated that HAL was cost advantageous if performed in less than 3 hours and the patient was discharged home within 3 postoperative days. CONCLUSIONS: Primary cost variables for nephrectomy include OR time, LOS stay and equipment cost. Using published data and decision tree analysis ON is slightly less costly by $205 US dollars than HAL at our institution. However, HAL can be more cost-effective than ON when OR time and LOS are low. Our model identifies several measures that can be used at any institution to render HAL economically superior to ON.

Cost-Benefit Analysis↗
PubMed2004

Donor nephrectomy: A comparison of techniques and results of open, hand assisted and full laparoscopic nephrectomy.

PURPOSE: Laparoscopic donor nephrectomy (LAP) has been gaining more popularity among kidney donors and transplant surgeons. There have been some concerns about the function of kidney grafts harvested by laparoscopic procedures. We report our results of LAP. MATERIALS AND METHODS: Prospective data were collected for our donor nephrectomy operations. A telephone survey was done by an independent investigator on the impact of surgery on quality of life. Graft function was also evaluated by serial serum creatinine and mercaptoacetyltriglycine renal nuclear scans. RESULTS: A total of 100 patients were included in the study; of whom 55 underwent open donor nephrectomy (OD), 28 underwent LAP and 17 underwent hand assisted donor nephrectomy (HAL). Mean patient age was 39 +/- 12 years and it was similar in all groups. Mean operative time was 306 +/- 40 minutes for LAP, 294 +/- 42 minutes for HAL and 163 +/- 24 minutes for OD (p = 0.001). Laparoscopic operative time was decreased to 180 +/- 56 minutes for LAP and 155 +/- 40 minutes for HAL in the last 10 patients. Mean estimated blood loss was 200 +/- 107 cc for LAP, 167 +/- 70 cc for HAL and 320 +/- 99 cc for OD (p = 0.0001). Mean warm ischemia time was 3 +/- 2 minutes for LAP, 2 +/- 2 minutes for HAL and 2 +/- 1 minutes for OD (p = 0.002). Postoperative hospitalization was 2 +/- 2 days for LAP and 3 +/- 2 days for OD (p = 0.01). LAP required 30% less narcotic medicine than OD postoperatively (p = 0.04). There were no major complications in LAP cases and no complete or partial graft loss was noted. Mean followup was 7 months. Recipient creatinine was not significantly different for kidneys harvested by LAP or OD (p = 0.5). Diuretic mercaptoacetyltriglycine renograms were performed in all recipients 1 to 3 days after surgery and mean effective renal plasma flow was similar for the 3 groups (p = 0.9). According to telephone survey results 85% of LAP, 71% of HAL and 43% of OD patients reported a return to normal physical activity within 4 weeks after surgery. Similarly 74% of LAP, 62% of HAL and 26% of OD patients were able to return to work within 4 weeks after surgery. CONCLUSIONS: Our data show no significant difference in graft function between LAP and OD. LAP and HAL were safe and complications were minimal. The main difference was that patients treated with LAP and HAL returned to normal physical activity and work significantly earlier than those who underwent OD.

Adult↗
PubMed2004

Laparoscopic radical nephrectomy for T1 renal cancer: the gold standard? A comparison of laparoscopic vs open nephrectomy.

OBJECTIVE: To evaluate the complication rate and clinical follow-up of patients treated for T1 renal cancer by open or laparoscopic nephrectomy at the same institution, as this approach appears to be attractive for treating small renal cancers. PATIENTS AND METHODS: Between 1995 and 2002, 39 patients underwent retroperitoneal laparoscopic and 26 transperitoneal open radical nephrectomy for T1 renal cancer (TNM 1997). Variables before during and after surgery, e.g. cancer recurrence, were compared between the groups. RESULTS: There were no differences between the laparoscopic and open groups in age, sex ratio, weight, height, fitness score, operative duration (134 vs 133 min), minor or major complications, tumour diameter, Fuhrman grade or length of follow-up. Patients who underwent laparoscopic surgery had less blood loss (133 vs 357 mL, P < 0.001), less need for transfusion (none vs 150 mL, P = 0.04), a lower consumption of analgesia drugs, and shorter hospitalization (5.5 vs 8.8 days, P < 0.001). With a mean follow-up of 20.4 months there was no recurrence or tumour progression. CONCLUSION: Laparoscopic radical nephrectomy for patients with T1 renal cancer is a safe, reliable procedure that decreases hospitalization time and bleeding, and ensures the same cancer control as open nephrectomy.

Adult↗
PubMed1996

[Transperitoneal and retroperitoneal laparoscopic nephrectomy in comparison with conventional nephrectomy].

We report on our clinical experience with laparoscopic nephrectomy in 35 patients. We have performed a total of 18 transperitoneal laparoscopic nephrectomies (TLN) for benign renal disease. After the introduction of a hydraulic dissecting device, we have since performed 17 retroperitoneal laparoscopic nephrectomies (RLN). These data were compared with those in 19 consecutive open nephrectomies (N). All groups were comparable in terms of indication. The mean operative time for benign disease was 206.5 min for TLN, 211.2 min for RLN and 117 min for N. Analgesic medication requirement per patient was 2 days for TLN, 1 day for RLN and 4 days for N, while the postoperative hospital stay averaged 7 days for TLN, 6 days for RLN and 10 days for N. Our results demonstrate the advantage of a laparoscopic approach over open surgery and also reveal the distinct benefit of a retroperitoneal approach. However, due to the small number of indications this procedure should be restricted to a few urologic centers.

Humans↗
PubMedDate not supplied

Hand-assisted laparoscopic nephrectomy for renal masses >9.5 cm: series comparison with open radical nephrectomy.

OBJECTIVE: To assess the feasibility of hand-assisted laparoscopic nephrectomy (HALN) for large renal masses (stage T2, mean size 9.7 cm) and compare outcomes with a similar cohort undergoing open radical nephrectomy (ORN). METHODS: A nonrandomized comparison of 19 consecutive patients who underwent nephrectomy for renal masses >or=7 cm was performed. The HALN group was compared to the ORN group regarding demographic parameters and perioperative data, including blood loss, operating time, narcotic usage, hematocrit change, return to standard oral intake, length of hospital stay, and complications. Data collected prospectively and statistics used 2-tailed t-test analysis. RESULTS: Patients underwent either ORN (mean tumor size 12.3 cm) or HALN (mean tumor size 9.7cm). Tumors up to 14 cm (n = 2) and pT3b, with renal vein thrombosis (n = 2), could be safely excised with HALN. There were no differences between the HALN and ORN groups regarding any demographic parameter. Blood loss, operating time, length of stay, parenteral narcotic use, and time to tolerating regular diet were all less statistically significant in the HALN group as compared to the ORN group (P < 0.05). Tumors >15 cm necessitated ORN. CONCLUSIONS: HALN is technically feasible even for tumors with mean size >9.5 cm. There is a significant advantage to HALN over ORN regarding the intraoperative and postoperative morbidity. Tumors >or=15 cm should, in most cases, be performed with an open approach.

Female↗
PubMed2003

Laparoscopic donor nephrectomy in a patient with previous upper pole partial nephrectomy.

A 56-year-old woman underwent laparoscopic partial nephrectomy for symptomatic angiomyolipoma. She then donated her remaining ipsilateral kidney for renal transplantation. The allograft had good, immediate function in the recipient. This is the first reported case of a patient undergoing renal donor nephrectomy after partial nephrectomy for angiomyolipoma.

Angiomyolipoma↗
PubMed2000

Comparison of preoperative embolization followed by radical nephrectomy with radical nephrectomy alone for renal cell carcinoma.

A series of 474 patients with renal cell carcinoma (RCC), who had radical nephrectomy during a period of 15 years, was studied to assess the prognostic significance of various pathologic parameters (tumor stage [pT], lymph node status, metastasis, tumor grade, venous involvement) and value of preoperative embolization of renal artery. There were: 20 (4%) pT1, 204 (43%) pT2, 245 (52%) pT3, and 5 (1%) pT4 patients. All 474 patients underwent nephrectomy including a group of 118 (25%) patients (24 pT2, 90 pT3, and 4 pT4) who underwent preoperative embolization of the renal artery. To compare treatment outcomes in embolized patients with RCC, a group of 116 (24%) nonembolized patients with RCC was selected. This group was matched for sex, age, stage, tumor size, and tumor grade, with the embolized patients (p<0.01). All important prognostic factors were studied as to their influence on survival by the treatment group. The overall 5- and 10-year survival was 62% and 47%, respectively. The 5- and 10-year survival rates were significantly better (p<0.01) for patients with pT2 than for those with pT3 tumors (79% vs. 50% and 59% vs. 35%, respectively). Involvement of regional lymph nodes (N+) was an important prognostic factor for survival in patients with pT3 tumors. The 5-year survival for pT3 N+ was 39%, compared with 66% in those with pT3N0 (p<0.01). Preoperative embolization was also an important factor influencing survival. The overall 5- and 10-year survival for 118 patients embolized before nephrectomy was 62% and 47%, respectively, and it was 35% and 23%, respectively, for the matched group of 116 patients treated with surgery alone (p = 0.01). The most important finding of this study was an apparent importance of preoperative embolization in improving patients' survival. This finding needs to be interpreted with caution and confirmed in a prospective randomized trial.

Adult↗
PubMed2003

Laparoscopic bilateral hand-assisted nephrectomy: end-stage renal disease from tuberculosis, an unusual indication for nephrectomy before transplantation.

The purpose of the study was to sterilize renal tuberculous foci in a pretransplantation patient with a laparoscopic hand-assisted approach and to verify the feasibility of bilateral nephrectomy for this indication. This case report is the first description of hand-assisted laparoscopic bilateral nephrectomy for this pathologic condition. The 33-year-old patient had end-stage renal disease from renal tuberculosis. A commercially available hand-assistance device was used through a midline 8-cm supraumbilical incision and with four ports. The procedure was successfully completed. The total operative time was 3 hours and 40 minutes. Estimated blood loss was 250 mL. The postoperative course was uneventful, and clinical follow-up at 3 weeks revealed a successful outcome. Hand-assisted bilateral laparoscopic nephrectomy in patients with chronic renal failure from tuberculosis represents a viable option because it is feasible and effective. The hand-assisted approach increases the safety of the procedure while retaining all the advantages of minimally invasive surgery.

Adult↗
PubMed2003

Quality of life, pain and return to normal activities following laparoscopic donor nephrectomy versus open mini-incision donor nephrectomy.

PURPOSE: We evaluated pain, convalescence and health related quality of life in patients undergoing laparoscopic and open mini-incision donor nephrectomy. MATERIALS AND METHODS: We compared the records of consecutive patients who underwent laparoscopic and mini-incision open donor nephrectomy from our donor nephrectomy data base in retrospective fashion using 2 questionnaires. The first questionnaire evaluated postoperative pain, return to functioning time and satisfaction. The second questionnaire was the RAND 36-Item Health Survey, version 2, a standardized and validated health survey quality of life assessment tool. Mean patient sex, age and followup were similar for the 2 groups. All data were analyzed using the 2-tailed t test for independent variables with commercially available statistical analysis software. RESULTS: Pain in the laparoscopic group was significantly less than in the mini-incision group at all followup time points (p <0.05). Statistically significant differences demonstrated that laparoscopy led to more rapid recovery time in certain categories, including walking, discontinuation of prescribed oral pain relievers, return to driving, and resumption of normal work and home daily activities. More subjective questions in the survey showed high levels of acceptance for the 2 procedures. Using the RAND 36-Item Health Survey, version 2 health related quality of life was significantly higher in the laparoscopy group in 3 domains that measure bodily pain, physical functioning and emotional role functioning. However, each group scored at or above age matched American averages in all domains. CONCLUSIONS: The laparoscopy group had significantly less postoperative pain and required less time to return to normal functional activities than the mini-incision group. In addition, the laparoscopic group showed significantly higher quality of life scores than the mini-incision group in 3 domains.

Activities of Daily Living↗
PubMed2003

Hand assisted laparoscopic radical nephrectomy: comparison with open radical nephrectomy.

PURPOSE: We compared the results of hand assisted laparoscopic and conventional open radical nephrectomy. MATERIALS AND METHODS: Clinical data on 54 hand assisted and 50 open radical nephrectomies performed at our hospital from September 1999 to October 2002 were reviewed. RESULTS: Mean operative time in the laparoscopic and open groups was similar (194.9 and 180.7 minutes, respectively, p = 0.087). However, estimated mean blood loss (182.8 vs 262.8 ml, p <0.001), mean days to oral intake (2.6 vs 3.7 days, p <0.001) mean duration of an indwelling drain (2.6 vs 3.2 days, p <0.001) and mean hospital stay (6.8 vs 8.9 days, p <0.001) were significantly less in the laparoscopic group. In the laparoscopic group no conversions or re-explorations were required and no major complications occurred. CONCLUSIONS: Our findings suggest that hand assisted laparoscopic radical nephrectomy represents an effective, minimally invasive treatment option in patients with suspected renal cell carcinoma.

Adult↗
PubMed2006

American Association for the Surgery of Trauma Organ Injury Scale for kidney injuries predicts nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries.

BACKGROUND: Despite broad clinical use of the American Association of the Surgery of Trauma (AAST) injury scale for kidney, it has only been found to predict the need for renal surgery in single institution series. We sought to validate this scheme for morbidity and mortality in a national cohort of patients with renal injury. METHODS: A retrospective cohort design was used to determine the association between increasing AAST scores and nephrectomy, dialysis, and mortality. The cohort included all patients with a renal injury in the National Trauma Data Bank (NTDB) from 1994 and 2003. Univariate and multivariate prediction models were used for analysis of data. RESULTS: At the time of review, a total of 742,774 patient records were registered in the NTDB. Renal injury occurred in 8465 patients (1.2%). Increasing injury grade was associated with a greater nephrectomy (RR 12-127), dialysis (RR 1.3-4.7), and mortality (RR 1.3-1.9) rate for blunt kidney injury. For penetrating injury, nephrectomy was the only outcome that was associated with higher grades of renal injury with a RR of 7.7 to 31 for grades III to V injuries. CONCLUSION: The AAST injury scale for kidney predicts for morbidity in blunt and penetrating renal injury and for mortality in blunt injury. Thus, we continue to support its use as a clinical and research tool.

Abbreviated Injury Scale↗
PubMed1994

Management of local recurrence following radical nephrectomy or partial nephrectomy.

Surgical excision remains the preferred form of treatment for isolated local recurrence of RCC. Involvement of contiguous organs is not uncommon for local recurrence after radical nephrectomy, and en bloc excision can be a formidable task. Local recurrence after partial nephrectomy is more likely to occur as an isolated event, and many of these patients can be salvaged with repeat partial nephrectomy or total excision of the renal remnant. Local recurrence appears to be particularly common in patients with VHL disease; repeat surgical excision has yielded encouraging results in this setting. Unfortunately, we still have little to offer patients with local recurrence associated with disseminated disease. Improved forms of systemic or adjunctive therapy will be necessary for the treatment of these patients.

Carcinoma, Renal Cell↗
PubMed1993

[A case of bilateral synchronous renal cell carcinoma treated with partial nephrectomy with temporary occlusion of the segmental renal artery (segmental nephrectomy)].

We present a case of bilateral synchronous renal cell carcinoma. A 57-year-old man visited our hospital with a complaint of fever up. On ultrasonography and computerized tomography scan, a round tumor about 2.5 cm in diameter in the posterior portion of the right kidney and another tumor about 7 cm in diameter arising from the upper pole of the left kidney. Selective renal arteriogram showed that the inferior branch of the posterior segmental artery supplied blood to the right renal tumor. Left partial nephrectomy with temporary occlusion of the main renal artery and posterior segmental nephrectomy of the right kidney were performed at the same time. In patients with cancer confined to the posterior segment of the kidney, segmental nephrectomy can be performed while allowing unimpaired perfusion to the remainder of the kidney from the main renal artery.

Carcinoma, Renal Cell↗