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PubMed2002

[Postoperative course after open nephrectomy for organ donation].

OBJECTIVE: To evaluate the quality of the postoperative course after conventional organ donation nephrectomy. PATIENTS AND METHODS: Over the last 29 months, 29 organ donation nephrectomies were performed in our hospital. Thirteen donors were non-residents. This series consisted of twenty organ donations between siblings, two organ donations from children to parents and seven organ donations from parents to children. The mean age of the donors was 42 years (range: 21 to 53). Ten pairs were HLA identical, 18 were semi-identical and one pair had only one A identity in common. The mean plasma creatinine on admission was 81 +/- 23 mumol/l. RESULTS: Twenty three left kidneys and 3 right kidneys were harvested, with the last two right kidneys removed via a right anterior subcostal incision. Among the 23 left lumbotomies, the 11th rib was preserved in 21 cases in order to decrease postoperative pain. The mean operating time for patients operated by lumbotomy was 90 +/- 11 minutes. The mean postoperative stay (MPS) was 4.56 days (range: 3 to 8 days). The mean morphine consumption during hospitalisation was 40 mg per patient (range: 0 to 105 mg). Only one complication was observed: pneumothorax requiring postoperative drainage for 48 hours with no subsequent sequelae. No donor was transfused intraoperatively or postoperatively and no wound sequelae were observed. The mean plasma creatinine on discharge was 113 +/- 23 mumol/l. CONCLUSION: These results in terms of analgesic consumption, complications, and mean postoperative stay appear to compare favourably with those obtained by other teams, particularly when organ harvesting is performed laparoscopically (MPS: 4.5 days vs 3 days).

Adult↗
PubMed2002

[Perioperative management for nephrectomy using combined spinal-epidural anesthesia with sedation in a patient with cerebral palsy under maintenance hemodialysis].

A 43-year-old man (166 cm, 53.5 kg) with cerebral palsy on maintenance hemodialysis underwent a right nephrectomy for gross hematuria under combined spinal-epidural anesthesia (CSEA) with sedation. The patient suffered from hemiplegia, speech disturbance and low intelligence (approximately 6 years and 8 months). Following premedication with midazolam 4 mg, he was calm and cooperative. An analgesic level below T 10 was obtained by spinal (L 4-5) anesthesia using plain 0.5% bupivacaine 4 ml. Further cephalad spread (below T 3) was secured by bolus (7 ml) and continuous (8.5 ml.h-1) administration of 2% mepivacaine for thoracic epidural (T 10-11) anesthesia. Intravenous sedation (midazolam 0.08 mg.kg-1.h-1 and pentazocine 0.24 mg.kg-1.h-1) with 2 l.min-1 oxygen via nasal cannula was given during surgery. The operation and anesthesia times were 216 min and 330 min, respectively. Intraoperative bleeding was 1,158 g and the extracted kidney weighted 2,333 g. Following a prompt recovery with exclamation at the end of surgery, a bolus dose of epidural buprenorphine 0.2 mg combined with droperidol 2.5 mg was administered. Three hours after surgery, sleep was induced by brotizolam 0.25 mg orally. We accomplished a giant nephrectomy under CSEA with sedation in a patient with cerebral palsy receiving hemodialysis. Sufficient premedication using midazolam was profitable for CSEA in mental-retarded patient.

Adult↗
PubMed2002

Hand-assisted laparoscopic live donor nephrectomy: a case report.

Live donor renal transplantation offers significant advantages over cadaveric renal transplantation. It yields significantly better patient and graft survival on both short-term and long-term follow-up. Laparoscopic donor nephrectomy minimizes the morbidities associated with the surgical procedure and allows a speedy return to normal daily activities. The operation also provides an atraumatic kidney subjected to minimal warm ischemia time and with adequate length of artery and vein, resulting in immediate functioning of the kidney after transplantation with a low rate of ureteral complications. A 37-year-old man was referred as a kidney donor for his brother. Both donor and recipient were hepatitis-B surface antigen carriers. Cross-matching and human leukocyte antigen test showed good compatibility. Left donor nephrectomy was performed successfully by hand-assisted laparoscopy. The warm ischemic time was 4.5 minutes and the graft kidney functioned immediately after transplantation. The donor was discharged from the hospital on postoperative Day 3 with good recovery.

Adult↗
PubMedDate not supplied

Multifocality of renal cell tumors is a factor to consider before performing a partial nephrectomy.

BACKGROUND: We conducted a retrospective analysis of radical nephrectomies performed in our clinic in order to evaluate the incidence of multifocality in relation to the stage, grade, size and histological type. MATERIALS AND METHODS: Preoperative imaging studies and the final pathological results of surgical specimens were reviewed. Separate primary tumors at a distance of more than one cm from the primary tumor were counted. Of 56 renal cell cancers 10 (17.8%) were multifocal. Of these 10, 3 were found with primary tumors less than or equal to 4 cm, while 7 were found with tumors between 4-10 cm. Three multiflocal tumors were found with TI tumors, none with T2, 4 with T3a and three with T3b primary tumors. Six cases were present where the histological subtype of the largest tumor was clear cell, while 4 had mixed cell histology. No multifocality was observed in the 4 grade I tumors, while 3 of the 32 grade II tumors and 6 of the 20 grade III tumors were multifocal. The only grade IV tumor presented with a separate primary tumor. Statistically significant correlation was found between multifocality and tumor grade stage and clear cell histology subtype. There was no correlation between the primary tumor size and the possibility of multifocality. CONCLUSION: Although partial nephrectomies are justified from their survival rates, close follow-up is necessary because separate primary tumors may still exist in the kidney, left behind, irrespective of tumor size.

Adult↗
PubMed2003

[Is laparoscopic surgery the technique of choice in nephrectomy?].

Laparoscopic is performed in adults for the treatment of benign renal diseases. It is widely accepted that laparoscopic surgery has more advantages than open surgery in many procedures such as nephrectomy, but there is no further experience in this technique. In pediatric urology laparoscopy has become an accepted approach for varicocele, non palpable testis, bladder augmentation, adrenalectomy and urinary diversion. We report our experience with 25 laparoscopic nephrectomies in children.

Adolescent↗
PubMed2003

The Auckland experience with laparoscopic donor nephrectomy.

AIMS: To examine the initial experience of laparoscopic donor nephrectomy (LDN) in New Zealand and compare it with open donor nephrectomy (ODN). METHODS: All LDNs performed between June 2000 and June 2002 were reviewed. An equal number of ODNs were reviewed. Data were also collected on the recipients of the grafts. Key clinical data were prospectively collected; remaining data were collected by retrospectively reviewing patient charts. Auckland Hospital databases were accessed for costing analysis. RESULTS: Thirty five cases of each procedure had been performed. There has been 100% LDN graft survival. There was no significant difference in graft function (serum creatinine) at one and 12 months (p = 0.25 and 0.35) between the two groups. There was no significant difference in donor morbidity (26% vs 31%, p = 0.59). LDN resulted in a shorter hospital stay (3 vs 6.5 days, p <0.0001) and convalescence period (3 vs 6 weeks, p <0.0001). LDN was significantly more expensive (13 357 dollars vs 6713 dollars, p <0.0001). CONCLUSIONS: LDN in the New Zealand setting provides effective grafts for renal transplant recipients and is safe for the donor. Advantages for the donor are a shorter hospital stay and convalescence period. The major disadvantage of LDN is its higher cost compared with ODN.

Adult↗
PubMed1992

[Place of partial nephrectomy in surgery of tumors of the kidney].

Partial nephrectomy for a small renal tumor is usually technically possible, especially in the case of polar tumors, but it does not ensure the same degree of therapeutic safety as radical nephrectomy. At the present time, it is preferable to restrict this technique to tumors in a solitary kidney, when possible, and to benign tumors and tumors less than 3 cm in subjects over the age of 50 years, when the contralateral kidney is healthy.

Adenoma↗
PubMed1992

Surgical complications after nephrectomy for Wilms' tumor.

We reviewed the charts of 1,910 children enrolled in the Third National Wilms' Tumor Study who underwent primary nephrectomy. Four hundred and ninety-five surgical complications occurred in 379 children (19.8 percent). Patients with inoperable tumors, bilateral renal tumors, peroperative therapy and those who refused treatment were excluded from this review. The most common complication was intestinal obstruction, which occurred in 132 patients (6.9 percent). This was followed by extensive intraoperative hemorrhage (112 patients), defined as blood loss exceeding 50 milliliters per kilogram of body weight. Intraoperative injuries to other visceral organs (including intestine, liver and spleen) occurred in 21 children and extensive vascular injuries were reported in 27 patients. There were nine deaths attributed to surgical complications (0.5 percent), only one of which was intraoperative. Survival of patients with complications was similar to patients without complications when stratified by histologic study and stage. Factors associated with the development of surgical complications included advanced local tumor stage at diagnosis, intravascular tumor extension and resection of other visceral organs at the time of nephrectomy. Complete removal of the tumor is important, but not at the expense of radical removal of adjacent structures, because of gross appearances at operation. They are often not invaded by the tumor, but rather are compressed, distorted or adherent without tumor infiltration. Identification of these groups will aid the surgeon in choosing the appropriate management for these patients at high risk. When initial exploration and precise surgical staging indicate that only a formidable operation will achieve total excision, shrinkage of the tumor with selective use of chemotherapy or radiotherapy, or both, may facilitate removal and decrease surgical morbidity. Preoperative therapy may also be the preferred approach for children with extensive intravascular tumor.

Actuarial Analysis↗
PubMed1992

Laparoscopic nephrectomy: a review of 16 cases.

Laparoscopic nephrectomy is a new procedure in which the entire kidney is removed via an endoscopic technique using a surgical sack entrapment method in combination with a recently developed high-speed 10-mm electrical tissue morcellator. Since June 25, 1990, this procedure has been successfully accomplished in 16 consecutive patients. The average operating room time was 5.6 h. Two patients received a blood transfusion (one and three units, respectively). The average hospital stay was 4.6 days, and convalescence was completed within an average of 12 days. We believe the methods developed for laparoscopic nephrectomy will allow surgeons in other disciplines to broaden their indications for laparoscopic surgery as the entrapment sack and morcellator can potentially be applied to the removal of many other solid intraabdominal and pelvic tissues.

Adolescent↗
PubMed2003

[Rhabdomyolysis after nephrectomy in the lateral flexed decubitus position].

We report two cases of the rhabdomyolysis of the erector spine muscles occurring after nephrectomy in lateral flexed decubitus position. Case 1. A 39-year-old man (170-cm, 85-kg) underwent right nephrectomy for a right renal tumor. The patient was placed in a left flexed lateral decubitus position with a roll placed under the dependent iliac crest and upper half of the body was rotated backward for 6 h. The patient complained of severe left low back pain after the operation. On postoperative day 2, serum creatinine increased to 28,480 U.l-1 (MM 99%). Computed tomography scanning performed on postoperative day 4 showed hypodensity of the left erector spine muscles. Although the patient complained of severe pain, no other critical complications including renal failure occurred during the postoperative period. Case 2. A 59-year-old man (169-cm, 87-kg) was scheduled for right nephroureterectomy and partial resection of bladder for a right renal tumor. The patient was placed in a right flexed lateral decubitus position with a roll of towel and sponge placed under the dependent iliac crest for 8 hr. On postoperative day 1, CPK increased to 35,315 U.l-1 (MM 99%) and peaked at 55,760 U.l-1 (MM 99%) on postoperative day 2. Haptoglobin was administered and lactated Ringer and loop diuretics were administered. Fortunately the patient did not develop renal failure. Direct, prolonged pressure on the paravertebral muscle was the etiology of rhabdomyolysis in our cases. Although our cases were not severe and the complications were not induced, it must be kept in mind that excessive pressure in a limited area can damage the muscle during prolonged surgery.

Adult↗
PubMed1992

[Experience with laparoscopic nephrectomy].

Laparoscopic procedures are promising techniques which allow less invasive surgery not only for intra-abdominal organs but also for retroperitoneal organs. Laparoscopic nephrectomy was first described by Clayman et al. We removed the left kidney of a 36-year-old male patient using laparoscopic procedures according to Clayman's technique. The kidney had developed hydronephrosis due to congenital ureteropelvic junction stenosis. In the peritoneal cavity the freed kidney was pushed into a Lapsac, minced using scissors and forceps, and removed without elongation of the wound. During the operation, pneumoperitoneum with CO2 gas induced increases in PaCO2, central venous pressure, pulmonary artery wedge pressure and cardiac output, all of which the patient tolerated well. The patient was discharged from the hospital on the 9th postoperative day. Laparoscopic nephrectomy is a useful alternative to the conventional open surgery in selected cases, when surgical techniques and instruments are improved appropriately.

Adult↗
PubMed1992

[Laparoscopic nephrectomy: a case report].

Presentation and clinical picture outline of a patient who underwent transperitoneal laparoscopy-assisted nephrectomy. The procedure lasted 4 hours and the patient was discharged 72 hours later without incidence or complications. The paper describes the technique (presently unique and for selective indications), as well as the resources that the extensive laparoscopic experience of our group put into practice to perform the first successful laparoscopic nephrectomy in humans in our country.

Female↗
PubMedDate not supplied

Laparoscopic live donor nephrectomy: a step forward in kidney transplantation?

Open donor nephrectomy for live donor kidney transplantation is a safe procedure that has been used for more than 30 years with excellent results. Laparoscopic donor nephrectomy is a relatively new technique that has the potential of decreased postoperative pain, less incisional morbidity, and shorter recovery time. Furthermore, it has been reported that this potentially less traumatic approach increases the number of potential live donors. This review article focuses on the currently used laparoscopic techniques in live kidney donation as well as the controversy regarding its efficacy, safety, and future.

Humans↗
PubMed2002

[Severe perioperative hypotension after nephrectomy with adrenalectomy].

A 70-year-old obese, hypertensive woman taking angiotensin converting enzyme (ACE) inhibitors and chlorthalidone but with no history of corticosteroid treatment or hypothalamus-hypophyseal-adrenal disease, underwent nephrectomy and adrenalectomy under combined general and epidural anesthesia. Severe hypotension with oliguria developed during surgery and persisted during postoperative recovery, with anuria, metabolic acidosis, hyponatremia and hyperpotassemia. Although the symptoms were initially attributed to prior treatment with ACE inhibitors and diuretics together with combined anesthesia, the patient's lack of response to crystalloid, colloid and inotropic catecholamine therapy in the context of anuria, metabolic acidosis, hyponatremia and hyperpotassemia led us to consider a diagnosis of Addisonian crisis. Blood samples were taken to determine adrenocorticotropic hormone levels, and hydrocortisone treatment was started. The patient responded to treatment and cortisol levels fell, confirming the diagnosis of adrenal insufficiency. Compensatory endrocrine secretion of cortisol by the contralateral adrenal gland has been observed in patients undergoing nephrectomy and adrenalectomy for excision of a hypernephroma, and replacement therapy is therefore not recommended. Perioperative Addisonian crises have also been described in patients suffering great surgical stress, and severe hypotension has been observed in patients on long-term treatment with ACE inhibitors after induction of general anesthesia and after epidural anesthesia with local anesthetics. The combination of these factors made rapid diagnosis and start of appropriate therapy difficult.

Addison Disease↗
PubMedDate not supplied

[The effect of unilateral nephrectomy on vitamin D metabolism in pregnant rats].

Unilateral nephrectomy causes a decrease in provision of vitamin D dihydro derivatives in pregnant rats, which correlated with the development of hypocalcemia and hypophosphatemia as well as with an increased content of parathyroid hormone. Fetuses of these females contained less amount of mineral components and active metabolites of vitamin D. Neonates, being born by these females with the nephrectomy, had vitamin D deficiency, which was manifested as a decrease in content of active vitamin D metabolites and minerals as well as an increase in activity of alkaline phosphatase and in the content of parathyroid hormone.

Alkaline Phosphatase↗
PubMed2004

[Videolaparoscopic nephrectomy and nephrouretherectomy in children].

The experience with 72 laparoscopic nephrectomies and nephrouretherectomies in children aged from 13 days to 14 years is reviewed. 51 children were under 3 years of age, 2 patients - under 1 month of life. Pathological changes of the kidneys with complete loss of function were indications for endoscopic surgery. Complex of examinations in the preoperative period included repeated USE, cystography, urography, scintigraphy, angiography. Time of surgery was 30-150 min (45 min, on the average). Blood loss during surgery was less than 50-60 ml and didn't require hemotransfusion. There were no complications during surgery. Fast recovery of physical activity after surgery, a decrease of hospital stay were seen. There were no postoperative complications and lethality. Laparoscopic nephrectomy and nephrouretherectomy are low-traumatic, safe and effective surgeries in children of any age in different diseases of the kidneys.

Adolescent↗
PubMed2004

Hand-assisted laparoscopic living donor nephrectomy.

INTRODUCTION: Laparoscopic living donor nephrectomy (LDN) for renal transplantation is increasingly being performed to improve donor outcomes, by reducing perioperative morbidity without adversely impacting on allograft function in the recipient. We report our initial experience with hand-assisted LDN. MATERIALS AND METHODS: From March 2002 to January 2003, 10 hand-assisted LDNs were performed in 2 institutions. Potential donors were evaluated for suitability, which included a renal angiogram. Only donors with uncomplicated vascular arrangements of the left kidney were offered this technique. During surgery, dissection of the donor kidney was performed laparoscopically, aided by the surgeon 's non-dominant hand inserted into the abdominal cavity through a hand-assist device via a 7-cm abdominal incision. The graft was subsequently delivered through the incision. RESULTS: The mean operating time was 163.5 +/- 32 minutes and the mean warm ischaemic time was 2.16 +/- 0.72 minutes. There were no conversions to the open nephrectomy technique or requirement for perioperative transfusions. Postoperatively, patients returned to normal diet by 1.8 +/- 0.8 days and needed opiate analgesia up to a maximum of 48 hours. On average, the patients started ambulation at 2.1 +/- 0.9 days and were discharged 4 +/- 1.5 days after surgery. There were no significant complications other than 3 superficial wound infections. All grafts had immediate graft function. Serum creatinine levels of all recipients fell within 24 hours and reached baseline at a mean of 5.7 +/- 4.6 days. CONCLUSIONS: Hand-assisted LDN is safe, feasible and can be performed with minimal morbidity. It also allows for excellent allograft function.

Adult↗
PubMed1992

Successful aggressive treatment against multiple intra-abdominal metastases from renal cell carcinoma 18 years after nephrectomy.

The management of late metastases from renal cell carcinoma is often difficult because of multiple organ involvement. We report a case of multiple metastases from renal cell carcinoma in the duodenum, pancreas, intestine, falciform ligament and liver, 18 years after nephrectomy. The patient underwent a total pancreatectomy following a gastroduodenal arterial embolization to control duodenal bleeding, a resection of the ileum and falciform ligament at a second laparotomy and repeated hepatic arterial embolizations to control the growth of liver metastases. Aggressive treatment should be undertaken in cases of late recurrence of renal cell carcinoma after nephrectomy because of the possibly slow-growing biological character of the tumor.

Abdominal Neoplasms↗