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At least 1,675 records · Page 93Linked to original sources
PubMed2004

Hand-assisted versus total laparoscopic live donor nephrectomy.

BACKGROUND AND PURPOSE: The optimal minimally invasive procedure to procure live donor kidneys for renal transplantation has not been established. This study compared the donor outcome of hand-assisted laparoscopic live donor nephrectomy (H-LLDN) with total laparoscopic live donor nephrectomy (T-LLDN). METHODS: The outcomes of 12 donors undergoing H-LLDN were compared to that of a subsequent series of 12 donors undergoing T-LLDN. Body mass index, operation time, warm ischemia time, hospital stay, surgical complications, and short-term graft function were compared between the 2 groups. RESULTS: LLDN was successfully performed in all 24 donors. Both approaches resulted in excellent early graft function. The mean operation time in T-LLDN (215 minutes) was slightly shorter than that in H-LLDN (258 minutes), suggesting that the skills developed as surgeons learned the H-LLDN procedure had transferred to their performance of T-LLDN. The mean warm ischemia time of the T-LLDN group (4.5 minutes) was longer than that of the H-LLDN group (3.8 minutes), although this difference was not significant. One minor tear of the lumbar vein occurred in the H-LLDN group and the resultant bleeding necessitated blood transfusion. One mechanical failure occurred when the renal vein was divided by endoscopic gastrointestinal anastomosis in the T-LLDN group. The length of hospital stay, resumption of diet, and the use of narcotic analgesics were not different between the 2 groups. CONCLUSIONS: Both H-LLDN and T-LLDN are safe and effective approaches for the procurement of live donor kidneys. The benefits of the H-LLDN technique include direct manual control of the operative field and increased safety margin. The development of a hospital LLDN program by starting with a hand-assisted approach may reduce the potential bleeding complications and facilitate the safe transition to the cosmetically preferable total laparoscopic approach.

Adult↗
PubMed2004

[Bilateral laparoscopic nephrectomy for renal cancer].

OBJECTIVES: To report the case of a patient with a bilateral synchronic renal tumor who underwent a laparoscopic surgical approach. METHODS: 57-year-old caucasian male with history of end stage renal disease and secondary hypertension, type II diabetes Mellitus, proteinuria of 2.83 g/24 hours, chronic smoker, and allergic to iodinated contrast who underwent right nephrectomy and simultaneous left laparoscopic transperitoneal nephroureterectomy for a bilateral renal tumor. RESULTS: Operative time was 4 hours; NG tube was inserted; estimated blood loss was 200 ml and no transfusions were required. Oral intake was re-established after two days. No intraoperative complications occurred; metabolic acidosis appearing in the intermediate postoperative period was corrected with intravenous sodium bicarbonate. Hospital stay was 9 days. CONCLUSIONS: Bilateral laparoscopic nephrectomy is an effective therapeutic option in the management of patients with bilateral malignant renal diseases, which ensures surgical radicality, and diminishes morbidity, hospital stay and recovery time.

Humans↗
PubMedDate not supplied

Robot-assisted laparoscopic partial nephrectomy.

The indications for nephron-sparing surgery and for minimally invasive surgery are continually expanding. Nephron-sparing surgery, also known as partial nephrectomy, presents a challenge to the minimally invasive surgeon. Herein, we describe our technique of robot-assisted laparoscopic partial nephrectomy. This approach may have potential advantages of including easier excision and suturing. Moderate training is required.

Aged↗
PubMed2005

[Anesthetic management for nephrectomy in a 2-year-old girl with abdominal aortic aneurysm].

We report anesthetic management for nephrectomy in an infant with aortic aneurysm. A 2-year-old girl with renovascular hypertension and abdominal aortic aneurysm, who had shown repeated episodes of heart failure, was scheduled for nephrectomy. Anesthesia was induced with sevoflurane in nitrous oxide (70%) and oxygen. During the surgery, anesthesia was maintained with sevoflurane (1.5%) in nitrous oxide (50%) and oxygen, supplemented with intermittent epidural block. The blood pressure did not show marked changes during the surgery. There was no perioperative cardiovascular complication.

Anesthesia, Epidural↗
PubMed2005

[Laparoscopic radical nephrectomy for renal cell carcinoma at Kobe City General Hospital].

Between April 2002 and March 2004, 21 patients with clinical T1-T3a renal cell carcinoma underwent laparoscopic radical nephrectomy at the Kobe City General Hospital. A transperitoneal approach was chosen in 9 patients with clinical T2 stage, tumors more than 5 cm in diameter at the upper pole of the kidney, and posteriorly protruded tumors at the middle portion. Otherwise, a retroperitoneal approach was chosen in 12 patients. The mean (range) operative time for the transperitonal and retroperitoneal approaches was 355 (290-410) min and 342 (275-490) min, respectively. There were no major intraoperative complications. Postoperatively, one patient underwent emergency operation due to the perforation of duodenal ulcer. In the mean follow-up of 15.9 months, lung metastasis was seen in one patient under adjuvant immunotherapy. Significant differences between transperitoneal and retroperitoneal approaches were seen in mean time to renal artery clipping (170 versus 85 min, p < 0.01), mean blood loss (548 versus 281 ml, p < 0.05) and concurrent adrenalectomy (66.7 versus 16.7%, p < 0.05). Laparoscopic radical nephrectomy is a safe and feasible procedure when suitable approaches are chosen depending on tumor size and location.

Adult↗
PubMed2005

Divergent effects of unilateral and subtotal nephrectomy on insulin sensitivity in rats.

OBJECTIVES: Insulin resistance is associated with chronic renal failure, which may amplify its cardiovascular pathologic manifestations. We previously showed the presence of insulin resistance in mild renal insufficiency due to chronic glomerulonephritis. These observations may be explained by a decrease in insulin sensitivity due to renal dysfunction. The aim of the present study was to evaluate the effects of unilateral and subtotal nephrectomy on insulin sensitivity. METHODS: Unilateral heminephrectomy and five-sixths nephrectomy (5/6Nx) were performed in male Sprague-Dawley rats, measuring steady-state plasma glucose (SSPG) during the insulin suppression test. RESULTS: The glomerular filtration rate (GFR) decreased significantly from sham-operated rats, to unilateral heminephrectomy group, to 5/6Nx rats. SSPG was unexpectedly lower in the unilateral heminephrectomy group than in controls, suggesting that unilateral heminephrectomy increased the sensitivity to insulin despite a mild decrease in renal function. However, when the analysis was limited to the 5/6Nx group, SSPG was inversely correlated with GFR (r = -0.65, p < 0.05). When renal failure caused by 5/6Nx had reached end stage, the rats became insulin resistant, despite a profound reduction in renal mass. CONCLUSION: It is suggested that unilateral heminephrectomy reduced GFR and increased the sensitivity to insulin. When rats became uremic, insulin sensitivity decreased, even, in 5/6Nx.

Animals↗
PubMed2005

[Laparoscopic partial nephrectomy].

We retrospectively reviewed the clinical results of 24 patients who underwent laparoscopic partial nephrectomy by a diagnosis of renal cell carcinoma (RCC) between 1999 and 2004, including 16 elective cases and 8 imperative cases. Twenty-two were successfully treated laparoscopically; two cases in the imperative group required conversion to open surgery because of uncontrollable bleeding. A vascular clamp was used in 12 cases for an average of 26 minutes. The creatinine clearance changed from 98 to 93 ml/min in the elective cases and from 49 to 44 ml/min in the imperative cases. Pathological evaluation revealed RCC in 10 elective cases and 6 imperative cases. Local recurrence (renal hilum lymph node and ipsilateral kidney) was found in 2 patients in the imperative group. Although laparoscopic partial nephrectomy is useful, long-term follow-up is necessary for evaluating the tumor control.

Aged↗
PubMed2005

Endovascular repair of transplant nephrectomy external iliac artery pseudoaneurysm.

The formation of a pseudoaneurysm at the site of transplant nephrectomy is a rare complication, having been reported only six previous times in the literature. Possible causes of this occurrence include infection or rejection of the anastomotic remnant. Diagnosis of the pseudoaneurysm with radiological imaging is necessary. The first successful repair of a noninfected pseudoaneurysm of a transplant nephrectomy patient is described using an endovascular graft.

Aneurysm, False↗
PubMed2005

Virilizing adrenal cancer and bail-out nephrectomy.

We report a rare case of virilizing adrenal cancer with tumorous invasion of the left renal vein in which a retroperitoneal adrenalectomy with bail-out nephrectomy was performed. A tumor thrombus infiltrated the wall of the left adrenal vein and extended into the left renal vein. Initially, a kidney sparing procedure with partial tangential excision of the involved renal vein wall was performed. After positive vein margins were confirmed with intraoperative histology, the indication for nephrectomy was made. To the authors' awareness, this is the first report of a virilizing adrenal cancer with a tumor thrombus infiltration of the renal vein and surgical tendency for kidney preservation.

Adrenal Cortex Neoplasms↗
PubMed2005

[Three cases of pulmonary hamartoma appearing after radical nephrectomy for renal cell carcinoma].

We report 3 patients with pulmonary hamartoma, all of whom had undergone nephrectomy for renal cell carcinoma. A lung tumor was detected 2 to 9-months following nephrectomy. Preoperative diagnosis was pulmonary metastasis from renal cell carcinoma and pulmonary tumor resection was performed in each case. There was a 9- to 12-month interval between the detection and resection of the lung tumor. The histological diagnosis of the lung tumor in all three patient was pulmonary hamartoma. Following the resection of the lung tumor, recurrence was not noted in any of the patients.

Aged↗
PubMed2005

[Unusual metastatic spread after converted laparoscopic radical nephrectomy: natural history of the tumour or role of laparoscopy?].

Retroperitoneal or transperitoneal laparoscopic radical nephrectomy is currently proposed by an increasing number of urologists as an alternative to conventional open surgery to treat renal tumours. The authors report a case of metastasis to unusual sites (sigmoid colon, small intestine, root of the nose) after converted retroperitoneal laparoscopic radical nephrectomy for a T3 renal tumour, which raises the problem of the possible role of the laparoscopic approach in this unusual metastatic progression of the disease.

Adenocarcinoma↗
PubMed2006

[Internal hernia of the small intestine after laparoscopic nephrectomy].

The authors report the case of a woman operated by transperitoneal laparoscopic left nephrectomy for destroyed kidney. At the third postoperative week, she developed small bowel obstruction requiring reoperation by laparotomy. This complication was due to a transmesocolic internal hernia of the small intestine via a breach created during access to the renal pedicle by the peritoneal incision at the duodenojejunal flexure that was not closed. Four other cases of transmesocolic internal hernia have been reported in the literature following left laparoscopic nephrectomy. An accidental breach of the left mesocolon was considered to be responsible. This rare complication appears to be facilitated by creation of a mesocolic breach and by positioning the patient in the lateral supine position. These breaches must be closed.

Aged↗
PubMedDate not supplied

[Bilateral radical nephrectomy and kidney transplantation as treatment for asynchronous bilateral renal cell carcinoma. A case report].

Bilateral renal cancer may require bilateral nephrectomy and chronic dialysis. However, an available option is kidney transplantation. Controversy exists about an adequate period of time to perform kidney transplantation and the role of immunotherapy on the risk of malignant recurrence. We report a case of bilateral asynchronous renal cell carcinoma treated with bilateral radical nephrectomy and kidney transplantation six years after without evidence of malignant disease.

Aged↗
PubMed2006

[Congenital renal arteriovenous fistulas--report of two cases treated by embolisation and nephrectomy].

Congenital arteriovenous fistulas of the kidney are very rare. Options for therapy range from embolisation to nephrectomy. It depends on symptoms and extensiveness of the malformations. We report two cases of congenital arteriovenous malformations successfully managed in the first case by embolisation and in the second case by nephrectomy. Renal arteriovenous malformations remain an uncommon clinical problem which causes often diagnostic difficulties. The proper diagnosis can be made on the basis of standard diagnostic procedures such as physical examination, Doppler sonography and spiral computerized tomography.

Arteriovenous Fistula↗
PubMed2006

[Is persistent arterial hypertension in patients on renal replacement therapy still an indication for bilateral native nephrectomy?].

Arterial hypertension (AHT) is common clinical symptom in 80% of patients at start of chronic dialysis and at 1 year remains overt in 50% of hemodialyzed and 30% of patients on peritoneal dialysis. The incidence of AHT post-transplant is 58% in long-term follow-up. The mechanism of AHT is complex, however in dialyzed patients the most common factor is (overt or hidden) fluid overload (volume-dependent AHT). It develops as a consequence of inadequate evaluation of body dry mass and/or insufficient dialysis technique. Post-transplant AHT may develop as side-effect of long-term calcineurine inhibitors and steroid therapy and/or high renin production by native kidneys. In patients with chronic allograft nephropathy complex pathology of renal failure becomes more important factor. The data concerning efficacy of bilateral native nephrectomy are inconsistent. NAPRTCS survey data show, that incidence of AHT is similar in nephrectomized and non-nephrectomized patients up to 5 years post-transplant. In nephrectomized dialyzed patients fluid overload is still a main cause of AHT. Many therapeutic modalities, both pharmacological and dialysis-related, are available to improve blood pressure regulation. Bilateral native nephrectomy should be regarded as the last option, mostly in patients with ongoing renal co-morbidities, such as heavy proteinuria or recurrent urinary tract infection.

Adult↗
PubMed2006

[Pancreatic and duodenal metastases from renal cell carcinoma 13 years after radical nephrectomy: a case report].

A 52-year-old male was admitted to our hospital complaining of orthostatic vertigo, fatigue and weight loss, who underwent right total nephrectomy for renal cell carcinoma(RCC) with curative operation 13 years ago (in 1992). Endoscopic examination revealed a submucosal tumor with erosion in the duodenum. The diagnosis made from the biopsy specimens was metastatic RCC in the duodenum. Abdominal CT scan revealed that his metastasis has spread to the pancreas. Five million units of interferon a was administered intramuscularly three times a week for 1 month. He received blood transfusions and palliative care. He died 5 months later because of disease progression. Metastases of RCC have been often reported in the lungs, the liver, and the bones, but rarely in the gastrointestinal tract. This is a very rare case of metastatic RCC in the duodenum, which was diagnosed 13 years after curative right nephrectomy. Since late recurrence is characteristic of renal cell carcinoma, careful long-term follow-up is needed. To our knowledge, this is the 19th case of duodenal metastasis from RCC reported in the literature.

Carcinoma, Renal Cell↗
PubMed1991

[Should adrenalectomy be performed systematically as part of radical nephrectomy for renal cancer? Review of 119 cases].

Systematic histological examination of 119 operative specimens of radical nephrectomies performed for renal cell carcinoma revealed adrenal invasion in 6 cases (5.04%). Preoperative computed tomography visualised the adrenal lesions with a sensitivity of 100%. Adrenal involvement was due to either contiguous invasion (3 cases) or metastatic spread (3 cases). Other visceral or lymph node metastases were detected in every case. The mean survival of patients with an adrenal lesion was 16.5 months. These data and those reported in the literature suggest the value of systematic adrenalectomy as part of radical nephrectomy.

Adrenalectomy↗