Safety of robot-assisted laparoscopic and laparoscopic heminephrectomy: a meta analysis / 现代泌尿外科杂志

【Objective】 To analyze the differences in efficacy of heminephrectomy with robot-assisted laparoscopy (RARN) and laparoscopic radical nephrectomy (LRN). 【Methods】 The published references in national and international databases on the comparison of clinical outcomes between heminephrectomy RARN and LRN for kidney neoplasms were searched. References were screened strictly according to PICOS criteria, and data including estimated amount of blood loss, operation time, length of hospital stay and complications were extracted from those that met the requirements. Sensitivity analysis was used to eliminate the included articles one by one to confirm the robustness of the results, and funnel plot and Eggers test were used to explore publication bias. 【Results】 A total of 16 studies involving 2 063 patients (1 097 in RARN group and 966 in LRN group) were included. The RARN group had less intraoperative blood loss and shorter hospital stay, but there were no significant differences between the two methods (P>0.05). The incidence of postoperative complications in RARN group was lower than that in LRN group (OR: 0.643, 95%CI: 0.467-0.886, P=0.007). 【Conclusion】 Compared with LRN, RARN has better control of complications in the treatment of renal tumor, but the overall effects of intraoperative bleeding, operation time, and hospital stay are comparable.

Experiencia en Nefrectomía Parcial y Enucleación de Tumor Renal Laparoscópico "Zero Isquemia", en Cochabamba, Bolivia

Resumen El manejo quirúrgico de los tumores renales pequeños es la cirugía conservadora de nefronas, este tipo de manejo se reservaba para pacientes seleccionados, con riñón solitario, enfermedad renal crónica o tumores bilaterales. La evidencia sugiere que la nefrectomía parcial laparoscópica es equivalente en términos de resultados oncológicos y superior en las mediciones de calidad de vida comparada al abordaje abierto. Objetivos: determinar los resultados oncológicos en cuanto a bordes libres del tumor y complicaciones quirúrgicas en pacientes sometidos a nefrectomía parcial y enucleación de tumor renal laparoscópico "Zero isquemia". Metodología: estudio retrospectivo, observacional, y comparativo, universo pacientes de la Clínica privada Los Ángeles y de la Caja Nacional de Salud, Hospital Obrero Nº2, Cochabamba, Bolivia, que fueron sometidos a nefrectomía parcial laparoscópica, se agruparon en dos grupos: Grupo I: nefrectomía parcial y Grupo II: enucleación, se analizaron: tamaño y localización del tumor, RENAL score, tiempo quirúrgico, sangrado, días de estancia, complicaciones y reporte histopatológico. Se utilizó el SPSS versión 20 (IBM, Chicago, IL). Resultados: se evaluaron 17 pacientes, 3 fueron excluidos por terminar en cirugía radical, 6 parciales (Grupo I) y 8 enucleaciones (Grupo II). Edad promedio de 45,7 (± 8,6) vs 51,2 (± 6,3) años. Tamaño del tumor 7,8 (2,5-10) vs 3,2 (1-5,7) cm, El RENAL score en global de todos los pacientes fue de baja a moderada, se realizó un análisis por separado, en el grupo I, la distribución fue complejidad baja n=2 (33,3%), moderada n= 1 (16,7%) y alta n= 3 (50%), en el grupo II, baja complejidad n=5 (62,5%), moderada n=2 (25%), alta complejidad n= 1 (12,5%). Hubo diferencias a favor del grupo II (enucleación) en cuanto a tiempo quirúrgico y sangrado transoperatorio, presentando solo 1 caso con fuga urinaria, resuelta con colocación de catéter JJ, se evidencia iguales tiempos de estancia intrahospitalaria, en cuanto a los bordes quirúrgicos, se tuvo 2 (14,2%) casos con bordes positivos 1 para cada abordaje, los cuales se mantienen en vigilancia estrecha. Conclusiones: el abordaje laparoscópico es una opción equiparable al abierto, se obtuvieron iguales resultados en cuanto a control oncológico en relación a bordes libres y con menos complicaciones, aunque se requiere experiencia en cirugía laparoscópica y aumentar el seguimiento en tiempo y mayor número de casos.

Abstract Surgical management of small renal tumors involves nephron-sparing surgery, which used to be reserved for selected patients with a solitary kidney, chronic kidney disease or bilateral tumors. Evidence suggests that laparoscopic partial nephrectomy is equivalent to the open approach in terms of oncologic outcomes and superior in quality of life measures. Objectives: to determine oncologic outcomes regarding tumor free edges and surgical complications in patients undergoing laparoscopic "Zero ischemia" partial nephrectomy and enucleation of renal tumor. Methodology: retrospective, observational, and comparative study, with a universe of patients from Los Angeles private clinic and Caja Nacional de Salud, Hospital Obrero Nº2, Cochabamba, Bolivia, who underwent laparoscopic partial nephrectomy, were grouped in two groups: Group I: partial nephrectomy and Group II: enucleation. The following were analyzed: tumor size and location, RENAL score, surgical time, bleeding, days of stay, complications and histopathological report. SPSS version 20 (IBM, Chicago, IL) was used for statistical analysis. Results: seventeen patients were evaluated, 3 were excluded due to completion of radical surgery, 6 partial nephrectomies (Group I) and 8 enucleations (Group II). Mean age 45.7 (± 8.6) vs 51.2 (± 6.3) years. Tumor size 7.8 (2.5-10) vs 3.2 (1-5.7) cm, The overall RENAL score of all patients was low to moderate, a separate analysis was performed, in group I, the distribution was low complexity 2 (33.3%), moderate n=1 (16.7%) and high n=3 (50%), in group II, low complexity n=5 (62.5%), moderate n=2 (25%), high complexity n=1 (12.5%). There were differences in favor of group II (enucleation) in terms of surgical time and transoperative bleeding, presenting only 1 case with urinary leakage, resolved with placement of a JJ catheter. In terms of surgical edges, there were 2 (14.2%) cases with positive edges, 1 for each approach, which are kept under close surveillance. Conclusions: laparoscopic approach is an option comparable to the open one, equal results were obtained with respect to oncologic control in relation to free edges and with fewer complications, although experience in laparoscopic surgery is required, as well as an increase in follow-up time and a greater number of cases.

Heminefrectomía en pacientes con doble sistema renal. Experiencia en el Hospital Garrahan / Heminephrectomy in patients with a duplex kidney. Experience at the Garrahan Hospital

La heminefrectomía puede constituir el tratamiento definitivo en el 85% de los pacientes con diagnóstico de doble sistema con uno de los mismos no funcionante. Actualmente el abordaje laparoscópico es de elección tanto por sus resultados estéticos como evolución postoperatoria. Materiales y métodos: se efectuó una revisión y análisis retrospectivo de todos los pacientes operados de heminefrectomía desde el año 2000 a 2014. Resultados: 44 pacientes fueron operados de forma convencional durante el período 2000-2010 y 30 de forma laparoscópica transperitoneal durante el período 2010-2014. La media de duración del procedimiento fue menor para el grupo convencional (89,6 vs 128 min, p = 0,000) mientras que la media de estadía hospitalaria fue menor para el grupo laparoscópico (4,2 vs 5,1, p = 0,19). La tasa de reoperación fue mayor en el grupo convencional (20,4% vs 6,7%, p = 0,18) y la principal causa fue por la presencia un muñón ureteral sintomático. En los controles por centellograma DMSA (en 19 pacientes del segundo grupo) no se objetivó la pérdida de función de la unidad remanente en ningún individuo. Conclusiones: La heminefrectomía es un procedimiento seguro con baja tasa de complicaciones cuya tendencia actual es realizar la cirugía de forma laparoscópica obteniendo resultados similares y menor tasa de complicaciones que en la forma convencional (AU)

Heminephrectomy may be the definitive treatment in 85% of patients diagnosed with a duplex kidney system of which one is not working. Currently, a laparoscopic approach is the treatment of choice because of both esthetic results and postoperative outcome. Material and methods: A retrospective analysis of all patients who underwent heminephrectomy between 2000 and 2014 was conducted. Results: 44 patients underwent conventional surgery in the period 2000-2010 and 30 underwent transperitoneal laparoscopy in the period 2010-2014. Mean duration of the procedure was less in the conventional group (89.6 vs 128 min, p = 0.000), while the mean hospital stay was less in the laparoscopic group (4.2 vs 5.1, p = 0.19). Reoperation rate was higher in the conventional group (20.4% vs 6.7%, p = 0.18) and the main cause was presence of a symptomatic ureteral stump. On DMSA whole body scan controls (in 19 patients in the second group) no loss of function of the remaining unit was observed in any of the patients. Conclusions: Heminephrectomy is a safe procedure with a low complication rate and a current trend to be performed using laparoscopy with similar results and a lower complication rate than in conventional surgery (AU)

Adenocarcinoma in Horseshoe Kidney

An adenocarcinoma arising in a horseshoe kidney (HK) is rare. The case of a forty five-year-old male patient, presenting with a recurrent, painless hematuria, is reported. On investigation the patient was found to have a horseshoe kidney, with an adenocarcinoma in the left hemi-kidney, which was treated surgically, with a hemi-nephrectomy, of the involved part, being performed to excise the tumor. A brief review of the relevant literature is also presented.

Laparoscopie Nephrectomy and Heminephrectomy in Pediatric Patients / 대한비뇨기과학회지

PURPOSE: Many operative procedures in pediatric urology can be performed by laparoscopy. We report our experiences with laparoscopic nephrectomy and heminephrectomy and evaluate its usefulness in pediatric patients. MATERIALS AND METHODS: Between August 1996 and December 1997, a total of 10 children aged between 2 and 9 years underwent laparoscopic renal surgeries in Seoul National University Hospital. The laparoscopic nephrectomy (including nephroureterectomy) was performed in 8 patients(4 multicystic kidneys, 2 dysplastic kidneys associated with ectopic ureter, 2 nonfunctioning kidneys associated with vesicoureteral reflux), and heminephrectomy was done in the other 2 patients(duplex kidney). RESULTS: All laparoscopic nephrectomies were completed as planned. Operative time ranged 120 to 300 minutes(mean 180 minutes) and there were no intraoperative or postoperative complications. Oral intake and mobilization were started from postoperative one day and the patients had hospitalized for an average 3.6 days. Laparoscopic heminephrectomy in one patient was performed successfully. Total operative time recorded 240 minutes and there were no intraoperative or postoperative complications. But the other patient experienced bleeding from the injured upper pole artery and subsequent conversion to an open surgery was needed. CONCLUSIONS: Laparoscopic nephrectomy in children is feasible as its morbidity and complication rate are low. Laparoscopic heminephrectomy is thonght to be a technically demanding procedure, requiring more experience.

Clinical Observation of the Ureterocele: 29 Cases / 대한비뇨기과학회지

Ureterocele, congenital dilatation of the terminal or intramural portion of the ureter, may be classified as either simple or ectopic and has a broad spectrum of presentation, anatomy and treatment must be individualized. From February, 1986 to March, 1994, our experiences with 8 single system ureteroceles and 12 duplex system ureteroceles were reviewed. Their presentation, radiographic findings, operative management and postoperative results were discussed. The patients in this series were distribution from 1 year old to 66 years old and the male and female ratio was 4:16. The most presenting symptom was flank pain, affecting 7 cases, and ureterocele was associated with ureteral stone: 7 cases, VUR: 2 cases, renal cyst: 1 case, and IgA nephropathy:1 case. In 8 cases of single system ureterocele, Transurethral incision(TUI) of ureterocele in 1 case, ureterocelectomy with ureteroneocystostomy in 3 cases were done. In 12 cases of duplex system ureterocele, TUI of ureterocele in 2 cases, heminephrectomy with partial ureterocelectomy in 2 cases were done. After operation was done, there was no evidence of complication. We conclude that the surgical approach to the problems associated with a ureterocele is modified by patient age, renal anomaly and the pathological condition of the lower urinary tract.